In the summer of 1811 the author was called to visit, professionally, Don Francisco de Salazar, who had arrived a few days before in London, on his route from Lima to Cadiz, as a deputy to the Spanish Cortes. He informed him, that Vaccination had been practised with so much energy and success in Lima, that for the last twelve months there had occurred, not only no death from, but no case of, Small Pox; that the new-born children of all ranks are carried as regularly to the Vaccinating House as to the font of baptism; that the Small Pox is entirely extinguished all over Peru; nearly so in Chili; and that there has been no compulsory interference on the part of the government to promote Vaccination.
It is now matter of irrefragable historical evidence, that Vaccination possesses powers adequate to the great end proposed by its meritorious discoverer, in his first promulgation of it in 1798, namely, the total extirpation of Small Pox. The first proof of this was at Vienna, where, in 1804, no cases occurred, except two strangers who came into the city with the disease upon them. In 1805 there did not occur a single death from it in Copenhagen[[2]]. Dr. Sacco, the indefatigable superintendent of Vaccination in Lombardy, stated, in his Annual Report, 3d January, 1808, that the Small Pox had entirely disappeared in all the large towns in that country; and that in the great city of Milan it had not appeared for several years. Dr. Odier, of Geneva, so favourably known for his high professional, scientific, and literary acquirements, testifies, that, after a vigorous perseverance in Vaccination for six years, the Small Pox had disappeared in that city and the whole surrounding district; and that, when casually introduced by strangers, it did not spread, the inhabitants not being susceptible. The Central Committee in Paris testify, in their Report of 1809, that the Small Pox had been extinguished at Lyons and other districts of France.
These are selected as some of the earliest and most remarkable proofs of the extirpating power. But it is demonstrable, that if at the first moment of this singular discovery, at any moment since, at the present or any future moment, mankind were sufficiently wise and decided to vaccinate the whole of the human species who have not gone through the Small Pox, from that moment would this most loathsome and afflicting of all the scourges of humanity be instantaneously, and for ever, banished from the earth.
It is farther manifest, that extirpation being the ultimate aim of this discovery, and there being the fullest historical and practical evidence of its being capable of accomplishing this end, all other questions with regard to its expediency must be futile and irrelevant. It is in the nature of all morbid phenomena to be liable to exception. One of the most essential and characteristic laws of Small Pox itself, namely, that of its affecting the human subject but once in life, is found in rare cases to be violated. It is, therefore, perfectly conformable to analogy, and naturally to be expected, that it may not in all cases be a complete security against Small Pox. But it is obvious, that, admitting these exceptions to be very frequent, much more so than the recurrence of Small Pox after Small Pox, this can constitute no objection to the practice, as long as the extirpating power remains unimpaired and unimpeached. Nay, it is obviously so far from an objection, that it ought to operate as a powerful additional incentive on every benevolent mind, to push Vaccination to the utmost, as rapidly as possible, in order that those who are still susceptible, either from peculiar natural constitution, or from the unskillful manner of conducting the operation, or from defective matter, may not, by any possibility, catch it; for, in the event of its extirpation, it could nowhere be met with. And in order to stimulate the good and the wise to aim strenuously at this consummation, let it be constantly borne in mind, that the adversary they are contending with is the greatest scourge that has ever afflicted humanity. That it is so, all history, civil and medical, proclaims: for, though the term Plague carries a sound of greater horror and dismay, we should probably be within the truth, if we were to assert, that Small Pox has destroyed a hundred for every one that has perished by the Plague.
It is true that in its last visitation of this metropolis, one hundred and fifty-four years ago, it carried off 70,000 victims in a few months; but since that time, the deaths from Small Pox, recorded in the bills of mortality, have amounted to more than 300,000; and a like number of the survivors have been afflicted with blindness, deformity, scrofula, or broken constitutions, which is not the case with the survivors of the Plague. It appears, by a Report of the Hospital for the Indigent Blind, that two thirds of those who apply for relief have lost their sight by the Small Pox. It is alleged by some of the soundest Political Economists that Small Pox does not diminish the numbers of mankind, nor Vaccination increase them; for population is determined by subsistence, and the indefinite powers of procreation soon repair the ravages of disease. But, however true this may be, the miseries incident to so many of those who survive Small Pox, whereby they become a burden to themselves, their families, and to society, render this disease uncontrovertibly an evil of the first magnitude, not to mention the intense sufferings and afflictions inseparable from it; and in this view of the matter the objection seriously adduced against Vaccination by one of its opponents[[3]], that Small Pox is a merciful dispensation of Providence for the poor man, by diminishing the burden of his family, will not hold good, for the burden is not removed.
And when it is considered that there are large portions of the globe, India, China, even one whole quarter of it (North and South America), besides all the tropical and arctic regions, in which the Plague has never been known; and that in all the countries liable to it, it seldom appears but at one season of the year, and in some at long intervals, the ravage which it makes is trifling when compared with the unceasing havoc of Small Pox, which spares no nation in any climate, or at any season. Yet the Legislative Regulations for excluding and checking the Plague are of the most harsh and despotic description, while the law touches upon Small Pox comparatively with the most lenient hand. It ought to be generally known, however, that in a late trial and conviction, it was laid down by the judge to be the law of the land, that a medical practitioner who neglects to exclude the person whom he inoculates from communication with others, is liable to fine and imprisonment. Morally considered, indeed, it is difficult to conceive a higher degree of flagitious turpitude than that of a professional person, in the present state of knowledge, exposing his fellow-creatures, from sordid motives, to one of the most grievous calamities of which human nature is susceptible.
The preceding reasoning is grounded on the supposition of extirpation: but, however demonstrable the possibility of extirpation may be, it may not in all communities be practicable; and may not these alleged failures so operate, as, in such circumstances, to render the expediency of the practice questionable?
In order to decide this, let the nature and amount of these failures be ascertained and estimated.
The description of those cases of Small Pox, (if they can be called so,) which occur in vaccinated subjects, is shortly as follows:—The invasion and eruption in every respect resembles that of the genuine Small Pox. I have seen it attended with high fever and a thick crowded crop of papulæ, such as precedes the most severe and dangerous cases of the confluent kind. This runs on till the fifth day from the eruption, both days included, at which time some of the papulæ begin to be converted into small sized pustules. The disorder then abruptly stops short. On the following day the fever is found to have subsided, with a shrivelling and desiccation of the eruption, and recovery proceeds without the least danger or inconvenience. The face is marked, for some time after, with brown spots, but without pits. It should never be forgotten, that all morbid phænomena are full of varieties and exceptions. Accordingly, though the fifth day is the most common limit of this disorder, it sometimes stops short on the third; sometimes not till the sixth or seventh; and, in a very few cases, it has been known to run the common course of Small Pox. What forms the strong line of distinction from proper Small Pox, is that, with a few exceptions, it does not advance to maturation and secondary fever, which is the only period of danger. I am not prepared to deny that death may not have occurred in a few instances; nay, there seems sufficient evidence that it actually has; but these adverse cases are so rare, as not to form the shadow of an objection to the expediency of the general practice. A few weeks ago at a meeting of this Society, at which forty members and visitors were present, I put the question whether any of these eminent and extensive practitioners had met with any fatal cases of this kind. Two gentlemen had each seen a single case, and two other gentlemen took occasion to say that they had each seen a case of second Small Pox, both of which proved fatal. It is evident, therefore, that according to that maxim which guides mankind in the conduct of life, namely, that of acting on a general rule and average, and not on exceptions, these adverse instances ought not to have the least influence on practice, even though they were much more numerous. Nor indeed do they, except in the very rare cases here cited, deserve the name of failures; for, though they fail in preventing Small Pox, they do not fail to prevent Death. And let me here, in the name of humanity, beseech practitioners not to be forward in publishing single cases of failures, real or supposed; for, when the weak minded and uninformed hear of these failures, without hearing at the same time that there are hundreds of cases of permanent security for every single case of failure, they are guided by the exception, which becomes to them the rule; their judgments being thereby most fatally perverted.
As it is of the utmost consequence to establish the strong and important distinction between Small Pox, properly so called, and that which takes place after Vaccination, which may be called the mitigated, or five day Small Pox, a few of the most impressive testimonies respecting the safe nature of the latter may be here recited. Mr. Brown[[4]], of Musselburgh, gives the detail of forty-eight cases, in none of which did the secondary fever nor death occur. Here was a saving of at least eight lives, at the lowest computation; for this is the number which, by the average mortality of natural Small Pox, would have died if the constitutions of these forty-eight persons had not been modified by previous Vaccination. Dr. Dewar, of Edinburgh, hearing that many vaccinated subjects had been affected with Small Pox at Cupar in Fife, where the natural Small Pox at the same time prevailed, he most laudably repaired to the spot to investigate the subject. He found that fifty-four vaccinated subjects had caught the Small Pox. All these, except one, had the mitigated or five day eruptive fever, and livid. The fatal case was that of a child, who had a complication of other disorders, and having died on the fifth day, the Small Pox, according to its ordinary course of fatality, could not of itself be the cause of death. All the rest were safe; while of sixteen cases of the natural Small Pox at the same time and place, six died; so that, if these fifty-three cases had not undergone the mitigating process of Vaccination, nineteen or twenty would have perished. Between thirty and forty cases of the same kind have occurred at Carlisle, on the testimony of Dr. Barnes, a respectable practitioner of that city[[5]]. Many proofs might be adduced from the oral testimony of private practitioners, which would overswell this article. The only other to be mentioned is from the Report of the Central Committee of Vaccination at Paris, made in December last, in which the description of the disease occurring after Vaccination corresponds exactly with the mitigated five day cases which have occurred in Britain. They refuse the name of Small Pox to it; but as I know from my own observation, as well as from the testimony of others, that the matter from it does by Inoculation give the Small Pox, we can hardly, perhaps, with propriety deny it that name; but it should be distinguished by some strong discriminating epithet, such as is suggested above.