IMAGE EVALUATION TEST TARGET (MT-3) k A {./ :A /.A 1.0 I.I 11.25 Ik |50 US u ■UUb US 1^ 1.8 U 11.6 % VQ A> '/ HiotDgraphic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Institute for Historical IVIicroreproductions / Institut Canadian de microreproductions historiques Technical and Bibliographic Notes/Notes techniques et bibliograph'^^ues The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. D D D D D D n Coloured covers/ Couverture de couleur I I Covers damaged/ Couverture endommag^e Covers restored and/or laminated/ Couverture restaurde et/ou peliiculde I I Cover title missing/ Le titre de couverture manque Coloured maps/ Cartes gdographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) I I Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ Relid avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ Lareliure serrde peut causer de I'ombre ou de la distortion le long de la marge int^rieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II So peut que certaines pages blanches ajoutdes Icrs d'une restauration apparaissent dans le texte, mais, lorsque cela 6tait possible, ces pages n'ont pas 6t6 filmdes. Additional comments:/ Commentaires suppldmentaires; L'Institut a microfilmd le meilleur exemplaire qu'il lui a 6t6 possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent mo'*M\er une image reproduite, ou qui peuvent exiger une modification dans la m6thode normale de filmage sont indiquds ci-dessous. I I Coloured pages/ n D Pages de couleur Pages damaged/ Pages endommag^es Pages restored and/or laminated/ Pages restaurdes et/ou pelliculdes Pages discoloured, stained or foxed/ Pages d^color^es, tachetdes ou piqudes Pages detached/ Pages ddtach^es Showthrough/ Transparence I I Quality of print varies/ Quality in^gaie de I'impression Includes supplementary material/ Comprend du materiel supplementaire Only edition available/ Seule Edition disponible Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc., ont 6t6 filmdes d nouveau de fa^on d obtenir la meilleure image possible. This item is filmed at the reduction ratio checked below/ Ce document est filmd au taux de reduction indiqud ci-dessous. 10X im lax 22X 26X 30X v/ 12X 16X 20X 24X 2i)X 32X The copy filmed here has been reproduced thanks to the generosity of: Bibliothdque nationale du Quebec L'exsmplaire film6 fut reproduit grAce A la gAn6ro8it6 de: Bibliothdque nationale du Quebec The images appearing here are the best quality possible considering the condition and legibility of the original copy and in keeping with the filming contract specifications. Les images suivantes ont 6X6 reproduites avec le plus grand soin, compte tenu de la condition et de la netteti de rexemplaire film6, et en conformity avec les conditions du contrat da filmage. Original copies In printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or illustrated impres- sion, or the back cover when appropriate. Ail other original copies are filmed beginning on the first page with a printed or Illustrated impres- sion, and ending on the last page with a printed or illustrated impression. Les exemplaires originaux dont la couverture en papier est imprimie sont film6s en commengant par le premier plat et en terminant soit par la dernlAre page qui comporte une empreinte d'impression ou d'illustration, soit par le second plat, selon le cas. Tous les autres exemplaires originaux sont fiim^s en commen9ant par la premidre page qui comporte une empreinte d'impression ou d'illustration et en terminant par la dernlAre page qui comporte une telle empreinte. The last recorded frame on each microfiche shall contain the symbol •-^> (meaning "CON- TINUED"), or the symbol V (meaning "END"), whichever applies. Un des symboles suivants apparaitra sur la derniire image de cheque microfiche, selon le cas: le symbols — ► signifie "A SUIVRE ", le symbole V signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent dtro filmds 6 des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit en un seul clich6, 11 est film6 6 partir de I'angle supdrieur gauche, de gauche 6 droite, et de haut en bas, en prenant le nombre d'images ndcessaire. Las diagrammes suivants lllustrent la m^thode. '.!.''' t : !■■■ ^ ■ ^ ■» ' 1 2 3 4 5 6 ^ ; REMARKS as Hi" ON VACCINATION BY WM. W HINGSTON, M.D. D.C.L., L.R.C.S., EDINGr. &c. \ ;:-):: ;;J:.. :j;; ;^:; •■:• j' *v " *■ ' ' * », * • * • • > • t • • ' : ; • • * •? Printed by The Perrault Printing Company 91 St. Jabies Street 1885 ' • , ,<.■■■■• ' • • ' I • * . • . • t % * I . ' • • • < • • • • % * VACCINATION, Gentlemen : 'I'he prevalence of small-pox in this city, disturbing its tables of mortality, aifocling its re[iiitation and injuiing its trade, has J^ tendered it necessary that more than usual tfforis siiould be made to eliminate it from our midst. Large and airy ho.->pitnls are esta- blished, where every care and attention are secured to those who are admitted, ft is hoped personal nnd .selfish, (if not patriotic) motives alone will induce those afflicted with the disease to isolate • themselves, and to seek comfort and alleviation within their portals ; and not continue to be sources of danger to others. But experience has shown that such isolation as can be secured is alone unequal I to arrest the progress of the lijlady, without the prophylactic means which science has secured to us. Your services, r'entlemen, have ^ been invited, and to you is entrusted the important task of vaccinat- */ ing throughout the city generally. While having every confidence in your thorough fitness for the important work; that you may pursue a common course of action * I have prepared a few rules for your guidiince which, I venture to hope, may be found suflicieiitly clear and distinct for the purpose for which they are intended. INSTRUCTIONS TO VACCINATORS. 1. As it has been ciinclnsivily istnblish'ed by all medical authority throiifi:h- oiit the world, and by the experience of almost every riiition, that small- pox can be prevented, or greatly modified, by vaccination ; and that revaccination confers Jin almost entire immunity from tliat disease, it is of the greatest moment that care should be exercised in the selection and preservation of pure vaccine virus ; tiiat its employment should be made with prudence, so that tliose who avail themselves of it should have ever}' sur.ty of its protection ; and that those who, for rarious cau. ses should not be subjected to vaccination, may be so advi.sed. 2. Do not act by deputy, but vaccinate, either by yourself, or by some fully qualitied medical practitioner, who believes in vaccination, as your substitute. 3. Vaccinate those of i' vac- cination often hmes its protective power tiiidnfjli time, and levnccinfition Kreatiy increases iminnnity from sniall-pox. Ucvaccinate as ol'tcn os the virus can be made to act, and in times of contagion, us ot'tin as once in five years. 5. Uo not vaccinate a Biihject U> wlmm, from the state of iiv alth, vaccination may prove injurious. Do not, as a general rule, vaccinate persons having eruptions beliind tlio ears : or in a febrile state ; or sullrring from eruptivi^ fevers (measles, .■^cal•latina, erysipelas) ; or te, thinj; ciiildren ; or preynant women ; although the two latter classes, when exposed to eontftgion, should be subjec.ed to vaccination, small-ptix being pe- culiarly fatal to both. 6. Procure bovine lymph from the most reliable sources in the ttrst instance ; the Provincial Board of Health will alwayw be prepared to give you advice if asked. 7 yhould yon tind it nuces-sary to continue the collection from human sources take the lymph only from well ( lillM^tcrizi d uninjured vesicles, on children of undoubted health, and having no taint roportion of inefficient vaecitiatiors — even with good virus— is so considcral.le that instruction, the most elemcfntary, is not uncalled for ; (a.) A.H a rule vaccinate on the arm (the left Is usually the more convenient in grown persons); the mother may select the best for the child ; motives of vanity may eoinpel selecting the leg. Make, in three places, six or eight parallel scratches, and as many at obtuse angles to them. (').) Make them so slight as scarcely to cause an'' appearance of l)lood, and not to make it to flo-v. When in vascular subjects blood flows wipe it off before apiilying the virus. (c) As the virus on ivory point aiid quill is near the pointed end on both sides of the former; and on the convcjx sur/ace of the latter, those parts only, after having been moistened with cold water, should be well rubbed over the abraded surface (It is well to note that som ■ producers of bovine virus who use the quill, place the lymph at the square cut end ; others on the convex surface near the point. We shotild suggest to producers uniformity in this matter.) (rt.) Should the lym|)h have been carried beyond the area of the abraded surface, scrape it lightly towards it. (e ) Apply no bandage or other covering, either of gauze, rubber or plaster of any kind; but allow the lymph a couple of minutes to dry, without artificial heat, beftjre the part is again covered. by the clothing. (J.) As virus, when good, and in persons susceptible of its action, fiils from one of three causes : insufficient scarification ; too deep scarification ; or a too free flgw of blood, the vaccinator should endeavor to avoid thost- three sources of failure by attention to every detail. ((/.) When vaccinated, leave the part alone, taking care the sleeve be not tight, or of a texture to irritate by its roughness : a piece of linen may be worn with advantage between the sleeve and the part. (h) Note particularly in each case, the soune from which vaccination is done, and keep a record of the vaccination for future reference. 18. When projierly vaccinated, and when every thing is normal in and around the patient, the following conditions may be noted ; two, more fre'iuently three, or sometimes four days elapse before any local action is visible. The efflorescence of the part then begins ; there is redness and slight swelling of the skin, of the form of the original wound ; then a pimple, and on the pimple a little vesicle or blister, plainly visible on th Ilcvaccinatiou which sixiuld be resorted to from timeto time, and, especial- ly in time of ejiidemic, sometimes produces the same local changes, and the same febrile disturbances as primary vaccination ; but this is not usual, and much local or goucral disturbance is supposed to indicate tiither insutficient primary vaccination in the first instance, or an in- terval too long to be covered by this jjrophylactic shield. Commonlv, however, in persons properly vaccinated '' no true vesicle forms but merely a paiiular elevation smrounded by an areola; and tbi^ result having attained its maximum on or before the fifth day qu ckly declines; or if a vesiole forms its shape is apt to vary from that of a regular vesicle, and its course to bi' more rapid, so that its maturity i.s reached on or before the sixth day ; its areola declines on or before the 8th day ; and the scabbing b<,'giiis correspomlingly earl^-. In either case the areola tends to diifuse itself more widely and regularly, and with more affection of the areolar tissue than in primary vaccination. 20. When the results of a revacclnation are not well marked, protection .should not be presumed unless the S'«;ne virus is proved to be efficient in a primary vaccination. 21. Combat the absurd, but somewhat common belief, that vaccination is unsafe during an epldeuuc of small-pox. Vaccination as late as the second day after exposure to small-pox lias prevented it ; and even at a later period it modifies that disease. Ikit under no circumstance does or can vaccination .add to the danger. It has been suggested to me by some of your body, that, in addition to the foregoing, something might be said to meet the objections urged by those active, but mistaken writers, against the practice of vaccination. To prove to the unprejudiced that vaccination exerts a protec- tive infiuence over the economy would be an easy task, for the writings of tliousnnds, from the time of Jenner to our own day, are before us for ihi: purpose: l)ut tlie attempt to convince tiiose who persistently close their eyes to the overwhelming evidence ot * almost every country and of every government in the world, includ- ing our own, would be fruitless. In deference, however, to wishes expressed, and suggestions offered, I venture some observations on the disease now unhappily too prevalent ; and on the chief means which science has furnished for its prevention. Small-pox has its periods of dormancy, and its periods of acti- vity, at one moment overspreading a district, and at another disap- pearing. It is fatal in direct ratio to its epidemic character. Cases occuring here and there in spots, are not so fatal. It is the most contagious of all diseases— and this is a point on which I wish to insist. Yet some industriously endeavor to circulate the belief that small-pox drops upon individuals as rain drops from heaven — touching this one, and sparing that ! It is communicable in every way: by inoculation ; by breathing a contaminated atmosphere ; by the contact or vicinity of fomites. It is infectious in the early febrile stage ; infectious before and during the eruption ; and in- fectious " so long as any of the dry scrabs resulting from the origi- nal eruption remain adherent to the body." It is «tf/ infections after these have dropped off, and the body has been thoroughly washed. It may be caught, therefore, from the living body ; it may be caught from the dead body ; or it may be caught from^ clothing and furniture near the living or the dead body. So much has this disease been dreaded, that different nations in times past endeavored to mitigate the malady by conimunicating it artificially. The Brahmins in India engrafted the virus ; so also did the Turks ; and the Chinese were in the habit of putting some of the crusts into the nostrils. The practice of inoculating with small-pox virus became more or less general in Europe ; and its efficacy in mitigating the severity and the danger of the disease was very great. But the time for small-pox inoculation is past, the law having wisely forbidden it. Ninety years ago a chance observation was matured into a rational and scientific form by a mind deeply imbued wflh the best principles of sound philosophy ; and a disease, mild in form, and .safe in character, was substituted for the inoculation of the Turks and Chinese. In 1798, Jenner published his first important paper. In 1799, the first public institution for vaccination was established 8 in London : in tliL- following year it was introduced into France and Germany ; and the practice of vaccination lias now become general over the whole educated world. Here and there, as might be expef'tod, it has met with opposition ; but every objection urged by the anti vaccinator has been answered again and again by the leading minds of the profession. So much is this the case that I feel I owe something like an apology to my meflical brethren for writing affirmatively of a practice which most of them endorse. I spoke a moment ago of Jenner as a discoverer : but Jenner did not discover vaccine any more than Watt discovered steam. He no- ticed the prevalent belief among the peasantry in the immunity from small-pox enjoyed by farm servants and milk maids ; and little by little he drew the conclusion which has been sc pregnant with be- nefit to mankind. The belief in the existence of a vaccine virus was not confined to Kngland. Cow-pox and its relations to small- pox had been noticed long before on the continent of Europe ; * and in France and Ger, says Curshmann, may serve as a model. As the times are so pregnant with mischief I proceed to ask and to answer questions asked and ^nswered a thousand times : I St. Does vaccination confer a certain degree of protection against small-pox ? In the first thirty years of the last century, when inoculation of small-pox was unknown, the mortality in London from that disease wa5 7, 4, and at the close it was 95 per cent, inoculation introduced in the interval having increased it, A Committee of the Epidemiological Society has compiled tables to show the ratio of * Doctor Michea published an article some years ago proving that Vac cination was known to, and practised by the Hindoo physicians. -■■^ wn i il i rlr ii mortality from small pox in London before and since vaccination was introduced, and tile foilovvinfj are the results: For the fifty years, from 1750 to 1800, the averaf^'e luimher of deaths fromsmall- |50x, out of every 1,000 deaths from all causes was 96 or nearly ten per cent ; while during; ihe first half of the present century (the half century succeeding [\\g introduction of vaccination) the mortality was 39. In the whole of Kn{i;land, accordiujj to official returns, the estimated death-rate from small pox alone at the end of the last century was 3,ooo''per million ; while from the same returns the death-rate from the same caus'; is only 200 per million ! An analy- sis of the latter is most interesting. During the first ten yea..- of the present century, the mortality from small -pox in every thousand deaths from all causes was j4 ; in the second decade, 42 ; in the third, 33 ; in the fourth, 23 ; and in the fifth decade it was 16. Not only has the average of deaths from small-pox diminished in the above ratio, but epidemics of the disease have become less frequent. Before vaccination it was as 48 ; during vaccination it was as 14. The inference from all this is thus drawn by Sir Thomas Watson one of our recognized guides in medicine: "Where vaccination is, the contagion of small- pox never comes." Dr. Robert Thomas, author of the "Practice of Physic," which serves as a text book for students and physicians, thus sums up : "the introduction of vaccination, notwithstanding all the abatements which must be made in the estimate of its powers, is still one of the greatest boons that science ever conferred upon mankind. Compare the ravages committed by smallpox, before and after this important epoch ; and we may, in the first place, appeal to g^^neral experience in the wo.ds of the Report of the National Vaccine Establishment, where the rarity of an example of disfigurement by small-pox now to be found in theatres, in churches, or any large assembly of the people, is adduced in proof of the continued pro- tective property of the lymph employed."' After a long and labo- rious analysis of the bills of mortality, and of the observations of Chr'stian of I/verpool, Percivall of Manchester, Monro, Ceely* Gregory, Thomson, Curtis and others, he says: "if these conclusions, derived as they are from somewhat extensive data, be at all near the truth, they will go far to prove .Mr. Curtis's asser<;ioti, where he says of vaccination, that its value is much greater th.^n that of any remedy for any known disease at all comparable to small-pox in mischief to the human race." 10 How is it in Wales ? Dr. Hughes, of Molci, states : " no child born in the Mold district, and alive at the date of the registration of its birth, has died of small-pox during fourteen years, yet small- pox has prevailed on various occasions all around it." How is it in Ireland. The immunity there afforded by vacci- nation has been such as to induce a*-'ide-spread belief in its efficacy amoTi^ ihe people. Vaccination is practised generally all over that country ; and the children of the soil, carrying wilh them an entire confidence in the practice, are always the most willing to be vacci- nated. 'I'he results are seen in the following figures, from which it appears, says an official report, that the Irish physicians have ba- nished small-pox from their island, as Saint Patrick is said to have banished the snakes. In tUe periods 1830 40, 1840-50 and 1850— 60, before vaccination was general, the respective annual average mortalities had been 5,800, 3,827, and 1,272. In the years 1864, 5, 6, 7, 8, '.hey were 854, 347, 187, 20 and 19, respectively. In the first half of 1869, the whole number was three ! 'J'he remarka- ble immunity frym small-pox conferred by vaccination, induced a laxity in the practice, and a few cases occurred subsequently to 1869, but they were supposed to have been imported. In. Montreal there are comparatively few children of I«ish parentage unvacci- nated, and our tables of mortality show how very few of that nationality die of small-pox. How is it in Scotland '> I quote again only our medical teach- ers — those from whom we are content to receive instruction. C^ne of the most distinguished medical philosophers that Scotland has produced ; and one who graced, for a great number of years, the chair of medicine in the University of Kdinburgh, writes thus : " The first question is whether or not we have, at this time, in the matter of cow-pox, a power at our command capable, if duly em- ployed, of depriving the poison of small-pox of all fatal influence over an immense majority of mankind. And on this subject ihere has been quite sufficient information collected, since the date of the papers which were held decisive of the question fifty years ago, to show that the same inference is still inevitable, and that he who disputes it is equally unreasonable as he who opposes, in like man- ner, any proposition in Euclid. Vaccinated persons placed ir cir- cumstances in which unvaccinated people have been generally affected, and many of them have died 01 small-pox, these vaccinated persons have nevertheless escaped, most of them without any indi- J^ 11 cation of disease. To siiow tliat tliis is the 'igln in which I have always regarded such collections of facts, I quote one sentence from my own lectures, written as long ago as 1820-1^21, and re- peated almost every winter since then : - '• You will remember that the question is, not how many vaccinated persons never take small- pox, but how many vaccinated persons are fully exposed to the contagion of small-pox and escape without any disease; and our assertion is that, so far as is yet known, absolute protection of the human constitution is the rule, and the occurence of any disease is the exception,' Those who, like mysell, have had the advantage of listening to that most profoundly logical and conscientious me- dical teacher, well know the care and thought he gave ro his every utterance. Dr. Alison has passed away, and what says Dr. I. Hughes Bennett, his successor in the professorial chair? 'We have no remedy for small pox but vaccination ! " How is it in Frmice—Kix'^x foremo^^t in all researches having science for their foundation. M. Kousquet, in his Traite de la Vaccine^ gives most accurate and interesting details of an Epidemic of Small-Pox which visited Marseilles in 1S25. The population of Marseilles, amounting to 40,000, might be divided into three classes, of which the respective numbers stood thus : 30,000 vacci- nated ; 8,000 neither vacciaated nor variolated ; and 2,000 vario- lated -that is who had the small-pox either naturally or by inocu- lation. Of the 30,000 vaccinated, about 2,000 were seized with the prevalent small-pox epidemic, of which number 20 died, or i for every 100 affected. Of the 8,000 non-vaccinated. 4,000 were affec- ted, and of this number 1,000 died, or i out of every 4 cases. From this it follows that one-half of the non-vaccinated, and only i-isth of the vaccinated took the disease. Gaultier de Glaubry states — and his statement is confirmed by others — that while, in 1841, small-pox in France carried off more than a seventh of those attacked by it who had not been vaccinated, the mortality was only one in a hundred among those who had contracted the disease after having been vaccinated " Vaccinat,ion concludes Bouvier, may be practised with success at all seasons. In times of Epidemic, children should be vaccinated as soon after birth as possible ; re- vaccinations are necessary to continued immunity: they are without danger, and are particularly useful during an epidemic whatever may have been the date of previous vaccination. " There are, in every country, men who stand out in bold relief 12 even among their compeers ; and high among the ablest medical writers of France, or of the world, is the name of GrisoUe — cette ame h la vieille marque. I here are ssome so bol"', — and I am one ol them - as to place his " Pathobgie fnterne, " among the greatest productions of genius — a work in which no unstable theories how- ever brilliant — no baseless speculations, however fascinating - tind place ; a work which reached its 9th edition in about twice as many years, and which, during that period was, and still is, the standard authority upon a most important department of medicine. M. GrisoUe says : We m ly vaccinaterat all seasons and at all ages. We generally wait till children have attained two or three months to vaccinate them ; but this practice, 7uhich nothing can Justify has no advantages. This delay has led to many contracting disease al- most always fatal -^which could have been spared them. I h^ve inoculated my two little girls, at the end of the first week of life. It is in this way we otight to act towards our children- more ex- posed doubtlessly, than others, to mediate contagion. Particu- larly should we vaccinate early in time of Epidemic : it is what I have done many times at the hospital without any inconvenience. Ihere is no preparation necessary for those to be vaccinated. The operation is simple. It is ceitain, in fine, that the greater number of those vaccinated are beyond all risk of an attack of small pox. " I have quoted at length from GrisoUe ; as he may be said to bear the relationship to medicine, in France, that Black- ! I stone does to law in England. How is it in Denmark'i The fatality from small-pox is but an ^ eleventh part of what it was before the introduction of vaccination. In Sweden ? A little over one-thirteenth : In Prussia, and in large parts of Austria ? but a twentieth : in Westphalia '( but a twenty-fifth ! ! In Bohemia, Moravia, and Silesia ? it has been reduced from 4,000 in every million of deaths, to 200 per million ! Not only is it satisfactorily established that vaccination is an effectual safeguard against small-pox, it is as effectual in preventing small-pox as small-pox itself. This was thoroughly tested in Hanover, where it was found that out of every hun- dred soldiers re vaccinated, sixty two per cent failed altogether in producing a vaccine vesicle ; and twenty seven per cent were only partly successful. Soldiers who had already had small-pox were operated upon in the same way, and with precisely the same result. Mfl 13 Taking Europe as a whole, the conclusion arrived at by Berard and DeLavit, of Montpelier ; Hodenpyl, (j1 Rotterdam ; aud Thompson, of Edinburgh, was : of those who had neither previously cow-pox nor small-pox, one out of every four who were seized with the disease, died ; of those who had small-pox naturally, or by inoculation, one of every twer.ty-five to one in seventy-five died ; while of those who had been vaccinated, and were afterwards seized with small-pox, not more than one in three hundred and thirty cases died : thus showing the great superiority of vaccination, even to the small-pox itself, in protecting the system from the fatal effects of a second attack. Snch information as I could glean from different sources leads me to the conclusion that an attack of small pox and vaccination confer the same degree of immunity from an attack of small-pox ; but that subsequent/^/c/ smallpox follows more frequently after small pox than after vaccination. Ho^ is it in the United States i Gentlemen : It would be an endless matter to quote the opinions of the many medical obser- vers in the adjoining Union in favor of vaccination : but I shall introduce the essence of their remarks as furnished to the State. Almost every State of thi* adjoining Republic has it State Board of Health: and each Board maybe considered to reflect the opinion of the medical minds in the State. On State Board of Health for 187 1, says: — '' No amount of disinfectants can cope with this dire disease. The only way to thoroughly drive it from the United States is by a national law, as in England, requiring every parent to duly register his child after having been duly vaccinated." The experience of Massachusetts is summed up in the report from which I quote : that small-pox appeared here and there ; but where it has appeared it has always been in places where vaccination had been neglected. The town of Holyoke, in the Connecticut valley, was an illustration. One-fifth of all the deaths from small pox occurring in the whole State took place there. The people in Holyhoke had not been vaccinated as elsewhere, Dr. George Darby, of Boston, Secretary of the State Board of Health, summarises for his Board as follows (and his summary receives the sanction of the Board) : vaccination " invests the human body with an armour which may nardly be penetrated by the subtle poi- son." A year later lan epidemic of small-pox having passed) he writes: the present epidemic is of such intensity, that it is quite il .1 1 t i u common for persons who have had small pox in former years to novv have it again. Such occurrences have been previously rare. Vaccination, whether from the cow or from the human body, *• takes" readily; and re-vaccinations prove abundantly the extra- ordinary susce|)tibility to the vaccine disease now prevailing and /lei'er before existing. In view of these facts, with which physicians and intelligent persons, ol whatever calling, ar?i now familiar, let us thank God for Jenner's great discovery, without which our homes would be desolated, and our peace and happiness destroyed. The imagination can hardly picture the horror which would to day pervade Massachusetts, were the present epidemic unchecked by vaccination," A year later the same authority, and the same Board, report mter alia: '' One year ago * * •' we were in the midst of an epidemic of small-pox of extraordinary intensity * * * the protective power of vaccine has been proved beyond all ques- tion, and the absolute need of careful vaccinaiion is equally evi- dent. Nothing, however beneficient, can escape the criticism of the times in which we live. But this criticism of vaccination, often passionate and violent, relates chiefly to points which however interesting they may be, leave the main question unaffected, Let any one read the history of the r. 'ages of small-pox before Jen- ntir's discovery, and compare it with . mortality of Massachusetts from I his cause in the present generation, and ask himself the rea- son of this change. There can be but one answer. We may spe- culate about the possibility of the potency of vaccine being exhaus- ted in the iiuuian family ; we may be surprised to find that people with good vaccine scars sometimes have small-pox ; we may dis- pute as much as we please about the average period when re-vac- cination may be considered a prudent safeguard ; we may even conjecture (wl\at no man has proved) that other diseases than that of cow-pox may be communicated by humanized vaccine ; we may turn the vaccination question with ingenious skill, so that its many facets shall reflect a multitude of curious lights, and after all we find that we rest in a security against this most horrid pes- tilence unknown to former generations. The disease is the same now as th-ii, for we see its effects among barbarous tribes ; but because Dr. Jenner lived, and made the greatest of all discoveries in preventive medicine, we are almost completely safe." I have quoted from a public document which received the sanction of a learned deliberative body, and the approval of the Government of ■MiaiiiHi 15 the State — the most generally intelligent State in the adjoining- Union. What says the state of Ohio; "Our comparative immunity from this loathsome and terrible disease conclusively demonstrates the preventive power of vaccination." I have purposely quoted at greater length from Continental than from British authorities, because it has been assc.teil at public gatherings in this city, that it was an " English remedy, and that Englishmen had a {)ride in engrafting their " beastly" virus on the (,'hristian children of fair Canada ! But American authority, ipio ud the vaccine ((uestion, cannot bo suspected of jartiality. I have singled out no individual writer on the subject (I might have quoted a thousand) ; but have confined myself to State documents containing the deliberate expressions of delibera_ tive bodies, reflecting the condensed thougiits of the best medical minds in the United States. I turn with little pleasure to this my own country, and especially to this my own city, and I lind anti. vaccination views advocated, and disseminated by a small but ceaselessly active section of the medical profession. I find, from personal know- ledge, a deeply rooted prejudice unfortunately created, ag...iiSt what the whole scientific world has sanctioned ; and I find desease, disfig- urement, and death following in the wake of those teachings ; teach, ings to the dissemination of which a portion of the daily press has until quite recently, (1885) unhappily lent its columns, I readily admit that small-pox has its periods of dormancy and its periods of activity, and that, every now and then, at irregular intervals it overspreads a district or country as if epidemic. But why should it press so lightly elsewhere ? Dr, Russell, Dr. Harden an J Dr. Lemieux ex-Presidents and President of the College of Physicians and Surgeons, residing' in Quebec, \x\. so many of those vaccinated have cicatrices deficient in number, and of a character not strikingly good, that re-vaccination should be resorted to where there is more than usual exposure to small pox. But if there is doubt as to the continued immu- nity afforded by vaccination, there can be none when it has been properly performed a second time. Re-vaccination, when successful, affords entire immunity; and in support of this assertion I shall cite but one or two proofs from among a thousand : It has been an imperative rule for the last thirty-five years at the London Small-pox Hospital that every nurse and other servant of the Hos- pital should, on entering the service, be vaccinated. In their case it is generally re-vaccination : and it is never afterwards repeated. These nurses live in tho closest daily and nightly 'attendance upon small-pox patients ; and the other servants are constantly exposed to the profuse contagion : yet in no single in>tance, during these thirty five years, has any one of these servants and nurses been affected with small-pox I I shall cite from a few official sources evidence of the immu- nity conferred by re-vaccination on some of the continental armies of Europe. In five years, says Seaton, there occured in 14,384 re-vaccinated soldiers in Wurtemburg, only one instance of vario- loid ; and among 30,000 re-vaccinated persons in civil practice only 1!» two of varioloid ; though durinj!; these years small-pox had prevailed in 344 localities, producing; 1,674 cases of modified or iiiimodifieil small-pox amonjj; the not re-vaccinated, and in part not \.ic(,inated population of 363,298 persons, in Uiose places in which it had pre" vailed. In the Prussian army, since the introiluction of systematic re-vaccination in 1834, the cases reported .is " varioloid," and, still more, those called " variola," have been, nearly all of them, among that portion of recruits whose term for re-vaccination had not come ; or whose re-vaccination had not been successful, or who were incuba- ting siTiall-pox when they were re vaccinated. In the 20 years which immediately succeeded the adoption of this system there occurred altogether but forty deaths from small-pox in this large army — (or an average of two deaths per annum) only four of the entire forty being in persons, who, it is said, had been succesfully re-vaccinated. So also in the Bavarian army, in which there had been compulsory re-vaccination since 1843, there had nc*, from that date up to the time of a report made by the Minister of War in 1855, been a single case of unmodified small-pox ; and only a very few cases of modi- fied small-pox, without any deaths. While, therefore, I answer the second q'uestion in the negative, as to the invariable permanency of primary vaccination, the statistics quoted from official sources, with the almost universal collateral concurrence of medical practitioners, warrant the statement that, after successful re-vaccination, small- pox, even the most slight or modified kind, is rarely met with ; and that when the post vaccinal small-pox is met with, of a severe cha- racter, it is due to the want of care in the performance of vaccination in the first instance ; or to want of preparedness in the system when primary vaccination had been performed. From what has been said, a question of vast moment to adults necessarily presents itself: as all those who have been vaccinated but once run more or less risk of contracting the disease ; and as it is admitted that re-vaccination renews, or adds to, the security against small-pox, common prudence would suggest revaccination to those who wish to guard ngainst this malady, and especially in tim^i of epidemic. 3rd. Is the e risk of vaccination lighting up local imjiatnmatory action. When we consider the disposition, the temperamment, the con- dition of health, of those vaccinated ; and the period of life at which vaccination is usually -and the period of the year at which it is sometimes- performed, it is a matter of surprise that local irritation, ■ I i 20 or erysipelatous action, is not more frequently lit up. At certain seasons of certain years any abrasure of the skin, however slij;ht, even without vaccine lymph, is apt to cause erysipelatous intlamma- tion. What medical man has not sometimes seen erysipelas to fol- low a^sli^lU bruise, or the scratch of a needle or of a thorn ? I have sjcn fatal convulsions in a child from swallowinji; an apple seed ; fatal lock-jaw from a tritlin}; scratch ; fatal paralysis from eating pan cakes. The accidents of this kind followinji; vaccination are comparatively few— not by any means as many as have been seen to follow the pulling of a tooth. Yet who ever advised that an aching tooth should be left alone because it had happened sometime, some- where, and in the hands of some one, that hemorrhaj^e from the tooth socket had taken place? These are accidental ; and so rare are they that they should not enter into one's calculations So con- vinced am 1 of the safety of vaccination, that 1 have no hesitation in saying that a viiccinator, who knows his business, would vaccinate a thousand children with fewer unpleasant results, than a compe- tent dentist would have in extracting the same number of teeth. There are, 'tis true, precautions to be taken, just as there are com- mon sense precautions to be used by every one in eating, m drink- ing, in travelling. But these occurences would be rare indeed if vaccinators exercised care and judgment in the selection of the lymph (which should be pure, taken at the proper time, and with- out admixture either of decayed epidermis blood or pus) and in the selection of their subjects (who should be neither too feeble or too sickly) ; and with proper surroundings ; and with these precautions, severe local inflammaiion would be rare indeed. But it is not to be expected that some degree of irritation will not be produced. On the contrary : children vaccinated with the purest lymph will ma- nifest, during the few days that the pustules are at the highest deve- lopment, a certain Jebrile disturbance of the general system, during which the temperature of the body sometimes reaches 104*^ F. But in certain constitutions, and in certain states of the atmos|>here, and especially when the crust is decayed, and with it there happens to be, either through carelessness or ignorance, decayed epithelium or dried pus or both, or even the purest lymph with an unclean instrument, the constitutional derangement above alluded to, and which was still within the range of health assumes a morbid character, and more or less severe local or constitutional disturbance is the result. It is useless to deny that we have had some of those untoward results in this city, and these have clone much to create the prejudice now unhappily existini> against vaccination. The third (juestion, there- fore, may he answered thus, moderate local inllammatory action may s()melimi:s he lit up, but thi; severer forms are, as a rule, due to (ai want of care in the selection of the crust , ibi inattention tf» the a;^e or health of the subject ; ci carelessness in the use of the sacrificator ; (di atmospheric influence ; (e) unhealthy surroundings ; or (f) to all combined. 4th. /s t/ie/e risA, when vaccinating, of inoculating the system 7vilh scrofula, or otlur hereditary disease 'i—\{ my answers to the previous questions were necessarily qualified, this one is not, and I emphatically answer : «a<.;ates ? Who sees it V The experience of the department is an cntirt- blank on the subject. For the last ten years we have been in incess.mt inlimati^connnuiucalion with IhedilTenMit jiartsof Kngland ondetails of public v.iceinations, and duriiij; these years, ev(My one of the .d)oul 350 vaccination tlistricts into which Mnj^land is divided has been visited three or four times by an uispector s|)ecially charj;ed with the duty of minutely invesiij;atinj; the local practice of vaccina- tion ; yet from this systematic and extremely detailed search for all that has to be said on the subject of vaccination in Kn^laud, no inspector has ever reported any local accusation, or su.spicion that a vaccinator had communicated syphilis. Ajiain, our national vaccine establishment has been in existence for more than 60 years vaccinating at its own stations every year several thousands of ap- plicants, and transmitting to other stations supplies of lymph, with which ev jry year very many (at present 50 or 60) other thousands are vaccinated, who in their turn, become sources of vaccination to others; but this vast experience does not, .so far as I can ascertain, include kiiowledjije of even one solitary case in which it has been [|l alle<;ed that the lymph has con.municafed syphilis. Is it concei- vable that these negative experiences could be adduced if the vaccine lymph of children with latent hereditary syphilis were an appreciable danger to the public health? Thirteen years ago it devolved upon me (as medical officer of the Board of Health), to make the widest possible enquiries, both of scores of i)ublic depart- ments and institutions, and also of m.iny hundreds of individual practitioners, in our own country and on the continent of Euro|)e, with a view »o elicit all existing experience on the validity of ob- jections which had been alleged against vuccinat'on ; and on thnt occasion I, of oourse, -rave great prominence to the point which is here raised. One .ne four questions which I circulated was the following: — 'Have you any reason to believe that lymph from a Jennerian vesxie, has ever bfcn a vehicle of syphilitic, vScrofulous^ or other constitutional affection, to the vaccinated person ; or that , unintentional inoculation with some other disease, instead of the proposeil Viiccitiation, h:is occurred in ihc hands ol a duly cducalcil ini'dical piaciiiioiicr ?" I'lii; answer wliich I received on this, as on each ot n\y oiher points, from 542 nu'nd)ers of my profession, are, as regards sypiiilitic inoculation, only just short of hi'ing an abso- lutely undorm "No." The alleged cases (of inoculation) were thrown into real insignificance by their relation to the main body of testimony. Men of the oldest and largest consulting [iratice in the United Kingtiom ; men who were believed to have seen eveiy variety of disease and accident to which the human body is liable ; our I^'aders who had taught medicine and suri^ory to the mass of th(. profession ; physicians and surgeons of our largest metropolitan an.i ^ rovincial hospitals, in Kngland and Scotland and Ireland; • physicians who specially studied the disea.s«;s of infancy ; surgeons who had specially studied the inoculative diseases ; pathologists of distinguished insight and learning,- -men of all these sorts, scores on scores of them, had never in their experience "had reason to believe 01 sus|)ect any such occurence as my (pjestion prescribed." In the series there may read all the most eminent British names of thirty years ago, certifying to such negative experiences ; there may I5e read, too, that equally negative in Paris had been the vast experience of Chomel and .VIoreau. Rayer and Kicord, and kostan and Velpeau ; equally negative at Vienna that of Hebra and O|)polzer, ami Sigmund. And in here recurring to that very remarkable mass of testimony. I may repeat the remark which my former review of it suggested to me : " Obviously one at least of two conclusions is inevitable : either it is thai with reprehen- sible carelessness as to the source of lymph, vaccination (so long as in any sense of the word it is vaccination) cannot be the means of communicating any second infection ; or else it is the case that in the world of vaccinators care is almost universally taken to ex- clude the possibility of danger. To the public, perhaps, it matters little wnich of these conclusions is true. 1 have every reason to believe that a present census of personal experience in this coun- try would give just the same practical results as those which accrued from the former enquiry. The Army Medical Department has, during the last eleven years, had cognizance of 151, 316 (adult) vaccinadons and re-vaccinations performed on the soldiers and recruits of Her Majesty's service, where, from the nature of tlie case, the subjects of the proceedings are persons who rucerwards permanently remain under medical observatic:, and in whom ! ( ^4 therefore, no syphilitic consequences of Viicciiialion could possibly escape n ^tice ; where, moreover, the chances of latent constitu- tional sy hilis in subjects furnishing the lymph must be about the same as among our civil population : but in all this vast and critical experience so far as is known to Dr. -Balfour (the eminent and laborious reporter on the diseases of the British army) no single case has ever been alltged of a soldier ^yphilized by vaccination i In- disputable certainties, wliich any one can verify for himself, are: — first, that year by year millions of vaccinations are performed in Europe with scarcely a solitary accusation transpiring that syphilis has been communicated by any of them \ and, secondly, (hat phy- sicians and surgeons who could not fail to see such cases in abun- dance, if such abundanca were a reality, concur with almost absolute uniformity, hundreds of them together, in declaring that they had " never in their experience seen even a single case of the kind " Surely for every practical purpose, certainties like these are our best guides; and with such certainties in our knowledge it would be the merest pedantry to insist on infinitesimal speculative uncer- tainties." It may be some stisfa:tion to the learned and laborious writers, from whom I have quoted above, to learn that their views are fully coincided in by almost all the leading minds of the profession in Montreal. On Friday of last week, 1 submitted the following questions to the members of the Medico Chirurgical Society of this city. Doctors are said to differ, but the unanimity of views on the following was most noteworthy. The meeting was an unusually \ large one, and the secretary (Dr. Bellj has kindly furnished me j with the accompanying extract from the minutes, with the permission j of the Society for its publication : Meeting of the Medico-Chirurgical Society of Montreal, on the 13th October, 187(3. Moved by Dr. Hingston, seconded by Dr. 11. I*. IIowakd. — Ist. That vaccination confers a certain degree of imnuuiity from small-pox, either pre- venting or modifying that disease. 2nd. — That such inniiunity is not always permanent, but may be rendered permanent by re-vaccination. 3rd. — That vaccination may produce, in some instances, a certain degree of inflammatory action, which may be moditied, increased, or dimi- nished, by the age, constitution or condition of the patient, or by the state of the atmosphere. 2» 4tli. — That vaccination does not, in any instance, produce scrofula or other hereditary disease. ftth. — That neitlier tlie r idence hitherto furnished to, nor the experience of Mie members of tliis Society, is of a character to lead to tlie conclusion that syphilis is ever inoculated with vaccine lymph, Carriel unanimouHly. But any further consideration — nay— even this much — can in Montreal to day, (1885,) have nothing but scientific interest — for vaccination is now being performed wiiA lymph which has never been transmitted thtough human subject — but has been taken fresh from the heifer : and the boldest and most reckless antivaccinator has not yet accused her of being a propagator of disease The advantages of using bovine virus moreover are : (i) it secures a more perfect or typical development of the vaccine disease ; and hence 't may be inferred a greater protection against small-pox (2) with i\ e bovine virus and with a clean lancet, and with clean sur- roundings no one need dread the danger of being inoculated with other than vaccine. (3) It is for purposes of re-vaccination far more effective than the humanized virus ; (4) greater care can be taken in the propagation of bovine virus ; (5) a fresh supply can be always at command ; and 16) always, but especially in times of urgent danger from small -pox -people have better guarantee that they are vacci. nated with genuine and pure vaccine virus. Gentlemen : I have detained you much longer than I intended, and beg to thank you. and my many medical freinds who have honoured me with their presence this afternoon, for their and your most patient attention. Since the foregoing was delivered, many of my medical friends, some not members of the Medico Chirurgical Society of Montreal, and some not piesent at the meetintf in question, expressed a desire to have an opportunity affc ded them of recording their opinion on the questions submitted to, and unanimousl} adopted by that Society on the 13th Ocrober last, and referred to on a preceding page. I willingly acceded to their request, and have been furnished with the following list, not at all complete, I am informed, of medical gentle- men practising in this City, supporting those resolutions. Their names are published in extenso,As it has been industriously circulated that those who practice vaccination are unsustained by medical opi- nion here. The reader will perceive the remarkable unanimity of though:, as expressed by the very large number, on a matter of such vital moment ; and will recognize among that number ourmostdis- •!'f 26 tinguished physicians — B'rench an:i English; nearly all the physi- cians at our hospitals ; nearly all the physicians at our dispensaries ; nearly all the professors in our medical schools and colleges ; near- ly all our oldest and ablest men in private practice, with a life long experience to appeal to, and without motive to mislead ; nearlv all our middle aged practitioners engaged ir 'arge and lucrative prac- tice ; nearly all our young men fresh from their studi'^.s. and familiar with the most advanced views of transatlantic medical minds — some of them just returned from Europe where they have had opportuni- ties of learning the thoughts and opinions of the most eminent in our profession there ; not, perhaps, the views of such men as might well be astonished to find themselves quoted as authorities three thousand miles away. I thank my medical friends for their readi- ness in expressing their opinion on this important question ; and much doubt if there is any other topic or point in controversy on medicine, surgery or pathology upon which so unanimous an expres- sion of medical thought could be obtained in this city. In matters ofhiw, judges differ ; but the decision of the majority is, after all, the decision of the court, and litigants must abide by it. Respect for a majority, so well pronounced, of competent medical judges will, in this instance, I hope — considering the contingency in events — lead to a cessation of those ill timed attempts to interfere with the efTorts that are now being made to check a loathsome disease by the only prophylactic which science has yet discovered. FroHunciamento of Physicians of Montreal, in favour of Vaccination. G. M. AV)bott, T. J. Alloway, P A. A Hard,' G. Archambault, Geo. Ariiistronri. [I. Arvhaiiilxndt. V. lieaubieii, J. Hell, F. Barnes, D. TJoyue.s, G A. Haynes, J. E. Berthelot, .]. G. Bibaud, A. Boiidy, U. Brodeur, V. Buller, G. (>. Beaudry, W. Enller, A. Fisher, J. If. Fulton. K. T. Godfrey, G. r. Girdwood, .1. Gagnon, VV. Gardner. F, L. (ieiiaiid, K. F. Ciodtrey, F. 11. Girard, Jas. J. Giterin John J. Gardner, II. GmUnnx. 'rii(>.s. I''.. Ilaye.s, B. !'. Howard, T. iluulies, W. II. Hing.st.un, H. Howard, W A. M Olson, C. J. Morse, J. W. Mount, L. D. Miijnmdt, J. A . Macdonakl, If. Muthieu. W. Nelson, J. Nichol, r. G'Leary, W. Osier, H. Peltier, E. A. Paquet, Jas. Perrigo, A. Piclu", Jos. C. Poitevin, E. K. Patton, P. E. Picault, Iv i ii^d * ■» •* •n (^ W. E. Bes.sj^y, A. A. HrowiK', G. A. K. Hruiu'llo, K. >L Hoiinjiu", W. H. liurland, W. H. IJurlaiKl. C. iV, /irthorn Smith, Ferd. Simard, E. H. Trudel, , F. X. Trudel, F. Z. Tasse, R. Thompson, E. H.Trenholme, Ls. Turgeon, S. R. Wanless, J. Wanless, Jos. T. S. Webb, M. O'B. Ward, Th. Wheeler, Geo. VVilkins. W. Wright. U. IT. Wttsmi. T'hose Wtttilics are added since the iirst edition. APPENDIX. Sept. 1885. There is little to be added to the above. But it may be stated the members of the Medical Profession of .Montreal ^t a meeting called by the Governors of the College of the Province ol Quebec and the Deans of Faculty of the two French Schools, again reiterateu their solemn declaration in favor of vaccination : and the School of Mediciiie and Surgery at a meeting of that body did likewise, we have therefore, in j^ddition'to Jhe views-of individiial. members, the recorded opinionst^^eYgVx, teaching bod)' ijv.nAedfc^ne in this city, i 38 which (he list above g.venj'^though far from complete, will show how insignificant in numbei s are those whose signatures are not appended . I could wish to have here added several letters I have received from members of the medical profession in this city, again reiterat- ing, in great earnestness, their belief in vaccination ; and giving their grounds of belief as furnished by cases under their own observ i- tion. But space forbids, and their names are among those who signed the pronunciamento. I have one, however, from a medical gentle- man, not of Montreal, whose reputation amongst the french residents of Canada — nay, of this continent — has perhaps never been equalled in this country— certainly never surpassed ; and one who has fairly earned it by thorough training ; by profound study ; and by long and repeated sojourns in the hospitals of France and other parts of Eu- ijl * rope; and who, having retired through ill health, from practice, "' cannot be suspected of being actuated by motives of interest. Dr. I'ainchaud of Varennes writes me thus : " ^ have not had any of those untoward circumstances following vaccination which others say they have seen ; but I have taken the precaution which every vaccinator should take. Sometimes there has been more or less febrile disturbance; but soon again all has returned to the normal. In my forty years experience, I have had nothing disagreeable to record." "I was not always a zealous vaccinator ; but many circum- stances have made me an enthusiast ; and one I may relate : Small- pox many years ago visited Varennes and I began to vaccinate , my patients. In one house I visited, there were ^6me children. I 'Ww^ .^\^\^^ vaccinated wf but was prevented vaccinating the remaining /w^. (2J Small-pox entered the house soon afterwards ; attacked the two un ' n j^ vaccinated; killed one. and blinded the other : the t h nw vaccinated '<'V4'*VV^, were untouched ! Judge if I have not reason to believe in vaccina- a tion." I ■■ ' '.' 'W<' .<: .••';!) I'l' ,' ' ,(■ , !. •:w'i,, • •, t. • ./If.) , ', *• »«•>'».* • > • • • .' ).« « i:', lt>'' ♦/fitv'. ■' \