[284] Medical Notes and Reflections. By Henry Holland, M.D., F.R.S. London: 1839. Pp. 401, 415, 416.
[CHAPTER XXXVIII.]
UNIVERSAL COMPULSION DEMANDED—1855.
Under the terror of the 20s. fine, proclaimed everywhere by vaccinators voracious for fees, a prodigious extension of practice was effected in 1854. The vaccinations under one year of age were more than doubled; and nearly 300,000 children above one year old, to whom the law did not apply, were driven into the net, and “cut for the pox” at the public expense. Thus the public vaccinations of 1854 exceeded the births of that year by 75,000. Subsequently the rate fell off and fluctuated as appears from the following table for England and Wales—
| Years. | Births. | Public Vaccinations. | Years. | Births. | Public Vaccinations. | |
| 1853 | 601,223 | 376,218 | 1857 | 649,963 | 423,421 | |
| 1854 | 623,699 | 698,935 | 1858 | 654,914 | 468,008 | |
| 1855 | 623,181 | 464,099 | 1859 | 669,834 | 455,349 | |
| 1856 | 640,840 | 435,012 | 1860 | 689,060 | 494,942 |
Yet this extension of practice did not satisfy the medical adventurers of the Epidemiological Society. They pointed out that universal vaccination was the desideratum, and these results fell short of universality—
The Act of 1853 was intended to apply not to 65 per cent. of the births, but to every child born. A certain deduction, it is true, must be made for those privately vaccinated; and whilst there are no data for exactly estimating the proportion of these (which probably varies considerably in different parts of the Kingdom); yet taking the country throughout, there is reason to believe that not more than from 10 to 15 per cent. of the children born are so vaccinated; for it is found that in unions where particular care is bestowed upon public vaccination, the number publicly operated on is from 85 to 90 per cent. of the births. If we estimate 80 per cent. only, as the number requiring to be provided for by public vaccination, the results of last year [1854] fall short of those which should be attained by nearly 100,000.
This estimate is worth attention as sustaining a conclusion I have repeatedly tried to enforce. Prior to 1840, vaccination was a matter almost exclusively of private concern, extending to no more than 10 or 15 per cent. of the population—or, let us allow, 20 per cent.—and those chiefly the well fed, well clad, and well housed. Yet the diminution of smallpox, dating from a period in last century when variolous inoculation was in full practice and cowpox was unknown, is persistently ascribed to the introduction of vaccination which up to 1840 did not apply to more than one-fifth of the people; the four-fifths exempt from the prophylaxy being notoriously the chief factors of the disease!
Parliament having so readily consented to the Compulsory Act of 1853, it gave cause for acute chagrin that more had not been asked, when more might so easily have been had; and the operators behind the Epidemiological Society set to work to try whether the lost opportunity might not be retrieved. In a Memorial addressed to the President of the Board of Health in the name of the Society, in 1855,[285] we find a project developed which lacked nothing of audacity and comprehensiveness. First, the virtue of vaccination was asserted in unqualified terms—
Smallpox is the most preventive of diseases, differing from all other epidemic diseases in this remarkable respect, that while these latter can only be prevented by discovering and remedying the various conditions (as of crowding, want of drainage, filth, and the like) which give rise to or assist in the dissemination of the specific poison of each disease, the former may be guarded against and prevented by a direct prophylactic measure. To Smallpox, in short, there is an antidote. The same cannot be affirmed, in the present state of knowledge, of any other epidemic disease.