Dunedin Alexander Sligo, Bookseller, George Street.MDCCCLXXXIII
I, the undersigned, being authorised by the Privy Council to give to persons whom I have instructed in the practice and principles of Vaccination, such certificates of proficiency as shall qualify them, if otherwise eligible, to be contracted with by Guardians and Overseers for the performance of Public Vaccination, do hereby certify that Mr. W. M. Stenhouse has under my direction, at my appointed Vaccinating Station, duly studied the practice and principles of Vaccination; and that I having from time to time enquired as to his progress therein, do now believe him to be skilful and well-informed in all that belongs to the duties of a Public Vaccinator
(Signed) Hugh Thomson.Dated at Glasgow this 21st day of September, 1874.
Dunedin: Alexander Sligo, Bookseller, George Street.MDCCCLXXXIII
Three or four years ago, when vaccination was being vigorously discussed in the Home Country by both lay and medical journals, and a great cry was raised for the introduction of animal lymph, as preferable to the humanised lymph till then exclusively used in Great Britain, it seemed to us that the subject was not unworthy of the attention of practitioners in New Zealand. Accordingly a supply of pure calf lymph was furnished us from home; and, after a careful study of the whole question, our views were embodied in a paper read before the August meeting, 1879, of the New Zealand Medical Association, which paper was almost identical with the present work. Since then the outbreak of small-pox in Sydney has attracted universal attention throughout New Zealand, and given to the subject a gravity and importance which it would be impolitic to ignore.
This has, therefore, appeared to us a favourable moment for educating public opinion in favour of vaccination, which after all is a mother's question, rather than a medical or state one; for, however unanimous medical opinion may be in its favour, or however strict legislation may be in its enforcement, the nation will never reap the full benefits thereof until mothers give an intelligent assent to the operation. To awaken the interest and excite the confidence of parents in cow-pox inoculation is therefore the object of this little work, which, if it succeeds in its mission will, we take it, be of some slight service to the cause of humanity.
We flatter ourselves also that some of its pages may be found useful to our fellow practitioners, who may not .have given the subject the same thoughtful consideration as ourselves; and that some of its suggestions may be thought worthy of adoption when next the Government of New Zealand legislates in this direction.
Wm. M. Stenhouse, M.D.Moray Place, Dunedin,
Sept. 1, 1881.
Vaccination and Small-Pox
here is nothing new under the sun, we are told on the highest authority, and the modern discovery of vaccination gives countenance to the proverb; for though popularly supposed to have originated with Dr. Jenner, in the end of the 18th century, it is now known to have been understood and practised in the earliest ages by the natives of India and Persia, and other countries of the East. Not only so, but Humboldt found during his researches in South America, that there prevailed among the inhabitants the belief that the eruption on the udder of the cow preserved them from small-pox. This in no way, however, detracts from the merit of Dr. .Tenner's discovery, which was arrived at without any knowledge on his part of its early history, and was the fruit of acute and accurate observation, patient investigation, careful experiment, and brilliant deduction. By this discovery Dr. Jenner immediately became the foremost benefactor of his age, and indeed we question if any single discovery ever conferred such a blessing on suffering humanity. His own generation, which had too often witnessed the ravages of small-pox, gave him his full meed of praise, and if we are less sensible at the present day of the benefits of vaccination, this is the strongest proof that could be adduced in its favour, as our indifference arises chiefly from the circumstance that few of us have ever seen, much less suffered from this dreadful disease. As, however, a knot of ignorant and presumptuous busybodies has of late attempted to destroy public faith in vaccination, and so far succeeded in evasion of the vaccination laws as to have made small pox endemic in London, we think we shall be doing the State some service by narrating in popular form the story of vaccination, proving its successes, and refuting alleged objections to the practice. We do this all the more readily from our knowledge that vaccination is constantly evaded in New Zealand, and very often imperfectly performed, so that should small-pox ever get footing amongst us, its effects would undoubtedly be most severe.
In order to convey to our readers some adequate notion of the ravages committed by small-pox before the era of vaccination, we may be permitted a quotation from the late Lord Macaulay's history. This historian describes it as "the most terrible of all the ministers of death. The havoc of the plague had been far more rapid; but the page 4 plague had visited our shores only once or twice within living memory, but the small-pox was always present, filling the churchyards with corpses, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover."
The asylums, workhouses, and hospitals of Great Britain were crowded with the victims of this loathsome disease, for its effects on the living were indeed fearful to witness, and we are told that two-thirds of the applicants for relief at the Hospital for the Indigent Blind owed their loss of sight to small-pox.
And although small-pox had thus raged for centuries among civilised nations, as yet no means had been found to cripple its power or mitigate its effects. True, Lady Mary Wortley Montague had introduced the practice of inoculation from Egypt, by which the disease was artificially produced in a modified form. But this, however advantageous to the individual, was undoubtedly inimical to the common weal, for it so multiplied the foci of contagion, the artificial being as contagious as the natural disease, that it rendered small-pox more prevalent than ever, and hence its effects became most disastrous, as it was seen that the general mortality from small-pox had greatly increased since the adoption of this practice.
The time was therefore ripe for the discovery when Dr. Edward Jenner hurried from his native Berkeley to London, and published in June, 1798, "An Enquiry into the Causes and Effects of the Variola Vaccina, known by the Name of the Cow-Pox." This pamphlet was the fruit of twenty-three years' study and experiment, which he pursued in spite of obstacles and opposition sufficient to discourage anyone possessed of less genius than himself. For it was in 1775 that Dr. Jenner's attention was first directed to the subject, by observing that a number of persons in Gloucestershire could not be inoculated with small pox; and, having ascertained in the course of his inquiries that there was a popular belief that persons who had caught the cow-pox from milking the cows were not subject to small-pox, he began to investigate the grounds for this belief. The inquiry was by no means an easy one, for at the very threshold he was confronted with a serious difficulty. He found that the cow's teat was subject to a variety of eruptions, all of which were indiscriminately named cow-pox. These he learned to distinguish, and ultimately ascertained that only one of them was possessed of a specific protective power over the human body. This he called the true cow-pox, the other the spurious. He then gave himself up to an exhaustive investigation of the qualities of true cow-pox, during which he ascertained that it underwent progres page 5 sive changes, and was endowed with prophylactic or anti-variolous properties only at one period of its progress, or in the acme of eruption. In 1796 he was first, enabled to carry his brilliant idea into practice by taking the decisive step of inoculating for the cow-pox, upon the success of which the truth or falsity of his deductions from his long labours would be demonstrated. Entirely successful as these first vaccinations were, with the patience characteristic of the man, he waited two years, testing his discovery in every possible way, before he published the results to the world. Every page of his work bore the impress of genius, and is still as deserving of study as it was when first issued from the press. In it Dr. Jenner contends that cow-pox does not originate in the cow, but is communicated from the horse, where it appears on the heels, and is known by the name of the grease, which is conveyed to the cow by the hands of farm-servants and milkers. He next suggests that small-pox may have been originally morbid matter of the same kind, which circumstances had changed and aggravated into a contagious and malignant disease. He finally states his conviction that cow-pox inoculation secures the constitution forever afterwards from the infection of small-pox.
If Dr. Jenner expected that his discovery would be immediately welcomed, and he himself hailed as on of England's foremost sons, he must have been grievously disappointed, for his work was received with marked hostility. The moth-minded and hollow-hearted men of his own profession—for many such, alas! then as now, disgrace this noble calling—were foremost in the attempt to run him down, lending the weight of their influence and reputations to crush this obscure country practitioner. Not a single medical man could be induced to make a trial of vaccination. It appeared for a time as if the discovery were to be lost to the nation. The comic periodicals of the day, taking their cue from the leaders of the profession in London, published the grossest caricatures of this great and good man. He was represented as attempting to bestialise his species by the introduction into their systems of diseased matter from the cow's udder. It was gravely asserted, and received a ready credence, that vaccinated children became ox-faced, that abscesses broke out to indicate sprouting horns, and that the countenance was gradually transmuted into the visage of a cow, the voice into the bellowing of bulls. Not only did his enemies attack his professional reputation, but they assailed his moral character, and the pulpit fulminated its anathemas against him, and denounced his discovery as diabolical. Indeed, so violent was the opposition at this time to the operation, that several persons who had sufficient courage to undergo vaccination were set upon by a mob, pelted with stones, and driven into their houses.
At length, having spent three fruitless months in London, Dr. page 6 Jenner returned to his native village, dejected and discouraged. But we hold that true merit and goodness can never be finally crushed by calumny, misrepresentation, and abuse, and will ultimately come to the front not only in spite of, but even because of such hateful opposition. And for Jenner the hour of triumph was at hand. Two ladies of quality, Lady Ducie and the Countess of Berkeley, whose names must for ever be placed in honourable juxtaposition to that of Jenner, had the courage to have their children vaccinated, a step which effectually broke through the prejudices of the day. In 1801 upwards of 6000 persons had been vaccinated, the greater part of whom were tested and proved to be protected from small-pox. Before the end of 1802 vaccination was introduced into Prance, Germany, Italy, Spain, and the East Indies. Everywhere Jenner was recognised as the greatest benefactor of his age, and received many tokens of grateful recognition of his services. In 1802 the British Parliament voted him £10,000; in 1807 it gave him other £20,000; decorations and public thanks were sent him by foreign governments;—but what he valued more highly than these tangible and ostentatious rewards were the blessings of those that were ready to perish.
When the success of his discovery had made Tenner famous, his conduct was marked by a degree of modesty and self-denial which invariably accompanies true goodness, an example which it would be well for physicians in our day to imitate—many of whom, apparently pursuing their high vocation with the sole object of gain, reduce their profession to the low level of shoddy manufacturers, huckstering merchants, and pettifogging lawyers. On being urged to quit his native village, where he practised as a physician, to settle in London where fame and fortune where within his reach, he thus wrote to a friend:—" Shall I who, even in the morning of my life, sought the lowly and sequestered path of life—the valley, and not the mountain—shall I, now my evening is fast approaching, hold myself up as an object for fortune and for fame?"
The Results of Vaccination.
If the experience of nearly eighty years has not justified Dr. Jenner's expectation that smallpox would be extinguished by his discovery, the results have been sufficiently striking, as can be conclusively proved by statistics. The apparent failures are due, in our opinion, to no inherent defect in the principle of vaccination, but to the simple operation being too often carelessly and inefficiently performed, and to the constant evasions of the Vaccination Acts which take place in spite of the most stringent regulations. A. careful study of the whole subject has convinced us, and page 7 will we expect convince our readers as well, that under careful, complete, and efficient vaccination, the disease of smallpox would become a pathological curiosity amongst us. At the same time it is to be borne in mind that there is in every community a certain proportion of individuals who are liable to take small-pox twice or oftener, just as we find others taking scarlatina or measles more than once. As an example of what is here stated, it is well known that Louis the Fifteenth died of a second attack of small-pox. Yet cases like his are so rare that it may be said of them that the exception proves the rule. But vaccination does not act solely in the way of absolutely protecting from small-pox. It also has a controlling power over that disease, which is taken in a milder form after vaccination, and runs a more favourable course, the primary fever being less severe, the eruption more scattered, the pustules neither so deep nor so much inflamed, the scab maturing sooner and very rarely pitting, and there being no secondary fever.
Look we now to the statistics of the disease. In 1780 the deaths throughout England and Wales amounted to about 1 in 40 of the population; in 1811 they had declined to 1 in 52; and in 1821 they had sunk to only 1 in 58; and are at present 1 in 62. It is in accordance with observed facts to credit the operation of vaccination with this great reduction of nearly 50 per cent, in the death rate. But this is brought out most conclusively in the following table:—
Table showing the average of deaths from small-pox out of every 1000 deaths from all causes during the half century preceding vaccination.
|For the 10 years ending 1760||100|
|For the 10 years ending 1770||108|
|For the 10 years ending 1780||98|
|For the 10 years ending 1790||87|
|For the 10 years ending 1800||88|
Table showing the same during the half century succeeding the introduction of vaccination.
|For the 10 years ending 1810||64|
|For the 10 years ending 1820||42|
|For the 10 years ending 1830||32|
|For the 10 years ending 1840||23|
|For the 10 years ending 1850||16|
In regard to other countries it is shown in Mr. Simon's blue-book that the fatality of small-pox in Copenhagen is but an eleventh part of what it was before the introduction of vaccination; in Sweden little over a thirteenth; in Berlin and in large parts of Austria but a twentieth; in Westphalia but a twenty-fifth.page 8
The decline in the death rate from small-pox is even more conspicuously seen by the following table:—
|Periods compared.||Annual death-rate of small-pox per million of population.|
|1. Average of thirty years previous to the introduction of vaccination||3000|
|2. Average of three years (1838-40) when vaccination had become diffused, but before public provision was made for its gratuitous performance||770|
|3. Average of nine years, when public vaccination was gratuitously provided, but was not compulsory (1841-53)||304|
|4. Average of twelve years (1854-65), during which vaccination was, to a certain extent, obligatory||202|
Facts equally conclusive are derivable from the health statistics of Her Majesty's troops. From 1817 to 1836 the following facts are recorded:—In Dragoon regiments and Guards, with an aggregate strength of 44,611 men, and a total mortality of 627, there were only three deaths from small-pox. Among the troops at Gibraltar one death occurred, the aggregate strength being 60,269, and the whole mortality 1291.
In the West Indies, although several epidemics of small-pox had ravaged the islands within these years, not one person died of the disease among the British or white troops, out of an aggregate strength of 86,661 and a total mortality of 6,803; while among the black troops (who had all been thoroughly vaccinated on enrolment) numbering 40,934, with a mortality of 1,645, there was not even one case of small-pox.
At Bermuda, Nova Scotia, New Brunswick, Cape of Good Hope, and the Mauritius, not a single death from small-pox occurred during those 20 years, and even the white troops of Western Africa wholly escaped this disease which was carrying off hundreds of the black unprotected population. But the strongest evidence of the protective power of vaccination is derivable from the experience of our troops in Malta from 1818 to 1836, when only two deaths occurred from small-pox amongst 40,826 British troops; whereas amongst the civil population of the island, all unprotected, there was a mortality of 1,169 persons in the years 1830 and 1831 alone, when small-pox raged as an epidemic.
It cannot be a matter of surprise, with such statistics before us, that vaccination gradually entered into the life of the nation, became highly popular, and formed a part of the daily routine of family life. If there were any objectors to the practice, their complaints had not page 9 as yet penetrated the public ear, but were either confined to their own bosoms or limited to the circle of their private acquaintances. We must now turn our attention, however, to the rise and progress of the recent crusade against vaccination, answer the objections urged by anti-vaccinationists, and point out what measures should, in our opinion, be adopted to improve the practice of vaccination as now adopted, in order to thoroughly stamp out the much-dreaded small-pox.
The attention of the legislature and of the public was first forcibly attracted to the subject of vaccination by a severe outbreak of smallpox, assuming an epidemic type, which took place in London in 1871. The government showed itself alive to the urgency of the position by appointing a special commission to inquire into the causes of these outbreaks, and to discover any defects in the existing Acts. Several eminent members of the medical profession took up the subject of their own accord, and pursued it with such painstaking research and fulness of inquiry as to materially supplement the labours of the commissioners. Nor were the opponents of vaccination less active. Hitherto there were to be found here and there a few individuals who objected on various grounds to the operation, and refused to have their children vaccinated. But these crotchety persons carried no weight, and their example was lost upon the public. Now, however, taking advantage of the scare of the public, they organised themselves into associations, having for their object the repeal of the Compulsory Vaccination Act. They produced statistics—manufactured, of course, by themselves to suit their preconceived opinions—to prove their objections. They circulated pamphlets in which they denied the beneficial effects of vaccination, and urged that it introduced into the system unheard-of diseases. Their mischievous efforts bore fruit among the ignorant section of English society, and there are now hundreds of parents who prefer fine and imprisonment to vaccinating their children; indeed, for a time their labours were crowned with so much success that it seemed as if England, the birth-place of vaccination, were to be robbed of the benefits of .Tenner's discovery. By and by the report of the special commission was issued, and several able pamphlets appeared from the pens of well-known medical men. The friends of vaccination were pleased to find therein overwhelming proofs of the success and efficiency of the operation, and a triumphant refutation of the slanderous and misleading assertions of its opponents. But so difficult is it to eradicate error and scandal, however baseless, that such idle tales will no doubt be repeated and accepted as truthful for generations. The commission clearly traced the extent of the recent epidemic to the total neglect of vaccination in numerous cases, and to the careless and inefficient manner in which the operation was carried out in others. The Acts were accordingly amended so as to remedy the defects which had come to light; and there can be no doubt thatpage 10
vaccination is at present carried out far more faithfully and efficiently in Great Britain than at any former period of its history.
The Objections to Vaccination Answered.
1. Vaccination alleged to be a failure.—A favourite cry of anti-vaccinationists is that vaccination has been a failure, that after an experience of more than half a century, small-pox still does its deadly work in our midst. In answer to this objection we have only to point to the statistics already adduced. We freely admit that vaccination has not quite realised the reasonable expectations of its discoverer; but that it has been to some extent a failure is an excellent argument for its more efficient performance—none at all against the operation. In a word, small-pox still exists because vaccination is sometimes wholly neglected, sometimes imperfectly performed, and in most cases too long delayed. But of this more anon.
2. The second objection we have to notice has more weight with parents than every other consideration; and if it can be shown that it is a groundless one, we shall have gone a great way in repopularising vaccination. Diseases, it is said, foreign to the infant's constitution are introduced along with the vaccine virus. If this were true to any appreciable extent, it would be necessarily fatal to the operation, for no parent would be justified in exposing his child to an immediate urgent danger for the sake of preserving it from a remote and casual one. Happily this question has been searchingly investigated by the most eminent medical men everywhere, and they are quite unanimous in deciding that the objection cannot be sustained. Moreover, every alleged case in which disease or death has been attributed to vaccination has, on strict investigation, completely broken down. Our own experience confirms these views. During three months that we attended the Faculty Vaccination Station at Glasgow, where we performed or saw performed many hundred cases of vaccination, in not a single instance did we see evil result. Our experience in Dunedin, where we have vaccinated hundreds of children, has been equally favourable. But let us see what men of the largest experience believe regarding this objection. Dr. Seaton says that although he has investigated many of such alleged cases, he has never yet in a single instance found that the child from whom the lymph was taken was suffering from the disease it was said to have imparted. Mr Marson states that in the performance of 40,000 vaccinations, he had never seen any other diseases communicated with the vaccine virus, nor did he believe in the popular reports that they are so communicated. Sir W. Jenner, at University College Hospital, London, in six years, in 13,000 cases, and Dr West in seventeen years, in 26,000 cases, both say that in no single case page 11 had they reason to believe that any constitutional taint had been conveyed from one person to another by vaccination. According to Sir James Paget, the worst that can be charged against vaccination is, that sometimes it evolves a constitutional affection till then latent in the system. Even this, he adds, can very seldom be charged with truth.
Finally, actual experiments have been made with a view of testing if disease is really communicable through vaccine virus. Persons suffering from constitutional diseases in an active state have been vaccinated, and with the lymph taken from them healthy individuals have been vaccinated, and in no single instance has it been found that the disease was so communicated from one to the other. It must therefore be considered proved, both by experiment and authority, that the danger of communicating infection through vaccine virus is so infinitesimally small as to be practically non-existent.
3. As a third objection, it is urged that erysipelas frequently results from the practice of vaccination. We have to reply, that although some cases of erysipelas, and even fatal cases, have followed vaccination, they have been so few in proportion to the millions of vaccinations that have been performed as hardly to deserve notice. Besides, the erysipelas is not due to the vaccine virus, but to the slight scratches or wounds that are made with the lancet. It is well known that this disease, in a fatal form, sometimes follows the most trifling surgical operation. We have seen erysipelas and death result from the amputation of a finger, in the practice of one of the best surgeons in Scotland, and we have seen tetanus follow the removal of a toe nail. But would any reasonable man argue that, because surgical operations sometimes eventuate untowardly, all surgical operations should be condemned? We have shown that thousands of lives are saved annually by vaccination, and millions protected from unseemly pitting. Is it reasonable to expect that this great result can be gained without here and there a child getting erysipelas from its vaccination? Even this, in our opinion, can be prevented by adopting a method of vaccination which we shall recommend below.
4. A fourth objection we have to notice is, that a skin eruption frequently breaks out subsequent to vaccination, which is therefore considered by the parents the fons et origo mail In most cases, our experience has taught us that the vaccination and eruption are not even remotely connected with one another, the latter being due to dentition or disorder of the stomach, liver, or kidneys, or inherent defect in the constitution. Even when no other cause can be assigned for the eruption than the vaccination, parents must not hastily assume that the vaccine lymph employed has been bad. No page 12 such thing. But inasmuch as vaccination causes a certain amount of irritation, from this irritation a skin affection may result in sensitive subjects. We have had two, or at most three, cases in which an eruption on the head has followed vaccination; but having kept a record of the vaccine lymph employed, we were able to prove that the vaccine virus was not at fault, as it had been used in other cases without evil effects. Moreover, the children so affected were not vaccinated till the fifth and six months; and this fact will give us a clue to a remedy which will be noticed below, when we come to speak of reform in the practice of vaccination.
5. Anti-vaccinationists have strongly urged in late years that although the mortality produced by small-pox has been reduced, yet the infantine mortality of other diseases has increased, so that no real gain of human life has followed from vaccination. We notice this objection only for the sake of exposing the disingenuousness of the opponents of Jennerism. For if these gentry had only consulted statistics before committing themselves to such a statement, they would have found, as has been conclusively shown by Mr Simon, that the mortality of measles, scarlatina, scrofula, and other infantile diseases has really diminished since the introduction of vaccination. And this is what scientific deduction would have led us to expect, because thousands of children who happened to survive smallpox had their constitutions so weakened that they fell ready victims to the next disease which attacked them.
Other objections still more absurd have been put forward by zealous anti-vaccinationists. For instance, vaccination has been said to have produced mental and physical degeneration of the human species, to have evolved diseases before unknown, to have diminished men's stature, to have rendered them incapable of supporting the same fatigue and exposure as their ancestors; and, let teetotallers mark this, to have driven men for consolation to dram-drinking and tobacco-smoking. All such objections have been gravely put forward from Jenner's time downwards. They prove the weakness of the case they are designed to support, and are so palpably false and inconsequent that we shall net stop to refute them, but merely leave them to the intelligence of our readers.
The prevalence of small-pox in London for some years, and its present attack on the good people of Sydney, point to some defects in the existing machinery which it is of the last importance to the health of the community should be discovered and remedied. It is vain to expect that we in New Zealand can always enjoy immunity page 13 from this unwelcome disease. Whether its visit will be short-lived or permanent will depend on the fidelity with which vaccination is here performed. For our own part, we know that in New Zealand we have a soil rich for the propagation of the pest, viz., a large proportion of the community wholly unprotected by vaccination. We know scores of children who have not been vaccinated at all; and there are many in whose cases the vaccination has been most imperfect. We shall therefore proceed to briefly indicate the measures which ought to be adopted, in our opinion, in order to guarantee to the community the full benefits and security of vaccination.
1st. It is essential that the penal clauses of the Compulsory Vaccination Act be strictly enforced. Every child on the register of births should, within the period prescribed by the Act, be registered as vaccinated, as dead, or as insusceptible of vaccination. Should every birth registered not be so accounted for, the Registrar should take steps to trace the child, and compel compliance with the Act.
2nd. The Vaccination Act in the Colony should be amended so as to restrict the period within which primary vaccination must be performed to three months There are serious objections against prolonging the period to six months. Parents, as a rule, delay getting their children vaccinated till near the expiry of the period. It then often happens that it has to be delayed owing to illness from dentition, diarrhoea, or mal-nutrition, all which ailments are more prevalent during the later age. It will thus be seen that by delaying the operation until the sixth month, there remains in the community a large number of unprotected infants who, were smallpox once in our midst, would become a standing menace, since through their agency small-pox would probably become epidemic. In every populous country there are many thousands of children under six months old. In Dunedin and suburbs there must be about 500, while at three months there would be but half that number. Statistics lend weight to our argument, as it has been proved in recent epidemics in London that 11 per cent, of the victims of small-pox die before their fourth month. Moreover, by reducing the period to three months, we are sure that a serious objection to vaccination—noticed by us above—would be almost entirely removed, inasmuch as it has been found that eruptions on the skin rarely follow vaccination when performed in the early weeks of infancy, and thus vaccination would be freed from the unjust imputation of having caused such eruptions. Three months of age is recommended by the principal vaccinators in Great Britain, and many practitioners perform the operation much earlier than this. Having performed page 14 hundreds of vaccinations between six weeks and three months, we have come to the conclusion that the younger the child the greater the safety and effectiveness of the operation, and we have every confidence in recommending the adoption of the third in place of the sixth month.
3. Uniformity of Operation.—Steps should be taken by Government to insure as far as possible a fixed standard of successful vaccination, anything short of which would not be recognised as vaccination in the sense of the Act. At present, the manner of performing the operation is left to the fancy or discretion of the operator. Under this system, or rather want of system, it happens that the vaccination of one man is something quite different from that of another operator. One surgeon scratches the arm; another punctures, but at his option puts two, three, four, or more punctures. The same rule prevailed at home before the Commissioners' report, after which Government adopted a uniform system for all public vaccination. That this is not a matter of indifference has been proved by recent observations in several epidemics of smallpox. According to these vaccination is efficient as a protection from smallpox in proportion to the number of sores produced on the arm. Of the patients admitted into the London Small-pox Hospital in the two last epidemics the great majority had never been vaccinated, and the rate of mortality was high. Next to the unvaccinated came those who had been vaccinated in infancy, and whose arm bore only one scar. In this class the mortality was still high, but very much less than in Class 1. The third class bore two scars, and amongst these the disease was greatly modified, and the mortality small. The fourth class bore three or four scars; the disease ran a mild course, there was no pitting, and a death was very exceptional. Lastly, none were admitted whose arm bore six good scars, thus showing that such persons enjoyed an absolute immunity from smallpox.
It has been our frequent practice to employ six punctures, in this respect following the practice of the Faculty Hall Vaccination Station at Glasgow, where during a three months' apprenticeship, we witnessed or performed many hundred operations, all by six punctures, not one of which was followed by a bad symptom.
Mothers often object to this number, but when it is explained to them that there are less risk and suffering from six small punctures than from two or three large blotches, and that the former method gives absolute immunity, their scruples usually give way. No. 2 of the Instructions for Vaccinators, issued by Her Majesty's Most Honourable Privy Council, recommends:—In all ordinary cases of primary vaccination, if you vaccinate by separate punctures, make such punc page 15 tures as will produce at least four separate good-sized vesicles; or, if you vaccinate otherwise than by separate punctures, take care to produce local effects equal to those just mentioned. This rule we beg to recommend in the strongest terms for adoption in New Zealand. If Government would insist on all public vaccinators operating by four—or, better still, six—separate punctures, the practice of this method would soon extend to private practitioners, and there would be thus secured a uniform standard, which could not fail to produce good results in the course of time.
4th. A supply of pure vaccine lymph should be provided by Government for all regular medical practitioners. A consideration of this recommendation opens up a vexed, but highly important, question, on which the highest authorities differ. The question is this: Does vaccine lymph, after being repeatedly transmitted from one human being to another, lose any of its prophylactic power? As early as 1809, Mr Brown, of Musselburgh, published the opinion that the prophylactic virtue of cowpox diminished as the time from vaccination increased. Dr Jenner dissented from this view, and ever since medical opinion has been divided on this point. In our judgment, Mr Brown was right, although he missed the explanation, which we shall here give. Humanised lymph deteriorates because in the course of time a large quantity of imperfect lymph passes into circulation. And to this want of care or skill in the selection and storing of lymph do we attribute any impairment of its protective power, and not to the mere fact of its having passed through many subjects. But let us see what is the opinion of the best authorities, dead or living. In the opinion of the permanent members of the National Vaccine Board, it maintains its quality undiminished; and in this opinion Sir Thomas Watson coincides (1871), declaring that he had opportunities of satisfying himself that lymph which had been transmitted without interruption from person to person ever since the time of Jenner, continued to generate what seemed a very perfect cow-pox vesicle.
On the other hand, Mr. Simon, who will be recognised as the highest authority on the subject, came to the conclusion "that the occasional impermanence of protection may depend upon impairment in the specific power of vaccine contagion, an impairment arising in the transmission of that contagion through many generations of men." M. Brîsset, in France, as early as 1818, alleged that the past ten years had made a marked difference in the visible characters of the vaccine vesicle. Dr. Meyer, of Kreutzburg, states that he has found the older scars much better marked than the more recent ones. Frequent opportunities of our own of testing this observation of Meyer, have convinced us of its truth.page 16
According to the testimony of many vaccinators, the proportion of unsuccessful to successful vaccinations is every year increasing. Dr. Gregory and Mr. Estlin, in England, have adduced similar facts in evidence that the vaccine lymph, by passing through the bodies of many persons, loses in process of time some essential part of its activity.
The experience furnished by the Prussian Army shows very clearly that vaccine lymph undergoes a gradual deterioration. It appears that where vaccine supply has seldom or never been renewed from the cow, the proportionate resusceptibility of vaccine disease at a given age has undergone a progressive increase. "And (in the words of Mr. Simon) it is difficult to conceive how the infantine generations of a country could, crop by crop, successively derive less permanent constitutional impressions from vaccination, unless the efficient causes of those impressions—the vaccine contagion itself—had year by year undergone enfeeblement of its powers."Moreover, the statistics of the Prussian Army in regard to revaccination of its recruits tells the same story. When the system of re-vaccination was adopted in 1833, the proportion of successful results was thirty-three in every hundred. Now the annual percentage is seventy. This proves conclusively either that vaccine lymph has deteriorated very materially, or that primary vaccination is not so efficiently performed now as in the early days of the operation, a hypothesis we have no ground to sustain.
Mr. Marson's (the highest authority in England) testimony agrees with this. According to him, vaccine lymph becomes humanised, and consequently weakened as a prophylactic, by passing many times through the human body; the scars are not so good as they were formerly; and the mortality after vaccination, estimated on a large scale, shows a considerable increase.
All which consensus of opinions points to the desirability of renewing the supplies of vaccine lymph directly from the cow.
Having more than three years ago recognised the desirability of introducing an entirely new supply of vaccine matter into our practice, we made application for a supply of pure calf-lymph, such as is used in Germany under Government supervision. This we obtained through Messrs. Hilliard and Sons, Surgical Instrument Makers, Glasgow and Edinburgh. Since receiving which we have operated with it in several cases with the result:—1st. That the percentage of failures is higher than with ordinary lymph. 2nd. That the vesicle produced in successful cases differs materially from the common vesicles in being smaller and less active, and leaving a deeper scar. 3rd. That after this calf-lymph has passed once or twice through the human system, its great superiority to old humanised lymph becomes apparent, as it shows page 17 such activity as to make it necessary to use the lymph more sparingly, comes to maturity more rapidly, and leaves a much deeper cicatrix, the separate pits of which are well marked. We have therefore formed a highly favourable opinion of animal as opposed to humanised lymph; and as the use of such calf-lymph would remove the strongest objection of parents to the operation, viz., the fear of introducing disease, it is in our opinion the clear and urgent duty of the government to afford a supply of such lymph to all registered practitioners. For the question of introducing calf-lymph is ripe for consideration; and, if left to individual action, mischief will undoubtedly arise, the propagation and storing of calf-lymph being beset with difficulties and dangers only to be adequately realised by those who have made or may make the attempt.
The advantages of having a lymph supply free from all suspicion of taint or impairment of energy will be admitted by all, and are simply incalculable at a time when the growing distrust of human lymph threatens to oppose a serious difficulty in the proper enforcement of the Compulsory Vaccination Act. Meanwhile we are content to claim for ourselves the merit of having, as far as we can ascertain, successfully introduced into this Colony a new supply of lymph derived directly from the original source.
5th. Re-vaccination.—The question of re-vaccination crops up ever and anon, as often as the public mind takes alarm at a threatened invasion of small-pox. Of its utility there cannot be a question, as the statistics of the British Army and Navy adduced by us in a previous page abundantly testify. Tn some Continental States re-vaccination has been made compulsory, and the results have been highly satisfactory. Indeed we have no hesitation in affirming, that were re-vaccination thoroughly carried out, in two generations small-pox would only be known from historical records. Apart from the question of the deterioration of the lymph now in use, it has been satisfactorily established that while one primary vaccination in infancy protects the great majority of individuals throughout life, there still remains a numerous class who become resusceptible to small-pox. As these individuals cannot in any way be distinguished from protected persons, it is necessary to re-vaccinate the entire population. This secondary vaccination ought to be performed about the age of puberty, with pure calf-lymph or with humanised infantine lymph, never with lymph drawn off are-vaccinated person.
As in all probability the country is not ripe for compulsory re-vaccination, the way might be paved for its becoming general by its being made compulsory in the case of every candidate for the public service, including teachers and railway officials.page 18
6th. We have, lastly, to recommend that Inspectors of Vaccination he appointed, whose duty should consist in visiting the different public vaccination stations throughout the country, watching the Public Vaccinator's mode of operation, inspecting the results attained as seen on the arm on the eighth day, examining the cicatrices, testing the quality of the vaccine lymph, and taking measures to correct whatever might appear to him faulty. This has been carried out in Great Britain for several years, and has resulted in a vast improvement in the quality of the vaccination. In connection with this inspection a system of extra payments by results was introduced, which has had the desired effect in reconciling public vaccinators to the inspection, and has stimulated them to obtain the best results possible. These extra payments take the form of grants, and do not interfere with the regular remuneration per head, which is paid to all public vaccinators alike.
The Therapeutics of Vaccination.
Medical men have been long familiar with the fact that one disease often expels another from the system, temporarily in most cases, the old disease returning after the cure of the new one, but in many cases effecting a permanent cure. But although in vaccination a ready means of introducing a new disease, viz., cow-pox, has been long available to the profession, this aspect of vaccination has attracted very little attention.
Having had the advantage of attending the lectures and clinique of Professor McCall Anderson, the celebrated Dermatologist, at the Glasgow Dispensary for Diseases of the Skin, we had our attention directed to this means of curing chronic diseases which refused to yield to the ordinary remedies. Ever since this has been a favourite subject of investigation to us, and has yielded us remarkable results. We were therefore much gratified lately when we came to know that this use of vaccination had not escaped the acute penetration of Dr. Jenner, who writes in his original essay, "Cow-pox inoculation holds out the prospect of great benefit to those who are labouring under chronic forms of disease, in which counter irritation is desirable."
Remarkable cases of the cure of old disease by means of vaccination have been published by Dr. McCall Anderson, Mr. Lawson Tait, and others; but there is nothing more striking than has occurred in our own practice, as a single example will show. In July, 1877, C.M., aged 18 months, was brought to us by her mother. We found her suffering from a severe form of eczema impetiginodes. Prom the history of the case as given us by her mother, we learned that she was a perfectly healthy child up till her fourth month, when the eczema attacked her face and head in the usual manner. She was immediately put under treatment, page 19 but no good resulted, as the child grew the longer the worse. When brought to us we found her a pitiful spectacle, being covered from head to foot with a mass of crusts and scabs, and she looked like a wizened prematurely-aged old woman. We treated her for a year with a varying result; on the whole the disease was modified, but a cure seemed as far off as ever, and her sufferings were so great, and her appearance so loathsome, her growth all this time being entirely arrested, that her mother often expressed a desire that death might end her sufferings. At length we suggested vaccination, and the mother consented. The vaccination ran the usual course, and was hardly at its height when the skin disease underwent a notable change for the better. In a few weeks it had entirely disappeared from the head and body, but lingered longer on the vaccinated arm. This, too, soon got well, the child began to grow, and she is now as healthy and fine looking a girl as a mother' heart could desire.
For upwards of six years we have had recourse to vaccination as a regular part of treatment in many morbid states of the constitution, particularly in mal-nutrition of infancy, in which it is undoubtedly of great value. In epilepsy, scrofula, syphilis, and in the gouty and rheumatic diathesis, we have tried it with considerable success. But this is not the place to enter at length into this aspect of' vaccination, and at present we take our leave of the subject. We must express the hope, however, that the therapeutics of vaccination, if it be permitted us to coin a phrase, will now receive a candid and unbiassed investigation from all medical men. We venture to predict as the result of such trial, that vaccination will establish itself as a valuable addition to a physician's armamentarium, and thus acquire a new claim to the gratitude and confidence of mankind.
Printed by John Mackay, Moray Place, Dunedin.