the points from which the contagion spread and kept up the disease. So obvious was this effect of the practice, that in many countries it was forbidden by law. In Great Britain, however, it continued and continues till this day; and that not merely in hospitals, but patients have been permitted to be vaccinated abroad, and thus to carry the contagion among thousands whose poverty or ignorance prevents them from having recourse to the same safeguard, and whose miserable habitations and filthy habits give certainty and efficacy to the poison, whenever they are exposed to it.

It would not be difficult, we believe, to shew that in most instances of the epidemic, the small-pox has been first communicated or afterwards disseminated by means of the variolous inoculation. The disease when introduced into the city of Norwich remained almost dormant for nearly a year, affecting only a few individuals, until an alarm being excited, four or five hundred persons were inoculated, each of whom thus became the centre of contagion. And in the adjoining country,

'Itinerant inoculators, irregular practitioners, and old women introduced and extended the disease to all quarters by inoculation, regardless of the admonitions given them, because the law authorized no direct measures against them. These disastrous effects were most severely felt in the county of Norfolk, the disease being thus continually introduced into parishes previously free from it.' Cross, p. 219.

This injurious result of the practice of inoculation is depicted by many in the strongest and most feeling language. One surgeon states that, from the first person who casually fell down with small-pox in his neighborhood, forty were immediately inoculated, spreading the disease in all directions; another, that in four parishes out of five, where he attended variolous patients, the contagion was brought by an irregular practitioner, who went about inoculating; a third, that a child went to an adjoining town to get inoculated, and became the centre whence the contagion spread through all the parishes under his care; a fourth, that a man of bad character and not at all acquainted with medical subjects, had, for a small gain, made it his business to extend the disease far and near.' p. 270.

Of the country surgeons in the neighborhood of Norwich, thirty-eight from various motives consented to communicate the small-pox by inoculation during the epidemic. Of those whom they inoculated, twenty-one died, and according to the usual proportion of deaths, the whole number who had submitted

to the disease under regular practitioners would be six thousand three hundred. Medical men, however, inoculated comparatively very few during the year of the epidemic. The greatest inoculators were the parents of poor children, farriers, blacksmiths, tailors, shoemakers, and old women.'

The effect which the introduction of the variolus inoculation had, to increase the actual number of deaths from smallpox, has been strikingly illustrated by sir Gilbert Blane, in the Transactions of Medical and Chirurgical Society of London, by a comparative statement of the mortality in London during four different periods of fifteen years each. The first includes the fifteen years immediately preceding the introduction of the variolous inoculation which took place in 1721; the second an equal length of time taken after the practice had become well established, beginning with the year 1745; the third refers to the fifteen years immediately preceding the discovery of vaccination ending in 1798; and the fourth embraces fifteen years, beginning with 1804, after vaccination had become extensively practised. The result of his computations exhibits the ratio of the number of deaths from small-pox to the whole number of deaths.

In the first period 1 death in 12.7 or 78 in 1000 were from small-pox

Applying these estimates to the whole population, sir Gilbert calculates that 23,134 have been saved during the last period in the metropolis of that country, which has less adopted vaccination than any other civilized country in the world.' It is not a little remarkable that the nation, which has the glory of having discovered vaccination, should have done less than any other towards the extermination of the small-pox, although in none have the medical profession been more generally convinced of its value, or more cordially disposed to co-operate in its diffusion. The continuance of the practice of inoculation, which has been relinquished by the good sense or forbidden by the laws of other communities, seems to be the principal reason why a greater effect has not been produced. By the laws of Great Britain, the public propagator of small-pox, who for a trifling fee jeopardizes the lives of thousands, is only liable to an action for misdemeanor ; and of the execution of the law which authorizes this there is only one instance, and that was of a parent who carried her

child th small-po eight die the publi fathers ha

ous in its convince ancholy i tions of s Britain, t would p

was in th fusing sm much les towns, so

ure to this were know years befo Even v individuals the power extermina upon the principal to settle e year 1804 with the ex with that d introduced forced. B received at prentice to a ed, unless effect has be

ly been hear hundred ind alone, for th cination, in in the whole eight have o effects of vac authority, ha

child through the streets of London whilst laboring under small-pox, from which eleven persons took the disease and eight died.' The pertinacity with which the ignorant part of the public cling to their right of having the small-pox as their fathers had it, would be not a little ridiculous, were it less serious in its consequences. And these consequences, we are convinced by the statements of Mr Cross, must be more melancholy in the country than in cities, and could the calculations of sir Gilbert Blane be extended to the whole of Great Britain, the proportional increase of mortality from inoculation would probably be found greater. In fact, he observes,' It was in the rural population that the effect of inoculation in diffusing small-pox was chiefly felt. In this situation there is much less intercourse of persons with each other than in towns, so that not only many individuals escaped from exposure to this infection during their whole life, but whole districts were known to have been exempt from it for a long series of years before it was universally diffused by inoculation.'

Even were vaccination far less effectual as a safeguard to individuals against the small-pox than the variolous inoculation, the power which it unquestionably possesses of completely exterminating the small-pox, gives it claims infinitely superior upon the attention of the world. This is and ought to be the principal object in view, and a few statements will be sufficient to settle every doubt of its practicability. So soon as the year 1804, no cases of the small-pox occurred in Vienna, with the exception of two strangers who came into the city with that disease upon them. In Denmark, vaccination was introduced in the year 1800, by laws which were rigidly enforced. By these it was ordered that no individual should be received at confirmation, admitted to any school, bound apprentice to any trade, or married, who had not been vaccinated, unless he had formerly undergone the small-pox. The effect has been that small-pox no longer exists and has scarcely been heard of since 1808; and whereas five thousand five hundred individuals died from it in the city of Copenhagen alone, for the twelve years preceding the introduction of vaccination, in the year 1805 not a single death occurred, and in the whole Danish dominions only one hundred and fiftyeight have occurred since the year 1802. In Prussia the effects of vaccination, diffused with the assistance of the public authority, have been almost equally decisive. Formerly, forty

thousand deaths were calculated to take place annually from the
small-pox, whilst in 1817 they had been reduced to two thou-
sand nine hundred and forty-the total number from all causes
amounting to three hundred and six thousand seven hundred
and twenty-eight; so that the proportion of deaths from small-
pox to those from other causes has been reduced from one in
seven to one in one hundred and four. And in Berlin, where
the greatest exertions have been made to introduce vaccina-
tion universally, but where also they are much more liable, as
in all great cities, to the introduction of small-pox, the pro-
portion of deaths from that disorder was, in 1819, only one in
two hundred fifty-four, whilst only two years before in Lon-
don the proportion had stood as one in nineteen. In the prin-
cipality of Anspach in Bavaria, containing a population of
two hundred and sixty-six thousand four hundred and six in-
dividuals, five hundred died annually of small-pox in the years
1797, 1798, and 1799, and sixteen hundred and nine in the
next year, 1800, giving a proportion in the former years of
about one death in thirteen from small-pox, and in the latter of
about one in four or five. In this state of things the cow-pox
was introduced, and its diffusion promoted by laws which im-
posed fines and penalties on those who refused to submit to it.
Inoculation for the small-pox was forbidden; and so posi-
tive has been the effect of the extension of this practice that
from 1809 down to 1819 only four cases have occurred of the
disease, and not a single death, and this too while the small-
pox
has been prevailing epidemically in the neighboring king-
dom of Wirtemberg. In France prizes are annually distribut-
ed to those surgeons who have vaccinated the greatest number.
The report of the central committee of vaccination for 1816
exhibits a striking view of the benefits derived from the prac-
tice in a single year. In 1815 from the unsettled state of pub-
lic affairs it had been neglected, but was resumed in 1816 with
great vigor. The effects were immediately perceptible from
a comparison of the number of cases and deaths from small-
pox in the two years. The vaccinations were increased and
the cases of small-pox decreased in number one third, the
deaths were not so frequent by one half, and the instances of
disfiguration, blindness, &c. were proportionally lessened. The
same committee had previously reported the extinction of the
small-pox at Lyons and other districts. In Lombardy the
small-pox had disappeared from all the large towns in 1808,

and in Mi neva, as s disease; a spread, the having cea Blane was Spanish co

energy and there had case of it;

as regularly tism; that Peru; nea pulsory inte vaccination. Evidence greater exte in our own capable of d For although ing under th seldom, if e selves. It i

we may not now owe o inroads of th

mer times I among the be adopt the ne great fear is. ease, society can seldom be and uneducat can feel certai every thing ha activity of tho

*In 1721, the visited Boston an hundred and eigh and forty-four di inhabitants at that this period.

and in Milan had not been known for several years. In Geneva, as stated by Dr Oder, vaccination has extirpated the disease; and even when casually introduced, it does not spread, the inhabitants, from the universality of vaccination, having ceased to be susceptible. In 1811, as sir Gilbert Blane was informed by a delegate from Lima in Peru to the Spanish cortes, 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 small-pox, but no case of it; 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.'

Evidence of this kind might be easily multiplied to a much greater extent, but this would be unnecessary when we have in our own country a daily example of what vaccination is capable of doing towards the extermination of the small-pox. For although probably not a year passes that subjects labouring under this disease are not introduced among us, yet it is seldom, if ever, that they extend the disease beyond themselves. It is our duty to take care that by an indolent security we may not be induced to neglect the means to which we now owe our safety, and lay ourselves open to the future inroads of that pestilence from which our country has in former times most severely suffered.* There is little danger among the better classes of the community, that they will fail to adopt the necessary precautions for securing themselves. The great fear is, that, from the long continued absence of the disease, society will cease to take care of the health of those who can seldom be induced to take care of it themselves, the poor and uneducated. We have no public means by which we can feel certain that vaccination will be kept up among them; every thing has been left to depend upon the benevolence and activity of those practitioners who are principally applied to

* In 1721, the year in which inoculation was introduced, the small-pox visited Boston and the adjacent country. In Boston, five thousand eight hundred and eighty-nine suffered from the disease, of whom eight hundred and forty-four died; an immense proportion, considering the number of inhabitants at that time, and nearly equal to the total number of deaths at this period.