VACCINATION AND SMALLPOX.

Daily Telegraph (Napier), Issue 3135, 15 July 1881, Page 4

VACCINATION AND SMALLPOX.

Sir, —The mind of the public is evidently so unsettled as to the ' protective' influence of vaccination that I venture to think it may not be indisposed to listen to what can be said on the question by one who has watched its course for more than half a century, with scientific as well as philanthropic interest, and who claims as complete a freedom from professional prejudice as any outsider—his sympathies in this matter being, not with the ' doctors,' but with the public, whose welfare is with him, not the primary, but the whole consideration. _It happened that my attention was especially directed to the subject at the very coynmencemei.. of n.y medical apprenticeship, in 1828, by the number of cases which then fell my notice of total and irremediable deprivation of sight by smallpox during the first months of infancy, my master, Mr J. B. Estlin, of Bristol, having a widespread reputation in the West of England and South Wales as an ophthalmic surgeon. Strict inquiry being made in every case as to previous vaccination, the reply was invariably negative. During the eight years of my attendance at Mr Estlin's eye dispensary I must have seen at least a hundred such cases (I well remember reckoning tbe average at more than one a month) and not one of these occurred after vaccination.

It was impossible for me, therefore, to be otherwise than strongly impressed with its " protective " agency, and I took an active part, both while I remained a pupil and during the few years in which I practised my profession, in diffusing without fee or reward what I regarded as its unquestionable benefits. That these benefits have been latterly called in question is due (as it seems to me) to three causes —first, the entire ignorance of the present generation, save the few who have specially studied the medical history of the last century, as to tho ravages of smallpox before the introduction of vaccination by Jenner at the beginning of the present; second, the exaggerated claim to complefe protection originally advanced by the advocates of vaccination ; and, third, the strangely illogical idea by which the anti-vaccinationists of the present time are possessed, that what is not complete protection is no protection at all. To each of these points, therefore, I must address myself as briefly as possible : — 1. There can be no question of the congenital liability of almost every individual born into the world to be, once in his or her life, the subject of certain diseases known in medicine as the Exanthemata — measles, scarlatina, and whooping-cough ; the cases being very rare in which persons exposed to tbe infection of these diseases during early life escape being attacked by them. This is shown in the most remarkable way when the infection of any one of them ia conveyed to a community among which there are few or no persons who are c protected' by having previously been its subjects. It will be in the recollection of many of your readers that the Fiji Islands were thus ravaged by measles not many years ago. It is within my own knowledge that the population of the Faroe Islands, old and young, were similarly affected some years further back, scarcely any escaping, save a few old people who had suffered in an epidemic 65 years previously, and the inhabitants of Suderoe, who kept themselves in a rigid quarantine. The smallpox belongs to this group of diseases and that the congenital liability to it is at least as great as it is to measles are amply proved by the medical records of the past century. That it was then quite exceptional for any one to reach middle age without having been the subject of smallpox is clearly shown by the arguments urged in favor of smallpox inoculation. Of the deaths among children only 10 years of age (a far higher percentage then now) it was estimated that half were due to smallpox; and of the total mortality of the country, deaths from smallpox were estimated at an average of 8 per cent. But the universality of the liability to smallpox was best shown by the ravages of its epidemics in communities not ' protected 'by a previous attack. Thus in Iceland, whose isolated position kept it free during very long periods from epidemic invasion, its well-kept records show that in 1720 the introduction of smallpox caused the death in a few months of nearly onefourth of its entire population ; so that, according to the ordinary rate of mortality from the disease, almost every one must have been attacked by it. And the readers of Mr Catlin's ' North American Indians' will recollect the almost entire extermination of the tribe of ' polite and friendly Mandans' by its fell ravages. The antivaccinationists have to show that the contenital liability to smallpox is les3 now than formerly, and to account for the broad fact that, though at least 19-20ths of our present popul-tion have never had the smallpox even in its mildest form, the number of our teeming millions who suffer in th c severe st small-pox epidemics of modern times is a very|small fraction of those who were affected by them in the corresponding period of the last century, when the population of England was scarcely a third of what it is now, and the great bulk of it was' protected' by having been previously small-poxed. 2. In the first days of vaccination it was affirmed, on the basis of a far too limited experience, that it afforded a complete protection against small-pox. This claim, however, was early negatived by tbe occurrence of small-pox in persons who had been successfully vaccinated ; but it was remarked that the disease was unusually mild in its type, the mortality being small and disfigurement and blindness rare. Hence the term ' modified' small-pox came into use as tbe designation of the type of the disease which generally (it was maintained almost invariably) presented itself in vaccinated subjects. But in process of time the advocates of vaccination were startled by the not rare occurrence of small-pox m its worst form among persons who had undoubtedly been thoroughly cow-pocked, and this of course was a severe blow to the believers of its efficacy. On careful inquiry, however, it proved that so large a proportion of such cases occurred among adults or adolescents that there was obvious ground for the belief that the ' protective' effect of early vaccination had died out. The practice of revaccination was then introduced, and it was found that when performed on adults who had been vaccinated in early childhood so considerable a proportion took the cow-pox a second time as to indicate that its ' protective' influence, whatever its nature, had expired. I may be allowed to quote my own case as an instance. Having myself been successfully vaccinated in infancy, I was revaccinated at the age of 11 and 12, but did not then take the cow-pox a second time. Having accidentally scratched myself with a charged lancet about 12 years afterwards, a very characteristic vesicle developed itself. The ' protection ' which the want of success of my first revaccination showed that I still enjoyed had died out by the time I arrived at manhood, and I might have been attacked by small-pox when exposed, as I was, to its poison but for the new protection I unintentionally gave myself.

Facts of this kind all tended to confirm the original belief of Jenner that cow-pox and small-pox are essentially the same diseases, tbe protection afforded by successful vaccination being just the same kind as that given by a first attack of small-pox. There can be no question that second attacks of small-pox did now and then occurr in old times, just as second attacks of measles, scarlatina, &c, do now • and this especially when the first attack occurred in infancy or early childhood, as in the historical case of Louis XV. Tho fact seems to be, alike in regard to cow-pox and small-pox, that, whatever be the constitutional effect left by the first attack, the original liability is much more likely to be reproduced during the period of growth, when tissue-change is very active, than it i 3 subsequently. And this obviously points to the importance of revaccination at or about the termination of that period, and to the probability that the protection it affords will then endure through

life. How completely this scientific anticipation is borne out by experience is proved by tho facts lately recorded in your columns as to the absolute immunity from small-pox enjoyed by tho 1000 nurses and attendants in the Asylums Board hospitals, who had undergone revaccination, although exposed to small-pox infection in its severest form ; and tho almost complete immunity enjoyed by the 10,000 employes in the Post-office, of whom a large number must have been in the way of_ catching the disease. Tho anti-vaccinationists have to meet the most cogent facts; which, to the scientific mind, carry the assured conviction that if it were possible to enforce, not only vaccination in infancy, but revaccination at the age of, say, 18, smallpox might be completely exterminated from our islands as it has been from Malta, when my scientific visits to that island in 1870 and 1871 gave me the opportunity of inquiring from its medical authorities as to the effect of the compulsory vaccination long in force there. And it is to be remembered that this immunity cannot be attributed to the insular position of Malta, for it is, from its constant communication with every Mediterranean port, quite as liable as Great Britain to have zymotic poisons brought in from without. That small-pox still lingers among ourselves is thus plainly owing (1) to the persistence of an unvaccinated residuum ; and (2) to the existence among the vaccinated of a certain proportion who (like those who in old times became the subjects of second attacks of have ;i 'quired a renewed liability which revaccination would destroy. That Jenner's view was correct, and that cow-pox is really small-pox modified by passing through the cow was proved many years ago by the experiments of Mr Ceeley, of Aylesbury, who succeeded in communicating true small-pox from a human patient to the cow by covering the latter with blankets taken from the former, and in reproducing cow-pox in the human subject by inoculation with lymph taken from the vesicles which appeared on the surface of the cow's skin. And it is not irrelevant to mention that analogous means _of mitigating the severity of various animal plagues are now being sought out and put in practice by our most advanced pathologists with a success which led Professor Lister to express to the meeting of the British Medical Association last year confident expectation that like means will be found before long of substituting a mild, innocuous disorder for the severe and often fatal infections of measles and scarlatina.

3. On the utterly illogical argument- of the anti-vaccinationists I need not waste many words. Suppose that Jenner had discovered that the eating some common wild herb, producing a slight temporary disorder, would afford the same ' protection ' against an attack of small-pox as the having once had tbat disease, say to the extent of 99 out of every 100, what would be thought of the mental capacity of the man who should refuse to make his children eat of that herb because it did not protect the 100 th? Suppose, further, that it was found by experience that the protection given by such eating died out during childhood, and that it could not only be renewed, but made almost absolute by the eating of the herb a second time at the age of 18, what should we think of the good sense of a young person who should neglect, still more should refuse, thus to obtain immunity for himself and to prevent his becoming a source of danger to others ? And, finally, to meet the objection which has been raised against vaccination, on the ground of the admitted, though extremely rare, transmission, with the vaccine lymph of some communicable poison which due care would prevent, I would ask whether it would be a sufficient reason to refrain from, eating the protective herb that once in 50,000 cases injury had accrued from some poisonous plant having been gathered with it which due caution on the part of the gatherer would have eliminated ? If the neglect of such caution were visited with severe penalties, I make no doubt that we should soon hear no more of its sad results, I am, Sir, your obedient servant, William B. Carpenter, m.d., p.r s. May 7.