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THE VALUE OF VACCINATION.
 PUBLISHER'S NOTICE.

Before deciding to publish this little work, the publisher as

usual placed the manuscript in the hands of two persons in whose
judgment he felt that he could rely, this time in the hands of two
—

physicians directly opposed on the question of vaccination. The

first, who was in agreement with the position taken by the author,
pronounced it a most interesting and exhaustive treatise ; the second,
while he did not assent to the conclusions drawn, unhesitatingly
declared it to be a scholarly effort and one that would be read with
interest by many in the profession "not a dull page in it," he said.
—

Such comment from two physicians of opposite principles on this

question, decided the publisher that the work could not fail to be of
value to those interested in the subject, and under this belief it is
now placed before the medical profession.

F. E. Boericke,
Publisher,
 THE VALUE

Ur<

VACCINATION
A NON-PARTISAN REVIEW OF ITS
HISTORY AND RESULTS..

GEORGE WILLIAM WINTERBURN, Ph.D., M.D.,

EDITOR OF THE AMERICAN HOMO30PATHIST ; PRESIDENT OP THE AMERICAN OBSTETRI

CAL LATE LECTURER ON CLINICAL MEDICINE, AND PHYSICIAN-IN-

SOCIETY;
CHIEF TO THE MANHATTAN HOSPITAL; FELLOW OF THE AMERICAN

MEMBER OF THE ANTHROPOLOGICAL SOCIETY, THE

AKADEMEJ
NEW YORK ACADEMY OF SCIENCES, THE AMERICAN

INSTITUTE OF HOMffiOPATHY, ETC.

'Gladly wolde he lerne and gladly teche."— Chaucer.

PHILADELPHIA :

F. E. BOERICKE,
HAHNEMANN PUBLISHING HOUSE.
1886.
 \f\l7s7v

Copyrighted, 1885, by G. W. Winterburn.

Press of Globe Printing House, Philadelphia.

 2* 3^
33?*

t^JSy >

TO MY

COLLEAGUE AND FRIEND,

PROF. STEPHEN POWELL BURDICK, M.D.,

THIS MONOGRAPH IS,

BY PERMISSION,

DEDICATED.
 PREFACE.

The following pages were

primarily intended to
form a
chapter in an
encyclopaedic work on the
Practice of Medicine. Had it been my desire to
write popular
a treatise on Vaccination, I should

probably have arranged my material in a somewhat

different manner, and have given less space to tech
nical detail. Whether the result would have been
more serviceable to the cause of truth, can only be
determined by the reception which may be accorded
to these pages.

This subject is one in which all intelligent per

sons are
rightly interested, and it seems wise to give
the facts here collated wider circulation than
a
they
would reach if printed, merely, as originally pro
posed. As I have elsewhere said, there is nothing
essentially medical in the art of Vaccination, no
phase of it beyond the comprehension of any ordi
narily educated person, and any attempt to hedge it
about as a something with which the people have
Vi PREFACE.

nothing to do, but pay liberally and unquestioningly

for, should be resisted.
Vaccination became a question of public policy,
when laws for its enforcement were enacted, and as

long people
as are support it, they
taxed to have
the common
right of investigation. As a medical

tenet, they might readily leave it to medical author

ities to dispose of; but when the ingenuity of the
law is invoked to make it obligatory, then the public
have a right to know what they get for their money.
In this little book, which I now submit to the in

dulgence of the
public and the tender mercies of
the critics, is
expressed the growth in knowledge of
the subject, on which it treats, extending over many

years, and in sending it forth, it is with the hope

that it may prove both instructive and entertaining.

G. W. W.

No. 29 West Twenty-Sixth St., New York.

December 10, 1885.
 CONTENTS.

Page.
Preface 5

Introduction, 9

The Eise of Vaccination as a Medical Dogma, . . 15

Cow-pox as Modified in the Human Subject, ... 27

The Nature and Origin of Vaccinal, Virus, .... 36

The Methods of Vaccinating, 45

The Extent of the Protection afforded by Vacci

nation, 55

The Alleged Dangers from Vaccination, 115

Compulsory Vaccination, 145

Bibliography, 151

Appendices, 161

Index, 175
 "He who only knows his own side of the case, knows little of
that." —
John Stuart Mill,

"I consider that the affirmation of facts is more powerful than the
assertions of men." —
Pascal.

"Persistent
misrepresentation of familiar facts must be set right.
If people are allowed to hear what is untrue repeated often enough
and confidently enough, they come, at last, to believe it, and that is
a
process, which one is bound to disturb." —
Pall Mall Gazette, August
16, 1883.
 Introduction.
The
subject of Vaccination has engaged the atten
tion of a multitude of
minds, both great and small,
and its literature is as varied, in
quality and com
plexion, as one need wish to find. It is one of those
unfortunate topics, which seem to exasperate the
most equably-tempered men, and to
produce ebulli
tions of unreasonableness whenever and wherever
broached. Conceived in ignorance of the real na
ture of disease, and born of fanaticism which brooked
no
questioning, fostered in the beginning by femi
nine conceit and courtly perogative, and later
by
governmental patronage and the conservatism of
habit, it seems to have been so imbued with the
spirit of intolerance and arrogance, that, even now
in these modern days, when we pride ourselves on
the impartiality with which we discuss scientific
topics, every one who believes in vaccination looks
with a sort of pitying scorn upon any one who does
not. To doubtor discuss is, to their
minds, con
vincing, nay irrefutable evidence of an
impairment
of that mental balance which we all pride ourselves
in possessing.
2 (9)
10 INTRODUCTION.

find the densest

singular, therefore, to
It is not
those who ought to
ignorance on this subject among
know its origin and history; ignorance and preju
dice being the twin handmaids of tyranny. It has

been my lot to stand in personal relations with num

bers of medical men during the past score years, and
being somewhat curious upon this subject, I have, as
the inquiry to some two
opportunity presented, put
hundred of them: Have you ever read Dr. Jenner's
works. With two exceptions, the answer has been
a
negative. To be sure, one might know a
great
deal about a subject without having read a particu
lar author, but those who do not know what Jenner
claimed, and upon what basis he is canonized as the
Immortal, can hardly be in a convenient attitude to
defend him, and his theories, upon logical grounds.
question, although affecting the welfare of
This
untold millions, is calmly asserted to have passed
beyond the domain of argument. Perhaps it has:
but no truth was ever hurt by exposure to the rays
of publicity, no matter how
pitilessly they might
beat upon it; nor, on the other hand, does truth
ever gain by slinking behind vested interests and
conventional phraseology. The object of this mono
graph is, therefore, to
investigate fairly and dispas
sionately the claims of the Jennerian
method, and
the tentative basis
upon which its theories were
founded. It is
hoped that sequestrating ourselves
from the
atmosphere of partisan strife, we may be
able to
perceive the just value of
theories, and
quietly study the history of their
growth
 INTRODUCTION. 11

It seems ludicrous that

a question of so much im

port, and of purely a scientific nature, should be a

so

matter of partisan clamor, but it ceases to be

comic,
and becomes painfully embarrassing, when men can
not discuss a question of vital
importance to them
selves and the race without being accused of sinister
motives or of mental unsoundness. And yet this is
just what has
happened since the earliest years
ever

of Vaccination. Jenner began it in his efforts to

suppress every fact wThich told against his theory,

and his mantle has passed with the passing years to
men of like aptitude for the suppression of disagree
able truths. This is not philosophic, it is not scien
tific, but it is
very human. Nevertheless, there has
always been a widespread disapproval of the phil
osophy and practice of Vaccination; and acumen,
probity, and learning have not been confined to the
disputants on either side. The anti-vaccinists are
neither more ignorant nor more fanatical than the
pro-vaccinists, and neither side has been free from
prevarication and unworthy methods.
My own interest in the subject is by no means
recent. During the war for the Union, many cases
of smallpox were brought up from the front to Cin
cinnati, where I lived during my boyhood. Cir
cumstances brought me into contact with these cases
to considerable extent, and I became interested in
a

the subject. Just previous to the war, I met an old

lady, who had been vaccinated and re-vaccinated,
and had had smallpox three times. This, as I then
12 INTRODUCTION.

thought, anomalous experience, and my subsequent

familiarity with the disease, awakened a natural
curiosity as to the value of vaccination that did not
protect. My interest in the matter was not lessened
by finding, upon questioning them, that nearly all the
smallpoxed-marked persons, whom I casually met,
averred that they had been vaccinated prior to tak
ing the smallpox. When one's mind is awakened
to a subject he naturally hears much about it, and
what would otherwise slip by unnoted is read with
I
attention, might say with avidity. In this way, I
have waded through much of the literature of Vac
cination, both pro and con, and it has been my en
deavor in the following pages to present such a re
sume of my reading as would commend itself to all
lovers of truth for its impartiality and directness.
Involving, as it does, the welfare of the race, either
for good or for ill, Vaccination deserves the calm
consideration of every thinking man or woman.
The policy of presenting medical to the
questions
general public is vehemently condemned in certain
quarters, and attempts to create a
priestly craft in
medicine are as persistently The
encouraged. Leg
islatures of our various States are
beseiged annually
by men whose aim is to establish
by enactment a
medical priesthood, under the plea that the people
are too
ignorant to judge for themselves. I am not
one of those who
sympathize with mysticism in
medicine. I believe that the
more rational the
lic may be on these pub
topics the better for themselves,
 INTRODUCTION. 13

for medical progress, and for the profession. Medi

cal men are no better, and never have been any
better, than the public demand; and the surest, the
most reasonable, nay the only way to raise the stand
ard of professional character and achievement is
through the demands made by an intelligent and
exacting public. I am, therefore, always glad to
serve as a medium of instruction. It is with that
purpose I send out this book, and it is for that rea
son that I have avoided a
popular style of writing,
and presented the matter from a purely scientific,
but I hope not uninteresting, basis. If this be medi
cal heresy, I am pleased to be a heretic.
 The Value of Vaccination.

THE RISE OF VACCINATION AS A MEDI

CAL DOGMA.

Vaccination consists in the introduction of a

specific virus into the system ; and is performed as a

prophylactic against the contagion of smallpox. It
was invented by Jenner, in 1798, as a substitute for
inoculation.1 Previous to this time, and indeed for
many years subsequently, inoculation had been in
vogue.
Inoculation was brought from the Orient by Lady

Mary Wortley Montagu, in 1721 ; and consisted of

the introduction subcutaneously of smallpox virus.2
"
Writing from Constantinople she said : The small
pox so general and so fatal amongst us, is here en
tirely harmless by the invention of engrafting, which
is the term they give it. There is a set of old women
who make it their business to perform the operation.
Every year thousands undergo it, and the French
1
Inquiry into the Causes and Effects of the Variolce Vaccina, London,
1798.
a
Vol. II, Letter XXXI, dated April 1, 1717.

(15)
16 INOCULATION.

Ambassador observes pleasantly thatthey take the

smallpox here by way of diversion, as they take the
waters in other countries. There is no example of
I
any one that has died of it, and you may believe
am well satisfied of the safety of the experiment since,
I intend to try it on my dear little son. I am patri
otic enough to take pains to bring this careful inven
tion into fashion in England." And she did. Rumors
of this method had been common enough in England
for a score of years, but no one had been found brave

enough to hazard the experiment, until Lady Mary

had it tried on her own daughter; the operation was
successful, and awakened great public interest. In
the same year (1721) Dr. Boylston, in Boston, Mas
sachusetts, inoculated244 persons, of whom six died.
Other deaths followed inoculation in England, and it
would probably have fallen into permanent discredit,
had it not been for two circumstances. Robert and
Daniel Sutton, two brothers, practitioners, one in
Essex and the other in Suffolk, perceiving the ad
vantages in the method of treating smallpox as out
lined by Sydenham, applied it to
inoculation, and
won great celebrity by so
doing. This consisted in
giving most minute attention to the personal hygiene
of the patient, and keeping the bowels
open with
purgatives. Immense sums were paid to them by
the nobility for attendance, and it became the fashion
to employ them. The other circumstance which
tended to give permanence to inoculation was the
establishment, in 1746, of the Smallpox and Inocu-
 SYMPTOMS PRODUCED. 17

lation Hospital, London; where inoculation con

tinued to be performed, on all applicants, until as
late as 1822.
In the Revue des Deux Mondes, Aug. 1, 1882, M.
"
Daremberg says in an article on M. Littre : In —

oculation of smallpox was practised in the second

century. This is proved by the following lines from
the Schola Salermtana:" —

Pour eloigner d'un fils ce poison dele"tere

Inocule en sa veine un virus salutaire."

The phenomena of inoculation is thus described

by Doctor Gregory, who had charge of the London
Smallpox Hospital for many years: "On the second
day after the operation, if the part be viewed with a
lens, there appears an orange-colored stain about the
incision, and the surrounding skin seems contracted.
On the following day a minute papular elevation of
the skin is perceptible, which on the fourth day is
transformed into a vesicle with a depressed centre.
The patient feels an itching in the part. On the
sixth day, some pain and stiffness are felt in the
axilla, proving the absorption of the virus into the
general mass of blood. Occasionally on the seventh,
but oftener on the eighth day, rigors occur, accom
panied sometimes with slight faintness, sometimes
with pain in the back, headache, or vomiting. The
patient complains of a disagreeable taste in the
mouth, and the breath is offensive, soon after which
the eruption shows itself."3 The disease then usually
3
Cyclopaedia of Practical Medicine, Vol. Ill, page 750.
18 INOCULATION SPREADS SMALLPOX.

runs the natural course, in a mild form. Inoculated

small
smallpox was as infectious as spontaneous
pox; and therefore Dimsdale
and other enterpris
ing inoculators recommended and superintended
the inoculation of entire parishes, so that all having
might catch it. During
smallpox together, none

the process, intercourse was, as far as possible, sus

pended with the outer world.

Up to the time of inoculation variola had not been
looked upon with particular disfavor, and was not
considered any more dangerous than measles. In
deed, in the Health Reports these two diseases were

classed together up to 1738, and until after that year

it is impossible to determine just how much smallpox
there may have been. From the most trustworthy
sources, however, it is evident that just as now we
have epidemics of measles, and other of the zymoses,
varying greatly in intensity and fatality, so in the
pre-inoculation period there were epidemics of small
pox of great fatality and others of very moderate
intensity. But after the introduction of inocula
tion, the ravages of smallpox increased, not only
directly as the result of inoculation, but each new
case became, as it were, a centre of
disease, from it
spreading in every direction, often with great viru
lence. It spread
smallpox just as the natural dis
ease did. It could be
propagated anywhere by send
ing in a letter a bit of cotton thread dipped in the
variolous lymph. In this
way, not only the number
of cases, but, also, the
general mortality was very
 INOCULATION MADE CRIMINAL. 19

greatly increased.4 But so hard is it to alter 'the

ideas of people
a they have crystallized into
after
habit, that it was evident that epidemics
although
of smallpox often started from an inoculated case;
and although the most strenuous efforts were made
to supersede it by vaccination, inoculation con
tinued to flourish for nearly a century and a half.
It wasfound necessary in 1840 to make inocula
tion in England, a penal offense, in order to put an
end to its use. Even that has not prevented its
secret practice by the lower orders, where ideas die

hardest, and the rite is even now probably more

than occasionally performed.

dwelt, with possibly undue prolixity,
I have thus
on this exploded medical dogma, because it throws

a broad side-light on the rise and history of vacci

nation. Viewed from our present knowledge of

mis
zymoses, inoculation is seen to be a gigantic
take. Instead of being the entirely harmless inven
tion that it was claimed to be in 1721, it was found
to be pernicious
so a custom, and so destructive of

public welfare, as to be branded as a crime in 1840.

At the time of its introduction it was hailed as the
greatest of medical discoveries, and the enconiums
lavished upon it equalled those that have since been
given to vaccination. Dr. Monteith relates:— "By
the year 1777 the arguments, in favor of Variolation,
had so far triumphed over the habits and prejudices

Dr. ,T. T. Marson.

20 ORIGIN OF COW-POX.

of the that there is no instance mentioned

profession
in Newcastle
any medical
man
in our reports of
opposing it. It is always spoken of of the best
as one

established facts of medical science. With the general

public the case was different. Their prejudices were
a horror of
as strong as ever, and they exhibited

Variolation which would satisfy the most ardent

anti-vaccinator. To combat these prejudices, various
means were tried sermons from the pulpit, pathetic
—

exhortations in the newspaper, etc In 1801,

there had been in all 3268 operated upon." —

Report
of the NewcastleDispensary, from its Foundation in
1777. Newcastle-upon-Tyne, 1878.
And yet, alas for human prescience, what was pro
claimed as the savior, proved to be the destroyer.
Probably, more than all other things combined, it
has contributed to keep smallpox alive, by constantly
disseminating the infection. The immediate deaths
from inocculation were one
per-cent.
Owing to the of
spread smallpox through inocu
lation, great fear of the disease had been produced,
so that, when Jenner
proclaimed vaccination as the
certain and unfailing prophylactic against this dis
order, there were multitudes, especially of the edu
cated and wealthy class, who were
ready to give
credence to the discovery.
Vaccinia (from vacca, cow) or the Cow-pox,
a

singular to say, never

originates spontaneously in
the cow, and is not one of its
natural disorders.
When found on that animal at
all, it will be seen
 COW-POX AND GREASE. 21

that it is the milch cow that is almost invariable

affected. The cause of this will presently appear,
and it was well understood by Jenner. Ir'fact,
he frequently declared, that, if a disease of similar
appearance ever did occur spontaneously on the
cow, that such was a spurious form of pox, and

utterly worthless for vaccinal purpose. It is well

that this should be understood clearly, as of late
years great stress has been laid upon the supposed
virtues of a particular virus-stock, as having been
obtained from a spontaneous case of cow-pox.5
When Jenner established vaccination he was very
particular to point out the importance of using only
a certain kind of virus. The cow-pox, to which he
ascribes these virtues, is a filth-disease, communi
cated to the udders of the animal by dirty stable-
boys, gotten their hands soiled with the
who had
matter from the greasy heels of ill-kept horses. Al

though it is not in every case possible to trace the

infection thus, there is the best authority6 for saying
that it is always communicated in some such way.
That it is not a disorder to which the bovine race is

subject, amply shown by the fact that bulls never

is
have it; a zymotic disease confined exclusively
and
to one sex would be an anomaly in nature. But who
ever heard of bull-pox?

This disease, which is called cow-pox in cows, is

known as grease in the horse. Grease is a disorder

5
A case of alleged spontaneous cow-pox at Beaugency, in France.
6
Prof. Simonds, Royal Veterinary College, 1879.
22 ORIGIN OF GREASE.

resulting from inflammation of the sebaceous glands

of the skin, about the heels of a horse, and is prop
called pustulosum. The disease origi
erly eczema

nates from a scrofulous condition, supervenes from

and from
subsequent lack of clean
exposure to wet,
liness, and is always the result of carelessness on the
part of the The discharge from these vesic
groom.7
ular pustules is often profuse, very irritating to the
surface over which it flows, and foetid. Prof. Hering
has found in it called sarcop-
large numbers of acari,
tes hippopodus. The presence, however, of this para
site seems to be purely accidental, and is said to have
nothing to do with the progress of the disease.
This purulent matter, carried on the dirty hands
of farm-laborers to the teats or other sensitive parts
of the cow, produced the disorder which has been
misnamed cow-pox.
It was or others, that be
noticed that milk-maids
came affected with this
disorder, from absorbing the
virus through cracks on the hands, were not, as a
rule, subject to variola during epidemics of that dis
order, and, consequently, it became a matter of
country-side gossip, that cow-pox was a preventive
against taking small-pox. This coming to the ears
of Jenner, led him to cogitate upon the best manner
of securing such prophylactic protection at
will, and
to finally adopt vaccination. This was no hurried
step on his part. For it was when, as a mere sur-
7
Kirby on Veterinary Medicine and Surgery
 JENNER'S EXPERIMENT. 23

geon's apprentice at Sodbury, near Bristol, in 1768,

that his attention was called to the matter by a

chance remark made by country girl,8

a and it was

not until nearly twenty years later that he made his

first vaccination. This was upon a lad named James
Phipps, who subsequently died of pulmonary con

sumption.
Two years later, in 1789, he vaccinated his own
son, then a year and a half old, with swine-pox; and
between that year and 1792, he repeatedly inoculated
him with small-pox. This son was always delicate
in health, and died in his twenty-first year, of pul
monary consumption, which many have claimed
was induced by the repeated inoculations.

It was natural that, having thus spent many years

of his life in developing this idea, that he should
claim perfection of security for those who submitted
to this rite. It was, perhaps, just as natural that the
medical profession should have been slow to accept
a new medical dogma thus thrust upon them by an

obscure, and not over-successful practitioner. Dr.

John Hunter, the celebrated physiologist, and a for
mer
preceptor of Jenner, thus voiced the medical
opinion by inocula
of the time: "The introduction
tion of mineral vegetable poisons into the blood is
or

hazardous, and in certain quantities may be destruc

tive; but the introduction of animal products from
another living body, be it a man, a cow, or even an

8
Baron's Life of Jenner, Vol. II, page 122.
24 AMATEUR VACCINISTS.

because allied to it
ass, is infinitely more pernicious,
in being vitalized."
ineffectual effort to
Jenner had, in 1797, made an

treatise into the Transactions

gain admission for his
of the Society; but he was given to understand
Royal
that
"
heought not to risk his reputation by present
to that learned body anything which appeared
ing
so much at variance with established knowledge, and
withal so incredible."9
Happily for Jenner, he succeeded in persuading
a number of aristocratic ladies to become amateur
vaccinators among their tenantry and dependents.
The method was novel and highly sensational, and
thus furnished pleasing diversion for the fashion
a

able world. protection of the Earl and

Under the
Countess of Berkeley, he was able to defy the medi
cal profession; and the art being alleged to be within
the ability of any one to apply, many were found
ready to spread the glad tidings. Lady Charlotte
Wrottesley was one of the earliest devotees to the
new rite and vaccinated thousands in Staffordshire.
The clergy were pressed into the service, one of
whom vaccinated three thousand
persons in about
three years. An enthusiastic friend of Jenner rec
ommended that "the
christening and vaccination be
always performed the
day." The Duke of
on same

Clarence caused his household and farm-servants to

be vaccinated. The Duke of York ordered the vac-

Life of Jenner, Vol. II, page 168.

 JENNER REWARDED. 25

cination of regiment. And in 1802 the King com

a

manded the prime minister to convey to Parliament

his majesty's desire that a benefaction should be
awarded to Jenner out of the public purse. When
the bill came up the princes of the blood attended in
its support. To the subservient Parliament of that
day, an intimation of the royal wish in a matter of
this kind was decisive. Jenner promised the credu
lous monarch and his faithful Parliament that vac

cination would put an end to

smallpox forever.
Not only werepeople to be perfectly secure from
the
death from smallpox, but they were to be equally
secure from attack. There were absolutely to be no
cases. In the anxiety of the Court to believe, and
the readiness of Jenner to promise, the fact that vac
cination had been on trial for only six years, and that
it was utterly impossible for Jenner or anybody to
know whether it would protect for a lifetime, was

lost sight of. Jenner's positive declaration was re

ceivedas if
proven.
The Commons granted the £30,000. The Court
breathed easily, they were to be made
perfectly se
cure for life. To Jenner's high gratification, the
medical profession, overawed by the attitude of the
Court and the nobility, found it convenient to with
draw their opposition to the now triumphant method,
and to publicly indorse what they had previously
rejected.
This, in brief, is the history of the establishment
of vaccination as an accepted medical dogma. It
26 JENNER REWARDED.

will be seen with how little of scientific research it

was adopted, and how much the whim of a few fash
it remained
ionable folk shaped its destiny. Had
be doubted
purely a medicalquestion, it may well
whether it would ever have attracted more than
all,
and if remembered at it would
passing attention,
possibly be as only one of the curiosities of medicine.
In endeavoring to present as briefly as possible the
present state of our knowledge of this very important
subject, I shall describe cow-pox as modified in the
human subject, the nature and origin of vaccine
virus, the methods of vaccinating, the extent of pro
tection afforded by vaccination, and the dangers, if
any, of vaccination. In doing this it is my honest
desire to present the arguments advanced by those
who thoroughly and unquestioningly indorse the
method, as well as of those who decry and despise
it, in such a manner as to elucidate the truth in this
vexed question, so that each reader may come to a
proper understanding of it.
COW-POX AS MODIFIED IN THE HUMAN

SUBJECT.
If a small particle of the virus from a fully formed
vesicle of cow-pox be taken upon the point of a
lancet, and inserted by puncture beneath the cuticle
of a person who has never had smallpox nor been
previously vaccinated, certain phenomena will ap
pear in a definite order. If the person be in other
wise good health, no particular effects will be notice
able during the first forty-eight hours, except a

temporary elevation of temperature, followed by a

fall to a point below normal. Within a few hours
a peculiar malaise, like that
preluding the whole
class of exanthems, the patient. He is
overcomes

dull and sleepy; pulse and respiration are both

slowed for a time; the pulse soon quickens, but the
respiration continues slow or shallow, with bronchial
rales, or slight laryngismus. At the end of the sec
ond day, or surely during the third, there will be
perceptible a papulous spot over the point of punc
ture, which, very slight at first, becomes by the fifth
day a distinct vesicle, bluish-white in color, the edge
raised and clearly defined, and the centre lowered,
thus forming a peculiar and characteristic cup-like
depression. This vesicle gradually fills with a clear
and limpid fluid, which is misnamed lymph, and
(27)
28 THE VACCINE VESICLE.

the in
by the eighth day, thatday week from
is the
and
sertion of the virus, it has become fully ripe,
while retaining the peculiar shape already noted,
Pre
it is pearl-like in color, round and plump.
now

or two days, there has

ceding this, however, by one

begun to form about the base a thin ring of inflam

mation, called the areola, which rapidly spreads and
takes on the character of erysipelas. This Jenner
declared to be the chief sign of the true character of
the virus, being even more important than the shape
and appearance of the vesicle. He repeatedly said
that without the accompanying erysipelas no vacci
nation could be counted upon as protective.10 The
amount of erysipelas varies greatly. Sometimes it
is a clearly circumscribed round spot of less than
three inches diameter. At others, it extends irregu
larly, involving perhaps the entire limb. Even
where it involves but a small cutaneous surface, there
is much hardness and swelling of the subjacent con
nective tissue, while in extreme
cases the arm may

become enormously swollen, and so rigid as to be

practicably immovable. In either case, the develop
ment of the areola is
accompanied by the usual
systemic symptoms of erysipelas. The temperature
continues low until the fourth
day, when it rises to
102° to 104° F.,
higher. On the eighth day
or even

there is usually a sharp rise of

temperature, respira
tion and pulse. The pulse
may even go as high as
10
Or, as he poetically expressed it, "The pearl
upon the rose."
 SYMPTOMS OF VACCINATION. 29

200, and the respiration to 80 ; but these are excep

tional figures. Restlessness, heat and dryness of the
skin, headache, nausea, diarrhoea, swelling of the
axillary and other glands, are present in varying
intensity, and are never altogether absent, even in
the mildest cases. In fact, these secondary symptoms
are looked upon, by all experienced vaccinators, as

marking the effectiveness of the protection afforded

by the vaccination.
The duration of these symptoms vary with their
intensity, but usually after the tenth or eleventh
day, that is about five days after the setting in of the

erysipelas, period of recovery begins. The tem

the

perature returns to nearly normal, and then sinks

slightly below it, the bowels become regular, the
headache disappears, the swollen glands are less
sensitive, the skin is more natural, the areola fades
gradually, the vesicle, which during this process has
changed to an opaque and pustular appearance, now
begins to dry in the centre, and a process of desic
cation and incrustation follows, occupying four or
five days, at the end of which time a hard, brown
scab has formed. This process lasts about five or
six days. The scab continues to dry, harden, and
darken, and at the end of the fourth week spontane
ously separates, leaving behind a permanent, slightly-
depressed cicatrix. This cicatrix, upon examination
with a magnifying glass, is seen to be indented with
a number of minute pits, from which
radiate fine
lines.
30 PERSONAL SUSCEPTIBILITY.

the spots
Inchildren, after vaccination, when
have nearly healed, an erysipelatous redness occa

over the arm and a great

sionally appears, spreading
of the trunk. The redness is often intense, the
part
tissues being very hard, painful and shiny; and this
inflammation may continue for weeks.11
Some persons are found, who, while never having
contracted smallpox nor been inoculated, yet are
peculiarly insusceptible to vaccination. In these,
even the most careful performance of the
operation
only results in a transitory illness, not incapacitating
them from their ordinary vocations, and leaving be
hind slight evidence in the way of a "mark." Such
persons seem to have the power to throw off the

poison through inherent vitality, and would prob

ably not take smallpox in the natural way, if exposed
to it. Occasionally, on the other hand, persons will
develop extreme susceptibility, which shows itself by
an
eruption on a portion of, or upon the entire body.
This eruption may be papular, vesicular, or
pustular.
Sometimes the sores are very similar to the one at
the place of puncture. These eruptions are not
generally long-lasting, ordinarily not extending be
yond the falling of the scab. In other cases, how
ever, persisting for weeks or
months, or perhaps
causing death.
Vaccination directly from the cow is now
very
rarely performed. The usual
plan is a modified
,y Ringer, M.D., Handbook of
Therapeutics, 8th ed
 VARIATION IN PHENOMENA. 31

form, by which the dried virus either from a vesicle

on the cow, or from another person who has recently
been vaccinated, is used. In either case the viru
lence is very much lessened, and in consequence,
the protective power greatly impaired.
From this use of virus of varying degrees of viru
lence, decided variations in the phenomena of vacci
nation occur.
Papulation is sometimes deferred un

til the eighth, ninth, or even eleventh day. The

areola may not appear until after the second week.
The vesicle is often wanting in that sharp definition
of edge, plumpness of appearance, and glistening
color which has been described. The areola may be
only a pink, or deepening in shade, it may
faint
pass through dusky brick-red to deep purple. In
a

some cases it fades and brightens in color, while the

swelling and hardness remain unchanged. The

scab sometimes does not fall until the sixth week.
None of these things necessarily impair the value of
the vaccination, though a too wide variation from
the normal phenomena will always subject the case
to suspicion.
There are three forms of variation which are rec

ognized, and which demand our attention: (1) accel

erated; (2) retarded; (3) irregular, or spurious.
Those cases are denominated as accelerated where
the symptoms all appear in quicker succession than
heretofore described. If the symptoms are twenty
or thirty hours in advance of their due course, and
the vesicle is irregular in appearance, the areola but
32 VARIATION IN PHENOMENA.

constitutional symptoms
slight, and the general
but little faith can be put in the protective
wanting,
If, however, the vesicle be
power of the operation.
constitutional symp
normal in appearance, and the
toms present and only briefer
in duration, the value

of the vaccination is not impaired.

Where the ordinary course of the vaccinal phe
nomena are modified by retardation, the circum

stances that cause it should, if possible, be deter

mined. In the wrinter season, especially if the pa
tient be exposed to the vicissitudes of weather, a de
lay of a couple of days is of no special moment.
Retardation rarely occurs in those vaccinated directly
from the cow, and though more common, is still in
frequent in immediate vaccination from arm to arm;
but when dry virus is used it often seems to need
several days of incubation before its specific charac
ter is aroused. Again, the state of the person's
health at the time has much to do with the progress
of the vaccine disorder. If they are so unfortunate
as to take cold at that time, or if they are incubating

some other disease, a marked delay in the develop

ment of the vesicle may result. Jenner noticed that
the vesicles are often arrested in their course if un

wittingly a child was vaccinated just it

as was falling
ill of measles or scarlet fever, and that the areola
did not appear until the morbillous or scarlatinal
symptoms subsided.12 If, however, the patient be
12
Continuation of Injuiry, page 31.
 SPURIOUS VACCINATION. 33

incubating smallpox, the two diseases, vaccinia and

variola, go on side by side, apparently unaffected by
each other; unless previous to the formation of the
vaccine vesicle the smallpox pustules appear, in
which event the vaccination fails to take.
There are still other cases where the natural march
of the vaccinal-disorder is delayed, at one point or
another. If, however, the major symptoms do occur,
even the whole progress of the disorder may
though
occupy six or seven weeks, no suspicion need be
thrown upon the character of the protection afforded.
Spurious vaccination runs an
entirely irregular
course, the varieties being practicably unclassifiable.
The vesicle instead of being cup-shaped, may be acu
minated or conoidal; the contained secretion may
be straw-colored or bloody, instead of limpid and
clear; the vesicle may have scabbed by the seventh
day, or even sooner; or the scab "may be a thin
scale, which drops off at the lightest touch. In
other cases the vesicle breaks spontaneously, and be
comes an open and unhealthy ulcer. None of these
forms can be relied upon as having the slightest pro
tective power.
While these irregular appearances may be often
due to inexperience or carelessness on the part of the
operator, or to the inferior quality or impurity of
the virus used, it is not always so. In the hands of
the most skilful and experienced vaccinator it will
happen, that in. a group of children operated upon at
the same time and with the same virus, some will
3
 SUSCEPTIBILITY TO VACCINIA.
34 SPECIAL

in due time, while

present perfectly formed vesicles,
perhaps on one it will not
take at all, and on another
a hideous ulcer will result.
It is well known that in the vastmajority of cases
an attack of measles, scarlatina, pertussis, or variola

renders the person insusceptible to the disease for

ever afterwards. There are, however, plenty of in
stances of individuals who have had one of these
diseases two or more times. The samerule, to some
extent, holds true of vaccination. The phenomena
which I have described, can, as a rule, be
produced
but once in an individual. A second vaccination,
providing the first has been thorough and severe,
either fails to produceany local effect whatever, or
else in a
very modified form. There are persons,
however, who are so susceptible to the influence of
this virus that
they will be severely affected by it
whenever it may be re-introduced. It not infre
quently happens that persons who can show ex
cellentvaccination-marks, upon being re-vaccinated
develop most severe constitutional disturbances, ac
companied with extensive phlegmonous erysipelas.
Cases have occurred
terminating fatally from pyse-
mia. It isimpossible to foretell what will be the
result of a re-vaccination, as the
relation to the character of the
severity bears no
primary disorder.
It is simply and always a matter
of good luck
when,
upon re-vaccmation, the patient escapes serious con-
stitutional effects.
 VACCINIA A DISEASE. 35

Dr. Ballard observes13 in his work

on vaccination
"
that, Vaccination is not a thing to be trifled with,
or to be made
light of; it is not to be undertaken
thoughtlessly, or without due consideration of the
condition of the patient, his mode of life, and the
circumstances of and of
place. Surgeon and
season

patient should both carry in their minds the regu

lating thought that the one is engaged in communi
cating, the other in receiving into his system a real
disease truly disease,
—

as a
smallpox measles;
as or

a disease
which, mild and gentle as its progress may
be, yet nevertheless now and then, like every other
exanthematous malady, asserts its character by an

unusual exhibition of virulence."

1:i
Vaccina/ ion, its Value, and Alleged Dangers, page 93.
 THE NATURE AND ORIGIN OF VAC
CINAL VIRUS.

history of vaccination is peculiar in several

The
very important particulars. We are now to consider
one of these. If it be asked, with what shall we
vaccinate? the answer would seem to be simple
enough why, with vaccinal virus, of course. But*
—

if ask, What is vaccinal virus? the answer is not

we

readily found; nor is there, even now, after nearly ,

a century of vaccination, any concord in the profes

sion as to the proper material to be used.

When Jenner first performed the rite, he used
cow-pox virus. We have already seen what was the
origin of this disorder in the cow, viz., that it was a
contagious disease transferred, by careless manipu
lation, from the heels of the horse to the udder of
the cow. Jenner believed thatsmallpox, swine-pox,
cow-pox and grease were
merely varieties of the
.same disease, as he implied by the name variolar ,

vaccinas. He vaccinated his own son with swine

pox. He employed the grease-virus in
'

(horse-pox)
a large number of cases, and
furnished it to other
vaccinators. Acting on his
suggestion, King of
the
Spain, in 1804, ordered all the children in the Found
ling Hospital at Madrid to be vaccinated with goat-
pox. Jenner claimed that the
virus of these and
(36)
 ORIGIN OF VACCINE. 37

various other animals were all equally efficacious

with cow-pox in warding off smallpox. He also
used arm-to-arm vaccination, derived both from the
cow and from the
horse. He therefore practiced
five distinct things under the one name of vaccina
tion: (1) Cow-pox vaccination; (2) cow-pox-child
vaccination; (3) horse-pox (grease) vaccination,
which he denominated as the equination of the
human subject; (4) horse-pox-child vaccination; and
(5) swine-pox vaccination.
Although he asserted that grease, cow-pox and
smallpox were all one disease, he made no attempt
to prove it by inoculating the cow with variola. But,
as
early as 1801, Gassner, of Giinsburg, inoculated
with variolous virus eleven cows, producing on one
of them vesicles having all the characteristics of
vaccinal vesicles, and from which "a stock of genu
ine vaccine lymph was obtained."14 With this
smallpox-cow vaccine four children were inoculated,
and from them seventeen other children were in turn
vaccinated. In the following year (1802) a number
of cows were
successfully variolated at the Veterinary
College at Berlin.15
,
In 1830, Dr Sonderland, of Barmen, by envelop
ing cattle in blankets taken from the bed of a
pa
tient who had died of smallpox, and by also hang
ing the blankets up around their heads, and thus

14Seaton's Handbook of Vaccination, Chapter IV.

Ij
M. Viborg.
 THE COW.
38 SMALLPOXING

the effluvia from them, suc

forcing them to breathe
ceeded in variolating several poor animals. The
"in manifested the symp
few days
cows, he says,
a

toms of cow-pox, and lymph taken from them pro

duced genuine vaccine vesicles in the human sub

ject.16 These wantonly cruel experiments were

repeated in various places in Europe and also in
India. In 1836, by inoculation of variolous virus,
Dr. Thiele, of Kasan, produced "the genuine vaccine
disease." AVith this he vaccinated, through seventy-
five transmissions, more than three thousand human
beings. In 1839, Ceely, of England, induced "vac
cine vesicles in two young heifers (out of three oper
ated on), by inoculation of variolous lymph," and
thus established vaccine-stock, which formed the
basis of thousands of vaccinations. In 1840, Mr.

Badcock, of Brighton, England, succeeded in small-

poxing a cow, and derived therefrom a stock of

"genuine vaccine lymph." He has since repeated

the experiment about six hundred times, succeeding
in thirty-seven cases. The vaccine virus thus ob
tained has been supplied to many hundreds of prac
titioners, and tens of thousands of vaccinations have
been performed with it. In 1849, the
experiments
were repeated in this country, at Waltham, Massa
chusetts, by Dr. Adams, and at Boston, by Dr. Put
nam, and in 1852, by Dr. Wm. C. Van Bibber and
Dr. Saml. Knight, of Baltimore, and the
vaccine
16
Dr. Edward C. Seaton.
 THE BEAUGENCY STOCK. 39

matter thus obtained is still handed down from arm

to arm.

Beside this variola-vaccine

lymph, as it is called,
another, and as it is
asserted, a new variety of lymph
or virus has been
imported. This is the celebrated
Beaugency stock, which is claimed to be a spon
taneous case of cow-pox, untainted with variolation
on one hand, or horse-grease on the other.
Thus there are a number of strains of vaccine
material :

a. The original cow-pox of Jenner;

b. Equine-pox stock ;
c.
Swine-pox stock;
d. Goat-pox stock;
e. Variola
cow-pox of Ceely, and others;
/. Spontaneous cow-pox of Beaugency.
Each of these have passed through many trans
missions, and to a certain extent have become
crossed intermixed, and with the exception of
or
"
what is called
now
calf-lymph," it is impossible
for anybody to tell what he is using. This so-called
"calf-lymph" is offered in two varieties. One of
these is claimed to be inocculation from the Beau
gency stock, which it is confessed, is of unknown
origin,and which from the mildness of the vaccine-
disorder which it sets up, is of dubious value. If
this Beaugency stock is what it pretends to be, then
it is confronted with a direct denial of its efficacy
"
by Jenner himself, who says : Pustulous sores fre
quently appear spontaneously on the nipples of the
4Q CALF-LYMPH.

cows, and instances have occurred, though very

of the servants employed in
rarely, of the hands
sores in consequence.
milking being affected with
are of a much milder nature than
These pustules
those which arise from true cow-pox. No erysipelas
attends them. This disease is not to be considered
as similar in any respect to that of which I am treat

ing, as it is incapable of producing any specific effects

on the human system. It is of the greatest conse

quence to point it out here, lest the want of dis

crimination should occasion an idea of security from
the infection of small-pox, which might prove de
lusive." That would seem to settle the question as
to the Beaugency stock.
The other variety of "calf-lymph" is derived from

smallpoxing heifer, and from the vesicles thus

a

calves are inoculated; these in their turn

produced
furnishing the "lymph" or virus for the human
subject.
This furnishes two more varieties of vaccine ma

terial :

Calf-Beaugency stock;
g.
h.
Calf-smallpox-cow-pox.
Now, if as Jenner declared, these various poxes
are really all one thing, and
simply derivations of
horse-grease, it can make little difference through
what animal it comes, provided such animals are
themselves free from disease. But here authori just
ties fail to agree. Drs. Drysdale,
Seaton, Badcock,
Ceely, Thiele, and Sonderland assert that
smallpox
 SMALLPOX NOT VACCINIA. 41

inoculation of produces "genuine vaccine

cows

lymph." But other

experimenters, equally entitled
to respectful attention, have shown that it is a delusion
to suppose that the inoculation of cows with small
pox has ever
produced
cow-pox; it produces small
pox and nothing else. The smallpox may be in
duced on the horse or cow by variolation, but the
variolous inocculation is never transmuted into
grease in the horse, or cow-pox in the cow.17 Ex
periments made in the United States, and also at
the Veterinary School at Berlin, have verified these
observations, originally conducted at Lyons, France.
Dr. Seaton says: "It is quite out of the
question
that cow-pox on the human subject should have
been transformed into smallpox." If, therefore,
cow-pox cannot become smallpox, it would seem
incredible that smallpox could become cow-pox.
Dr. Geo. Wyld, of London, who is
certainly compe
tent authority on any matter
pertaining to vaccina
tion, and a man of unimpeachable integrity, indorses
the conclusions of the French Academy. He I
"

says :
find that many medical men are under the false im
pression that all that we require to do is to inoculate
the heifer with smallpox matter, and thus get a sup
ply of vaccine lymph. This might become produc
tive of disastrous consequences. Smallpox inocula
tion of the heifer produces not vaccinia, but a modi
fied smallpox capable of spreading smallpox amongst
human beings by infection."18
17
M. Chauveau. Report of Committee of the Academic des Sciences.
18
London Daily Xews, February 17, 1877.
42 SPONTANEOUS COW-POX.

It would thus appear that a large proportion of

the vaccination now performed is in reality but a

modified form of inoculation, having smallpox as its
basis, and containing nothing of the Jennerian
method but the name. It is not cow-pox, neither

spontaneous nor inoculated from horse-grease, but it

issmallpox propagated from human beings, through
calves, to human beings again.
Much has been claimed for the Beaugency stock,
and it has been given wide currency. There had
been growing up for many years such a wide-spread
dissatisfaction with the prevailing vaccine material,
that when, in 1866, it was announced that a case of
natural cow-pox had been discovered at Beaugency,
in France, there were hundreds of practitioners who
were willing to give the new brand a trial. It has
thus been in use nearly twenty years, and it is al
leged can be had humanized or vitulated. That is
a child was vaccinated
directly from the cow, eigh
teen years ago, and the virus has passed through some
four or five hundred transmissions, with the chance
of having been corrupted at any one of them. The
vitulated stock has, in like manner, been handed
down from calf to calf in a
long succession of ani
mals, and the evidences of its present genuineness
would be deemed inconclusive in
any court in Chris
tendom.
It will thus be seen on what
slight
foundation the
whole questionof vaccinal virus rests. Millions of
vaccinations are made every year, and
nobody knows
 IS IT VACCINIA? 43

what they are made with. 19

The whole process is a
haphazard game with chance. Vaccination was ac
cepted on the simple dictum of Jenner that it would
stamp out smallpox. The medical profession of to
day buys its vaccinal virus of those who make mer
chandise of it on their simple dictum that it is the
right thing to use.

19
Dr. Charles Cameron, M.P.
 THE METHODS OF VACCINATING.

In matters of experimental science, the 'predic

tions of the greatest geniuses only show the

imprudence of those who express them.—

Warlomont.

When Jenner introduced vaccination he believed

that if the cow-pox virus was directly brought in
contact with the cutis, so as to be acted upon by the

absorbents, that it would necessarily find its way

into the system, and produce its specific results. An

operation so simple apparently required no particu

lartraining, and could be performed by a layman
just as well as by a legally qualified practitioner.
In this way a large proportion of the earlier vacci
nations were performed by laymen and ladies.
When, however, smallpox began to appear among
the vaccinated, it was at first indignantly denied,
then ignored, and at last when the failures of vacci
nation became too numerous to be hidden from pub
lic attention, it claimed that those cases which
was

smallpox subsequently attacked had been but im

perfectly vaccinated, and that the manner of the vac
cination was at fault, and not the itself. This
thing
was not but in the main true. Vac
only plausible,
cination was seen to be a rite which
required to be
performed with due observance to detail in order to
(44)
 MULTIPLE VACCINATION. 45

be effective. Thenceforth amateur vaccination was

discountenanced, and the matter was relegated to pro-

" "
fessionalsupervision. Up to this time one mark
was considered protective for life; but when it was

found that persons who showed a "good" mark,

which had been made by a competent surgeon, nev
ertheless took smallpox, it was admitted that the
effect gradually wore off, and that those who had
been vaccinated in infancy, should again submit to
the operation at the dawn of puberty. The possible
fallibility of the rite having been admitted, and
smallpox continuing to show itself even among the
re-vaccinated, double vaccination was recommended ;
that is vaccinating in two places, either on the same
arm or one on each, at the same
operation. This
has been successively increased to seven or more,
while the frequency of the operation has doubled up
with each decade, until now there are many pro-vac-
cinists who urge its annual performance. I am ac
quainted with persons who have been thus vacci
nated fourteen or fifteen times, with several distinct
marks for each time. In this way, one starting

early enough might be pretty well tattooed in the

course of a moderately long life.

Without attempting to decide how much of this

is the eager partisanship of extremists, let us now
consider what are the necessary conditions for the

proper and successful conduct of a vaccination.

There are three things which demand our attention,
the state of health of the person to be
(1) present
46 CARELESS VACCINATION.

vaccinated ; (2) the selection of the virus to be used ;

and (3) the thorough and effective manner of insert
ing it. The failure to thoroughly appreciate the im
portance of either of these three circumstances, and
to carefully attend to them in performing the vacci

nation, may make the operation fruitless of good

results, or fraught with danger and disaster to the
vaccinated.
I. I think it may be laid down as an invariable
rule of practice, that no one should be vaccinated
except after the most rigid physical scrutiny. The
carelessness of the Health authorities in this par
ticular is amazing. Vaccination is performed, with
the easy nonchalance of the impossibility of doing
harm, upon multitudes without the slightest inquiry
as to their physical condition or antecedents; and
this among the very class, where the greatest danger
always lurks the tenement house population. Vac
—

cination to be effective, pervades and alters the en

"
tire constitution. Says Sir James Paget, The action
of vaccine is to establish a
permanent morbid con

dition of the blood."20 There are innumerable in

stances, in which vaccination has awakened a latent
disease, whose fires were smoldering in the system.
A lady, aged 33, who had had a small fibroid in
tramural uterine tumor for several years, was vac
cinatedduring the smallpox epidemic of 1881-82.
The vaccination took nicely, went normal
through a

20
Lectures on Inflammation.
 VACCINIA AND LATENT GERMS. 47

course, and the scab fell on the twenty-sixth day,

leaving a
perfectly characteristic cicatrix. The
genuineness of the vaccine was thus
duly attested.
Previous to this time, the tumor had
grown very
slowly, and had for some months seemed at a stand
still. Within a few weeks after the vaccination,
with no other perceptible for
reason
exacerbation,
the tumor was noticed to be
growing rapidly, and
in six months it increased from three or four ounces
in weight to seven or eight pounds.

During the same epidemic a man, aged 39, in

apparently good health, was vaccinated. The vac
cination ran an irregular course, leaving an
open
ulcer, which did not heal for several months. This
could not be ascribed to faulty vaccine, as others
were vaccinated with the same virus at the same

time, and all these had the vaccine-disorder norm

ally. In this case, before the ulcer healed, diarrhoea
set in, which persisted, with transient ameliorations
from treatment received, until his death. He was
vaccinated in January. In May, mesenteric tubercles
could be easily perceived upon physical examina
tion. He lived until the following December, and
died of tuberculosis intestinalis cum marasmus.

These cases are not

given as in any way reflecting
on vaccination ; but
only as illustrating how vaccine
may act in liberating the latent germs of a diathesis,
and to enforce the necessity of extreme carefulness
in performing the operation.
It is self-evident, that where the person is suffer-
 DISORDERS MODIFY VACCINIA.
48 SKIN

from acute disease, as for instance, diarrhoea

ing an
be delayed. Skin
or bronchitis, vaccination must
affections greatly modify and frequently nullify
vaccination. A simple intertrigo may completely
and before proceed
spoil the effects of an operation,
to vaccinate, the operator should carefully ex
ing
amine the folds of the neck, behind the ears, and
about the buttocks for chafed patches, and if abra
sions be found, the lancet must be withheld. The
same advice holds true in regard to all skin dis

orders, especially those of the eczematous or

herpetic
sorts, vaccine is nearest allied to these, and is
as

most frequently aborted by them on the one hand,

or
greatly adds to their virulence and chronicity on

the other.
In the case of infants, themselves apparently
healthy, there always arises the interesting inquiry,
whether there be any taint of syphilis in either
parent. Should there be even the slightest well-
grounded reason
believing there may be, vacci
for
nation should be postponed until the infant is six
months old. As hereditary syphilis nearly invari

ably manifests itself before the child is four months

old, this precaution will prevent a disease which was
pre-natal in its origin from being ascribed to the
vaccination.
Nearly all writers on vaccination
urge the per
formance of indiscriminate vaccination or
re-vacci
nation during an epidemic of
smallpox upon all
classes and conditions of men
(including the babies);
 VACCINIA A ZYMOSIS. 49

and it is the practice of the Health Board here in

New York, discovering a case of smallpox, to re
on

move the patient to Riverside Hospital, Blackwell's

Island, disinfect the house, and indiscriminately re-

vaccinate everybody in the vicinage. As to the
moral right of the Health Board to thus enforce vac
cination, I have nothing to say in this place. Waiv
ing that point, altogether, at this time, and viewing
the question solely from the physical point, this
seems a mistake. It is well known that persons, re

covering from of the

zymotic disorders,
one
prone are

to take any other that may be prevalent at the time.

A person weakened by scarlet fever is likely to take

diphtheria, if it is about, or vice versa. It is then

but fair to believe that if the vaccine-disease be
made plentiful that it will turn the community into
a convenient nidus for other zymoses, including
smallpox. The error seems to be, in looking at vac
cination, not as a disease-bearer, but as a
purifier,
while the vaccine-disorder is as
truly a disease as

measles typhus.
or

As smallpox is so largely confined to infants and

very young children, one-fourth of the deaths from
that disease being of children under one year old,21
if the infant is to be vaccinated, health permitting,
the earlier it is done, the better, The earliest period

21
Of
42,277 deaths from variola, in England, during the ten years,
18o6— 1865, 10,223 were of children under one year of age. (Seaton.)
In the variolous epidemic of 1837-8, when 9,762 perished in Eng

land, 9,008 of the victims were under fifteen years of age.

50 VACCINE SHOULD BE UNTAINTED.

is
of life, that is during the first three months, par
suitable to vaccination, for at that time the
ticularly
infant is free from the disturbing influence of teething,
and if the health is otherwise good and the vaccine
is selected with care, the probabilities are that the
child will pass through the vaccine-disorder in a
normal manner. Children vaccinated during den
tition often suffer
severely from diarrhoeal com
plaints. Frequently the tooth-making process is in
terfered with, and the teeth are imperfectly devel
oped, or are subject to early decay.
The chances of an adult taking smallpox are re
mote. Like measles, whooping-cough and scarlet
fever, smallpox is mainly a disease of childhood.
After the tenth year the probabilities of taking it
rapidly lessen, and it is hardly worth while under
going the risks of vaccination, to ward off a danger
so problematical. I know I am not in accord with
most vaccinists in this conclusion, but the facts upon
which it is based are admitted by all.
II. The vaccine22 to be used should not only be
free from all taint, but, like Caesar's wife, above sus
picion. The vaccinator should make assurance that
the "lymph" that he introduces into the system of
the helpless babe before him is from a perfectly
healthy animal, or if it is humanized virus, that it is
from a child of perfectly
healthy stock. The vacci-
22
The origin of the word vaccine is thus described: "Dr. Odier, of
Geneva, has baptized the new disease, la vaccine, or
vaccinia; rejecting
as absurd the name of the English,variola vaccina." —Br.
Medical and
Pearson, in
Physical Journal; Vol. Ill page 100" 1800
 VACCINE ACCIDENTS. 51

nator has no
right
to trust to chance in this matter
of virusation. It involves consequences too
perva
sive and long-lasting for a
happy-go-lucky style of
selection. The difficulties of the problem offer no

valid excuse for evading its solution. Vaccine is an

article of commerce, and has therefore a
mercenary
element, in addition to the uncertainties to which I
have referred in speaking of the and nature
origin
of vaccinal virus. Many accidents have arisen from
the use of impure vaccine,23 but vaccinists, as a
rule,
have been loath to admit the facts, fearing to
preju
dice the public mind against the whole matter. It
is often unpleasant to face the truth, but it is
always
cowardly to evade it.
Arm-to-arm vaccination has almost ceased in New

23
The following communication from Dr. T. S.
Hopkins, of Thom-
asville, Ga., concerning the results which have followed the use of
"patent solid lymph," is published for general information:
"Our town authorities have employed a physician to vaccinate all
persons who present themselves for the purpose. The virus was
pro
cured from the New England Vaccine
Company, Chelsea, Mass., as
'bovine matter.' The result has been fearful.
Nearly every one
vaccinated has suffered severely from Erythema or
Erysipelas, the
arm swollen from shoulder to
wrist, and the point of puncture pre
senting the appearance of a sloughing ulcer, discharging freely sani-
ous pus.
Many of the sufferers have been confined to bed, with high
fever, from five to ten days, requiring the constant application of
poultices to the arm, and a free use of morphia for the relief of pain.
I deem it my duty to inform you of the result here from the matter
used and from whence it came. It came in cones, each cone said to
contain enough to vaccinate one hundre
persons, at a cost of one
dollar per cone. Those who have tried it tell me they would much
prefer to have smallpox," From the National
—

Board of Health Bul

letin, Washington, D. C, March 4, 1882.
52 SOURCES OF VACCINE.

York. Occasionally a doctor will ask to have a

scab saved for him, but of immediate arm-to-arm

operation from the vesicle, I have known of no in
stance for some years. I think this a misfortune, as

when the doctor thus had a whole series of vaccina

tions under direct purview, he was enabled to judge
of the quality of the vaccine he was using. It has
now assumed purely commercial aspect, and
a more

the family doctor is

simply a "middleman," between
the vaccine dealer and the vaccinated; conveniently
and dextrously shoving off upon the former any ill-
effects which may appear in the latter.
In New York our main supply of vaccine has long
been the Health Board, which, through the energy
of Dr. Taylor, has not
only been able to keep up the
supply for its large corps of vaccinators, but has
own

it on sale for all comers. Dr. Taylor first obtained

his material from the Essex Market Dispensary,
where it was gathered from the unwholesome dwell
ers in that
populous but filthy quarter. At that
time, the mother was required to report at the Dis
pensary, with the child, on the twenty-first day after
the vaccination. The scabs were then taken off and
dropped into open-mouthed, glass fruit-jar.
an A
sufficient quantity of water was added from time to
time to soften these scabs into a paste, and into this
filthy mixture the quills dipped, then
were
dried,
then sold with the official aroma of true Jennerian
cow-pox. Fortunately the medical fashion changed,
and "calf" lymph came into vogue. Dr. Taylor, as
public vaccinator, not to be behind the times, estab-
 METHODS OF VACCINATING. 53

lished a calf farm, and from this source, the city and
surrounding towns have been supplied for eight or
nine years. Just what is the genesis of this vaccine
I have been unable to discover. It is said to be
Beaugency, but I am inclined to think it is another
instance of smallpoxing the cow.

III. Various methods employed for inserting

are

vaccine, and various places the body are selected

on

for the operation. A favorite place, especially for

girls, is on the inner surface of the thigh several
inches below the groin; this prevents the marks
from showing, many mothers objecting to having a

girl's arm scarred. The point at which the vaccine

is introduced is Of no moment, provided it is brought
well in contact with an absorbing surface. The
most common method here in New York is by
scarification. Various instruments are manufac
tured by the surgical instrument makers for this

purpose, but the best tool is a thin bladed and very

sharp lancet. With this a number of
scratches, about half an inch long and equi
distant, are made through the cuticle. The
abrasion must be deep enough to draw a little blood
in order to ensure that the true skin has been
reached. Sometimes the abrasion is criss
crossed, in thismanner. As soon as the
blood appears, it is quickly wiped away,
and the vaccine smeared over the wound. If fluid
is used, all that is necessary is to dip the
lymph
of the lancet into it before making the incision;
point
but if matter is used, it is better to soften it with
dry
54 METHODS OF VACCINATING.

the smallest possible amount of water, and when it

is of the consistency of cream, plaster it on with the
flat of the blade.
Many operators err by making the cuts too shal

low, fearing that if there is much oozing of blood,

that the vaccine will be washed away, and the ope
ration prove a failure. This is a mistake, failures
to "take" being commonly caused by insufficient
scarification. There is a
great difference in the vac

cinal successes, even of experienced vaccinators. A

failure of more than one per cent, of primary vacci
nations should be considered prima facie evidence
either of the poorness of the vaccine, or of the in
efficiency of the vaccinator. The best operators
often make a couple of hundred successive vaccina
tions without a failure.
One good operation, such as I have described, is
all-sufficient; but some vaccinators prefer 5^ '

to make a line of small abrasions like this, ^#

which, if close enough together, will, as the vesicles
fill, run into one long compound vesicle,
tied down at as many points as there
were original punctures. There have
been various ways proposed for accomplishing the
same thing, but none of them possess
any advan
tages over the method of scarification which I have
described.
Ths question of insusceptibility to vaccination is
a mooted point. Probably there are few cases of in
susceptibility to real cow-pox, although they are un
doubtedly occasionally met with.
 THE EXTENT OF THE PROTECTION
AFFORDED BY VACCINATION.

When one meets a fact in opposition to a domi

nant theory, we must accept the fact and
abandon the theory, even though, being sup
ported by great names, it may be generally
acceftted. Claude Bernard.
—

In considering the amount of protection afforded

by vaccination, naturally the first query which pre
sents itself for solution is, Does vaccination prevent

smallpox in the vaccinated? If it does, without in

any way endangering the system in other directions,
or rendering it more liable to other diseases, then it

ismanifestly the duty of every one to submit to the

operation, under the advice of their regular physi
cian.
This as it may seem, is not to be
question, simple
answered off-hand. The testimonies as to its pro
tective power are so conflicting, in fact, so
absolutely
contradictory, and this from men of equal probity
and experience, that it can only be by the most care

ful and impartial sifting of the evidence that we may

be able to reach an authoritative conclusion. Cast
aside prejudice, therefore, let us first see what
ing
Jenner actually claimed; secondly, whether this
by the eighty-five
claim has been substantiated years
of subsequent experience.
(55)
56 JENNER VS. JENNER.

When Jenner began the practice of vaccination, in

1798, he assumed that it was a preventative of small

pox for life.2* This, it will be readily seen, was mere

theory on his part, because in the nature of things it
was not possible to determine, at that time, except

theoretically, that the artificial production of one

disease, would surely prevent, forever afterward, in

that person, the occurrence of another analogous
disease. That he had abundant reason for his the
ory, I am quite ready to admit; and, probably, any
of us so situated, would have been equally sure of
thefar-reaching quality of the discovery. But as

sumption is not law, and Jenner lived to see his

error. He found that the vaccinated were not only
subject to smallpox, but that it attacked them some

times twice.23 He thereupon advised (nearly sixty

years since) re-vaccination. It was evident that he
did not ascribe these failures to lack of care, or to
the use of improper material, for he finally re-vacci
nated his own patients once a year.
"
It was only, however, to efficient vaccination," says
Dr. Seaton, "that is to vaccination which had gone
through all its stages with perfect regularity, and
had given evidences of infecting the constitution, that

24
"What renders the cow-pox virus so extremely singular, is, that
the person who has been thus affected is forever after secure
from the infection of the smallpox. —

Jenner.
25
During the recent
epidemic, a man 89 years of age was admitted
to the Wynberg Smallpox Hospital, and it was the fifth occasion of
his being attacked by variola.—Port Elizabeth Telegraph, Dec. 9, 1882.
 PROTECTION THROUGH VACCINATION. 57

he attributed protecting power. Observations made

since Jenner's day, by Mr. Marson, of the London
Smallpox Hospital, have conclusively established
that, for thoroughly infecting the constitution, a cer
tain amount of local affection (i. e.,
erysipelas) is as
necessary as a
perfect character of vaccine vesicle.
We must, therefore, so far extend the meaning of the
words 'due and efficient' performance of vaccina
tion, as to make it include amount as well as quality
of vaccine influence; and with this extension, the

experience of seventy years tends to show the cor

rectness of Jenner's estimate."26 But which estimate
does this refer to, that of 1798, when vaccination
protected for life, or of 1821, when he was re-vacci
nating year by year? The context clearly infers
the former, for nowhere is it suggested, in this long
article from which the above is quoted, that Jenner
advised re-vaccinations.
It is claimed that all who do not have variola are

preserved from it by vaccination. In other words,

that all persons do have smallpox unless they have
been vaccinated, with rare exceptions. This is a
broad statement, and can hardly be true. Even if
every person one or two centuries ago had
smallpox,
that would be insufficient evidence upon which to
base a statement that all would have it now. Surely
modern improvement in living, increased knowledge
of hygiene, and advances in sanitation must be al-

Reynolds' System of Medicine. Vol. I, page 166.

4
58 FLORENCE NIGHTINGALE'S OPINION.

lowed to count for something, unless, indeed, we are

willing to accept the dictum of the Public Vaccinator

of New York (Dr. Taylor), that it is the robust, the
healthy, the clean, who are most likely to be stricken
with this disease. This latter view, separating, as it
does, variola from its kindred zymoses, is neither
common sense, nor in accord with the experience of
the wise. Proofs that smallpox and other zymotic
diseases originate in filth are almost innumerable.
Florence Nightingale is good authority here. She
"
says : I was brought up both by scientific men and

ignorant women to believe the smallpox, for in

stance, was a thing, of which there was once a first
specimen in the world, which went on propagating
itself, just as much as there was a first dog, or pair
of dogs; and that the smallpox would not begin it
self any more than a new dog wou'ld begin without
there having been a parent dog. Since then I have
seen with my eyes smallpox growing up in first

specimens, in close rooms or overcrowded wards,

where it could not by any possibility have been
caught, but must have begun. Nay more; I have
seen diseases begin, grow up, and
pass into one
another; with overcrowding, continued fever; with
a little more
overcrowding, typhoid; with a little
more, typhus, and all in the same ward or hut." I
have myself seen diseases grow and in the
develop
same manner. About four years ago, I saw scarlet
fever grow through four transmissions from an in
fluenza. Squalor, sewer-gas, cold and
neglect were
the factors in the case.
 MORTALITY FROM SMALLPOX. 59

Mr. John Simon, F.R.S., the able and zealous

Medical Officer of the Privy Council (England), said:
"When smallpox attacks an unprotected population
after lapse of years, it seizes all who come in the way
a

of the contagion, who have not previously had the

disease. Supposing there is an island, and it has
not had a smallpox epidemic for fifty
years, the epi
demic, when it comes, will take all up to the age of
fifty."27
The facts, as far know them, do not warrant
as we

this assertion. According to Dr. Lettsom and Dr.

Gilbert Blane, both ardent pro-vaccinists, the aver

age death-rate from smallpox, for the thirty years

previous to the introduction of vaccination, was
estimated at three thousand per million of popula
tion. This, it will be noticed, is a mere estimate, by
those who were anxious to
place the death-rate before
vaccination ashigh possible. A modern writer
as

remarks that "Dr. Lettsom possessed the facile art

ofextracting suitable percentages from unknown
numbers;" and Dr. Farr, the Registrar-General,
when questioned whether there were any statistics
that would warrant any such conclusion, said em
phatically: "No, it is a mere estimate; no statistics
of the last century or the previous one are to be re
28
lied upon."
What the average mortality from smallpox may
have been during the last century, it is impossible

27
Parliamentary Vaccination Committee of 1871.
28 Committee of 1871.
Parliamentary Vaccination
60 DEATH-RATE OF SMALLPOX.

to determine, but the following table will give an

approximate idea; and, as they are hospital cases,
are
likely to be above rather than below the mark,
as it is well known that isolated patients do better
than those collected into wards.

Fatality of Hospital Smallpox before Vac

cination.

PER CENT.

DATE. AUTHORITY. CASES, DEATHS. OF

DEATHS.

1723 17,151 2,848 16.6

1700-63 24,594 4,635 18.85

1779 Eees' Cyclopaedia . . .

400 72 18.0

1700-79 42,145 ;
7,555 17.64

Dr. Seaton, in his valuable work on vaccination,

"
says : Dr. Jurin, writing early in the last century,
laid it down as the result of his investigations, that
of persons of all ages taken ill of natural smallpox,
there will die of that distemper, one in five or six.
From returns made to the Epidemiological Society
in 1852, by 156 medical practitioners in various
parts of England who had kept numerical records
of their smallpox experience, it appeared that the
proportion of deaths to cases which
they had met
with in the natural form of the disease was 19.7
per
cent., or as nearly as
possible, one in five."
 A BOSTON EXPERIENCE. 61

In
Newcastle-upon-Tyne 2616 cases, from 1777-
1877, caused 428 deaths, 16.3 per cent.29
or

Admitting the correctness of Dr. Lettsom's esti

mates, and calculating all deaths at the hospital
rate, there would be only an average of 18 cases per
year of smallpox to every one thousand of popula
tion. With even this liberal count it is evident
that not half the inhabitants could have had the
disease. The claim, therefore, that vaccination alone
preserves from smallpox, falls to the ground.
One of the most reliable accounts of
smallpox in
the last century is that of a very severe epidemic in
Boston, Massachusetts, in 1752, which may be found
in the Gentlemen's Magazine of 1753. The
popula
tion of Boston was then 15,684; its
sanitary condi
tion was, like most cities of that period,
extremely
bad; and variolous inoculation was freely practiced,
as it had been for
nearly thirty years. One-third of
the inhabitants, 5545, were attacked with smallpox.
The mortality among these was 539, or 9.7 per cent.
This previous to vaccination. As inoculation
was

is now
freely admitted to conduce to the intensity
of the disease, it is probable that natural smallpox,
uninfluenced by inoculation, would have shown a
lower death-rate.
Smallpox during the fifty years prior to inocula
tion, that is during the latter portion of the seven
teenth and the beginning of the eighteenth century,

Dr. Monteith, Handbook of Vaccination, ISfiS, page 191 et seq.

62 SMALLPOX LESS FREQUENT SINCE 1770.

formed variable, but considerable cause of death.

a

During this period, in London, out of every one

thousand deaths, fifty-six were from this disorder.
After the introduction of inoculation the proportion
of deaths steadily rose until it reached one hundred
and eight out of every one thousand, in 1770. From
this date, which was nearly thirty years before vac
cination, it began, in common with other diseases,
to decline. As Dr. Farr, the Registrar General, ob
serves: "Smallpox attained its maximum after in
oculation was introduced; this disease began to

grow less fatal before vaccination was discovered;

indicating, together with the diminution in fever,
the general improvement in health then taking
place." Now, if smallpox declined while inoculation
was disseminating the disease, it is reasonable to

suppose, nothing else interfering, that the decline

would be more marked at the partial discontinuance
of inoculation about 1800, and again upon the prac
tice being made penal in 1840. The annexed table
shows what did happen :

Smallpox deaths Smallpox de

5Tear. per 1000 deaths. Year. per 1000 dei

1700-1720 . , . ... 56 1801-1810 .

1721-1740 . . . ... 65 1811-1820 . .... 42

1740-1750 . . . • . 80 1821-1830 . .... 32
1751-1760 . , , ... 100 1831-1840 . ...• 23
1761-1770. , . ... 108 1841-1850 .
.18
1771-1780 . , , ... 98 1851-1860 . . ... 21
1781-1790 . . , ... 87 1861-1870 . ....
27
1791 1800 . . . ... 88 1871-1880 . • ... 19
 TWO CENTURIES OF SMALLPOX. 63

Vaccination was introduced when smallpox was

a
diminishing factor, and by checking inoculation
withdrew a fertile source of variolous propagation.
Mr. Marson admits that the discontinuance of inocu
lation, rather than the practice of vaccination, was
the of the lesser prevalence of
cause
smallpox dur
ing the first three decades of the present century.30
Sir Lyon Playfair, the scholarly representative of
the Universities of Edinburgh and St. Andrews, in
a speech before
Parliament, in June, 1883, thus tab
ulates the death-rate from smallpox in Great Britain
during the past two centuries:
Deaths from smallpox
Year. per lui.lion iuhabitauts.

1701-1800 3000
1801-1840 600
1841-1854 . . . 305

Under Compulsory
Year. Vaccination.

1855-1871 223
1872-1882 156

Sir
Lyon Playfair observes: "These great reduc
tions in the rate of
smallpox mortality I believe to be
due wholly to vaccination. Sanitation is not the cause,
for it would diminish all other diseases likewise;
but these have only diminished six per cent., whereas
smallpox has diminished eighty per cent, in chil
dren under five."
It is hardly fair to compare the mortality of small

pox with all other diseases, because a large propor-

30
Report of Parliamentary Committee, 1871.
64 SMALLPOX COMPARED WITH FEVER.

tion of the total mortality arises from causes with

which sanitation has nothing to do. But if we com
pare smallpox to the group of cases so nearly allied
to it from a sanitary point of view, viz., typhus, ty

phoid, etc., the Registrar General's figures are (with

the exception of 1847-49, for which he does not
give the figures for fever):
Deaths per Million Living
Year. Smallpox. Fever.

1850-53 310 986

1854-70 223 940
1871-80 156 .... 473

Sir Lyon Playfair is willing to allow six per cent.

for sanitation, but if sanitation had done for small

pox what it did for fever, the last decennial death-

rate would have been 140 and not 156; and this
without allowing anything for vaccination.
Dr. Farr states that fever has declined progress

ively since 1771, in nearly the same proportion as

smallpox.31 These are his figures:
Deaths per 10,000 Living.
Year. Fever. Smallpox.
1771-80 621 502
1801-10 264 204
1831-35 Ill 83

The deaths in England from

smallpox, per million
living, are thus stated by the
Registrar General.
Those for the years 1843-6 are not given by him, but
the number was small:

McCulloch's Statistics of the British Empire.

 SMALLPOX DEATHS PER MILLION. 65

Year. Deaths. Year. Deaths.

1841 367 1863 293

1842 181 1864 373
1847 246 1865 309
1848 398 1866 144
1849 264 1867 118
1850 263 1868 96
1851 396 1869 72
1852 409 1870 118
1853 174 1871 1022
1854 153 1872 831
1855 136 1873 102
1856 121 1874 92
1857 206 1875 40
1858 335 1876 99
1859 197 1877 174
1860 140 1878 74
1861 66 1879 21
1862 81 1880 25

Precise data has never been collected to enable us

to state what proportion of the

successfully vacci
nated are liable to take smallpox. The proportion
will vary, of course, with the age of the person and
the degree of exposure to the contagion. Some
epidemics are much more virulent than others, and
seize upon a much wider range of victims. Ameri
can statistics are utterly unreliable, and in many

instances purposely misleading.

There are few vital statistics in the United States
worthy of credence, and none that are of any help
in this inquiry. Only twenty-nine of the States have
Boards of Health, and not more than a fourth of
these have existed ten years. Some have never
66 AMERICAN STATISTICS.

issued a report. Even in Massachusetts and Michi

gan, the only two States, where the reports on

zymotic disorders have even an appearance of ac

curacy, the opportunity for comparative study of

smallpox in the vaccinated and un vaccinated is
meagre and unsatisfactory. The National Board of
Health has done nothing, and evinces no disposition
to do anything. Here in New York things would
be in better shape, if funds were forthcoming to pay
for the work. The Registrar of Vital Statistics (Dr.
Nagle) is an accomplished and efficient officer, but
he can do little unaided. From the imperfect re
turns which are made to him it is impossible to tell
in any week of any year how many cases of measles,
diphtheria, or any other disease may have occurred.
This is not the Registrar's fault; but must be laid
to the baneful influence of the political jugglers, who
hamper every department of civil administration.
No reports on vital statistics have been published in
this city in the past eleven years. And take the
country through, we are totally ignorant of vital
statistics, as they are understood in Great Britain
and Germany. Having had abundant
opportunity
to compare the work done here, with that of such
men as Farr, of England, or Kolb, of Bavaria, I am
obliged to confess with shame the
shortsighted
ness of our various State Governments. I
recognize
the great advantages in a settled population like
England, over a growing and migratory population
such as we have here, in the matter of statistic col-
 LONDON HOSPITAL STATISTICS. 67

lection ; but on the other hand, the diffu

general
sion of intelligence makes the of data
gathering
easier here than in countries less favored in this re

spect.
The
Smallpox Hospital, London, is believed to be
a fair of English experience.32 The
representative
number of cases of
smallpox after vaccination has
steadily risen from about 5 per cent, at the begin
ning of this century to 44 per cent, in 1845, 64 per
cent in 1855, 78 per cent, in 1865, 90
per cent, in
1875, and is now about 96 per cent, of the whole
number of cases admitted. The residual 4 per cent.
is mainly composed of infants under one year of
age, who on account of tainted constitutions, or the
nomadic character of their parents have the
escaped
official lancet. They the waifs and strays of
are

civilization; the children of vagabonds; the natural

victims of disease. That the deaths
among this resid
ual per cent, of unvaccinated should be more than
one to three, will excite no
surprise. They would
have died at the same rate from whatever disorder

happened to strike them first, whether it was mea

sles, whooping cough, or diarrhoea; if they at all cor
respond to the same class as we see them here in our
tenement-house life. During the last smallpox epi
demic in New York (1880-2) the number of vacci
nated cases very largely exceeded the unvaccinated,
and of these latter the vast majority were infants.

:i-
M arson.
68 SMALLPOX AFTER COW-POX.

In the first report of the Vaccine Pock Institution,

in
"

page 111, it is said : It is not manifest

1803, that
the vaccine inoculation has been of benefit to the
public, however great a one it has been to individ
uals."
In the second report of the Royal Jennerian So
ciety, 1806, is the following: "The Committee admit
to having seen a few cases of smallpox by persons
who had passed through the cow-pox in the usual
way."
In the same year (1806) the Royal College of Sur

geons issued a circular-letter to 1,100 of its members,

asking their experience of vaccination. They re
ceived 426 answers, and the information of 56 cases
of smallpox after vaccination, 66 cases of eruptions,
and 24 bad arms. It may be interesting to compare
the smallpox deaths, at this period, in New York
and London.
 NEW YORK AND LONDON. 69

Comparison of smallpox deaths.

NEW YORK. LONDON.

NO VACCINATION THE
VACCINATION. FASHION.

PER HUNDRED THOUSAND LIVING.

YEAR.

1804 .... 169 61

1805 .... 62 163

1806 48 110

1807 29 122

1808 62 108

1809 66 106

1810 4 106

AVERAGE .
63 111

The London Medical Observer, Vol. VI, in 1810,

published the particulars of 535 cases of persons
having had smallpox after vaccination, the opera
tion in some instances having been performed by
Jenner himself, including their names, with an
index, pointing to the authorities as witnesses; also
similar details of 97 fatal cases of smallpox after
vaccination; and of 150 cases of injury arising from
vaccination, together with the addresses of ten med
ical men, including two Professors of Anatomy, who
had suffered in their own families from vaccination.
70 VACCINATION INEFFICIENT

Whereupon,' Dr. Maclean, a well-known medical

"

authority of that time, observes: Although numer —

ous, they are few in comparison to what might be

produced. It will be thought incumbent on the
vaccinators to come forward and disprove the numer
ous facts decisive
against vaccination here stated on
unimpeachable authority, or make the am.ende honor
able by a manly recantation. But experience forbids
us to
expect any such fair and magnanimous pro
ceeding, and we may be assured that, under no
circumstances, will they abandon so lucrative a
practice, until the practice abandons them."
In 1820, that is before Jenner's death, it was said :
"
Cases of smallpox after vaccination have increased
to such an extent, that no conscientious practitioner
can recommend vaccination as affording certain
security against the contagion of smallpox."33
In 1828 there was a severe epidemic in Marseilles,
when about 2000 were attacked with smallpox who
had been vaccinated.3* In the epidemic, 1831, et seq.
in Wirtemberg, 955
persons wTere attacked with
smallpox after vaccination.35
The Registrar-General of Sweden in his official
report, 1856, declared that to explain certain statis
tical data it is necessary to suppose, either that the
effect of vaccination is little or none, or that the

workings of the vaccination system are highly defec-

33
Gazette of Health, Vol. V, page 656. London, 1820.
K
s*Marson. Heira.
 SMALLPOX AFTER VACCINATION 71

tive.36 This is after forty years of compulsory vac

cination.
Dr. Ducharme, speaking of an epidemic in 1868,
which broke out in his regiment (Voltigeurs of the
Guard) a few months after he had re-vaccinated it,
says:— "To what should we attribute this epidemic
in a regiment in which 437 re-vaccinations had been

performed, and where the hygienic conditions, as to

space, ventilation, and food, were excellent, when in
the 2d Regiment of Voltigeurs lodged in a
precisely
—

similar barrack situated in the same court, but on

whom no vaccinations had yet been made not a —

single case of smallpox existed?"

The London
Morning Advertiser, November 24,
1870, reports that "the smallpox is making still
greater havoc in the ranks of the Prussian army,
which is said to have 30,000 smallpox patients in its
hospitals." These were all vaccinated and re-vacci
nated.
The following are a few samples cases out of
many, in the United States Navy Department Re
ports: —

"In 1850, in the U. S. frigate Independence, with a

ship's company of 560 persons, there were 116 cases
of smallpox, seven fatal. Fleet-Surgeon Whelan
writes: 'The crew of this ship almost universally
—

presented what are regarded as genuine vaccine

marks. The protection, however, proved to be quite
imperfect.'
Rektor P. A. Siljestrom, April, 1877.
72 VACCINATION INEFFICIENT.

Upon the U. S. steamship Jamestown, serving in

"

Japanese waters, there occurred, in 1864, among a

ship's company of 212 persons, 31 cases of smallpox,
with four deaths. The entire crew had been vacci
nated afterleaving the United States.
"
In 1870, sixty-one cases occurred on the U. S.
steamship Franklin. The disease first appeared on
'
a sailor with an excellent vaccine scar.' The officers
and crew were immediately vaccinated with fresh
vaccine matter obtained at Lisbon, this vaccination
being the thirdduring the cruise. Nineteen
one
'

days later, the second case occurred. The disease

has been epidemic in many places in Europe during
the past season, but I hoped our vaccinations would
prevent trouble with it on board ship.'
"
In a cruise of the North Carolina up the Mediter
ranean, she shipped at Norfolk a crew of 900 men,
most of whom had been vaccinated, or had the
smallpox, but were nevertheless twice vaccinated
prior to the ship sailing, a third time at Gibraltar,
and a fourth time at Port Mahon. Dr. Henderson,
who reports these facts, states that notwithstanding
this ultra vaccination under such various circum
stances of virus, climate, etc., 157 of the crew had
varioloid."
In the of Bavaria, where no one for
Kingdom
many years, except the newly born, escaped vacci
nation, there were in the epidemic of 1871 no less
than 30,742 cases of smallpox, of whom 29,429 had
 SMALLPOX AFTER VACCINATION. 73

been vaccinated, as is shown

by the documents of
the StateDepartment.37
In the first Annual Report of the Health Depart
ment of the city of New York, 1870-71, it is stated:
"This extraordinary prevalence of smallpox over
various parts of the globe, especially in countries
where vaccination has long been efficiently practiced ;
its occurrence in its most fatal form in persons who
gave evidences of having been well vaccinated, and
the remarkable susceptibility of people of all ages to
re-vaccinations, are new facts in the history of this
pestilence, which must lead to a re-investigation of

the whole subject of vaccination and of its claims

as protecting agent." Smallpox continued epi
a

demic during this period in New York, in spite of

the most rigorous enforcement of vaccination.
In Baltimore, during 1882, there were 4,930 cases
of smallpox, of which 3,506 were children. The
deaths numbered 1184, of which 959 were children.
Of the vaccinated 2853, 327 died. The victims were
mainly Germans, colored persons, and sailors, hud
dled together in the worst quarter of the town. As
many as twenty cases were taken from a single
house. During one month (January) 162,414 were
vaccinated city physicians, beside large
by the
numbers in the previous months.
The Report of the Health Department of the city
of Chicago, for the years 1881-82, shows the total

37
(r. F. Kolb, of the Eoyal Statistical Commission of Bavaria.
74 VACCINATION INEFFICIENT.

mortality from smallpox for the last thirty years

(the population having increased from 252,000 in
1868 to 560,000 in 1882) has been as follows:—

Years. Smallpox deaths.

Decade— 1851-60 109

1861-70 778
1871-80 1479
One Year— 1881 1180
"
1882 : 1292

Thus as vaccination was more rigidly enforced,

smallpox increased.

In 1859-62 there were, in the British troops quar

tered in England, 430 cases of smallpox after vacci
nation. During the Franco-Prussian war (1870),
there were 23,469 cases of smallpox, in the French

army, all of them vaccinated, and the larger part re-

vaccinated. Dr. Bayard, of Paris, says: "Every
French soldier on entering a regiment is re-vacci
nated; there are no exceptions." In 1871 smallpox
was epidemic in Milan; 17,109 cases were recorded,
of which only 278 were classed as unvaccinated. In
1871-2 there were 11,174 cases of smallpox after vac
cination in the London hospitals. Of this year, Dr.
Seaton said: "An epidemic of smallpox so intense as
that which recently prevailed, has afforded a very
severe test of the value of our
present vaccination
laws." If the Jennerian theory had been true, this
virulent epidemic could not have occurred in a pop
ulation where ninety-six per cent of the births are
 SMALLPOX AFTER VACCINATION. 75

registered as officially vaccinated.38 As a portion of

the remaining four per cent, must have succumbed
to the hardships of living, the actual substratum of
the unvaccinated must be very thin.

Men
are prone to see
things much as they imagine
they ought to be. In a controversial question few
can be
magnanimous, and fewer still impartial. As
showing the different manner of looking at this sub
ject, I present side by side two statements, made by
reputable men. Which shall we credit?

John Leacroft, M.K.C.S., writ- Dr.Browning, the Medical

ing from Fechenham, near Eed- Officer of Health, for Kother-
ditch, Feb. 16, 1883, says: "I hithe, writing On Vaccination
have been a Public Vaccinator of with Cilf-Lymph, 1882, says:
"
several districts since the passing That children and adults com-

of the Compulsory Vaccination

paratively recently vaccinated
Acts, and have, during the past with humanized lymph, and some
forty years, vaccinated many thou- showing good marks, may subse-
sands of children, and am per- quently, within a few days,

feetly satisfied that vaccination, months, or years, contract small-

38
"The deaths from smallpox have assumed the proportions of a
plague. Over 10,000 lives have been sacrificed during the past year
in England and Wales. In London, 5641 deaths have occurred since
Christmas. Of 9,392 patients in the London Smallpox Hospitals, no
less than 6,854 had been vaccinated, i. e., nearly 73 per cent. Taking
the mortality at 17J per cent, of those attacked, and the deaths this
year in the whole country at 10,000, it will follow that more than
122,000 vaccinated persons have suffered from smallpox! This is an
alarming state of things. Can we greatly wonder that the opponents
of vaccination should point to such statistics as an evidence of the fail
ure of the system? It is necessary to speak plainly on this important
matter."— Lancet, July 15, 1871.
76 LEACROFT VS. BROWNING.

properly and efficiently performed, is pox is an undoubted fact, probab'y

not only a protection against the known to all of us. I have my
confluent form of smallpox, but self recorded 469 cases of persons,
that in no case does it cause either of all ages and both sexes, suffer
sores orany disease likely to ing from smallpox after vaccina
shorten life. Any such cases that tion, with 99 deaths —
an
average
may and do
occasionally arise, are of 21 per cent.; and higher fig
those where the operation has not ures are given by Dr. Collie.
been properly and with efficient Now, many of these sufferers
care
performed." showed good vaccine marks of the
kind that would be deemed worthy
Vaccination, when pro of an extra grant from the Gov
perly and efficiently per ernment-Inspector (at least, I
used formerly to receive such
formed, prevents conflu
ent and pro grants for doing similar work) ;
smallpox, and yet they took smallpox some —

duces neither sores or

within six days, some within six
any disease likely to months, and some within six years
shorten life; and when of their vaccination."

vaccination does not pre

vent confluent smallpox, Dr. Browning, there
and does produce sores fore, recommends the dis
and diseases use of humanized lymph,
likely to
shorten and direct vaccination
life, then vacci
nation has not been pro from the calf.

perly and with efficient

care
performed.
The following candid view of the
question is from
the pen of one of the wisest
physicians of his day,
Sir Henry Holland : Present Questions
Regard
—

ing Vaccination.
London, 1839. "The questions
already stated bring us to those which regard
the completeness of Vaccination as a
preventive
 sir henry Holland's opinion. 77

remedy, the duration of its protecting power, and

the changes its virus may undergo by long use and
frequent transmission the most momentous by far
—

of all the inquiries affecting the subject. The events

of the last 10 or 15 years have forced them
strongly
upon us, while apparently at the same time prepar
ing evidence for their final determination. Not only
in Great Britain, but throughout
every part of the
globe from which we have records, we find that
smallpox has been gradually increasing again in
frequency as an epidemic, affecting a larger propor
tion of the vaccinated, and inflicting greater mor

tality in its results. I do not enter into any detail

of these facts, as they are now generally admitted.
We can no longer deny that the protection given by
Vaccination is unequal in different cases, or that it
may be lessened or lost by time. Experience has
here confirmed a presumption, which some ventured
very early to entertain, and which, indeed, was sanc
tioned, prior to experience, by various considera
tions. The early enthusiasm for the great discovery
of Jenner swept those doubts away; and they re
turned only tardily, and under the compulsion of
facts. . . And though more palpable at one time
than another, according to the greater or less prev
alence of epidemic causes, yet every succeeding year
has multiplied them, and every statement from
other countries has attested their truth. The cir
cumstances, of late years, have greatly changed the
that relates to this It is
aspect of all question. no
78 vaccination delusive.

longer expedient, in any sense, to argue for the

present practice of Vaccination as a certain
or
per
manent preventive of small-pox. The truth must

be told as it is, that the the earlier anticipations on

this point have not been realized."
Dr. G. F. Kolb, of Munich, Member Extraordinary
of the Royal Statistical Commission of Bavaria, and
the author of several statistical works of acknowl
edged value, says: "From childhood I have been
trained to look upon the cow-pox as an absolute and
unqualified protective. I have, from my earliest re
membrance, believed in it strongly than in
more

any clerical tenet or ecclesiastical dogma.

The nu
merous and acknowledged failures did not shake

my faith. I attributed them either to the careless

ness of the operator or the badness of the lymph.

In the course of time, the question of vaccine com

pulsion came before the Reichstag, when a medical

friend supplied me with a mass of statistics favorable
to vaccination, in his opinion conclusive and unan

swerable. This awoke the statistician within me.

On inspection, I found the figures were delusive;

and a closer examination left no shadow of doubt in
my mind that the so-called statistical array of proof
was a complete failure."

Dr. H. Boeing, for very many years a prominent

vaccinator at Uerdingen, on the Rhine, says: "As I
began these researches in the belief and with the
hope to gain a sure guaranty for the correctness of
the present protective theory of vaccination, nobody
 VACCINATION IN LONDON. 79

can
regret it more than myself that their result
proved unfavorable to
compulsory vaccination.
and every friend of
humanity feels the constraint of
being compelled to resign a
prophylactic operation,
the inventor of which is called
yet to-day one of the
greatest benefactors of mankind, and the real practi
cal effect of which has to be
placed among Hart-
man's illusions."39
Having thus been forced to admit that vaccination
does not prevent
smallpox in the vaccinated, let us
now determine what is its
power in the mitigating
disease. There are two points to be here considered :
the ratio of deaths from
smallpox, and the amount
ofdisfigurement in those who recover; the latter be
ing taken as a mark of the severity of the attack.
On the first point, Mr. Marson, who has for
thirty-
five years had charge of the
Smallpox Hospital at
London, is excellent authority. During that time
he has had more than seventeen thousand cases of
smallpox under his immediate personal supervision,
and has had ready means of
knowing the exact par
ticulars of the entire English
hospital experience.
He has found, while the unvaccinated
among these
cases have died at the rate of
thirty-five deaths to
one hundred cases, the ratio
among the vaccinated
has only been about six to a hundred. But what is
still more conclusive, as shown by this concensus of
cases, is that the modifying power of vaccination

Facts on the Smallpox and Vaccination

Question, Leipzig, 1882.
80 LONDON HOSPITAL EXPERIENCE.

is in direct ratio thoroughness and excel

to the
lence of the operation, shown by the cicatrices.
as

The number of the vaccine-marks, and the quality

of the vaccine, as proven by the appearance of the
mark, enable him to determine beforehand the prob
able severity of the impending attack. The sub
joined table clearly presents the facts to the eye.40
Number of Deaths
Classification of Patients afflicted with per Hundred in
Smallpox. each Class
Respectively.
1. Unvaccinated 35.
2. Stated to have been vaccinated, but having no cicatrix 23 57
.

3. Vaccinated —

«.
Having one vaccine cicatrix 7.73
b. Having two vaccine cicatrices 4.70
c. Having three vaccine cicatrices 1.95
d. Having four or more vaccine cicatrices .... 0.55

A.Having well-marked cicatrices 2.52

B Having badly marked cicatrices 8.82
4. Having previously had smallpox 19.

Among the vaccinated the influence of the quality

of the cicatrix was remarkable. In those having
one vaccine cicatrix, the death-rate, where the mark
was good, was 3.83 per cent., while among the badly-
marked it was 11.91. Those having two vaccine
cicatrices, died at the rate of 2.32 per cent, when
well-marked, and 8.34 when badly marked.
In studying this interesting table, there are cer
tain points that should not be overlooked. The un

vaccinated died at the rate of thirty-five in the

*°
Seaton on Vaccination. Reynolds' System of Medicine. Vol. I
page 168.
 SMALLPOX OBLITERATES VACCINATION. 81

hundred ; but as I have already pointed out, this

class was mainly recruited from infants who had
failed to receive the benefit of vaccination, because
of morbid physical traits which made the operation,
to the mind of the parish vaccinator, undesirable.
In other words many of them had been refused vac
cination. As far as we can know, the death-rate
from smallpox prior to vaccination and inoculation

was, the average, one out of every five cases. It

on

is, therefore, reasonable to suppose that the addi

tional deaths above that rate, viz., fifteen out of every

thirty-five deaths, were due to the previous condi

tion of the patients.
The second class includes persons who claimed to
be vaccinated, but showed no evidence. Now, while
it is possible that some of these patients may have
tried to deceive the doctors by saying that they were
vaccinated when they were not, men rarely lie with
out a motive, and it would hardly seem that there
was here any adequate motive for prevarication.
On the other hand, as the death-rate in this class
was much above that of smallpox naturally, these
were evidently severe cases; and as the disease in
its virulent form effectually obliterates all traces of
vaccination, we have at once the double explanation
as to the reason these cases were fatal and why vac
cine cicatrices could not be found. They had been
obliterated by the severity of the disease.
Dr.Vacher, in a report of the smallpox epidemic
at Birkenhead, in 1877, states "that there were 595
5
82 MR. MARSON'S TESTIMONY.

cases, of whom 223 were vaccinated, 72 unvacci

nated, and 220 unknown. Of these there died 12
vaccinated, 53 unvaccinated, and 28 unknown. The
mere assertions of patients or their friends that they
were vaccinated, counted for nothing, as about eighty
per cent, of the patients entered as unknown were
reported as
having been vaccinated." As a corollary
to this I wish to refer to a report by Dr. Russell, of
the Glasgow epidemic of 1871-72. "Sometimes per
sons were said to be vaccinated, but no marks could

be seen, very frequently on account of the abund

ance of the
eruption. In some cases of those which
recovered, an inspection before dismission discovered
'
vaccine marks, sometimes very good'."
That this is the explanation of the high death-
rate is evidenced by Mr. Marson's testimony: "The
danger nearly always depends upon the amount of
eruption upon the body. The unvaccinated who
have confluent smallpox, die at the rate of 50 per
cent., of semi-confluent smallpox the deaths among
the unvaccinated are only 8 per cent. The death-
rate from discreet smallpox among the unvaccinated
is only 4 per cent., and even those 4 per cent, die of
convulsions, or some other disease to which children
are liable. Of 104 cases of corymbose smallpox 74
were vaccinated and died at 41 per cent., and 29
were unvaccinated, who died at 44 per cent., the
remaining one being after inoculation. In corym
bose smallpox the protection would seem to be very
small."41
41
Vaccination Evidence, page 248 and 265.
 "
THE VALUE OF MULTIPLE MARKS." 83

It would be interesting to know in the cases of

those having more than one cicatrix, how many
represent distinct re-vaccinations. The value of sev
eral punctures at one operation would seem to be

solely to give the vaccine disease in a severer

form,
while several re-vaccinations would represent so

many successive attacks of the vaccine disease. The

protection afforded by several cicatrices, is in a*iy
event remarkable; those having four cicatrices in

curring but one-sixteenth the risk of those having

only one.42 Numerous cicatrices, however, do not
prevent persons from having the smallpox. Pa
tients entered the hospital having as high as seven

teen good marks; yet even they caught the small

" "
pox. Thus it is true that the well-marked and
the "badly marked" alike find their way to the
hospital. Twelve hospital reports during the last
decennium (1871-80) show 19,779 cases of smallpox.
These classified according to their marks are as
follows :

42
It is but fair to say that many Public Vaccinators protest against
this large area of scars as necessary, useful or expedient. One of them
in writing to the British Medical Journal, Dec. 9, 1882, says: "This
practice, though supported by statistics, is pure fallacy, and has done
more to make vaccination a bugbear than all the outcry of the anti-
vaccinators. I believe an excessive amount of inflammation, as is
caused by a large area of pustules, does more to damage the protect
ive quality of the vaccination than to improve it. Vaccine virus is
known to be capable of unlimited auto-multiplication. The lymph
taken from a case in which one small pustule only has been devel
oped, gives as good results as that taken from large and more inflamed
pustules."
84 CLASSIFICATION OF CASES.

Cases.
With Good Marks —

one mark .■
1,408
two marks 1,105
three marks 806
four marks or more 768

With Imperfect Marks —

one mark 2,062

two marks 1,733
three marks 1,211
four marks or more 653

Somehospitals do not separate in their report the good

from the imperfect marks, these are

With Marks, Quality Not Specified —

one mark 1,124

two marks 1,722
three marks 936
four marks or more 741

Other Vaccinated Classes —

Traces of vaccine marks 938

Doubtful cases 228
Number of marks 1,205
Unvaccinated —

No marks 3,139
Total
19,779

It will be seen, upwards of six thousand have

three vaccine marks or more; or, 28.85 per cent.
It would seem therefore that, from the stand
point of Dr. Seaton, while the protection afforded
by thorough vaccination is unequivocal, and that
the protection is in exact proportion with the thor
oughness of the vaccination, yet in certain consti-
 VACCINATED INFANTS DIE OF SMALLPOX. 85

tutions there is such a

predisposition to the dis
order, that the most careful and repeated
even

vaccination only lessens the chances, and does not

prevent an attack.
That it does not protect
invariably
even for a

year, is shown bythe many instances where

persons
have smallpox within a few weeks or months after
vaccination. Every table
of smallpox statistics shows
vaccinated deaths among the very
young, where vac
cination ought to be protective, if
any where. Thus,
in the epidemic in Scotland of
1871-73, there died
of smallpox 762 infants under one
year of age, who
are classified in the return of the Registrar-General
as: —

Year. Vaccinated. Unvaccinated.

1871 64 142
1872 314 64
1873 139 39

Total, 517 245

Thus 517 died of smallpox within less than a year

after vaccination. Evidently vaccination did not
mitigate the attack in these 517 cases.
With regard to the duration of the protective power
of vaccination, the experiments of City Physician
Schuppert, of New Orleans, are instructive. Schup-
perf vaccinated 30 boys, varying in age from 8 to 14;
of these, 5 had had smallpox, and 4 others had been
vaccinated. The vaccination succeeded with 7 only;
of which 4 had had smallpox. The 25, who had
proved insusceptible, were revaccinated every eight
86 schuppert's experiments.

days, from the pustules of the successful cases, with

the following results :
23 vaccinated, 14 insusceptible.
"
t 14 9
"
9 6
6 2

Those who had been successfully vaccinated at

the first three trials, were revaccinated three weeks
after the scab had detached, with this result:
7 from the second trial, 0 insusceptible.
" " "
9 third 3
" " " "
5 fourth 1

Of the 7, who had been successfully re-vaccinated,

6 were
again for the third time successfully vacci
nated. As a result, Schuppert lost faith in vaccina
tion, and consequently had to resign his position as
City Physician.43
The following resume, by Mr. Alex. Wheeler, of
the statistics of the Homerton Fever Hospital, shows
the number of cases and deaths from smallpox in
1876-77.

Homerton Fever Hospital.

1876-1877.

Smallpox cases received into Hospital : —

Total.
Vaccinated, 784
Unvaccinated, 131
*

915
Divided as follows : —

Discreet cases —

Vaccinated, 499
Unvaccinated, 22
521
(Majority of vaccm.-fted, 477.)

Prof. Deschere.
 SMALLPOX IN HOMERTON HOSPITAL. 87

Confluent cases— Vaccinated, 255

Unvaccinated, 99
.",54
(Majority of vaccinated, 159.)
Malignant cases
—

Vaccinated, . 30
Unvaccinated, 10
40 915
(Majority of vaccinated, 20.)
Deaths of Vaccinated; 102
" "
Unvaccinated, 70
172
(Majority of vaccinated, 32.)
Summary.
Deaths
Cases. Deaths, per cent.
of cases.
Discreet —

Vaccinated, 499 2 .4
Unvaccinated, 22 0 .0
Confluent —

Vaccinated, 255 70 27.0

Unvaccinated, 99 60 60.0
Malignant —

Vaccinated, 30 30 100.0
Unvaccinated, 10 10 100.0

915 172 18.7

Dividing these cases at

puberty, shows the number
of children who had smallpox and died of it.44

'

vaccinated. unvaccinated.

Under 16 Over 16 Under 16 Over 16

years of age. years of age. years of age. years of age.

Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths.

Discreet
177 2 322 0 20 0 2 0
Smallpox.

Confluent
72 20 183 50 80 49 19 11
Smallpox.

Malignant 9 9 21 21 8 8 2 2
Smallpox.
44
British Medical Journal, April 14, 1883.
88 VACCINISATION VS. VACCINATION.

Here evidently is a great mass of ineffective vacci

nation ; that is vaccination which does not protect. The

figures are official and their reliability cannot be

questioned. The vaccinations were performed under
governmental inspection, and their genuineness can
not be impugned.
Dr. Leon Colin, who is an acknowledged French
authority, thus defines what really constitutes pro
"
tective vaccination : —

We must not stop with each

subject single vaccination. We must have in
at a

the minds of our lawgivers, and in that of the pub

lic, a firm conviction that vaccine
prophylaxy rests
not upon one practice, and the success of a single

operation, but that it is only real and complete by a

series of inoculations which should be periodically
renewed in order to mantain immunity during the
entire life. It will be possible to first impose re
peated inoculations upon State officials, and then
45
afterwards upon all classes of society."
This very nearly corresponds with the recommen
dations so earnestly urged by Dr. Warlomont, the
chief of Belgian vaccinators. Dr. Warlomont was
the inventor of what is now called vaccinisation. He
insists that vaccination, as usually performed, is
little better than make-believe, and that vaccinisation
is the only real protective. This consists in subject
ing the vaccinated again and again to the operation
in quick succession, until vesicles cease to form after
the insertion of virus. Then, and then only, is safety
from smallpox thoroughly assured.
La Variola.
 AUSTRIAN EXPERIENCE. 89

Dr. Leander Josef Keller furnishes vaccine statis

tics, which deserve attention. The Austrian system
of railways is all under one
management, and Dr.
Keller is the physician-in-chief. In the epidemic
of 1872-73, he carefully examined the relative effects
of smallpox on those who had been
vaccinated, and
those who had not. These railways
employ about
37,000 officials and workmen; and these with their
wives and children give quite a sum total.
Among
these there were 2627 cases of smallpox, of which
469 died, or 17.85 per cent. The ratio of deaths at
various ages was : —

Vaccinated. Unvaccinated.

Under 1 year, 57.14 43.78

From 1 to 2 years 52.05 38.96
" " "
2 3 34.15 17.86
" " "
3 4 21.88 16.88
" " "
4 5 2.3.64 13.70
" " "
5 10 19.23 7.76
or
" "
3 to 15 15.41 10.32

These are the years usually considered fullypro

tected by vaccination; but it will be seen in every
case that the unvaccinated had the advantage.
Dr. Keller concludes his paper as follows: —

1. Generally more vaccinated than unvaccinated

persons were attacked by smallpox.

2. Re-vaccination did not protect from smallpox,
and did not lessen the general mortality.
3. Neither vaccination nor re-vaccination exer

cised a favorable influence upon the mortality of

smallpox."46
Allgemeine Wiener Medizinische Zeitung, August, 1873,
90 SMALLPOX PRIOR TO VACCINATION.

There isan unfounded opinion that smallpox was

extremely virulent before the era of vaccination. It

is true, there were mild epidemics and severe ones,
but on the whole, in civilized communities, the
death-rate was moderate compared with the total
mortality. Dr. Lotz
gives the statistics of smallpox
during a epidemic in Posen, in 1798. The percentage
of deaths to cases was under one
year, 35.9 per cent.;
under two years, 29.0 per cent. ; under three years,
19.6 per cent.; under four years, 16.6 per cent.; under
five years 13.4 per cent. That is of all the children
under five years of age, who took smallpox, 22.9 out
of 100 died. This corresponds very nearly to Eng
lish hospital experience already quoted.
In the annexed table a comparison is instituted
between two epidemics in the last century and that
of 1871.
A Comparison of Smallpox Mortality in E
with that of the Year

—
There died of Smallpox in last century in w
■•
a
population of

THREE TRUSSIA
BERLIN, 174G. 17 OX
AGE-CLASSES.

Persons No. of Deaths Persons No. o

living. Deaths. per 1000. living. Deaths

0-1 year . . .

2,000 41 20.5 400 13

"
1-5 6,560 129 19.5 124
...

1,386
"
5-10 7,120 15 2.1 44
...

1,493
'
10-20 13,360 1 0.1 4
...

2,626
above 20 years 50,960 0 0 0
. .

7,425

Average 80,000 186 2.3 13,330 185

 B.

1871. —
In Berlin, Duisburg, and Hamburg among a
population
vaccinated, there died of smallpo

1871 IN BERLIN. 1871 IN DUIS

AGE-CLASSES.

Persons Deaths Persons

Deaths. Deaths
living. per 1000. living.

0-1 year . . .
18,917 1.038 54.6 992 93

"
1-5 ...
69,176 1,189 17.2 3,586 143

"
5-10 ...
71,011 243 3.4 3,933 46

"
10-20 ...
144,422 172 1.2 6,072 28

above 20 years . .
519,043 2,443 5.7 15,946 222

Average 822,569 5,085 6.2 30,533 532

 muller's orphan home. 93

It will be noticed that in the well-vaccinated Ber

lin, of 1871, the deaths were three times the rate of
non-vaccinated Berlin of 1746. This, by no means,
proves that vaccination was a cause of mortality, but
it does prove that vaccination did not prevent it.
Dr. Muller writes that out of 179 cases of vaccinated
children under year of age, which came under
one

his notice in Berlin, in 1871, more than one-half,

namely 99, or 55.30 per cent. died.
That smallpox does not first attack the unvacci
nated, and from them spread to the vaccinated, is
shown by the statistics of many local epidemics

during the past twenty years. Thus in the Cologne

epidemic, of 1870, 173 vaccinated persons were at
tacked before the first unvaccinated one; in Leignitz,
in 1871, 224 vaccinated, before one unvaccinated;
and in Bonn, in 1870, 42 vaccinated, before one un
" "

vaccinated.47 This would seem to be the protected

"

infecting the residual dangerous class."

Every one has heard of Muller's Orphan Home, at
Bristol, England. As in all public schools in Eng
land, the children are all vaccinated. During the
early months of 1872 an epidemic of smallpox pre
vailed, and 293 children had the disorder; with 19
deaths, 6.66 per cent.
or This is a favorable show

ing, and would seem to be strongly confirmatory of

the protective power of vaccination. But mild epi
demics of smallpox occurred before vaccination, and
therefore we can hardly insist upon claiming mild-

*7 Vv\ J. M.D.
Collins,
94 smallpox a hundred years ago.

ness as a logical sequence of vaccination. Jenner,

on
page 54 of his Inquiry, says: "About seven years
ago (1791) a species of smallpox spread through
many of the towns and villages of this part of Glou
cestershire. It ivas of so mild a nature that a fatal in
stance was scarcely ever heard of, and consequently so
little dreaded by the lower orders of the community,
that they scrupled not to hold the same intercourse
with each other as if no infectious disease had been
present among them. I never saw or heard of an
instance of its being confluent. The harmless man
ner in which it showed itself could not arise from

any peculiarity either in the season or the weather,

for I watched its progress upwards of a year without
perceiving any variation in its general appearance."
And yet these were all unvaccinated cases.

That this
was not a
solitary instance, is shown by
the following quotation from a pamphlet published
by Isaac Massey, apothecary to Christ's Hospital, in
London, in the year 1723: "The children of Christ's

Hospital are
generally a flux body of about nine
hundred or more; and I affirm that in that
place
not one out of
fifty have died these last twenty
years of that distemper, and but one the last nine
years of the smallpox, although near six hundred
have been constantly in the house, and I believe
some hundreds have been down of it." Dr. Wag-
staffe, writing in the previous year of the same epi
demic, states that the fatality amounted to hardly
one in a hundred. If such a mild epidemic should
 SMALLPOX NOW. 95

occur in this
year of our Lord, 1885, how many there
would be who would exclaim, Behold and see what
a
goodly thing vaccination is.
Very different was the epidemic at Birmingham,
England, which culminated in 1874, and which
called forth the remark, "Smallpox has lost its usual
respect for vaccination." Dr. Alfred Hill, Medical
Officer of Health for Birmingham, gives the total
number of cases of smallpox during this epidemic,
as 7,706, of which 6,795 had been vaccinated, 830
not vaccinated, and 81 doubtful. There had been
1,270 deaths, of which 840 had been vaccinated, 404
not vaccinated, and 26 doubtful.48 The 830 not vac
cinated, included 475 from the workhouse, mainly
infants under one
year of age, and too young, too
weak, or too diseased to
undergo vaccination. The
81 doubtful persons claiming to be vacci
cases were

nated, but in whom, owing to the severity of the at

tack, ocular demonstration was impossible. The
number of adults over forty years of age, who died
" "
not vaccinated was two.

Henry Tompkins, of the Manchester Fever

Dr.

Hospital, reports 1,138 cases of smallpox; 932 were

vaccinated, 46 claimed to be vaccinated, 64 were un
determined, and 96 were unvaccinated. Of the 1,138
cases, there died 195, or 17.13 per cent., which was
about the ordinary death rate of smallpox before the
vaccination era. Of the 932 vaccinated, 86 died, or

48
Daily News, August 25, 1875.
96 SMALLPOX DEATH-RATES COMPARED.

9.22 per cent. ; and of the 96 unvaccinated, 60 died.49

The City of Manchester is vaccinated almost to the
these unvaccinated cases
verge of its birth-rate, and
represent a class of infants which all tenement-house
doctors recognize as hopeless cases, if overtaken by
either of the zymoses.
The following table shows very conclusively that
the average death-rate from smallpox remains the
same now that it was a century ago.

DEATHS
VACCI
PER
BATE. AUTHORITY. CASES. DEATHS
NATED.
CENT.

1723 Dr. Jurin

quoted by
o
M Dr.
Duvillard, 18,066
. . .
None. 2,986 16.53
H
1746-63 London Smallpox Hos-
M
u 6,456 do. 1,634 25.30
u
1763 Lambert quoted by Dr.
>
72 do. 15 20.8

o 1779 Eees' Cyclopaedia, . .

400 do. 72 18.0

24,994 4,707 18.83

1836-51 Mr. Marson's Hospital

o
5,652 3,094 1,129 19.97
1870-72 Metropolitan Hospitals, 14,898 11,174 2,764 18.66
<
do. do. 1,470 338 23.0
*
1876
o
O H 1871-77 Homerton Hospital (Dr.
OO «<
5,479 4,236 1,065 19.43

1876-80 Dublin Hospital (Dr.

2,404 1,956 523 21.7
Grimshaw), ....

15,171 11,412 2,677 17.6

1876-80 Metropolitan (Jebb), .

H 552 17.3
1881 Deptford (McCombie) 3,185 2,654
5
48,169 34,526 9,048 18.78
49
The Amount of Protection Afforded by Vaccination against Small
pox. London, 1883.
 VACCINATED INDIANS DIE OF SMALLPOX. 97

This Table shows that before the introduction of

vaccination, the percentage of deaths from small
pox was no higher than it is at present. Inasmuch
as the deaths in the second division include a large
majority of vaccinated persons, it is further shown
that vaccination has had no effect in diminishing
the percentage of mortality. Smallpox as treated
now, and smallpox as treatedby the medical men
of the 18th century, is the same unmodified disease.

It exacts the same ratio of victims to cases, runs the

same course, and is as fatal now as then.

Catlin, the historian of the North American In

dians, though a firm believer in vaccination, men
tions it as a curious fact, that amongst a tribe of In
dians all those who were vaccinated, during an epi
demic of smallpox died.
"
Dr. H. Oidtmann says : Our German municipal
records show thousands of cases of attack or death
from smallpox, even in newly-vaccinated persons.
The modern analogical proofs drawn from the ex
periments of M. Pasteur with anthrax or splenic
fever, have been proved by the counter experiments
of Dr. Koch to be miserable illusions. Artificial in
oculation is thing, the epidemic development of
one

disease quite another; and. to base the right of the

State to enforce vaccination on the variolous test a

la lenner, is to occupy a
position that cannot possibly
be maintained."50

50
Address to the Reichstag.
98 SMALLPOX MORTALITY STATISTICS.

The continued mortality from smallpox, in spite

of the predictions of the more ardent pro-vaccinists
to the contrary, drew from Joseph Baxendell, F.R.
A.S., the following comparison: "As the best test of
the value of vaccination, I have compared the results,
in London, for the five years 1849-53, before vacci
nation was made compulsory, with those for the five
years 1869-73, when compulsory vaccination had
been twenty years in operation. In the former five
years, when vaccination was voluntary, and the
number of vaccinated persons probably did not
amount to ten per cent, of the total population, the
death-rate from smallpox in London was .292; but
in the latter five years, when vaccination had been

strictly carried out for twenty years, and the number

of vaccinated persons was 95 per cent, of the popula
tion, the rate was .679, thus showing the extraordi
nary increase of 132.5 per cent." I do not quote this
as indorsing it fully, but only as it bears on what is

to follow. Smallpox being one of those diseases

which appear in cycles, apparently dying out and
then again gradually culminating, only again to
diminish and then increase, and as it has been doing
this for centuries, it is easy to so manipulate statis
tics as to prove either side of the question. By dex
trous elision of epidemic years, smallpox can
appa
rently be shown to be constantly decreasing in viru
lence; while by re-arranging the statistics it can be
demonstrated just as clearly that it is rapidly in
creasing. As for instance in the five years 1853-7,
 dr. Cameron's letter. 99

the smallpox mortality in London was 2,631, or

an
average per year of 526. In the five years 1868-
72, there were 11,543 deaths, or an average of 2,308
per annum. Such conjuring with figures is mis
leading, and therefore dishonest. Smallpox is not
rapidly increasing in virulence, although it must be
admitted that recent epidemics have shown an unex
pected malignancy.
Dr. Charles Cameron, M.P., the able champion of
vaccination in the House of Commons, in a letter to
the London Times, in May, 1882, said: "Since 1836
our statistics have been compiled so as to enable us
to compare the mortality not merely in smallpox
occurring in all classes of vaccinated persons at dif
ferent periods, but in each separate class of vacci
nated persons —

in persons, that is, with one, two,

three, or four good or indifferent marks. I have
gone into these details, and found that not merely
has the mortality in smallpox occurring after vacci
nation progressively increased in the aggregate, but
it has increased in each class of cases, and increased
enormously in the best vaccinated class of cases."
When it is remembered that these are the words not
of opponent but of a defender of vaccination,
an

their import will be duly realized.

During the ten years, 1870-9, the deaths from
smallpox among the vaccinated in London was
10.10 per cent.51 This is undoubted evidence of in-

51
Lancet, Nov. 12, 1881.
100 AN ARMY OF VACCINATORS.

efficient vaccination, and it is

probably occasioned,
in part, by using smallpox-cow virus instead of the
true Jennerian cow-pox. The observations made
by
Drs. Edward C. Seaton and George Buchanan, dur
ing the epidemic of smallpox in London, in 1863,
and published in the official report of the Privy
Council, in 1865, shows this fact as to the quality of
"
vaccination very plainly : As the best means of ob
information on this point, we examined the
taining
cicatrices on the arms of 49,570 vaccinated children
in variousschools, industrial establishments, and
workhouses of London. Of these 50,000 children,
only 180 in a thousand were found to be properly
vaccinated. In one-fifth of the whole number of
children examined, vaccination was found to be
wholly bad."52
During the past twenty years, since the above was
penned, every possible effort has been made by the
English government to secure perfect vaccination.
An army of vaccinators have been deployed all over
the kingdom, extra rewards for efficient service have
been offered and paid, criminal prosecutions have
been brought by the tens of thousands53 against those
who object to being thus parentally guarded by gov-

52
Lord Lyttleton, in the House of Lords,
April 12, 1853, showed
on

that in 1852 the ratio of vaccinated to the birth-rate varied

widely in
different parts of the kingdom. Birmingham, 91 per cent. ; Derbv,
42; Leicester, 41; Loughborough, 18; Paddington, 16; Bideford,
11 ; Winchcomb, 6; Westminster, 4.
53
A thousand at one time in a single town.
 ZYMOSIS A CONSTANT QUANTITY. 101

ernment, a sum
aggregating upwards of ten millions
of dollars has been spent to accomplish what? To —

"stamp out" smallpox. I low far all this parapher

nalia of governmental interference has succeeded, the
statistics I have given show. But we will suppose it
had succeeded. We will suppose the tens of thou
sands of the vaccinated who took smallpox and died
of it in the past twenty years, and the other and
greater multitude of vaccinated who were attacked
by the disease and recovered, never had it; that they
were actually and really "protected" from the dis
order. What then? One great fact stands behind
all the statistics which have been brought forward
during the past eighty years to prove the saving of
life by vaccination.
Nowhere has it been shown that less smallpox
means fewer deaths, and it cannot be shown.
Zy
mosis continues a constant quantity, though showing
various and subtle changes in appearance; one epi
demic predominates for a time, during which the
other forms of zymoses are in abeyance. As this
particular form fades away, another takes its place,
and the death-rate goes on with singular uniformity.
The law of vicarious mortality is amply shown in
every table of mortuary statistics. Living under
certain conditions, the death-rate of a people will be
a definite number every year per million living.

Nothing will vary this number, to a sensible degree,

excepting an alteration in the conditions of living.
The prevalence of one disease means the subsidence
102 LAW OF COMPENSATION.

of others, which again in its turn subsides to make

way for another. The law of compensation is shown

for instance in Sweden, where, in 1825, smallpox
killed1,243 persons, and typhus 3,962; but in 1829,
smallpox killed only 53, while the deaths from
typhus rose to 9,264. Again, in 1846 the mortality
from smallpox was only 2 ; and the total deaths from
all causes 72,683. 1851, smallpox being epi
In
demic in spite thorough vaccination, the deaths
of
from that disorder was 2,488 ; and the general mor
tality 72,506. What is true of Sweden in this par
ticular, is true of every country.
In Prague, from 1796 to 1802, the general mor

tality was 1 in 32, at a time when the death-rate

from smallpox was 1 in 396f ; but in 1832-55, when
that from smallpox was only 1 in 14,741^, the
general death-rate was still 1 in 32^.54
Dr. Robert Watt, in 1813, was astounded to find
that though smallpox abated when vaccination came

into fashion, yet the death-rate in

general did not
diminish. Considering the terrible devastation
smallpox had wrought among the young, he says :
"
I began to reflect how different the case must be
now; and to calculate the great saving of human
life that must have arisen from the Vaccine Inocu
lation. At this time (1813) above 15,000 had been
inoculated publicly at the Faculty Hall, and per
haps twice or thrice that number in private practice.

Simon. Papers Relating to Vaccination, 1857.

 GLASGOW STATISTICS. 103

In eight years (1805-12) little more than 600 had

died in Glasgow, of smallpox; whereas in 1784 the
deaths by that disease alone amounted to 425, and
in 1791 to 607; which, on both occasions, exceeded
the fourth of the whole deaths in the city for the
year. To ascertain the real amount of this saving
of infantilelife, I turned up one of the later years,
and, by accident, that of 1808, when, to my utter
astonishment, I found that still more than a half
perished before the tenth year of their age ; I could
hardly believe the testimony of my senses, and
therefore began to turn up other years, but I found
it amounted to nearly the same thing. To make
the facts clear, let us bring the results of the past
three decades together, thus :

Glasgow Mortuary Statistics. 1783-1812.

Decade. From Smallpox. Measles. Whooping Cough.
1783-1792 3,466 211 854
1793-1802 2,894 398 914
1803-1812 1,013 1,655 1,151

Children Children Total Deaths

Decade. under two. under ten. all ages.

1783-1792 7,293 9,919 17,607

1793-1802 6,277 9,050 16,685
1802-1812 7,120 10,913 20,175

To ascertain in what way the deficiency occa

sionedby the want of smallpox was supplied by
other diseases, he divided the years 1783-1812 into
fiveperiods, of six years each, and thus set forth the
proportionate mortalities :
—
104 relative mortality.

Glasgow Mortuary Statistics. 1783-1812.

Years. From Smallpox. Measles. Whooping Cough.
1783-1788 19.55 .93 4.51
1789-1794 18.22 1.17 5.13
1795-1800 18.70 2.10 5.36
1801-1806 8.90 3.92 6.12
1807-1812 3.90 10.76 5.57

Children Children Total Deaths

Years. under two. under ten. all ages.

1783-1788 39.40 53.48 9,994

1789-1794 42.38 58.07 11,103
1795-1800 38.82 54.48 9,991
1801-1806 33.50 52.03 10,034
1807-1812 35.89 55.69 13,354
"
The first
thing which strikes the eye on survey
ing the preceding table is the vast diminution in
the proportion of deaths by the smallpox— a reduc
tion from 19.55 to 3.90 per cent. ; but the increase in
the measles column is still more remarkable an in —

crease from .93 to 10.76 per cent. In the smallpox

we have the deaths reduced to nearly a fifth of what
they were twenty-five years ago, whilst, in the same
period, the deaths by measles have increased more
than eleven times. This is a fact so striking, that I
am astonished it has not attracted the notice of other
55
practitioners."
In 1832, cholera replaced fever almost entirely as
a cause of mortality, affecting the same class of per
sons who would have otherwise died of typhoid.
55
An Inquiry into the Relative Mortality
of the Principal. Diseases of
Children, and the Numbers who have Died under Ten Years of Age, in
Glasgow, during the last Thirty Years. By Kobert Watt, M.D., Lec
turer on the Theory and on the Practice of Medicine in
Glasgow.
Glasgow, 1813, pp. 64.
 plague statistics. 105

In view of these facts what must be

thought of
such remarks those made Sir
as
by Spencer Wells,
the world-famous ovariotomist, that
"
It may not be
generally known, but it is true, that Jenner has
.saved, is now saving, and will continue to save in all
coming ages, more lives in one generation than
were
destroyed in all the wars of the first Napo
leon."56
This idea of the displacement of one disease, by
another of the same class, has been
very hotly con
tested. Seaton makes a very elaborate argument in
disproof; but while an excellent specimen of special
pleading, it does not cancel facts.
Nor is this law of compensation In
a new
thing.
1665, John Graunt, a Fellow of the Royal Society,
published a volume, giving the vital statistics of
London yearly from 1604 to 1664, a period of sixty
years. In the period 1604-11, there died of plague,
14,752 persons; of all other diseases, 50,242; total,
64,994; the proportion of deaths from the plague
being 28 out of every 100 deaths. In the next
period of eight years, 1612-19, there died of plague
171 persons; of all other diseases, 64,346; making
a total of 64,517. Thus, when plague destroyed
14,700 persons, the general mortality only 477
was

more than when plague killed the insignificant

number of 171 persons.57 JohnGraunt very quaintly
66
To the Medical Officers of the Egyptian Expedition, Nov 21,
1882.
"
Charles T. Pearce, M.D.
6
106 MORTALITY FROM PLAGUE.

"
remarks, that a true account of the plague cannot
be kept without the account of other diseases."
It is
interesting similarity between the
to note the
fluctuations in the death-rate ofplague and small
pox. Compare the table on
page 132 with this,
showing the mortality from plague.
Mortality from Plague in London, 1604—1651.
Year. Deaths. Year. Deaths.

1604 896 1628 3

1605 444 1629 0
1606 2,124 1630 1,317
1607 2,352 1631 274
1608 2,262 1632 8
1609 4,410 1633 0
1610 1,803 1634 1
1611 617 .1635 0
1612 64 1636 10,400
1613 16 1637 3,082
1614 22 1638 363
1615 37 1639 314
1616 9 1640 1,450
1617 6 1641 1,375
1618 18 1642 1,274
1619 9 1643 996
1620 21 1644 1,412
1621 11 1645 1,871
1622 16 1646 2,635
1623 17 1647 3,507
1624 11 1648 611
1625 35,417 1649 67
1626 134 1650 15
1627 4 1651 23

Leprosy, the black

death, plague, spotted fever,
cholera, and influenza have followed each other
down the centuries. Sometimes one the chief cause

of mortality and again another. Sydenham ob

serves: "I conjecture that diseases have certain

periods, according to the occult and unaccountable

 SIR THOMAS CHAMBERS ON SMALLPOX. 107

alterations which happen in the bowels of the earth.

And as there have been other diseases which are

now either utterly extinct, or at least almost wasted

by age, fade away and very rarely appear (of which

sort is a leprosy and some other), so the diseases
which now reign, will vanish in time and give place
to other kinds, whereof, indeed, we are not able so

much as to guess."

Addressing the House of Commons in 1878, Sir

Thomas Chambers said: "You cannot show that
vaccination has reduced deaths, or saved a single
life. There may be no smallpox, but the disappear
ance of smallpox is by no means equivalent to a
reduction of mortality."
Illustrations of this are as "plentiful as black
berries." As, for
instance, take the year 1796, which
was the worst year for smallpox of that decade,
when 3548 died of it in London, and the whole
numbers of deaths 19,288. In 1792, when the
were

smallpox deaths were only 1568, the general mor

tality was 20,213. That is, though smallpox in
creased two thousand, the total deaths fell off one
thousand.
Again, comparing the forty years, 1841-80, and
taking the three years when smallpox deaths were
the lowest, and comparing them with the three
years when it was the highest, we find, that while
in the latter there were nine thousand more smallpox
deaths, the average mortality remained unchanged.
108 ZYMOSIS AND CLEANLINESS.

GENERAL
SMALLPOX DEATHS. DEATH-RATE
PER THOUSAND.

Three lowest years . . . 1841 . . .

1,053 24.2

1851 . . .
1,062 23.4

1855 . . .
1,039 24.3

Average . . .
1,051 23.9

Three highest years . . . 1863 . . .

1,996 24.5

1871 . . .
7,912 2.46

1877 . . .
2,551 21.9

Average . . .
4,153 23.6

The only thing which has been found competent

to contend with zymosis is cleanliness. As a people
learn to keep their houses clean, their streets and
by-ways clean, their water-supply pure, their food
free from adulteration, their persons free from ac
cumulations of effete tissue, they rise superior to the
thraldom of zymotic disorders. Under unfavorable
sanitary conditions a person insusceptible to one
type of disease-element will fall a victim to some
one of the other zymotic disorders to which his
peculiar dyscrasia To protect renders him liable.
him against any one of this class of diseases, still
leaves him subject to the others, until by a complete
change of his personal surroundings and habits, he
is rendered proof against them all.
The London Lancet said during the epidemic of
 DR. FARR'S REPORT. 109

1871: "Those who have been building up in their

imagination great and beneficient system of State
a

medicine, under which the great causes of disease

were to be controlled, must abate their
hopefulness.
It must be admitted that the existing system of
public vaccination has been sadly discredited and
almost mocked by the experience of the present epi
demic."58
The Registrar General (England) puts this whole
question of the relativity of the zymoses to sanitation
very tersely, when he saj^s in his official report for
1880: "The decennium which closed with the year
1880 was one of lower
mortality in London than any
of the preceding decennial periods These
facts are strong evidence that the sanitary efforts of
recent years have not been unfruitful The
evidence in support of this position is rendered still
stronger, if, instead of fixing our attention upon the
total mortality, we take into consideration its causes.

For it will be found that the saving of life al

was

most entirely due to diminished mortality from

causes whose destructive activity is especially

58
At the Conference on Animal Vaccination, in London, December,

1881, Dr. Ballard, who gets thirty-five hundred dollars a year as a

public vaccinator, in a speech, said: "That if it were not for the in
terference of such smallpox epidemics as that of 1871, the records of
vaccination would be perfectly satisfactory;" whereon Dr. Enoch
Robinson observed, "that Dr. Ballard reminded him of a bankrupt
who avowed that he would be perfectly solvent, if it were not for his
confounded losses,"
110 FLORENCE NIGHTINGALE'S OPINION.

amenable to sanitary interference namely, the so-

—

called zymotic diseases The death-rate from

fever fell nearly fifty per cent that of scarla
tina and diphtheria fell 33 per cent. One dis .....

ease alone in this class showed exceptionally a rise, and

no inconsiderable one. This was smallpox, which,

owing to the two great outbreaks of 1871-2 and 1877-8,

gave a death-rate nearly 50 per cent, above its previous
average.
Thus it will be observed the only disorder which
vaccination could mitigate; the only one for which
it was considered necessary to provide a special pro
phylactic; the only one for whose prevention im
mense sums were voted out of the public funds ; was

the very one, and the only one, that failed to be

ameliorated by the general improvement in the con
dition of the people.
Florence Nightingale observes that "every one

59
Here are the figures :
Smallpox Deaths in London.
1851-60 7,150
1861-70 8,347
1871-80 15,551
The deaths in England from the last three great epidemics of small
pox were :
Deaths.

1857-9 14,244
1863-5 20,059
1 870-2 44,840
Dr. W. B. Carpenter, M.P., excuses the heavy mortality in the
last epidemic by saying that never before had smallpox swept so ter
ribly over the country. The protective power of vaccination which
is only useful when the danger is absent is of singularly little value.
 SMALLPOX IN INDIA. Ill

who knows anything of public health questions, will

agree as practical unity of epidemics and their
to the

determining causes, and that exemptions from all

alike must be sought, not by any one thing, such as
vaccination, but by inquiring into and removing the
causes of epidemic susceptibility generally."

In the official report on sanitation in India, we

read: "The vaccination returns in India show that
the number of vaccinations does not bear a ratio to
the smallpox Smallpox in India is related
deaths.
to season, and also to epidemic prevalence. It is
not a disease, therefore, that can be controlled by

vaccination, in the sense that vaccination is a speci

fic against it. As an endemic and epidemic disease,
it must be dealt with by sanitary measures, and if
these are neglected smallpox is certain to increase
during epidemic times. Vaccination has no power,
apparently, over epidemic smallpox. It would
scarcely answer, in the face of these facts, to go on
vaccinating the people to protect them from small
such disease
pox, while leaving them surrounded by
causes as the reports would show to exist in all the

villages affected."60
Again, following year, the same idea is en
in the
forced: "It must not be forgotten that the amount of
smallpox depends not only on the proportion of un
vaccinated people in a country, but also, and prima
rily, on the sanitary condition of the people and their
60 Measures in, India, 1879-80, Vol. XIII, 1881.
Report on Sanitary
112 lord Shaftesbury's opinion.

surroundings, by these
and the influence exercised
elements on their general health and
resisting power
against epidemics The whole history of In
dian smallpox appears to show that it is essentially
an
epidemic disease, and, as such, it ought to admit
of mitigation by ordinary sanitary procedure, like
other maladies of the same nature."61
The last proposition that I set out to prove was
that the less disfigurement now from smallpox, shows
that it has been mitigated by the practice of vaccina
tion. I have endeavored to find evidence that small

pox-marked faces are less frequently seen now-a-days

than formerly. I supposed I would have no trouble
to do so ; but though I have ransacked every library
in New York since beginning this chapter, I have
been able to find not a particle of real evidence. I
believe it to be so, but of evidence wTorth the name

there is not a
particle.
It would seem then that it is to sanitation alone
that we can turn for any real solution of this prob
lem. Lord Shaftesbury, whose death has but re

cently been chronicled, observed perfectly

: "It is true
that smallpox is chiefly confined to the lowest classes
of the population; and I believe that with improved
lodging houses, the disease might be all but exterminated^
No doubt if, by some magical means, this entire
class, as we see them, for instance, here in New
York, could be lifted out of their present abodes and
S1 Measures in Vol.
Report on Sanitary India, 1880-1, XIV, 1882.

•
 infantile mortality. 113

put into nice, clean dwellings, a large number of

them would be permanently benefitted; but, fortu
nately, no such radical adopted. The
means can be
elevation of the lower classes of the population can
only be practicably accomplished by opening wider
the possibilities of self-advancement. Then, as is in
fact being done now, the more thrifty and vital will
work upward to a state of independence. Any ele
vation of the masses, which comes not from active

acceptance on their part of enlarged opportunity,

but from artificial, outside pressure, would be dele
terious. It is not inhumane to say, that things being
as they are, the extravagant death-rate among these
classes is a National blessing. For if these thou
sands of diseased and weakly children, who now die
because they have not vitality to sustain themselves
under the circumstances into which they are born,
were by a radical change in their surrounding kept

alive, they would in a few years marry and multiply

to such an extent as to overwhelm the thriftier and
hardier portion of the race. Cruel as the fact may
seem ; lay the blame where you will ; nevertheless,
it
is terribly true that the excessive mortality among
the children of the vicious and degraded, alone pre
vents our civilization from being crushed out by
them.
In conclusion, I think we are warranted in main

taining, that an impartial comprehensive study

and
of vital statistics proves, that the extension of the prac
tice of vaccination cannot be shown to have any
114 sanitation a preventive.

logical relation to the increase or diminution of cases

of smallpox; and that these same vital statistics, gath
ered from every quarter of the world, establish the
fact that smallpox, like the other zymoses, originates
from unsanitary modes of life, and can only be
effectually conquered by removing the cause; and
that, finally, vaccination is inoperative on the gen
eral death-rate where sanitation is defective, and
superfluous where sanitation is efficiently enforced.
THE ALLEGED DANGERS FROM VACCI
NATION.

I have clearly perceived the progressive dangerous

influence of Vaccination in England, France,
and Germany. Alexander von Humboldt.
—

Having thus determined the actual value of Arac-

cination prophylatic power,

as a we come now to the
consideration of the dangers, which it has been

alleged, await those who are subjected to the opera

tion. These are of two kinds; first, the immediate
danger from the operation, and secondly, the re

mote.
The persons who die from the immediate effects
of a vaccination are inconsiderable, when taken in
relation to the millions who are vaccinated. Still,
taken by themselves, they make quite a ghastly list,
extending down from the beginning of the century,
and hailing from every clime. Dr. William Rowley,
F.R.C.P., London, Physician to Her Majesty's Lying-
in Hospital, Lecturer on the Theory and Practice of
Medicine, wrote in 1805: "Out of 504 persons vacci
nated, 75 died from the consequences. There is no
question here of supposition, or calculation of prob
it is truth. It is evidence which seems to
ability —

speak, and leaves no Now, if in the space

doubt.
of seven or eight years (from 1798 to 1805) Vaccina

tion has shown itself so grievous to society, what

may we not fear for the future."

(115)
116 DR. HENRY MAY'S OPINION.

In the year 1807, Mr. Birch, of St. Thomas Hos

pital, and Surgeon Extraordinary to the then Prince

of Wales, mentions a number of cases as occurring
at Chelsea, in Hertford, at the Lambeth AVorkhouse,
and elsewhere. It is needless to give the details
here. I compiled a list of upwards of a thousand
instances of persons who had suffered permanent
injury, or death, but I cannot give space for them.

Of these, nine have been personally known to me.

It is no
infrequent thing, however, to hear a public
vaccinator say that he has vaccinated a certain
number of thousands and has never seen the slightest
evil resulting. Well, one need not see the sun, if he
will shut his eyes. Again, I am
only resolutely
sorry to say, that many medical men who recognize
evil results, imagine that they may be covered up
by prevarication. As if any good was ever done by
a lie. But it is rarelythat one is so outspoken as

Dr. Henry May, who, in an article on "Certificates

of Death," in the Birmingham Medical Review, Jan
"
uary, 1874, thus expresses himself: In certificates
given by us
voluntarily, and to which the public
have access, it is scarcely to be expected that a medical
man will give
opinions which may tell against or reflect
upon himself in any way, or which are likely to cause

annoyance or injury to the survivors. In such cases

he will most likely tell the

truth, but not the whole
truth, and assign some prominent symptom of the disease
as the cause
of death/ As instances of cases which
may tell against the medical man himself, I will
 SILLY CHARGES AGAINST VACCINATION. 117

mention erysipelas from vaccination, and puerperal

fever. A death from the first cause occurred not
long ago in my practice, and although I had not
vaccinated the child, yet in my desire to preserve vac
cination from reproach, I omitted all mention of it from
my certificate of death." Dr. May but voices the

practice of many of his cis-atlantic colleagues.

On the other hand, the most silly and extravagant
charges are brought against vaccination. Mothers,
in our tenement-house class, are
prone to refer back
to '"the time when baby was vaccinated," as from
whence came subsequent ill which might hap
every
pen to the child. In a lengthy hospital and dispens

ary experience, covering more than eighteen thousand

cases,it has been my lot to hear many such pre
posterous charges. I have investigated at least fifty
such that I have thereupon been able to declare

utterly without foundation.

It is alleged that vaccinated children are more

liable to die from other diseases (than smallpox)

than those who have not been vaccinated. We have
seen that the average death-rate has not declined
with the lessened frequency of deaths from small
pox ; but theproposition here advanced is, that vac
cination, by weakening the child's constitution, or
by implanting other diseases, tends to shorten life.
Let us see if there is any warrant for this assertion.

It has been noticed that the death-rate from cer

tain diseases has very greatly increased since vacci
nation has become universal, and that this increase
118 HERBERT SPENCER'S OPINION.

has been proportional to the extension of vaccina

tion. Now, although this is true, it is by no means
positive evidence that the doctrine post hoc ergo
propter hoc applies, for many other influences are
constantly at work, and these must be duly con
sidered before passing judgment.
There are two classes of diseases which are sup
posed to bespread by vaccination. Those which
are
distinctly inoculable, as syphilis and scrofula,
and those to which persons may be predisposed by
a
lowering of physical force, such as pneumonia, or
typhoid.
Herbert Spencer, speaking of the deplorable ill-
health of the rising generation, says: "We are not
certain that the propagation of subdued forms of
constitutional disease through the agency of Vaccina
tion is not a part- cause. Sundry facts in pathology
suggest the inference that when the system of a

vaccinated child is excreting the vaccine virus

by
means of pustules, it will tend also to excrete
through
such pustules other morbific matters; especially if
these morbific matters are of a kind ordinarily got
rid of by the skin, as are some of the worst of them.
Hence it is very possible probable even that a
—
—

child with a constitutional taint, too slight to show

itself in visible disease, may, through the medium
of vitiated vaccine lymph taken from it,
convey a
like constitutional taint to other children, and these
to others."62

Education, page 181. 1881.

—
 VACCINAL-SYPHILIS. 119

Vacctnal-Syphilis.
The existence of vaccinal-syphilis was until re
cently most strenuously denied. Says Simon (1857),
"
if syphilis could be diffused
by the vaccine lymph
of children with an hereditary taint of that disease,
this possibility must long ago have been made evi
dent on a scale far too considerable for question;"63
and this was unquestionably the opinion of almost
all competent practitioners down to that date; al

though Mosely, in Jenner's time, and other writers

of later years had insisted upon the
possibility of
the propagation of syphilis in arm-to-arm vaccina
tion. This opinion has since been very much modi
fied. In 1802, M. Ricord, who
up to that time was
a disbeliever in vaccinal-syphilis, in a lecture in
Hotel Dieu, in Paris, said: "it is not impossible that
the disease [syphilis] was transmitted with the vac

cine lymph, but in the estimation of facts which

seem to establish such transmission, it is necessary
to distrust the evidence of our senses ; ... let
us admit a careful inquiry into these cases, and let
us guard against any predetermined notions on the
subject; but as to the interpretation offered, let it be
received with an amount of hesitation and doubt,
increased by the obvious fact, that if ever the trans
mission of disease with vaccine
lymph is clearly demon
strated, vaccination must be altogether discontinued; for
in the present state of science, we are in possession

Papers Relating to the History and Practice of Vaccination, p. 66.

120 RICORD ON VACCINAL SYPHILIS.

of criterion which may permit the conscientious

no

practitioner to assert that the lymph with which he

inoculates, is perfectly free from admixture."
In the following year (May 19, 1863) standing
in the place, this eminent syphilographer said:
same

"At first I repelled the idea that syphilis could be

transmitted by vaccination. The recurrence of facts
appearing more and more confirmatory, I accepted
the possibility of this mode of transmission, I should
say, with reserve, and even with repugnance; but
to-day I hesitate no more to proclaim their reality."
In 1864, Dr. 0. Kratz, a surgeon in the Confeder
ate army, reported some cases of vaccinal-syphilis.64
1866, W. B. Collins, M.D., of St. Bartholomew's
In
Hospital, London, reported some cases.
In 1867, M. Depaul, the Chief of the Vaccination
Service of the French Academy of Medicine, pub
lished an essay on the danger of syphilitic infection
through vaccination. He enumerated half a dozen
outbreaks of vaccinal-syphilis, in the course of which
160 children had been infected.65
In
1868, Prof. Joseph Jones, M.D., of Nashville,
Tenn., reported a large number of cases as occurring
at Andersonville, and elsewhere, during the war.66

64
Confederate States Medical and Surgical Journal, Vol. I, page 104,
1864.
65
Address at the Calf-lymph Medical Congress, by Charles Came
ron, M.D., M.P., 1879.
66
Abnormal Phenomena accompanying and
following Vaccination in the
Confederate A rmy.
 BALLARD ON VACCINAL-SYPHILIS. 121

In 1868, Dr. Ballard, one of Her Majesty's Vaccine

"

Inspectors, observed : There can be no reasonable

doubt that the vaccine virus and the syphilitic virus
may both be drawn at the same time, upon the same

instrument, from one and the same vesicle. The

vesicle which is thus capable furnishing of both
vaccine and syphilitic virus may present, prior to
being opened, all the normal and fully developed
characters of a true Jennerian vesicle, as ordinarily
met with."67 In the same year (1868), B. F. Cornell,
M.D., President of the Homoeopathic Society of this
State, declared in his Annual Address, that "to no

medium of transmission is the wide-spread dissemi

nation of this class of disease largely indebted as
so

to Vaccination."68 Dr. Heim, public vaccinator,

Wurtemburg, said: "I have myself transplanted
syphilis from a child which seemed at the time per
fectly healthy."69 In 1871, Dr. Chas. T. Pearce,
London, testified before the Parliamentary Commit
tee, that "he had unwittingly transferred syphilis
from lymph supplied by the Royal Jennerian In
stitution; had twenty such cases within four years
at Northampton." He also quotes Whitehead, of

Manchester, a very distinguished practitioner, "who

had seen several instances of syphilitic taint, trans
ferred from a true Jennerian vesicle." John Simon,
67
Essay on Vaccination.
68
Address delivered before the Homoeopathic Medical Society of
the State of New York, February 11, 1868.
69
Horrors of Vaccination, page 26.
122 M ARSON ON VACCINAL-SYPHILIS.

"

F.R.S., testified that there was not the least doubt

thatsyphilis has been communicated in what has

purported to be vaccination." Dr. Bakewell, Vac

cinator- General of Trinidad, "had seen
leprosy and
syphilis communicated by vaccination. Leprosy is
becoming very common in Trinidad; its increase
being co-incident with vaccination. Sir Ronald
Martin, M.D., agreed with him that the leprosy arose
from vaccination." Mr. Marson, of the Smallpox
Hospital, London, "had never seen syphilis after
vaccination, but M. de Meric, who is very clever
a

man, believes in it. Mr. Rollet holds a similar

opinion. The syphilis may be conveyed

fact that

by vaccination proved in the Rivalta cases,

has been
also in France, and Germany." Dr. Wood, F.R.C.P.,
Edinburgh, "never listens to alleged cases of syphilis
or scrofula. If those diseases show themselves soon

after vaccination, they are

unjustly ascribed to vac

cination." Sir William Jenner, M.D., "has never

seen
syphilitic resulting from vaccination.
affections
Considers the assertion, that syphilis has been com
municated by the lymph, of very little worth;
though he admits that Ricord and Hutchinson are
men of scientific
position." Sir William Gull, M.D.,
"had never seen vaccinal-syphilis, and thought it
would be the most insane thing to give up vaccina
tion. Hunter, and others, maintained that syphilis
could not be communicated by vaccination. Thinks
Ricord's conclusion a very hasty one." Dr. West,
as
Physician to the Children's Hospital, had seen
 HUTCHINSON ON VACCINAL-SYPHILIS. 123

60,000 cases [all diseases], "never had a case of

syphilis in consequence of vaccination." Jonathan
Hutchinson, M.R.C.S., "has seen the syphilitic con
tagion conveyed by vaccination in eleven cases; has
had great experience in syphilis; has another series
of cases strongly suspected to be of the same kind
now under investigation, and has had many sus

pected cases sent him during the last fortnight.

Ricord is certainly an authority. Is not sure the
540 medical men, quoted in the Blue Book of 1857,
denied the possibility of syphilitic communication
by vaccination; they expressed their own non-
familiarity with it, and said they had never seen it
happen. The general opinion held by the profession
must doubtless greatly affect their interpretation of
facts. Would attribute much less force to mere
negative than to positive evidence. Having worked
at the subject of syphilis specially, was able to de
tect appearances of that disease, which, possibly,
not be done by most medical men." E. C.
might
Seaton, M.D., thinks the above "mistaking sequence
for consequence. The danger of syphilitic com
munication quite infinitesimal. No doubt, the
mode in which persons deal with facts is largely
affected by the views they hold, and the profession
would have been much less inclined to believe in
such possibility than they would be in the future."70

"
70
All the above from the words Parliamentary Committee," page
121, line 19, condensed from testimony before a Committee of the
House of Commons, 1871.
124 HUTCHINSON ON VACCINAL-SYPHILIS.

In 1872, William Hitchman, M.D., D.C.L., of

"

Liverpool, said : That he had seen impure conse

in the hands of
quences following vaccination, even
"
Mr. Marson himself; and speaking of certain ulcers,
he said: "They owe their disgusting origin to the
foul exudations of that indefinite, nameless, hideous
thing now in course of active propagation through
out the land, yclept vaccinal-syphilis."71
In 1873, Mr. Hutchinson again came forward, at
a
meeting Medico-Chirurgical Society, with
of the
the details of new cases of vaccinal-syphilis. "He
also drew some general deductions from the facts as
already ascertained, which, together with others elic
ited in the course of the discussion that
followed,
constitute the most important practical suggestions
yet made in regard to this most unsatisfactory sub
ject. That syphilis could be communicated by vac
cination, was, though admitted abroad, long disputed
in this country. Since the publication of Mr. Hut
chinson's paper, and a communication by Mr.
Thomas Smith to the Clinical Society, where the
patient was exhibited, it can no longer be so. We
have now emerged from the region of doubt, to one
of belief in the possibility of such an untoward oc
currence The facts now before the public
will tend to rouse them, if they have not been roused
already from the false security, into which they had
been lulled."72

71
The Anti- Vaccinator, December 16, 1872.
72
Medical Times and Gazette, P'ebruary 1, 187 .
 TROUSSEAU ON VACCINAL-SYPHILIS. 125

In 1874, Prof. A. Trousseau, M.D., Physician to

Hotel Dieu, Paris, observes: "The transmission of
syphilis by vaccination appears now to be an estab
lished fact. To the examples, which since the be
ginning of this century have been reported, and of
which the number is singularly augmented of late

years, I could add that which has come to our notice

in our hospital If there are still some doctors,
who doubt the possibility of the transmission of

syphilis by vaccination, the greater number have

succumbed to the evidence The assertion
that blood only conveys the disease, is hypothetical.
It is difficult to understand that what the blood
serum contains the vaccinal serum does not contain
"
also."73 Prof. Germann, M.D., said: Above all, the
"dire fatality, which lately occurred at Lebus, a sub
urb of Frankfort-on-the-Oder, would alone warrant
the abolition of the vaccination laws.
Eighteen
schoolgirls, averaging twelve years of age, were re
vaccinated, and thereby syphilised, and some of
them died Yet the lymph, the syphilitic lymph,
used in this case, was obtained from the Official

Royal Establishment, and was the new regenerated

or'annualized' vaccine lymph so warmly recom

mended for the revaccination of schools."74

1877, Brundenell Carter, F.R.C.S., L.S.A., etc.,
In

Surgeon to St. George's Hospital, London, observed :

73
Clinique Medicale, Vol. I, pages 116-18, Paris, 1874.
74
From an address to the Diet of the German Empire.
126 CARTER ON VACCINAL-SYPHILIS.

"
I think that contamination by vaccine
syphilitic
lymph is, by no means, an unusual occurrence, and
that it is very generally overlooked because people
do not know either when, or where to look
for it. large proportion of the cases
I think that a

of apparently syphilis are in reality vac

inherited
cinal; and that the syphilis in these cases does not
show itself until the age of from eight to ten years,
by which time the relation between cause and effect
is apt to be lost sight of."75 In the same year, Mr.
Hutchinson, in a work on Surgery, again said:
"There can be no doubt that the danger of trans

mitting syphilis by vaccination is a real and a very

important one."76
Prof. Robert Alexander Gunn, M.D., of New York,
'
"
declared that, the appalling evils that have been
and are still produced by it, are sufficient to con
demn the practice as a crime."77
1878, the eminent and beloved Constantine
In
Hering, M.D., of Philadelphia, wrote: "I have more
than once plainly seen, and often heard of, cases
where children remained ailing from the time of
vaccination, who were previously in robust health."78
In 1879, J. R. Newton, M.D., of Boston, said:
"
AVere I to relate a few of the cases that have fallen

75
Medical Examiner,
May 24, 1877.
76
of Clinical Surgery.
Illustrations
77
Vaccination, its Fallacies and Eri/s, page 13.
78
From a letter to the Homoeopathic Practitioners of Great Britain,
Philadelphia, August, 1878.
 SIMON ON VACCINAL-SYPHILIS. 127

under my observation of persons injured by this

practice, it wTould fill the mind with horror." Sam'l
Eadon, M.A., M.D., of Gloucester, said: "The sins of
the fathers to the third and fourth generation is im

ported into the young organism." Prof. Alexander

Wilder, M.D., etc., observed: "Hence a vaccinated
people will always be a sickly people, lived, shorter
and degenerate." Prof. Niemeyer, M.D., etc., of

Tubingen, said: "It cannot be denied that vaccina

tion sometimes leaves permanent impairment of
health."79 John Simon, F.R.C.S., etc., wrote: "Thus
the vaccine lymph of the syphilitic may possibly
contain the syphilitic contagion in full vigor, even
when the patient, who thus shows himself infective,
has not on his own person any outward activity of

syphilis."80
In 1880, A. G. Springsteen, M.D., of Cleveland,
Vice-Eresident of the National Eclectic Medical As
sociation, said: "No one, who has given the subject
the least consideration, doubts that impurities may
81
be conveyed in this manner." Sir Thomas Watson,

M.D., F.R.S., D.C.L., wrote: "There has fallen an

ugly blot Such facts as Mr. Jonathan Hut

chinson has demonstrated, constitute a rational ex

cuse objecting compulsory

for to vaccination. I can

father
readily sympthise with, and even applaud a
in his
who, with the presumed dread or misgiving
79
Text-Book of Medicine. 1879.
80
British MedicalJournal, December 13, 1879.
81
Xew York Medical Tribune, January, 1880.
128 DESJARDINS ON VACCINAL-SYPHILIS.

mind, is willing to submit to multiplied judicial

penalties, rather than expose his child to the risk of
an affection so ghastly."82

In 1881, Dr. Desjardins gives a

complete account
of the syphilisation of 58 French recruits in Algeria.
The most cautious silence was preserved by the mili
tary authorities; and not without reason, if vaccina
tion is to retain its holdon popular credulity. Dr.

Desjardins proposed to solace these soldiers by pen

sions for injuries which the Government cannot re
dress.83
In 1882, S. B. Munn, M.D., of Waterbury, Conn.,
Ex-President of the National Eclectic Medical Asso
ciation,' declared: "That if medical men were made
pecuniarily responsible for the ill-effects, no
physi
cian would ever vaccinate."84
In 1883, Dr. Brereton reports cases of invaccinated

leprosy in Hawaii.
In 1883, Ch. Pigeon, M.D., of Fourchambault,
addressed a Deputies of the French
letter to the
Chamber, proposed bill upon compul
relative to the
sory vaccination, in which he speaks of having then
under his care some cases of vaccinal syphilis.
This chronological record of invaccinated syphilis
is brief but conclusive. If need be, it could be
swelled to a portly volume. Upwards of nine hun-

82
Nineteenth Century. June, 1880.
83
Journal d' Hygiene, Aug. 25, 1881. Edited by Docteur de Pietra
Santa, a scientific gentleman, of eminent reputation.
84
Address before the Eclectic Medical Association of Connecticut.
 A CASE OF VACCINAL-SYPHILIS. 129

dred well-attested cases are on record; and when it

is remembered with what difficulty
even a single

case can be
indubitably sustained, the mind realizes
the probably thousands, which have been overlooked
or ignored. My own dispensary experience leads
me to aver that a systematic, impartial, Govern

mental investigation wrould reveal an undreamt of

multitude of cases. Such an investigation will never
be permitted.
I have only space to give the details of one case
which has come under my observation. In Decem

ber, 1879, there came to the out-patient department

of the Manhattan Hospital a mother with her little

girl, twenty-one months old. The woman was a

widow, whose husband had died some time previ

ously, of pneumonia, leaving three children aged
three years, twenty-one months, and seven months

respectively. The two oldestgirls, were and the in

fant,a boy, born I believe after his father's death.

The mother supported them all by odd jobs of

laundry work. Although very poor, they were neat,
and attracted my attention thereby, before I had in
quired into the cause, which brought them to my
clinic. The woman's story was this : some seven or
more weeks previously, the three children had been
forcible vaccinated by a
public vaccinator, in a house-
to-house visitation. The arms of all the children
had remained ever since. About a week
sore ago
she had noticed ulcers on the baby, and had obtained
a salve from a drug-store ; but the child continued
7
130 A CASE OF VACCINAL-SYPHILIS.

to get day by day. Yesterday she

worse noticed
places, breaking out on the second child, and she
had, therefore, come to find out what was the matter.
On examining the child, I found the place of inser
tion of the vaccine virus, a shallow, clean-cut ulcer,
filled with a
dirty exudation. The cellular tissue
round about it was infiltrated and very hard, ex
tending over nearly one-half of the upper arm. The
axilla was tender, and the glands swollen. There
were six ulcers the
body; four of them very
on

small, just forming that

day, and two somewhat
larger, having appeared thirty-six hours previously.
These ulcers began, like a blister, the size of a split
pea, with a swollen indurated base of a copperish
hue, and in all respects resembling syphilitic rupia.
The ulcers were so characteristic, that I ordered the
whole family to appear before me on the morrow.

When, on following day, I saw the infant strip

the
ped of its clothes, revealing no less than thirty dread
ful ulcers, some of them as large as a silver dime;
it made me heart-sick. Some of these had already
begun to scab, showing the peculiar wratch-crystal
formation, so characteristic of this eruption. On the
oldest child I found four small blisters on the back,
and she also, in a
day or two, had a full share of
syphilitic sores. Here were three children, which
avery careful investigation in the neighborhood,
where they lived, showed that they had been, up to
the time of their vaccination, in very good health,
suddenly stricken with the most incontestable evi-
 INFANTILE SYPHILIS. 131

dences of. this dreadful disorder. As many other

children in the same
neighborhood were vaccinated

by the same vaccinator, I was loath to admit to my

self that the vaccine could have caused the disaster.
I therefore tried to discover some other means of in
oculation. I examined the men whose clothes the
woman had
laundered, the woman herself most par
ticularly, but was, at last, obliged to admit that
there was no apparent means of infection, except
through the vaccination.
The infant was the most severely affected, and the
oldest child the least. I had them under treatment
for about four months, during which time they were

seen by a number of physicians. At the end of that

time the ulcers had all healed and the children were

apparently well, but I unfortunately lost all trace of

them by the mother moving out of the neighbor
hood.
Meanwhile, syphilis is
constantly increasing
a

mortality. In the appendix to the

factor in infantile
37th Annual Report of the Registrar General of Eng
land, Dr. Farr, page 221, writes: "Syphilis was . . .

twice as fatal in the five years, 1870-74, as it was

twenty years ago. Its most fatal recorded forms
occur in children under year of age."85 The fol
one

lowing table gives the relation between vaccination,

smallpox and syphilis during a

period of 44 years.

85
Since the above was written Dr. Farr has died. His memory de
serves atribute of respect from all who are interested in sanitation.
Although a believer in vaccination, the labors of his long official life
furnish a repertory of statistical facts, which show its futility as at
present practiced.
 A Table of Mortality in England a
SHOWING

The Deaths from Smallpox and Syphilis; also the number of Suc
Compiled from the Reports of the Kegistrar-General, from
Registration, by W. T. Stephen, 61 Victoria Eoad,

Successful Deaths Death

Deaths from
Vaccinations Deaths Smal
from Small Ann
Population. at the ex from
Smallpox pox per Ave
pense of the in Periods. Smallpox.
Poor Rates. Million for e
Pop. five Y

1838 15,287,699 35,833 16,268 1,064

1839 15,514,255 (3 vears) 9,131 589 57
1840 15,730,813 1838-40 10,434 663 183
1841 15,929,492 6,368 400
1842 16,130,326 2,715 168

1843 16,332,228
1844 16,535,174 No official From 1843 to 1846 in
account of
29,522 | not
1845 16,739,13(5 (6 vears) \ analysed
1846 16,944,092 vaccina
1841-50
tions before
1847 1852. 4,227 246
17,150,018 29
1848 6,903 398
17,356,882 (4 y
4,644 264
1849 17,564,656 184
4,665 263
1850 17,773,324
* From Uth Annual Report of Local Government Board, p. 346.
 smallpox and syphilis. 133

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 D
Successful Deaths
Deaths from
Vaccinations from Deaths
Small
Years. Population. at the ex from
Smallpox per
pense of the In Periods. Smallpox pox
Million
Poor Rates.
Pop.

1871 22,788,466 693,104 23,062

1872 23,095,819 669,320 19,022
1873 23,407,317 501,189 2,303
1S74 23,723,017 493,285 2,084
1875 24,042,974 498,952 57,422 849
(10 yrs.)
1876 24,367,247 566,5*7 1871-80
1877 24,695,894 529,376
1878 25,028,973 513,575
1879 25,366,544 519,715
1880 25,708,666 513,283
1881 26,055,406 533,005 3,098

VACCINATION ACTS.

1867.— T
1840.— To extend the practise of Vaccination.
1871. —
T
1841.— To amend the Vaccination Act.
1853.— Vaccination made Compulsory.
1874.—T
1861.— To facilitate prosecutions.
 VACCINAL- PHTHISIS. 135

Vaccinal-Phthisis.
It is alleged that phthisis has greatly increased
since vaccination, and in consequence of it. This
is totally denied by some authorities, and others,
such as Mr. Seaton, while admitting that tuberculo
sis has greatly increased, say that children, who
would have died of smallpox, are saved
by vaccina
tion until adolescence, to die ofconsumption. Now
it is evident that whatever may be true of phthisis,
this last assertion cannot be true. For we have seen

that the death-rate among young children has not

been lowered, to any considerable extent, by the
diminution in smallpox mortality; but that those
who formerly killed by smallpox, now die of
were

measles, scarlatina, whooping-cough, bronchitis, or

syphilis. The increased ratio of deaths from tuber
culosis must, therefore, be explained in some other
manner.

Those who state that vaccination is a cause of

phthisis, bring forward the

following arguments in
favor of this position: That vaccine-virus, having
its basis in horse-grease, is a product of scrofula, and
that scrofula and tuberculosis are interchangeable
terms ; that vaccine-lymph taken from a tuberculous

person will convey both viruses, just as it has been

shown that vaccine-lymph taken from a syphilitic
subject, will transfer to the inoculated both vaccinia
and syphilis; and that an attack of smallpox, if re
covered from, extinguishes the tendency toward
scrofula and tubercle, and that therefore vaccina-
136 GLANDERS, farcy and grease.

tion, so far as it keeps such persons from taking

smallpox, reserves them for a more lingering and
painful death.
Let us examine critically these three propositions.
Glanders, farcy, and grease are claimed by some
veterinary surgeons to be varieties of the same thing,
and that they are the equine analogue of scrofula;
that farcy buds and grease grapes are essential
manifestations of the same disorder, just as scrofula
shows itself in multiform appearances.
This virus, which is the true Jennerian cow-pox,

engrafted upon a healthy human being might pro

duce no effects, except of puncture.
at the point
But in person predisposed
a scrofula, it would
to
the latent disorder, and show
very likely light up
itself in no uncertain form. Nor must it be forgot
ten, that as invaccinated and hereditary syphilis
may lie latent and unsuspected through many

years, so tubercle, engrafted into the system, may

remain until critical period enables
quiescent some

it to assert ascendency over the heretofore restrain

ing vital force.

That tubercle or scrofula can be engendered or
intensified by vaccination is no new theory. Dr.
Squirrel suggested the idea some seventy years ago,
and the experiments of Connheim, Fox, and Tous-
is a
saint confirm his hypothesis. That the danger
real one, probably as important as its cognate, vac

seems now, in the presence of recent

cinal-syphilis,
al-
investigations into the inoculability of tubercle,
 SCROFULA AND TUBERCLE. 137

most affirmed as a scientific fact. Professor Conn-

heim has declared that the test for tubercle is, that
virus inoculated on a guinea-pig will produce tu
bercle. Wilson Fox has shown that vaccine virus
inoculated on a guinea-pig does produce tuberculo
sis; that vaccine is tubercle. Toussaint took lymph
from a tuberculous cow and vaccinated various ani
mals, who all subsequently became tuberculous,
proving that the quality of the lymph, which was
not previously tuberculous, was altered by the
media (i. e., the tuberculous animal) through which
it passed.
That scrofula and tubercle have an increasing in
fluence in the ratio of the extension of vaccination,
is shown by successiveReports from the Registrar
General's office (England). I give the figures, and
leave the reader to draw his own conclusions.
The annexed table, compiled from a Parliament
ary Return (No. 392, 1880), gives the figures in three

periods, corresponding with the changes that have

been made in the Vaccination laws, whereby a more

thorough vaccination has been secured:

England.

Vaccination Vaccination Vaccination

Voluntary, Obligatory, Enforced,
1847-1853. 1853-1867. 1867-1878.

Deaths under one year of age, an

nually,per million births, from

—

Scrofula 351 611 908

Syphilis 564 1206 1738
Skin Diseases 183 253 343
Pyaemia
—
155 180
Mesenteric tuberculosis .... 2981 3371 4373
138 INOCULABLE DISEASES.

Mean Annual Rate of Mortality in England

from Smallpox, and from six
directly indirectly or

inoculable causes, during each Quinquennial of

30 years, 1850-80. (P. lxxix, Table 34, of the 43d
Annual Report of the Registrar-General, 1882.)
N. B. Vaccination made compulsory, -1853; more
—

stringently so, 1867.

ANN0AL DEATHS PER MILLION LIVING.

Increase
CAUSES of Mortality

OF DEATH.
1 I 1880 over
1850-4 1855-9.1S60-4 1S65-9 1S70-4 1875-9 187 S-80 1850.

Smallpox* ....
279 199 190 i 147 433J 81 40

37 50 63 82 81 85 84 127 per cent.

302 327 368 404 442 492 510 70 per cent.

Tabes Mesenterica 264 261 272 315 298 330 340 29 per cent.

Phlegmon and Py-

20 18 23 23 29 39 40 100 per cent.

Skin Disease . . .
11 15 15 17 .18 23 23 109 per cent.

Bronchitis f .... 1,016 1,358 1,658 1,839 2,105 2,464 2,505 144 per cent.

Total 6 causes . .
1,650 2,029 2,399 2,6S0 2,973:
3,433 3,502 112 per cent.

Increase 1,852, or, in round numbers, 48,000 annually. J

*
Smallpox is an epidemical disease, and there has occurred but
one great outbreak (1871-72), 18 years subsequent to the introduction
of enforced vaccination, and four years after the further and more

stringent act.
f Bronchitis, though not, perhaps, directly inoculable, is often ob
served by intelligent medical authorities to supervene upon, or soon
after, vaccination; and it is obvious that diminished constitutional
vitality will render recovery from any disease more precarious ; hence
 PROGRESSIVE INFANTILE MORTALITY. 139

As
showing how infant mortality on the whole
has steadily increased during these same periods, I
quote from the Parliamentary Return, No. 433, 1878,
the following statistics: —

Average number of deaths per annum of Infants

under one year of age from 15 specified diseases
which are inoculable, or
presumably intensified by
vaccination :

Prior to Vaccination Act —

1847-53 —

Infants
died, 1847, 62,619
Out of a' population of 17,927,609.
Vaccination obligatory 1854—67
— —

Infants died, 1854, 73,000

do. 1867, 92,827
Out of a population of 20,066,224.
Vaccination enforced —
1868-75 —

Infants died, 1868, 96,282

do. 1875, 106,173
Out of a population of 22,712,266.

Thus, while the population of England had in

creased from 18 millions to 23 millions, the deaths
of infants from 15 diseases had risen —

in the same

period— from 63,000 to 106,000. Had the mortality

kept pace with the population, the deaths in 1875

the benefit derived by newly-born children from improved sanitation

isnearly neutralized by vaccination.
X The single epidemic (1871-72) carried off 44,000 only, the gen
eral death-rate of the years being somewhat under the average of the

period. There was, therefore, no loss thereby, because, had smallpox

not been the epidemic, more would have died from other causes;

nevertheless, we see that in the vain attempt to prevent this errone

ously supposed loss in two years out of thirty, 48,0U0 lives are now
annually sacrificed.
140 NEWCASTLE DISPENSARY.

would have been only 80,000 ; that is to say, in 1875

there perished in England, 26,000 infants under one
year of age more, than should have died under the
ratio of 1847; and this in spite of greater attention
to sanitation, and the consequent lowering of the
total [all ages] death-rate from 22.4 for the decen-
nium 1841-50, to 21.4 in 1871-80.
The difficulty of obtaining reliable statistics, ex

tending over a long period of time, is very great.

The following figures, however, from the Newcastle,
England, Dispensary, extending over a period of a
century, are trustworthy. During this period, the
Dispensary has treated 250,637 cases, of which 2,616
were of smallpox, or about one per cent. The total
deaths during the century were 14,088, of which 428
were caused by smallpox or about 1 in 33, whilst

scalatina killed 1 in 18; diarrhoea 1 in 30; and

whooping-cough 1 in 3S.86
Newcastle, England.
1777-1802 1803-27 1828-52 1853-77

Smallpox —

Cases 365 273 925 1053

Deaths ... 90 57 152 129
Scarlatina —

Cases ...• 355 795 1856 3659

Deaths 33 30 155 567
TVTph files
Cases 186 435 1572 2537
Deaths 16 22 83 123
Whooping Cough
—

Cases . 7 245 220 743 1716

Deaths •
22 23 112 241
Diarrhoea —

Cases 1390 1529 3995 6117

Deaths 67 7 43 362

in 1777.
Report of the Newcastle Dispensary, from its Foundation
B6

Printed by order of the Committee. Newcastle-upon-Tyne, 1878.

 ANIMAL VIRUS. 141

The increase, beyond actual expectancy of various

other disorders, have been ascribed to vaccination,
with some slight show of evidence; but it is not
necessary to enlarge upon such here.
What more nearly concerns us is to rescue vacci
nation, if possible, from this reproach. Dr. Charles
Cameron, Dr. Lyon Playfair and other distinguished
gentlemen have commended the use of animal virus;
that is direct inoculation from the cow. In this way
it is hoped to get rid of the danger of inoculating
other diseases along with vaccinia. But it must not
be overlooked that domestic animals are as
likely to
suffer from constitutional disorders as human beings;
and that an
incipient tuberculosis in a cow, or a
latent farcy in a horse, may be just as readily en
grafted upon a child, as it is now admitted a latent
syphilis or phthisis, of human origin, may be unwit
tingly invaccinated along with vaccinia.
We have seen that so good an authority as Prof.
Simonds, after forty years experience among ani
mals, declares that the bovine race do not suffer nat
urally from pox ; that, if they have it, it must be in
oculated upon them. In order to obtain animal
virus, therefore, it is absolutely necessary to inocu
late a smallpox or horse-grease. The use
calf with
of virus obtained by smallpoxing a calf spreads, ac
cording to Sir Thomas Watson, M.D., a mitigated
smallpox by infection; and not so very mitigated

either, for people take it, and die of it. And if, upon
the other hand, we adopt horse-virus, there is con-
142 ceely's experiments.

stantly the liability of a recurrence of such horrible

outbreaks as was seen in Italy, in 1879. 87
Nor are the authorities by any means agreed as to
the advisability of the of animal virus.
use
Says
Dr. John Shorthouse: "Some
crazy enthusiasts rec
ommend that lymph be taken direct from the cow.
They cannotsurely have seen those frightful pictures
of the disease so produced which were
published by
Ceely, of Aylesbury, some thirty years ago. Ceely
carried out numerous experiments at the instance
of the Provincial Medical and Surgical Association.
Those experiments were carefully and minutely ob
served, and their results faithfully and graphically
recorded. Those observations and experiments are
illustrated by a great number of beautifully executed
plates drawn from life. Some of the pictures are
something frightful. There is one which shows the
back of the hand and arm of a youth who got inoc-

87
The following is from the Lyon Medicate, of June 22, 1 879 : "On

April 26 and 28, the local doctors vaccinated with this lymph (animal
virus) thirty-eight children, all aged less than twenty months.
Whilst they were awaiting the incubation of the vaccine pustules,
they soon perceived that they had inoculated one of the most horrible
of maladies, and that they were the involuntary authors of a real
massacre of the innocents. The gentleman who sent these particu
lars to The Gazette a" Italia betook himself to San Quirico. He saw
the victims. He observed vast phlegmons laying bare the muscles
and penetrating into the joints, accompanied by eclamptic symptoms.
To him it appeared very probably to be an epidemic of glanders."
See also The Gazette d' Italia, for May 21 1879. The disaster occurred
,

at Castiglione d'Orcia, in the Province of Siena, and among the vic

tims was the granddaughter of the Syndic.
 BOVINE TUBERCULOSIS. 143

ulated accidentally while milking a cow. There is

another which depicts a corroding ulcer on the
thumb of a man who got inoculated in the same

manner. If these enthusiasts inspected the pictures,

I think they would be induced to pause before they
advocated the practice of inoculation direct from the
cow." Having studied these illustrations, I can fully
agree with Dr. Shorthouse.
The possibility of the transmission of bovine tu
berculosis is admitted.88 Even Simon says: "When
a
given body is
possessed by one of these constitu
tional diseases, no product of that body can be war
ranted safe not to convey the infection." As to the
probability of its transmission, one has but to remem
ber that bovine tuberculosis is hereditary, and occurs

in 4.75 per cent, of any given number of cows. The

risk, therefore, of invaccinating this formidable dis
"
ease by the use of the so-called calf-lymph," is evi-

88 "
M. Touissaint vaccinated a cow in an advanced stage of tuber
culosis with lymph absolutely pure. The vesicles progressed nor
mally, and with the lymph obtained from them he vaccinated differ
ent animals, all of whom subsequently became tuberculous. The

significance of these experiments can scarcely be over-rated, for

though a judicious vaccinator would not use lymph taken from a
child who exhibited already evidence of the disease, the chances of
cows in whom spontaneous vaccinia may appear, and whose lymph

would at the present time be eagerly sought after, being, like so many
of their species, tuberculous, would be great ; and it would seem in con
be greater than those
sequence that the dangers of animal vaccination may
which are supposed to be avoided by having recourse to the
of human,
cow." 3[edical Times and Gazette, Sept. 3, 1881.
—
144 VACCINE A MENACE TO HEALTH.

dently very great, and its use inexpedient and dan

gerous.
It is evident, therefore, that we are unable to
measure the dangers which may lurk in any speci
men of vaccine ; that it can only be tested by its re
sults; that these results are not immediate and ob

vious, but are often not completely developed until

years after the vaccination; and that no amount of

care on the part of the vaccinator will obviate the

possibility of danger and disaster.

 COMPULSORY VACCINATION.
I am strongly opposed to Compulsory Vacci
nation. Herbert Spencer.
—

It is an intolerable tyranny to compel vacci

nation by law. Coiistantine Hering.
—

Whatever may be the verdict in regard to the

value of vaccination, there can be but one opinion,
among lovers of human liberty and equal justice,
as to its compulsory enforcement. Even though
vaccination had proven all that Jenner, in the flush
of his earlytriumph, so confidently claimed for it,
to make it compulsory would be a wrong without

justification in law or morals. Vaccinia is a disease,

and no man has a right to disease another against
his will. Disease is a crime, and never anything
but the result of the disobedience of law. To, there
the infraction of law, in the name
fore, command
of law, is a subversion of the very prin
complete
upon which law is based.
Vaccinia perma
ciple
nently impairs the integrity of the body; as does
every attack of disease.
A man once ill is more
vulnerable for every other ill. And while every
man has a to chose for himself, what appears
right
to him, the lesser of two evils, no man, nor any

assemblage of men, no matter by what name called,

nor with what powers vested, have the right to vio
human
late by force the physical integrity of another
146 COMPULSORY VACCINATION.

This system of
compulsory vaccination is founded
upon formulary too preposterous for a moment's
a

serious argument. It arose from the curious dogma

that a healthy person was a focus of disease; and
that not having been diseased (i. e., vaccinated) he
would be the propagator of disease (smallpox) to
those who had been diseased (vaccinated). If vac
cination protected the vaccinated, they would have
no occasion to fear infection. While, if vaccination
does not protect the vaccinated from taking small
pox from the unvaccinated, it is a monstrous fraud
on human credulity. In either event the vaccinated
have no reason to find fault. If they really believe
that vaccination protects them, all is well; while if
they do not so believe, then they have not the
shadow of an excuse for forcing it upon others who
do not believe.
No American can dispassionately view our com

pulsory vaccination laws without a blush of shame.

For while vaccination is not here openly enforced
as it is in
England, yet we have permitted a meaner
kind of compulsion to crawl into our statute books ;
more repulsive to every humane mind, for it is a law

that bears only upon the poor.

Vaccination is the key that opens Castle Garden
to every immigrant that comes into this port, and
the public school to every poor man's child. Be
re-vaccinated, or
stay out, we shout aloud to every
immigrant that approaches our shores; be vacci
nated, or grow up in ignorance, is commanded to
 COMPULSORY VACCINATION. 147 »

every child who knocks at the school-house door.

But vaccinated with what? Shall it be with syphi
liticlymph, or tuberculous lymph, with horse-grease,
or smallpox, or shall it be with some innocuous pre
paration from a spontaneous cow, that bears no rela
tion to smallpox other than as a charm or a fetich?
In this, the law is conveniently silent. No man
knows what lies latent on the vaccinator's lancet,
and no man less than the vaccinator himself; but
be vaccinated, and take the chances, is the fiat nailed
on every poor man's door.

To command a person to do that of which the

results can only be known after they have occurred,
and which involve conditions so serious to the in
dividual and to society, is a monstrous tyranny;
and that such a law has been permitted to find a
on our statute books, I believe is solely due to
place
the fact that neither the laity nor the medical pro
the
fession have ever really seriously considered
matter.
I have faith in the medical profession— in the
humane of which its
noble, self-sacrificing, men

could be in
body iscomposed— to believe, if they
duced to study this subject, as I have done, unbiased
by the fanatical clamor of a few, or the specious rea

soning of those interested pecuniarily in the spread

of the dogma, that they would demand the abroga
tion of all vaccination laws, with overwhelming
unanimity.
To my colleagues everywhere, I appeal for a sober,
t
148 COMPULSORY VACCINATION.

thoughtful consideration of thissubject, as one of

the most momentous questions of the day. A ques
tion which no man can rightfully set aside. The
silence of medical men who are skeptical as to the
value of vaccination, gives opportunity to ardent
pro-vaccinists to claim that the medical profession
are unanimously in its favor; that the
argument is
closed; that vaccination is proven beneficient beyond
peradventure. But it is not closed; it is a wide open
question. And we, who have patiently studied its
history and results, will never be silenced, until every
compulsory vaccination law is swept away, and sani
tation recognized as the only scientific protective.
If anybody choses to be vaccinated, like Dr. Cory,
the chief of the Lamb's Conduct Street (London)
Vaccine Station, let him be vaccinated. This in
credulous gentleman, desiring to prove that vaccine
lymph could not convey syphilis, invaccinated him
self from a syphilitic subject, with such serious re
sults, as to forever silence disbelief. If, on the other
hand, anybody chooses not to be vaccinated, the
whole history of vaccination, from its inception to
the present hour, gives him amply warrant.
How true it is, that every wrong,' in seeking to
perpetuate its power, commits felo de se. The surest
way to destroy faith in the vaccination dogma, was
to resort to compulsion. The attempt to enforce re
peated vaccination upon those who were skeptical as
to its prophylactic value, has aroused fierce
opposi
tion in every land where it has been tried. An
 COMPULSORY VACCINATION. 149

opposition, which having reason and history upon

its side, has conquered in Switzerland, and will
surely triumph everywhere. Vaccination is destined,
sooner or later, to take its place by the side of In

oculation as an exploded medical theory. It has

been tried and found wanting, and the frantic efforts
of its devotees may postpone for a time, but cannot
avert the downward plunge of the sword of Damocles.
Die Weltgeschichte ist das Weltgericht.
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 BIBLIOGRAPHY. 159

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 Appendices.
APPENDIX A.

I.

The Vaccination of Immigrants.

I left Bremen, on theNeckar, of the North German

Lloyd line, in the midst of a severe rain-storm, which was

accompanied by a strong wind. During the voyage two

accidents occurred, the first being the death of an eight-
year old child in the steerage from the effects of brandy.
The parents being very sea-sick, the child, unobserved, ob
tained possession of a bottle of brandy which they had, and
drank sufficient of its contents to cause death. A young

lady also died, from heart disease it was said ; but we

brought into port the same number of passengers as we left

with, for there were two births on board. Besides 110
cabin passengers, the Neckar carried between 700 and 800
in the steerage. The United States law provides that every

immigrant, without regard to age or physical condition,

shall be vaccinated within twenty-four hours after leaving
the foreign port. Many of those on board were exceedingly
ill, and to any one who has ever suffered the pangs of sea
sickness, it will be apparent that that was not a favorable
nor a proper time for vaccination. But it must be done,
for the law is clear and peremptory ; there is no evading it,
for on arrival at New York, all those who cannot show a
certificate from the ship's surgeon are consigned to Black-
well's Island.
(101)
162 VACCINATION OF IMMIGRANTS.

During the three days following our

departure from
Bremen, vaccination was the order of the day in the steer
age. I was enticed thither by curiosity, and what I there
saw was
suggestive, to say the least, to me, and may be of
interest to you. The surgeon sat on a box in the store
room, lancet in hand, and around him were huddled as
many as could be crowded into the confined space, old and
young, children screaming, women crying; each with an
arm bare and a
woe-begone face, and all lamenting the
day they turned their steps toward "the land of the free."
The lymph used was of unknown origin, kept in capillary

glass tubes, from whence it was blown into a cup into

which the lancet was dipped. No pretence of cleaning the
lancet was made; it drew blood in very many instances,
and it was used upon as many as 276 during the first day.
I inquired of the surgeon if he had no fear of inoculating
disease, or whether he examined as to health or disease be
fore vaccinating. He
replied that he could not stop for
that, besides, no choice in the matter was left with him.
The law demanded the vaccination of each and every one,
and he must comply with it or be subjected to a fine. I

thought it a pitiful sight, and am persuaded that could the

gentlemen through Avhose instrumentality the law was

enacted, see what 1 saw of the manner in which it was car

ried into effect, they would be zealous in its

as
seeking re

peal. As conducted the law is

outrage, and no one can
an

estimate the number of helpless, innocent children, as well

as adults, who are inoculated with
syphilis or other foul
disease, on every ship bringing steerage passengers to our
shores.
G. H. Merkel, M.D.,
In the Massachusetts Eclectic Medical
Journal, November
18-82.
 VACCINATION OF IMMIGRANTS. 163

II.
The Vaccination of Immigrants.
When there is an outbreak of
smallpox in the United States, it is
frequently ascribed to the presence of unvaccinated immigrants, and
quarantine is said to be defective. It so happens, however, that im
migrants are carefully vaccinated, and often re-vaccinated, as will be
seen by Dr. Merkel's statement, above ; but it is not
unlikely, through
overcrowding on shipboard, aggravated by vaccination, and un
wholesome quarters on shore, they are peculiarly liable to variolous
disease. The following letter, describing the painful treatment to
which immigrants are subjected, is from a layman. While not
agreeing with some of its harsh expressions, I give it place here, as
a picturesque description of an every-day occurrence. It is needless
to say, cabin passengers are exempted from this brutal imposition.

Brooklyn, New York, May 7, 1883.

Dear Sir. —
I found the vaccination tyranny much
more than sentiment on board the "Adriatic." Aboard-
ship, aseverywhere, it has attained terrible proportions,
which makes it probable that in the near future it will be
come The Great Terror that shall "cause that as
many
as will not worship theimage of the beast shall be killed,"
and that "no man
may buy or sell save he that has the
mark of the beast."
The first intimation that I had that vaccination was a

requisite for free travel in America was an

"Important
Notice" on the stairway to the effect that passengers not

provided with certificates of vaccination were liable to be

detained quarantine on arrival, and that the ship's
in
medical officer was prepared to give certificates to those
unprovided on showing marks of successful vaccination.
In a few days I heard of this ship's medical officer mag

nifying his office down among the women and children.

I conversed with one young woman who had submitted to
164 VACCINATION OF IMMIGRANTS.

the great ordinance, and after characterizing the whole

business as the most idiotic folly of the times, I begged of
her to suck the poison out of her arm. But many hours had

elapsed, and the endeavor failed. Day by day she had to

carry her burden of pain until she landed. Whether she

is now rejoicing in enhanced health as a consequence of the

smallpox proofing process, or whether she is suffering from

the weary illness that is often its "accident," I have no
means of knowing.

I was anxious to know to what extent the immigration

vaccination law was enforced at New York, and had a

chat on the subject with the chief steward. His informa

tion was
terrifying. Said he, "when we get to New York
the doctor comes aboard, sometimes with half-a-dozen po
licemen, and you have to be vaccinated." "But," said I,
"suppose you refuse to be vaccinated, what then?" "Then
they'll sling you into the tender, and clap you in gaol till
you submit." "But I won't be vaccinated. I'll stay out
of New Yoi'k forever first." He replied: "No use; you'd
have to be. Five of our crew, once, refused to be done;
but they just put 'em into quarantine and kept 'em there
until they came to. They might as well have been done
first as last; they only delayed the vessel."
One morning it was rumored that the doctor was coming
to examine the passengers, and I went with two friends to
the surgery to state our objections. I told him that as we
had been vaccinated, if that fact would let us pass without
further trouble, we could satisfy him ; but if not, vaccina
ted we would never be. Like most doctors, he was with
out capacity to understand our conscientious objections,
and the degradation involved in submission to the rite.
He curtly told us the law was not his ; it was United States
 VACCINATION OF IMMIGRANTS. 165

law. He should come forward at two o'clock, and if we

showed him that we had been vaccinated, he would give
us a certificate, and if not, he would vaccinate us if we
chose; if not, we must take the risk of passing the doctor

at the port. It mattered nothing to him.

About two great commotion for'ard.
o'clock there was a

Such a stripping of clothes, rolling up of sleeves, and

searching Some were craning their necks
for "marks."
over their shoulders inhalf-hopeless search after obliter
a

ated or invisible scars; some calling in the help of a neigh

bor to make them out; and some raising an excited dis
cussion as to whether a certain indentation was a vaccina
tion mark, forgotten boil,
or a going and
ecstasy into an

of satisfaction when they had settled it was exactly what

was wanted. Others, in despair of vaccination marks, re
collected that they had had smallpox, and set up a search
for pock-marks. Some, after a protracted quest for marks,
vaccine or variolous, put on their coats sadly, with the air
of criminals about to be hanged. It was a sight to make
men blush with shame for the devilish superstition that has

taken possession of the Christian civilization of the uine-

teenth century.
By-and-by came the doctor in his gold-laced cap, with
his bottle of
"
pure from the of children or
lymph," sores

heifer's buttock, and commenced operations. First

rope a

was stretched from a post, and held by two stewards in a

horse-shoe form, and into this enclosure passed, one by one,
the victims of an insane medical legislation, and bared their
arms to the Medical Ignoramus, who stood on
the other

side. If he there saw the orthodox scars, he forthwith

bestowed a ticket like this: —
166 VACCINATION OF IMMIGRANTS.

White Star Line.

S.S. "Adriatic."

VACCINATED.

C S. Murray,

Surgeon.
14th April, 1883.

Which further had this exhortation on the back :

—

PASS.

Keep this card to avoid detention at

quarantine, and on railroad in the United

States.

If a poor wretch could not show vaccine or pock marks,

he got no ticket, and was asked whether he would be vac
cinated, or risk being stopped at landing. All preferred
the first alternative as the lesser evil. The doctor, dipping
his lancet in the bottle of mystery, wiped it on a
spot on

the arm, and cut and cross-cut the skin, and then, after
rapidly stretching and the incisions with his thumbs,
closing
gave the wretch his ticket and passed him on. Such was
the ordinance of vaccination a
sight not to be
—

forgotten.
A crowd of hundreds passiug forward to prostrate their
conscience or manhood, or lack of them, at the shrine of
the most outrageous humbug of these latter days! A
 VACCINATION OF IMMIGRANTS. 167

mixed crowd of big and little, fat and lean, dirty and clean,
reputable and disreputable, sober and drunken, healthy
and diseased, all ground down to the dead level of vacci
nated. There nothing
was in
common among them save

their degradation, aud, as I thought, the most degraded of

the lot was the Vaccinator. How a man with any sense

of decency and the congruity of things, could for mere

pay
consent to the folly that the individuals of such a hetero

geneous crowd were all alike liable to smallpox, and were

all alike saved by his performance, passes my understand

ing. It is hard to believe in a man's sincerity in view of
such absurdity ; and yet he may be sincere. When a lie
is taught, and still more when a lie is practised, it con
founds the intellect, and is ultimately taken for the truth
of truth.
Yours truly,
F. Scrimshaw.

III.
Vaccination of Immigrants.

The abuses which possible in compulsory vaccination

are

a pathetic instance which has

illustrated in
are
forcibly
come under our notice during the past week. An Irish
servant girl in the city has been for a long time saving up
her earnings that she might be able to pay the passage of
her brother to this country, and by economy and persist
ence she at length accomplished her object.

Last week the lad arrived, but he had, with others, been
and he
compelled to submit to vaccination on shipboard,
now lies at death's door from the effect of the use of im

pure virus. The surgeon of the ship in a case like this

ought to be brought to strict account. Steerage passengers

168 vaccination of immigrants.

are at least human, and their lives should not be left at the

mercy of every careless practitioner who prefers to risk

their health rather than to take the trouble of ascertaining
the safety of his materials.
The case of which we
speak seems
especially cruel, as

the poor girl is nearly heart-broken that her labor has re

sulted only in bringing her brother to die in a strange land ;
but as a matter of fact, it is
only one instance among many.
The matter is one that needs
looking to closely ; since even
the most determined opponents of immigration can hardly
be prepared to go to the length of legal murder as a means
of preventing it. Boston Courier, May 3, 1883.
—
 APPENDIX B.

Infection and Disinfection.

The following passages of an article in the Wiener Medi-

cinischeWochenschrift, of June 3, 1882, may enlighten the
ignorant and reassure the timid. Dr. Lorinser, one of the
leading physicians of Vienna, writes as follows:
"A great deal of printer's ink has of late been wasted in
' '
discussions the of the so-called infectious dis
on spread
eases, and on the best means of preventing it. In all these
discussions public attention is more
particularly drawn to

smallpox. It is easy to describe the dangers and the con

tagiousness of such a disease, and when this has been done,
it but little pleading to obtain the public sanction
requires
for a or preventive measures apparently
series of defensive
as efficacious as they are vexatious and tyrannical. The
first cry is for a more vigorous enforcement of vaccination,
then schools and markets are to be closed, fairs to be pro

hibited, and as cabs cannot be prevented from conveying

variolous patients and convalescents, and as the dangerous
contact with members and frequenters of infected house
holds cannot altogether be avoided, a universal disinfection
with the carbolic acid becomes a matter of
irrepressible
measures recommended
urgent and obvious necessity. The
the authorities which might have reassured the
by sanitary
public are then emphasized and gloated over by newspaper
writers in such a manner, that the public, instead
of
silly
is frightened and alarmed without any
being reassured,
necessity.
"
The doctors, who are in a responsible for
great measure

the shafts
this state of public feeling, ought to remember that
they have caused to be directed against
the public may at any
(169)
170 infection and disinfection.

moment be turned against themselves. Already there are

people who dread their doctor's visit, not knowing whether
he might not come fresh from a smallpox patient, convey

ing the dreaded poison in his clothes and in his very breath.
"Under these circumstances it would seem
opportune to

inquire, for once, how much of these opinions concerning

variolous infection has been scientifically ascertained.
What has been proved is only this by subcutaneous inoc
—

ulation of liquid variolous lymph we can produce either a

local crop of pustules or general variola. We also know
from the Chinese, that the same disease can be induced
through the inhaling of the dust of dried variolous scabs
into the cavities of the nose.
Consequently variola can be
propagated by the contact of variolous matter either with
the broken skin or with the mucous membrane. But it is
not this fixed contagion which is dreaded so much, and
which is to be disinfected ; such a substance (whether fluid
or
solid) being hardly liable to be altered by the fumes of
carbolic acid. That which is most dreaded and most

eagerly combated is a 'volatile gaseous' substance, which,

fortunately, thus far has not been proved to exist outside
the imagination of the learned. If we take for granted that
such a volatile contagion fixes itself on the skin or the hair,
on clothes and utensils, and that it can remain there for
days or weeks without losing its efficacy, it becomes
easy
enough to explain the
spread of the disease. But when we
ask whether there is single fact that could prove the ex
a

istence of such a contagion, and its power of

conveying the
disease, we are bound to reply in the negative. We know,
as a matter of fact, that thousands of
persons, though living
in daily contact with variolous patients, have not
caught the
disease; but that one single person has ever caught it by
inhaling the "volatile contagion" can never be proved, con-
 INFECTION and disinfection. 171

sidering that variola, like all other diseases, can also break
out spontaneously. Nevertheless, both doctors and patients
cling fondly to this belief in a volatile contagion : the doc
tors because it frees them from the
necessity of investigating
the genuine causes of the disease ; the patients because indi
viduals (like nations) prefer to seek the causes of their suf
ferings in their neighbors, their owTn sweet body being quite
incapable of generating such loathsome disease.
"Thus indolence and amour
propre are the chief support
of this popular belief. Unfortunately, this dogma can

neither be disproved nor proved; but if it were true, if such

a thing as volatile contagion really existed, it would be
found in its greatest concentration and virulence in small
pox hospitals, and nothing would be more natural than that
the attending doctors and nurses should be those most fre
quently affected by it. Yet such is not the case. Neither
in the terrible epidemic of 1871, nor in any subsequent epi
demic, have I heard of a single case of a doctor or a nurse
catching the disease in the Vienna smallpox hospital. . . .

"The remarkable immunity of hospital attendants, what

ever it may prove concerning the volatile contagion, proves

clearly that even the fixed contagion cannot possibly be

considered as a very formidable agent. And this being so,
the question arises, What is it we want to disinfect? What
is it we dread ? In truth we do not know. That is the only
answer we can give or we ought to give. The belief in in
fection has no scientific basis, and the efficacy of disinfection
is on a par with that of vaccination and re-vaccination,
which even credulous beginning to doubt.
physicians are

"There is no royal road to health, and preservatives like

these can only act where they are not wanted in persons
—

who know how to keep their skins clean and their blood
a proper life."
pure, and by leading
 APPENDIX C.

What to do about Animal Disease.

The following editorial from the New York Tribune, March 18,
1884, will apply just as well to smallpox, and will be instructive
reading during the next smallpox scare.

There has not been before in many years such general

health among American cattle and hogs as there is now.
The late Swine Commissioners one of whom visited twenty
—

six States— found practically no disease. There is, and

probably always will
be, occasional trichinae, a very small
percentage, but the "experts" know little or nothing of its
cause ; it effects our
pork, perhaps, no more than that of
other countries; and the one and easy safety is in thorough
"

cooking. The cholera," which has been made excuse for

selfish sensationalism so costly to producers, had "dis

appeared" last fall, according to official admission. But

how about pleuro-pneumonia? Not an item of
proof has
been brought against the many competent witnesses who
testify that there is very little of that.
Whence, then, all this noisy affirmation? It emanates
from a few persons already in Government employ and
naturally anxious to enlarge and perpetuate their easy
places. Every slight local sickness is magnified and tele
graphed over the whole land, as was the case the other day
in Columbia County, N. Y. The alarmists are thoroughly
organized; they have been working toward this one end
half a dozen years, and it is proverbial that Plea is much
more active than Protest. But we are not saying and —

(172)
 WHAT TO DO ABOUT ANIMAL DISEASE. 173

have never said —

that there is no
pleuro-pneumonia in the
Atlantic States. It would be strange, if there were not,
with frequent
our cattle importations from the infected fields
stamped out," but do
"
of Europe. Let what there may be
it in sensible,
a business-like way.
If the few States, claimed to be infected, are not deemed

capable of dealing with the disease, as in Massachusetts and

elsewhere, then let Government put the whole matter into
the hands of some one practical, honest business man, with

authority to quarantine, to buy, to kill and bury or burn,

calling tohis aid all necessary assistants and co-operation ;
and then let him present the bill, with vouchers for every
item of expense. But to organize for this simple work the
Bureau of Animal Industry," and that, too, in
"

proposed new
"

connection with the highly esteemed Agricultural De

not

at Washington, and equip it with a quarter of

partment,"
a million dollars, and twenty men appointed by political
" "

intrigue, is to repeat on a mammoth scale the hog cholera

disgrace and the "grasshopper" folly of past years.
So of "foot-and-mouth disease," of which we have lately
heard in Maine and Kansas. That, too, if it is here at all,
was also imported. Get rid of it at once, in the same simple
above ; and our coasts once clear
of these
way suggested
much-talked-of sources of danger, let us see that we stop
of either infection across the Atlantic —

bringing any more

since quarantine restrictions seem to prove ineffectual. For

of America be
why should the whole vast cattle interests
put in jeopardy for the profit
of the few who ship cattle
We have a good plant of
here for speculative purpose?
make the
all the leading thoroughbreeds of Europe; let us
of and likewise of our own hardy, healthy
best them,
de
natives which contain elements capable of unsurpassed
velopment.
174 WHAT TO DO ABOUT ANIMAL DISEASE.

But, after all, it is one comfort to reflect that this costly

sensationalism, which has characterized the agitation of
"

contagion," will not be wholly without compensating re

sults, if it serve indirectly to draw attention to the impor

tant truth that health in domestic animals, as in human
creatures, only
can result from wholesome food, pure air,
comfortable quarters and general provision for maintenance
of strength. Western hogs cannot keep well, nested in mud
and cold, or in sties reeking with filth, and eating frozen,
mouldy corn ; nor Eastern cows in crowded, un ventilated
stables, with fermenting brewers' grains, glucose meal and
half-decayed ensilage as insufficient feed. When all stock-
keepers humanely regard the comfort of their animals,
there will not be a hook left for hungry alarmists to lay
hold upon.
 INDEX.

of Waltham, small-
Adams, Dr.,
Bayard on smallpox after vac-

poxes a cow, 38. nation, 74.

Amateur vaccinists, 24. Beaugency vaccine stock, the, 39.
American statistics unreliable, Berlin, smallpox after vaccina
66. tion in, 92
An appeal for justice, 147. —
deaths in, 1746 and 1871, 91.
,

Animal disease, what to do about, Bibliography, 151-159.

172. Birch on deaths from vaccina
—

virus, 141. tion, 116.

Annual vaccination, 45. Birkenhead, smallpox after vac
Appendices, 161. cination in, 81.
Arm-to-arm vaccination, 51. Birmingham, the smallpox epi
Army of vaccinators, an, 100. demic of 1874 in, 95.
Austria, smallpox after vaccina Blane, Sir Gilbert, on eight
tion in, 89. eenth century smallpox, 59.
Boeing, PL, vaccination a delu
experiments with sion, 78.
Badcock's
smallpoxing the cow, 38. Boston, Mass., experience with
Bakewell, leprosy and syphi smallpox, 61.
lis communicated by vacci —
inoculation introduced, 16.
,

nation, 122. Bovine tuberculosis, 143.

Ballard, Edward, on the dan Boylston, Dr., introduces inoc
gers of vaccination, 35. ulation at Boston, Mass., 16.
—
the epidemic of 1871, 109.
, Braxendell, Joseph, on small
vaccinal-syphilis, 121. pox mortality statistics, 98.
—

Baltimore, smallpox after vacci Brereton on invaccinated lep

nation in, 73. rosy, 128.
British smallpox after
Bavaria, smallpox after vaccina army,
tion in, 72. vaccination in, 74.
(17-:
176 INDEX.

Browning on smallpox after Cow-pox derived from horse-

vaccination, 75. grease, 21.

Buchanan, George, on inef
—

, origin of, 20.

ficient vaccination, 100. prevents smallpox, origin of
—

the belief that, 22.

Lalf-lymph, 39. —

, spontaneous, 21.
Cameron, Charles, smallpox
deaths among the vacci from vaccination,l 1 5.
nated, 99. Dangers
of vaccination, 35, 144.
—

—
on vaccinal virus, 42.
,
Daremberg on inoculation, 17.

Carpenter, W. B., on post Death-certificates, false, defend

vaccinal smallpox mortal ed, 116.
ity, 110. Death-rate of smallpox, 60.
Carter, Brundenell, on vac —
not mitigated by vaccination,

cinal-syphilis, 125. 110.

Ceely's experiments, 38, 142. —
and fever, 64.
Chambers, Sir Thomas, vac Delusion, vaccination a, 78.
cination has not reduced Depaul on vaccinal-syphilis,
death-rate, 107. 120.
Chauveau on smallpoxing the Desjardins on vaccinal-syphi
cow, 41. lis, 128.

Chicago, smallpox after vaccina Does vaccination prevent small

tion in, 73. pox in the vaccinated? 55.
Cholera replaces fever (1832), Dogma, curious, 146.
a

104. Ducharme on smallpox after

Cicatrices, numerous, 83. vaccination, 71.
Colin, Leon, on what consti Duisburg, smallpox after vacci
tutes vaccination, 88. nation in, 92.
Collins, W. B., on vaccinal-
syphilis, 120. Samuel, on vaccinal-
Compensatory death-rate, law of, Eadon,
syphilis, 127.
102. Early devotees of vaccination, 24.
Compulsory vaccination, 145. Eczema pustulosum, 22.
a monstrous tyranny, 147. England, 122,000 cases of small
—

Cornell, B. F., on vaccinal- pox after vaccination in six

syphilis, 121. months (1871), 75.
Cory, Doctor, invaccinates him Epidemic smallpox varies in in
self with syphilis, 148. tensity and fatality, 18.
 INDEX. 177

Equination, 37. Grease, 21.

Equine analogue of scrofula, the, —
the product of scrofula, 22.
136. Gregory on inoculation, 17.
Erysipelas from vaccination, 34. Gull, Sir William, on vaccinal-
necessary to vaccination, 40. syphilis, 122.
—

Essex Market Dispensary vac Gunn, Kobert A., on vaccinal-

cine, 52. syphilis, 126.
Evil results of vaccination, 47,
51. after vacci
Hamburg, smallpox
nation
in, 92.
death-certificates defend Heim vaccinal-syphilis, 121.
on

Falseed, 116. Henderson on smallpox after

Farcy, 136, 141. vaccination, 72.

Farr on the decline of small Hering, Constantine, on vac
pox, 62. cinal-syphilis, 126.
—

eighteenth century statis

on
—

M., on grease, 22.

,

tics, 59. Hill, Alfred, on smallpox after

—
on the relativity of zymoses vaccination, 95.
to sanitation, 109. Hitchman, William, on vacci
Fatality of hospital smallpox be nal-syphilis, 124.
fore vaccination, 60. Holland's, Sir Henry, opin
"
Fifteen-marks" vaccination, 45. ion, 76.
First vaccination, the, 23. Homerton Fever Hospital statis
French army, smallpox after tics, 87.
vaccination in, 74. Hopkins, T. S., on vaccine acci
dents, 51.
experiments, 37. Horse-pox, 37.
Gassner's
Germann vaccinal- on
—

virus, evil results from, 142.

syphilis, 125. Hunter, J., on vaccination, 23.
Glanders, 136. Hutchinson, Jonathan, on
—

conveyed by vaccination, 142. vaccinal-syphilis, 123, 124.

Glasgow mortuary statistics, 104.
smallpox after vaccination in, vaccination of, 146,
Immigrants,
—

82. 161, 163, 167.

Goat-pox, children vaccinated Impure vaccine, 51.

with, 36. India, smallpox in, 111.
Graunt, John, on vital statistics Indians, vaccinated, die of small
(1604-1664),' 105. pox, 97.
9
178 INDEX.

Infants, vaccinated, die of small Jurin on deaths from natural

pox, 85. smallpox, 60.
Infantile mortality, 113.
—
from syphilis, 131. J., L.
smallpox on

Infection and disinfection, 169. Keller,

after vaccination, 89.

Inoculability of tubercle, 136. Kirby on grease, 22.

Inoculable diseases, 138. Knight's experiments, 38.
Inoculation an
exploded medical Kolb, G. F., on smallpox after
dogma, 19. vaccination, 73.
—

by the Suttons, 16. —

vaccination a delusion, 78.
,

—
in Boston, Mass., 16. Kratz, O., on vaccinal-syphilis,
—
in second century, 17. 120.
—
introduced by Lady Mary
Wortley Montagu, 15. John, on vaccinal
—
made criminal, 19. Leacroft,
accidents, 75.
—

, phenomena of, 17. —

Browning, 75.
vs.
—

spreads smallpox, 18. Lettsom on smallpox prior to

, vaccination substituted for, vaccination, 59.

15. London hospital experience, 80.
Insusceptibility to vaccination, —

statistics, 67.
30. —

, smallpox
after vaccination in,
Introduction, 9. 74.
Invaccinated leprosy, 122, 128. —

,
deaths among the vaccinated
—

syphilis, 119. in, (1870-9), 99.

Is it vaccinia? 43. Lyttleton, Lord, on the ratio
of vaccinated to birth-rate,
guarantees absolute im 100.
Jenner
munity (1798), 56.
—
hears of cow-pox, 22. on inefficient vacci
—
re vaccinates every year (1820), Maclean
nation, 70.
56. Manchester, smallpox after vacci
—

rewarded, 25. nation in, 96.

spontaneous cow-pox, 39. Marseilles, smallpox after vacci
—

Jenner, 56.
vs nation in, 70.
—
Sir
William, on vaccinal- Marson, J. F., comparative
syphilis, 122. death-rate among vaccinated
Jones, Joseph, on vaccinal- and unvaccinated, 79.
syphilis, 120. —

, death-rate from
smallpox, 82.
 INDEX. 179

Marson, J.
F., inoculation, 18. Dispensary report,
—

, "Jenner's
estimate", 57. Newcastle
140.
on
vaccinal-syphilis, 122. Newton, J. E., on vaccinal-
—

Martin, Sir Konald, on invac syphilis, 126.

cinated leprosy, 122. New York, smallpox after vacci
May, Henry, on death-certifi nation in, 73.
cates, 116. —

in, 1804-1810, 69.

Meric, M. de, on vaccinal-syphi Niemeyer on vaccinal-syphilis,
lis, 122. 127.
Method of vaccinating, 44, 53. Nightingale's, Florence,
Milan, smallpox after vaccination opinion, 58, 110.
in, 74.
Mild epidemic smallpox (1872), the father of the words
93. Odier
"vaccine" and "vaccinia,"
—
Jenner's experience (1791), 50.
94. Oidtmann on smallpox deaths
—
Isaac Massey's account (1723), among the vaccinated, 97.
94. Origin of cow-pox, 20.

Montague, Lady Mary Wort —

grease, 22.
ley, brings inoculation to
—
the words "vaccine" and

England, 15, "vaccinia," 50.

Monteith, on inoculation, 19. —

vaccine, 37.
—

smallpox mortality, 61.

Mortality from plague, 106. Sir
James, on vaccina
—
from smallpox, 59. Paget,
tion, 46.
—
1700 to 1880, 62. Parliamentary grant to Jenner,
Moseley on vaccinal-syphilis, 25.
119. Pearce, Charles T., on vacci
Mueller on
smallpox after vac nal-syphilis, 121.
cination, 93. Pearson on the origin of the
Muller's Orphan Home, smallpox words "vaccine" and "vac
after vaccination in, 93. cinia," 50.
Personal susceptibility to vacci
Multiple "marks", value of, 83.
nation, 30.
—

vaccination, 45.
Phenomena of vaccination, 27.
Munn, S. B., on vaccinal-syphi
lis, 128. Phipps, James, vaccinated, 23.
Phthisis causedby vaccination,
135.
180 INDEX.

vaccinal- the preventive of

Pigeon, Charles, on

syphilis, 128. Sanitation

smallpox, 114.

Plague statistics, 105. Sarcoptes hippopodus, 22.

Playfair, Sir Lyon, on small Schools, vaccination in the pub
pox mortality, 63. lic, 146.
Preface, 5. Schuppert's experience, 85.
Progressive infantile mortality, Scrofula, the equine analogue of,
139. 136.
Protection through vaccination, —
and
tubercle, 137,
57. Seaton, Edward C, on efficient
Prussian army, smallpox after vaccination, 56.
vaccination in, 71. —

,
inefficient vaccination, 100.
Putnam's experiments, 38. —

, smallpoxing the cow, 37.

—

vaccinal-syphilis, 123.
,

Farr on Shaftesbury, Lord, on sanita

Registrar-General
eighteenth century statis tion as a preventive of

tics, 59. smallpox, 112.

—
on relativity of zymoses
the Shorthouse, John, on animal
sanitation, 109.
to virus, 142.
Eelative mortality, 104. Silly charges against vaccina
Eelativity of zymoses to sanita tion, 117.
tion, 109. Simon, John, on bovine tubercu
Eetarded vaccinal phenomena, losis, 143.
32. —

contagiousness of smallpox,
,

Ee-vaccinations, 83. 59.

Eicord on vaccinal-syphilis, —

, vaccinal-syphilis. 121, 127.

119. Simonds bovine pox, 141.
on

Einger, Sidney, on vaccine Skin disorders modify vaccinia,

phenomena, 30. 48.
Eobinson's, Enoch, observa Smallpox a
filth-disease, 58.
tion, 109. —
after cowpox, 68, 70.
Eollet on vaccinal-syphilis, —
less frequent since 1770, 62.
122. —
mocks at vaccination, 109.
Eowley, William, on deaths —
not vaccinia, 41.
from vaccination, 115. —

obliterates vaccination marks,

Eussell on smallpox after vac 81.
cination, 82. —

prior to vaccination, 90.

—

spread by inoculation, 18.

 INDEX. 181

Smallpox and Inoculation Hos smallpox after vaccina

pital, London, founded, 16. tion, 95.
—
and syphilis, deaths from, 132. Touissaint on bovine tubercu
Smallpoxed five times, 56. losis, 143.
Smallpoxing the cow, 37. Trousseau, A., on vaccinal-
Smith, Thomas, on vaccinal- syphilis, 125.
syphilis, 124. Tuberculosis from vaccination,
Sonderland's experiments, 37. 135.
Sources of vaccine, 52. —
in the cow, 141.
Spencer, Herbert, on vaccinal- Tuberculous lymph, 137.
syphilis, 118. Two centuries of smallpox, 63.

Spontaneous cow-pox of Beau

gency, 39, 42. States Navy, smallpox
Springsteen, A. G., on vaccinal- United after vaccination in, 71.
syphilis, 127.
Spurious vaccination, 33. 135.

Susceptibility, personal, to vac Vaccinal-phthisis,

Vaccinal-syphilis, 119.

cination, 30. —

,
a case
of, 129, 148.
Sutton, Daniel and Eobert, —

, opinions and experiences of

apply inoculation, 16. Surg. Genl. Bakewell, Drs.
Sweden, smallpox after vaccina- Edward Ballard, Brunde-
nation in, 70. nell Carter, W. B. Collins,
Swine-pox, Jenner uses, 36. B. F. Cornell, M. Depau^
Switzerland and compulsory vac M. Desjardins, Saml. Eadon,
cination, 149. Profs. Germann, Eobt. A.
Sydenham on alterations in dis Gunn, Sir William Gull,
eases, 106. Drs. Heim, Constantine
suggestions applied to inocu Hering, William Hitch-
—

lation, 16. man, Jonathan Hutchinson,

Symptoms of vaccination, 29. Sir William Jenner, Joseph
Syphilis as a cause of infantile Jones, O. Kratz, J. F. Mar
son, M. de Meric, Mosely,
S.
mortality, 131.
—

through vaccination, a case of, B. Munn, J. E. Newton,

129. Prof.Niemeyer, Drs. Charles
T. Pearce, Ch. Pigeon, Prof.
Eicord, M. Eollet, Drs. Ed
experiments, 38. ward C Seaton, John Simon,
Thiele's
Tompkins, .Henry, on Thomas Smith, Herbert
182 INDEX.

Spencer, A. G.
Springsteen, Vital statistics in United States,
Trousseau, Sir
Prof. A. 65.
Thomas Watson, Drs. West,
Whitehead, Prof. Alexander on vaccinisation,
Wilder, 118-128. Warlomont 88.
Vaccinal virus, 36. Watson, Sir Thomas, on small
Vaccination a substitute for in poxing the calf, 141.
oculation, 15. —
vaccinal syphilis, 127.
—

, early devotees of, 24. Watt, Eobert, on proportionate

—
of immigrants, 146, 161, 163, mortalities, 102.
167. Weakens the constitution, vacci
—
in the public schools, 146. nation, 117.
—

laws, 146. Wells, Sir Spencer, on the sav

—

, personal susceptibility to, 30. ing of life by vaccination,

—

, phenomena of, 27. 105.

—

, smallpox after, 68, 70-78. West on vaccinal-syphilis, 122.

, symptoms of, 29. What to do about animal disease,
—

Vaccine accidents, 51. 172.

—
a menace to health, 144. Wheeler, Alex., on smallpox
—
should be untainted, 50. after vaccination, 86.
—

vesicle, the, 28. Whelan, on smallpox after vac

Vaccinia a
disease, 35, 145. cination, 71.
—
a
zymosis, 49. Whitehead on
vaccinal-syphi
—
and latent germs, 47. lis, 121.
Vaccinisation, 88. Wilder, Alexander, on vacci
Vacher, smallpox after vacci nal-syphilis, 127.
nation, 81. Wirtemberg, smallpox after vac
Value of multiple "marks," 83. cination in, 70.
Van Bibber's experiments, 38. With what shall we vaccinate,
Variation in vaccine phenomena, 147.
31. Wood on vaccinal-syphilis, 122.

Vesicle, the
vaccine, 28. Wyld, Geo., on smallpoxing the
Viborg on smallpoxing the cow, cow, 41.
37.
Vicarious mortality, law of, 101. constant
a
quality, 101.
Virus, vaccinal, 36. Zymosis
—
and cleanliness, 108.
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