Ai IMAGE EVALUATION TEST TARGET (MT-3) // .*duction indiquA ci-dessous. 10X 14X 18X 22X T 26X 30X 12X 16X 2GX 24X 28X 32X tails du 3difier une Tiage Tha copy filmvd h«r« has baan raproduead thanks to tha ganarosity of: L^islature du Quibec Quebec Tha imagaa appaaring hara ara tha bast quallT/ possibia considaring tha condition and lagibiiity of tha original copy and in Icaaping with tha filming contract spacifications. Original copias in printad papar covars ara filmad baginning with tha front eovar and anding on tha last paga wHh a printad or lllustratad impras- sion, or tha bacic covar whan appropriata. All othar original copiaa ara filmad baginning on tha first paga with a printad or iiluatratad impraa- slon, and anding on tha last paga with a printad or iiluatratad impraasion. Tha last racordad frama on aach microficha shall contain tha symbo! -i'^' (moaning "CON- TINUED"), or tha symbol V (moaning "END"), whichavar appliaa. L'axamplaira film4 fut raproduit grAca k Is g^nirosit* da: L^iilature du Quebec Quebec Laa imagaa suivantaa ont 4t« raproduitas avac la plua grand soin. compta tanu da la condition at da la nattati da i'axampiaira film*, at an conformiti avac laa conditiona du contrat da fllmaga. Laa axamplairaa originaux dont la couvartura an papiar aat ImprimAa eont filmto an commandant par la pramiar plat at an tarminant soit par la darnlAra paga qui comporta una amprainta d'impraasion ou d'illustration, • jit par la sacond plat, salon la oaa. Toua las autras axamplairaa originaux aont filmte an comman9ant par la pramlAra paga qui comporta una amprainta d'impraaaion ou d'illustration at an tarminant r^r la darnlAra paga qui comporta una talla amprainta. Un daa symbolaa suivants apparaftra sur !a darnlAra imaga da chaqua iriicroflcha, salon la cas: la symbola — »> signifia "A SUIVRE", la symbols y signifia "FIN". rata 5 elure, n I2X Maps, platas. charts, ate, may ba filmad at diffarant raduction ratios. Thosa too larga to ba antiraly Includad in ona axposura ara filmad baginning in tha uppar laft hand cornar, laft to right and top to bottom, as many framaa aa raquirad. Tha following diagrama iilustrata tha mathod: 1 2 3 Laa cartaa, planchaa, tablaaux, ate, pauvant Atra filmis k daa taux da rMuction diffirants. Loraqua la documant aat trop grand pour Atra raproduit an un saul cllchA, i! aat f limA A partir da I'ar^gla aupAriaur gaucha, da gaucha k droita, at da haut an baa, on prenant la nombra d'imagaa nAcaaaaira. Las diagrammaa suivants illustrant la mAthoda. 1 2 3 4 5 6 ''%^f^ SMALL-POX AND VACCINATION. A LETTER TO THE Eight Hon. LYON PLAYPAIE, C.B., M.P., F.R.S., 4-c., 4-c.; WITH REFERENCE TO MR. HOPWOOD'S MOTION mi THE REPEAL OF THE COMPULSORY ' CLAUSES OF THE VACCINATION ACTS. BY WILLIAM B. CARPENTER, C.B., M.D., F.R.S., ^c, 4-c., Corresponding Member of the Institute of France. LONDON: HARRISON AND SONS, ST. MARTIN'S LANE, |rinhrs hi Orbiimrg to ftr ^ajtstjj 1883. ! 'I SMALL-POX AND VACCINATION. Dear Dr. Playfair, Before the House of Commons is moved to repeal the compulsory clauses of the Vaccination Acts, I desire to call your attention, and that of other Members of the Legislature, to what appear to me the very cogent reasons against this measure, drawn from facts which cannot be contested. I take as my basis Mr. P. A. Taylor's own Table^'' of the mean annual death-rate from {Small-pox per 1,000,000 living in England and Wales, from 1 838 to 1879 ; substituting for the rate 344 given by him as that of the last period (which is really that for measles) the true small-pox death-rate now admitted by him to be no more than 82.t With this I combine a similar Table for Scotland, commencing with the date at which the Registration -system was intro- duced ; and across each column I have drawn a line, showing when Vaccination was made conipulsory :— England and Wales. Scotland, 1838—42 571 1843—46 No returns. 1847—49 303 1850—54 279 . 1855—59 199 1860— C4 190 1865—69 147 1870—74 433 1875—79 82 Now, although, by Mr. Taylor's own showing, the Smull-pox death-rate had progressively come down in England and Wales from 571 in 1888-42 to 147 (or scarcely more than one-fonrtli) in 18G5-G9, * Nineteenth Century for May, 1882, p. 794. t See my letter in the Echo of May 31, 1882, and his reply thereto in the Echo of June 2. 1855—59 208 1860—64 302 1865—69 47 1870- 74 37.3 1875—79 10 3 he sees no evidence that Vaccination had anything, to do with this dechne. Such evidence is fbrnished however, by the marked irregulwrUy in the rat<'. of that redaction ; by far the greatest fall occurring in the periods which followed the two principal leo-isla- tive measures for the promotion of Vaccination Previously to 1840, the Vaccination of the rjreat bulk of the population depended upon the grTxtui- tous action of the Medical profession ; and in inanv country localities it was altogether neo-Iected The consequence of this was, that severe epidemics of bmall-pox were not unfrequent ; but as there was no general system of Registration until 1838, the actual inortality could not be determined. It was in 1840 that provision was first made for Vaccination out of the Public purse ; and it is only by separating the years of Mr. Taylor^ first quinquennial period, thft the immediate effect of that measure is made apparent. Year. Small-pox Death-rate. Averages. , 1838 1 064 1839 '.589 184^ 663 772 _ Puhhc Vaccination. 1841 400 1842 1(38 284 Admitting the death-rate of 1838 to have been exceptionally high, I do not think it fair to take the short three years' average, 772, as representing the ™;P.^\,^e''^^h-rate previously to the introduction ot i'ublic Vaccination ; but accept Mr. P A Taylor's own average, .571, of the entire quinquennial period feo, agam, as the death-rate of 1842 was excepticn- ally low, I do not claim the whole of the sudden reduction of the two years' average to 284 as the result of that measure. But it is clear that it was oilowed by a sudden and marked reduction, and tiat this reduction was continuously maintained- the death-rate being little more than one-half m the E 2 iM period 1847-49, and less than one-half m the next quinquennium.— It was in 1854 that Vaccination was made comjjulsory \n England and Wales; and another sudden reduction took place in the next quinquennial period, followed by a further con- tinuous reduction in the two succeeding periods, bringing the death-rate down in the years 1865-61) to little more titan one-fourth of what it had been in 1838-42. These facts are made conspicuous by the follow-, ing graphic arrangement : — IS Deatli- mte. GOO 600 400 300 200 100 1838-42. 1847-49 1850-54. 1855-59. 1860 64, 18G5-69. 1870-74. 1875-79. ')^0^ ' 11 i70-7t. 1875-79. Now that this second reduction in the Enirli,h death-rate was not due either to any mi ilation in 11 the health of the population, is sliown By the fict that the Small-pox death-rate in Scotland whe^e Vaccination was not then compulsory, wa3Art7ner cent h^Wier than that of ii.'gland^ for tife Urs i e ,;: ; TstT/ P'" "i *'"'*'^'^ per cental tie} ears 18^0-64.— Compulsorv Vaccinafmn h^- tiien introduced into Sco5a,id, Wd bei" i„ "a^cep ef by ts popu a ion generally without resistance the bcotch mortality immediately underwent a most extraordinary diminution ; the mean for the LmZ hve years fa Img from 392 to 47, a reduction of nf less than eiyhtu-eight per cent. .ff f° f'v *¥". .e™.rytl"ng telh in favour of the effect of Vaccination m preventing Small-pox ; since It can scarcely be contended that (W such successive reductions in the death-rate foHowLl^ directly upon three legislative measure , and 2 :m^be"friruf '^'"^^'^^^' •'"* -^^y ---'%-' But, it is affirmed, the whole case for Vaccination breaks down under the severe Epidemic visTtltion of bmall-pox which commenced in 1871, carrying up tht mean deatli-rate for the lamquennnium f87°0-7'4 to 4-i3in England, and 373 in Scotland fact thatTrF'?/''''-*^''-.^?^'™ ^ controvert the Uct that this Epidemic originated in the imnorta. tion'i^ at the end of 1870, rf a type of SmXpo^ which had not prevailed in this c/Jntry during X present century, but was often mentioned t? the "mS nt »^1 °^">%f'=='^ding 200 years as the mahgnant bearing the same relation in severity the 'confluent," tliat the confluent bears to the nnld or "discrete." Not Ji,e per ceM. oftho^ * It seems now clear that this " mali<-nan«- " f ,rr,.. ^e a n If i 6 attacked hy it recover ; and death usually takes place within four or tive days — often hefoia any eruption appears. It is the frequent occurrence of this form among the ?//i vaccinated since 1870, which has raised the total proportion of deaths in that class in tiie Sniall-pox Hospitals of London to forty-Jive per cent, of the cases ; a proportion which (having been never even approached in any modern Small- pox epidemic) Mr. Taylor and his supporters have treated as " incredible," but which the returns published by the Metropolitan Asylums Board unequivocally prove ; while even higher rates have l)een shown in North America, as, for instance, above 50 per cent, in Boston, 54 per cent, in Montreal, and above G4 per cent, {nearly two-thirds of the unvac- cinated cases) in Philadelphia (see pp. 11, 12). It is urged, however, by Mr. P. A. Taylor, that if this Epidemic is really of a more malignant cha- racter than has been known since the introduction of Vaccination, this only shows the fallacy of the ex- pectation expressed by Jenner and his followers as to the mitigation of Small-pox, if not its entire extinction. But no one has ever (that I know of) anticipated any such eftbct upon the wwvaccinated ; just as well might it be expected that Pasteur's " vaccination " of one flock of sheep would protect from the deadly charbon another flock turned into a poisoned pasture. That the vaccinated have thus been almost entirely exempt from the " malignant " type of Small-pox, is shown by the fa-ct that the proportion of deaths to cases among them in this epidemic has been but little above the average. I shall not go again over the proof of this which I formerly gf' ve ;* but shall support my case for the protective influence of Vaccination, by the figures given by the E-egistrar-Generalt in regard to the renewed outbreak of Small-pox in the Metropolis in 1881. Of the 2,P75 recorded deaths, 902 occurred * Nineteenth Centm-ij for April, 1882. t Annual Summary for 188li p. vi. fe-tl mmm 'ii^tmK' among the cortified unvacvinated, nnd 524 uiuonir the cHvtifted mmnr,^.J 885 being reported as '•doubt, till. It 18 quite obvious that even if f.he uuvac- cinated reHiduum be admitted to constifnte 15 per cent, of the Metropohtan population, the advantLe .s enormously on the side of the vaccinated ; ft (puttmg aside the " doabtful " cases) if the vaccinated portion of the population of London had died at the sarne rate as the unvaccinated, their mor^.ality would have been 5,451, or more than ten times as great as it actually was. This comparative exemption of the vaccinated is a tnbuted by Mr. Tjiylor and his party to the hffeient Sanitary conditions of the two populations ; Imt what evidence is there of this ? Doubtless some ot the large areas which were almost entirely un- visited by this peculiarly localized epidemic, con- tamed a population on the whole more favourably circumstanced in this respect than that of the North- east and South Districts, in which 68 per cent, of the total bmall-pox mortality occurred.'"' But what about the nearly two million vaccinated subjects mhabiting the latter, who, according to Mr. Taylor had no protection whatever, and were exposed! equally with the unvaccinated, to the infection ? Ihere is a more cogent way, however, of testing Mr laylor s doctrine. If Vaccination affords no pro- .ection, the ages at which the vaccinated and the un- vaccinated respectively die should correspond ; but the e^ax:t reverse of this is shown to be the fact by the Registrar-General's latest figures, as by all previous compp^-isons. Of the 962 deaths among the unvac- cinated three-fowrths (speaking roughly) occurred mder the age of 20, the disease showing the same fatality among the young at present, that it used to do ill pre-vaccination times : but of the 524 deaths among the vaccinated, three-fourths occurred ahove the age of 20, -that is to say, among adults, who * Kegistrar-General's Annual Summary for 1881, p. vii. ii|l a had outgrown tlielr original protection, arid Imd not (so far as was iif- irtained) renewed it by )'<3vaooina- tion. The pronoition of children under 5 years old, vaccinated however iudifierently, that died in tlie epidemic of 1S81, was quite insignificant, being only 5-2 per cent, of the 524 deaths among the vaccinfited ; whilst the proportion of deaths among wwvaccinated children under 5 years of age ^/a8 38-2 per cent, of the 902 deaths in that class. (Op. cit., p. vi). T(3 the ev'dcnce of the protection afFo*-ded by re- vaccination which I have given elsewhere, ^^ I "now add the following, the cogency of which can scarceh' be over-estimated : — In Germany, vaccination Is compulsoiy in children under a year old ; and every ma i on his entrance into the army is reyaccinated. In /ranee, on the other hand, vaccination is not compub^ry, and revaccina- tion is not enforced on army-recr.iits. During the Franco-German War of 1870-71, the total number of deaths from Small-pox in the German array was 263, while in the French army it was 23,4(59, or very nearly ninetij times as great. Of the 263 Small-pox deaths among the half-million or more of men bi-ought into the field on the German side, it may be safely said that as many would have suffered in this Epidemic if they had been all "protected" by a previous attack of Small-pox ; and no one now claims for vaccination a greater power than this. What reason is there to doubt that the adoption of com- pulsory revaccination in the French army would have saved a large proportion of the 23,469 who died of Small-pox, as well as an enormous amouno of sickness i The testimony as to the protective power exerted by revaccination upon nurses aiid hospital-attendants during the recent severe epidemics in the United States and Canada, is fully confirmatory of that of our own Small-pox Hospital superintendents. * NineUenth Century for April, 1882. 'isiw^- D The control which Vaccinat'.r^ has exerted and 18 exevLr.g, over the ravjiges o: Jr^ deadly pest, is further shown by the fact tTia even durin.r the worst period of Its epidemic spread, the niear rate of Small-pox mortahty was only a little more than hree-wurths that of che period 1838-42. the later hein^r 43.}, and the earlier 57 1 ; whilst upon its cren -al subsidence, the deatli-rate of Engh.^ 1 and Wales feU during the next quinquennium to 82, -a figure far lower than it had ever previoush/ approached. The reduction was still more remarkable in Scotland for the Small-pox death-rate of the epidemic years (which wan somewhat lower than that of the years ieGO-4 nnmediately preceding the introduction of compulsory vaccination) dropped suddenly from 375 to 10 and Jia« tor the last fivD years averaged only 4 per million.* J t Now it is very easy to treat this extraordinary tail as an etfect of the previous epidemic prevalence ot hmall-pox, which gave it to the great bulk of the subjects susceptible of the disease. But this theory fails in two particulars. In the first place it is totally unsanctioned by experience, the amount of reduction being altogether unprecedented, as Mr laylor s own Table shows ; and, in the second place It does not accord with the fact that, though the disease is still present among us in undiminished riiajgnity (as is proved by the occurrence of local outbreaks in the Metropolis and elsewhere through the whole series of years since 1874), it attacked scarcely any of the four millions of infants born and vaccinated in England and Wales during the years 1875-9, or of the 800,000 born and vaccinated in * In drawing attention to the fact that the total nur>.ber of •'^jnall-po.v deaths m all Scotland in 1878 was only four, the Itegistrar-Geneml lor that kingdom remarks—" This is a most sutistactory cn-cumstance, for which we have no doubt in a great measure, to thank our excellent Vaccination Act, and the common sense of our people, which does not dispose them to receive without qualification the statements of the Anfi- vaccinators." 10 Scotland during the same period. And this con- dition of things has continuod, as regards the Pro- vinces and Scotland, to the pr(!sent time ; the only considorahlo exception to it being fnrnished hy the oiithronk of 1881 in London and the surrounding couutias. I^ut this outbreak, as already shown, was almost exclusively confined (I) to the known unvaccinated, (2) to tliose (ranked *' doubtful ") whose arms showed no sign of vaccination, and (3) to vaccinated adults who had not renewed the pro- tection they had outlived. I feel fully justified, therefore, in re-affirming the protective power of Vaccination, as eminently shown m the control it has here exerted over this most deadly Epidemic ; more especially since Legislative provision Wiis made, by the compulsory appointment of Vac- cination othcers, for the more thorough enforcement, in the country generally, of the Law which it is now p~ tposed to repeal. Of that enforcement, the locali- ties in which it has been resisted are receiving the benefit ; just as unvaccinated families who are living in parts of London not visited by Small-pox, are en- joying the practical imnuniity conferred by the " pro- tection " of the great bulk of their inhabitants. Of what would be the consequence of the aboli- tion of Tonipulsory Vaccination among ourselves, we may judge from the recent experience of the United States, where the system had never been adopted either by the Federal or the State Governments. The malignant t}pe of Small-pox poison carried across the Atlantic in 1871, was extensively diffused over the American continent in succeeding years, causing severe epidemics in most of its great cities. During a visit which I paid in the latter half of last year to the United States and Ouiada, I made a special point of gaining all the information I could from the most autlientic sources in regard to this Epidotnic ; and I everywhere received the same testimony to its extreme severity among the un- vacc'nated population. Owing to the former absence ^J^^&^^j^j^seSStUt 3k«F(|gr«. 11 of any public proviHlon for Vaccination in the United fetatcH, the proportion of un vaccinated was there much greater tlian in tlii.s country ; and no uiconsi(i(3rahle number of pcraouH amor.ir the UDper classes were deatitute of its i,rotection. The disease prevailed epidemically in Roston (NJil.) in 1873 ; and the number of dciithw out of a population of 205,000 was 1,045 in thirteen months, or at the rc,,te of '^65 for twelve months. This was a far heavier mortality in proportion t the population, tlian even that of London ,n 18/., for the ^letropolitan population, hcmg tlien VZS times that of lioston, its pro-ratd mortality would have been 11,809, or almost exactly mi/ P'r^ cent, more than the actual mortality of London m that year, which was 7,912. Now it ciiinot be said that the general sanitary conditio^ of Boston IS worse than that of London ; but we are exijressly told that " the disease in its most malignant and contagious form ivas present in every part of the cify."^'' The total number of cafies was 3 187 and tlie number of deaths 1,045, being thus at' the high rate of nearly one-third of the whole number attacked ; mainly owing to the terrible proportion of deaths to cases— considerably over 50 per cent — among the wnvaccinated. In Philadelphia (in which city the labouring population is remarkably well housed, "tenement- dwelling being almost unknown), the number of ca*Y'.s ot Small-pox m the twelve months' epidemic of 1871-2 was 2,3;J7; nearly equalling the total number of cases (2,517) of this disease during the previous thirty years.f The total of deathstrom bmah-pox during the previous thirty years had been only 429, or at the rate of 17 to 100 cases ; but in the Epidemic of 1871-2 the total number of deaths was 743, raising the death-rate of those attacked to .52 •15, or nearly double the previous average. That * North Amenran Review, Apri], 1882, p. 370. H \l ^^\l ^Ji'""'' ^^''"""^ ^''^"^ *'»<^ J^'Toifc of" the Board of Health of the City of Phihidelphia for the year 1872. ■p lyMiv ^' ^ 1 ■]' ^'^^K'9 |B|ii mm 12 this excess was mainly due to the large proportion of deaths among the i^ivaccinated (of whom a consider- able proportion were negroes), is shown by the fact that putting aside the 51 cases in which there was no evidence m regard to previous vaccination, the numbers and percentages of deaths among the two classes were as follows : — Vaccinated • , Unvaccinated Admissions. 1,029 697 Deaths. 276 449 Per Cent. 16-94 64-41 Thus while the proportion of deaths to cases among t.iose who had been vaccinated, whether well or indifFerentlv, scarcely exceeded one-sixth, the pro- portion among the unvaccinated was nearly two- thirds, or almoscfour times as (jreat—Surelv in the face f such evidence, Mr. P. A. Taylor and" his sup- porters will no longer contend that there is nothing peculiar about this Epidemic, or continue to treat as incredible the statistics of our own Metropolitan bmall-pox Hospitals, which showed a percentage of deaths among the unvaccinated amounting to nearly 45 per cent. '^ I further learned that this Epidemic had been particularly fatal among the coloured population of some of the Southern States, where Vaccination, formerly enforced by most of the planters on their slaves (lor the protection of their " property ") had been of late very much neglected. I was personally assured by a medical officer, who had beeii sent by the United States Government to take charge of a femall-pox Hospital in the South, that the negroes smitten with this malignant "black-pox" often fell down by the road-side ; and that such was tixe prevalent terror at this deadly plague, that these poor wretches were left untended by their own people, whilst he himself could with difficulty incliice a-*r««»'» n 13 his hospital attendants to bring them in, so certai ■was their speedy death ! In Canada, the severity of the Epidemic in flitterent locahties bore a most direct relation to the proportion of wwvaccinated. Quebec, wliere vacci - nation had been all but universal, was passed over very lightly, notwithstanding the continual fresh importation of the poison. Among the immigrants, the mitigatiye efficacy of previous vaccination was very marked. Thus of iSl cases admitted into hospital between May, 1874, and June, 1875 the' superintendent reported that among 54 returned as vaccinated, only one died; while of 69 unvaccinated 37 died, and of the :12 who recovered most were disfigured. In Toronto and Three Rivers, where vaccination had been general, there was scarcely any femall-pox. But in Montreal, where the French Catholic population had, as a class, been prejudiced against vaccination by a medical man of their own nationality and religion, the epidemic broke out with great severity. The Municipal authorities endea- voured to check it by compulsory Vaccination ; but this was resisted even to the extent of public rioting. Having heard of this at the time from my brother the late Dr. P. P. Carpenter, who spent the last twelve years of his life in Montreal, I made a point of enquiring, during my stay there in August last, as to what had been the subsequent course of affairs. 1 learned, on the very best authority, that the objec- tions of the French CathoHcs had been completely overcome ;-partly by the public exposure made by the Medical profession of the ffagrant mis-statements by which they had been misled,- partly by the very decided testimony in favour of the protective influence of Vaccination, given by the Catholic bisters who took charge of the nursing in one of the femall-pox Hospitals,— and partly by their recoff- niuon of the fact, that the Irish Catholic population <)t their own class, living under the same conditions, wjtii themselves, but /or the most part vaccinated * 14 almost entirely escaped. Vaccination being now as well carried out in Montreal by its Officers of Health, as in the other great cities of the Dominion, Small- pox has become almost entirely extinct. So sensible are the highly intelligent people of the United Sl,ates of the value of Vaccinntion, that although they do not consider direct compulsion a proper subject for Federal or even for State legisla- tion, yet they are now generally adopting a method of indirect compulsion, which has long been in use in many Continental countries — namely, the vaccina- tion of the whole existing School-population by Public Vaccinators, and the refusal to admit any child into the Public Schools without a Vaccination certificate. Of an admirable result of the adoption of this system— showing itself in the remarkable immunity of the whole School-population of San Francisco from a recent outbreak of Small-pox which originated in the Chinese quarter, and rapidly spread among the adult population through even the best parts of the town — I last year gave an account,''' drawn from the Keport of its Officers of Health. I shpll now cite another case from a Circular addressed on the 20th September, 1882, by the Secretary of the Board of Health for the State of Illinois, to County Superintendents, School Boards, and Teachers, with reference to the " School Vaccina- nation Order" of the State Board of Health, pro- mulgated in December, 1881. At the date of this Order more than tiuo-thirds of the School-population of Illinois proved to have been unvaccinated ; but subsequently to January 1, 1882, no fewer than 1,300,000 vaccinations had been performed, raakino-, with those of the previous nine months, a total of two millions. " Until these measures were fairly under way, there was a steady increase of Small-pox in the^ State ; but coincidently with their successful operation came the decline of the disease, until now * Nineteenth Century for April, 1882, p. 544. i^9|: €M^i^^^. sen in use e vacoina- 15 it is practically at an end in Illinois,"— but for a lew small local outbreaks rtwow^; unprotected persons which showed that thf poison Jiad not lost its virulence : — . if "In Munroe county an outbreak was caused by an infected StatP?T«l r\'"*° '^'^ Mississippi River, which lodged in Staten Island. Some unvaccinated persons came in contacfc with the mattress, and a number of cases ensued. Thence 1 was earned into Randolph county, where it found a number of other unvaccinated individuals near Prairie du Rocher and caused an outbreak among them, with 3 deaths at date of S report In Alexandra county, some 19 cases and 4 deaths have resulted from infection brought from the river ; all these were among unvaccinated persons." With this may be contrasted the following re- sults of the enforcement of the Vaccination Order upon the School-population of the State, " demon- strative, as the Secretary justly remarks, " of its wisdom and utility :"— \.J/''''^' ^f'^^'Sth^J^onsands of cases of Small-pox which have occurred m the State since the Order was issued nnfnZ IS reported of a Public Scholar who had been prol^:: recently vaccinated. Several cases, however, with a We pro^ portion of deaths, have occurred among Scholars who^eifher had not been vaccmated at all, or not since infancy. becmd. In no instance where the Order was thoroughlv enforced has it been necessary to close the Public Schools, eveJ when Small-pox existed in a community. On the other hand Shoals have been broken np a,ul .ladies interrupted in a number t ^?f*^"«««' ^h^'-e-'^^ «l^own by the returns in this oS- the Order had been neglected." With reference to the statements sometimes met with, of serious results from Vaccination, the Secretary adds that :— «f 1 ^t^^A^ f^i^}^ ^'^ personal duty to investigate every report of the kind which has come to his knowled-e the net rlfnlf Ko been that .ot<>ne such report has been sr^bTaftM. HeTs bee^ wholly unable to find any evidence of a death caused hv vaccination n this State, or'even of permanent nlury^rserioul illness, due to the operation alone." J" J' "^ seiious I have received from several other quarters the same testimony to the al>8ence of injurious results in an aggregate of recent vaccinations, now amount- ing to many millions, that have been made under r ■ t ■■• ; i !i. public authority in the United States, with the pure Dr MlSoft^K"^ \r '^'' establishment S Ur. Martin of Roxbmy, Massachusetts; and havino- S withth^ h*;^' '''""'^''^y '^ the 'conscient "uf lliere wf nn t" ^^^^ l^"^?^ '' there supphed. Ll ' T ^^"^ ^^^^^ ^^^'^' been some most werT wT to'\r "" f P"^"^^^^ infection wS Znomvtnf • ^ employment (from motives of so rce ^ihl ''^"^^*^"^ *'^««^ another source, M^hich proved, on microscopic examination thist :tei ^''' P-e-Pu-'e^-The^raToi attentlT ''°™?™ese/ecent experiences to the attentive consideration of those, with whom rests the grave responsibility of .leciding whethr,mder the guidance of Mr. P. A. Taylor, fnd in So " t„ to the general voice of the Medical Professfon ev mUundo a system, under which the death-rate from m"f Tt^ '•'''"" '-'^ ^'•- ^*y'°''« "™ Tabl - S We infd * •=''"-^T"'''"S -'■""^ f"'- Sootland-to wMch has r^^^^'" •"°""™' '''^""*'""' ^"'' Epidemic lho!f^'°i'^ ™""" ""~" ''-"'t^ «» -cpiaemic whose virulence among the unnrotected populations of Borneo, the Gold Coast, anrMada ffascar (aa attested by recent Consular r ports) diots most of%r ^^^V'J?''% than that whfch LZZ z^:2s;ztz f^^r '- ^"^ - ■- ^^J^"I^KuleV^^^^^^^^ Of the advocates of Vaccination, in order to coverlts t^d^'SV^^' ^^^^"F^- «f yol hSuI: wm Tave now VL '1^ ^^""''^ '^*, ^^ *^^ additional facts I iiave now adduced from authoritative sources. I remain, Dear Dr. Playfair, Yours faithfully, London, WILLIAM B. CARPENTER. April 23, 18S3. HABBlgON AND SONS, PEINTKES .N ORB.NAR, ~o UEH MAJKSTV, ST. MABTIN', XA.n. .ij4 I the pure hment of id having scientioua supplied. )me most on, which lotives of another nination, moral of 5s to the >m rests )r, under )poHition on, they ate from 'le — still and — to •n ; and lits an 'otected Mada- ) shows 'avaged n more f'orner le part )ver its isewill facts I rER. INi.