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diff --git a/old/67824-0.txt b/old/67824-0.txt deleted file mode 100644 index 8216660..0000000 --- a/old/67824-0.txt +++ /dev/null @@ -1,1157 +0,0 @@ -The Project Gutenberg eBook of A Statement of Facts Tending to -Establish an Estimate of the True Value and Present State of -Vaccination, by Gilbert Blaine - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: A Statement of Facts Tending to Establish an Estimate of the True - Value and Present State of Vaccination - -Author: Gilbert Blaine - -Release Date: April 13, 2022 [eBook #67824] - -Language: English - -Produced by: Charlene Taylor, Daniel Lowe and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The - Internet Archive/American Libraries.) - -*** START OF THE PROJECT GUTENBERG EBOOK A STATEMENT OF FACTS TENDING -TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND PRESENT STATE OF -VACCINATION *** - - - A - - STATEMENT OF FACTS, - - TENDING TO - - ESTABLISH AN ESTIMATE OF THE TRUE VALUE - - AND - - PRESENT STATE - - OF - - VACCINATION. - - ---------- - - BY SIR GILBERT BLANE, BART. - - _F.R.S. of London, Edinburgh, and Göttingen; Member of the Imperial - Academy of St. Petersburgh; and Physician in Ordinary to the King._ - - ------------------------- - - FROM THE TENTH VOLUME OF THE MEDICO-CHIRURGICAL TRANSACTIONS, PUBLISHED - BY THE MEDICAL AND CHIRURGICAL SOCIETY OF LONDON; - - WITH ADDITIONS. - - ------------------------- - - LONDON: - - PRINTED FOR THOMAS AND GEORGE UNDERWOOD, 32, FLEET STREET. - - ---------- - - 1820. - ------------------------------------------------------------------------- - - J. MOYES, GREVILLE STREET, LONDON. - ------------------------------------------------------------------------- - - A - - STATEMENT OF FACTS, - - TENDING TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND - PRESENT STATE OF - - VACCINATION. - - BY SIR GILBERT BLANE, BART. F.R.S. Lond. &c. - - _Physician in Ordinary to the King._ - - ------------------------- - - _Read Nov. 10, 1819._ - - ------------------------- - -It is now twenty-one years since Vaccination was promulgated in this -country by Dr. Jenner, and fifteen years since it began to produce a -sensible effect in diminishing the mortality from Small Pox. In regard -to the latter period, it is coeval with this Society; yet, though no -discovery in nature nor in medicine has been more important to the -interests of humanity, nor any which has ever so rapidly and universally -won the assent and practical adoption of mankind, there are no notices -of it on our records, except in our second volume, in an article by Dr. -Bateman, in which he relates a case of a mother who was affected with -the Small Pox a second time, by being exposed to infection, from some of -her own children who had caught it casually; while her other children, -who had been vaccinated, resisted it. As it is to be hoped that our -labours will prove to posterity some of the principal sources of -reference regarding the medical and chirurgical discoveries and -improvements of the age; as it is one of the reproaches of our country, -that it has not availed itself so much as any other of the benefits of -Vaccination; and as there are writers among us who still allege that the -failures are so numerous that the value of the discovery is very -ambiguous, it seems one of the duties of the Society to lend its aid in -placing these important points in their true light. - -It seems almost needless to premise, that the Small Pox is of all -maladies that, which, during the last thousand years, has destroyed the -largest portion of the human species, and been productive of the largest -share of human misery. There is, perhaps, no disease over which medical -art has less power; and this power, such as it is, has consisted more in -abolishing pernicious practices, than in ascertaining any positive -methods of controlling its fatality, unless we except the inoculation of -it with its own _virus_. But, though the beneficial effect of this on -those on whom it is actually practised is undeniable, it has no tendency -like Vaccination to extirpate the disease; and from the impossibility of -rendering it universal, it has actually been found to add to the general -mortality of Small Pox, by opening a new source for the diffusion of its -_virus_. - -It ought to be stated also, with a view to a decision on this question, -that Vaccination itself is attended with no danger, and frequently takes -effect without any visible disturbance in the system. There is even -reason to believe, that in its process it wards off other diseases, by -pre-occupying the constitution. - -In order to bring this matter to the test of calculation, in order also -to institute a comparison of the mortality of Small Pox as influenced by -Vaccination, as well as by Inoculation from itself, I have selected from -the bills of mortality four periods, each of fifteen years, for the -purpose of exhibiting the mortality of Small Pox in each of these series -in regard to each other. These are thrown into the form of Tables, and -annexed to this article. - -The first series, is the fifteen years immediately preceding the -introduction of Inoculation; that is, from 1706 to 1720, both included. -Previous to this period, no account that could be depended upon -regarding the Small Pox, could be derived from the bills of mortality; -for down to the beginning of last century such was their imperfect -construction, that Small Pox, Measles, and Flux were blended under one -head. Exception may be taken against the accuracy of these bills, even -in this improved state, particularly with regard to the discrimination -of diseases. This objection, however, is certainly less applicable to -Small Pox than any other disorder, its character being so striking as -not to be mistaken by the most ignorant and careless observer. - -The second series is taken at the middle of the last century, when -Inoculation had made considerable progress; that is, from 1745 to 1759, -both included. In comparing this with the preceding series, with regard -to absolute numbers, it ought to be taken into account, that eleven -parishes were added to the bills of mortality, between the years 1726 -and 1745, both included: so that the progressive improvement of general -salubrity ought to be estimated still higher than what is indicated by -the diminished mortality, as it stands in the Tables. - -The third series comprises the fifteen years previous to the -introduction of Vaccination, when Inoculation had made still greater -progress; that is, from 1785 to 1798, both included. - -The fourth series comprises the time in which the vaccine Inoculation -has been so far diffused as to produce a notable effect on the mortality -of Small Pox; that is, from 1804 to 1818, both included. - -The result of these computations stands as follows:— - - _Ratio of the Mortality of Small Pox to the total Mortality._ - - From 1706 to 1720, one in 12.7; that is, 78 in 1000. - From 1745 to 1759, one in 11.2; that is, 89 in 1000. - From 1785 to 1798, one in 10.6; that is, 94 in 1000. - From 1804 to 1818, one in 18.9; that is, 53 in 1000. - - Fractions are not noticed in the last column of numbers. - -It appears from this statement, that the proportion of deaths from Small -Pox to the total mortality, increased in the course of last century; so -that Inoculation appears to have added to the mortality. It is but fair -to mention, however, that this total mortality is not quite a just scale -whereby to measure the relative mortality of Small Pox; for in the -course of that century, the general mortality itself was greatly -diminished in relation to the population. This diminution of general -mortality was chiefly owing to the diminished mortality of children -under two years of age, which, at the time when the account began to be -kept, 1729, averaged about 9000; but at the end of the century not more -than 5000[1]; also to the decrease of fevers, and still more of fluxes. -The relation of the mortality of Small Pox to the population, would -therefore be a more fair criterion of its increase or decrease. In this -view it might, at first sight, be thought that it had decreased; for the -population of the metropolis nearly doubled in the course of the last -century. But it is to be remarked, that there has been little increase -of population in that portion of the metropolis which is included in the -bills of mortality; the great increase having been in the parishes of -Mary-le-bone and St. Pancras, which are not included in these bills. It -is computed in the remarks subjoined to the last parliamentary returns -of population, that the population of London, within the walls, had -decreased more than three-fifths in the course of last century, from the -widening of streets, the erection of public buildings and warehouses, -and, it might have been added, from the migration of mercantile families -to the west end of the town. As a set-off to this, there has certainly -been a great addition, in the same time, to those parishes within the -bills, which stand on the verge of the metropolis, such as St. George’s -Hanover Square, St. George’s Bloomsbury, Poplar, and Stepney. But the -addition to the population, if any, within the bills of mortality, does -not seem to be so considerable as to affect the computation. And, if -this is admitted, the absolute numbers of the deaths from Small Pox, -estimated in relation to the population, that is, exactly as they stand -on the Tables, afford a fair comparative statement of the mortality in -the last century, and seem to prove that Inoculation has not added so -much to it as has been alleged. It was in the rural population that the -effect of Inoculation in diffusing Small Pox was chiefly felt. In this -situation there is much less intercourse of persons with each other than -in towns, so that not only many individuals escaped from their not being -exposed to infection during their whole lives, but whole districts were -known to have been exempt from it for a long series of years, before it -was universally diffused by Inoculation. - -But the truly important result from these statements consists in the -clear, undeniable, and great diminution of it since the introduction of -Vaccination. It appears, that in the last fifteen years, the mortality -from Small Pox, in the bills of mortality, has not been much more than -one-half of what it was in the two like series of years in the middle -and latter end of the last century. Nor does this comprise the whole -benefit derived from this discovery in the metropolis; for, besides that -the sixth part of it lies without the bills, it was found, in levying -the tax on burials for the last six months of 1794, that the number of -unregistered deaths, chiefly those of dissenters, amounted in that half -year to 3148; and the reporter of the parliamentary enumeration thinks -that, as besides these there were undiscovered interments, the -unregistered deaths may be computed at one-third of the total mortality, -that is, about 7000. (_See Abstract of the Parish Registers, 1811, -printed by authority of Parliament, page 200._) - -Assuming, therefore, that Vaccination had not been practised the last -fifteen years, and that the mortality from Small Pox, within the bills, -had in that time, that is, from 1804 to 1818, been the same as from 1784 -to 1798, that is, 27,569 in place of 14,716; and assuming that there has -been the same proportional diminution of deaths in the districts without -the bills, and among the unregistered subjects, the account of lives -saved in this metropolis by Vaccination in the fifteen years, will stand -as follows:— - - Within the bills of mortality 12,853 - Without the bills of mortality 2,570 - Unregistered cases 7,711 - ------ - Total 23,134 - -The first of these numbers is found by subtracting the amount of deaths -by Small Pox, in the bills of mortality, during the practice of -Vaccination, from the amount of them, during the same number of years, -immediately before the discovery of Vaccination. - -The second number is found by dividing the first by 5. The population of -the metropolis without the bills is stated at one-sixth of the whole, -which is evidently one-fifth of that within the bills. - -The third number is found by dividing the sum of the two others by 2; -the unregistered cases being, as before stated, one-third of the whole. - -It appears, therefore, that, even under the very imperfect practice of -Vaccination which has taken place in this metropolis, 23,134 lives have -been saved in the last fifteen years, according to the best computation -that the _data_ afford. It will be seen, by an inspection of the Table, -that in that time there have been great fluctuations in the number of -deaths. This has been owing partly to the Small Pox Inoculation of -out-patients having, by an unaccountable infatuation, been kept up at -the Small Pox Hospital for several years after the virtue of Vaccination -had been fully confirmed. The greater number of deaths in 1805 may -chiefly be referred to this cause. Since the suppression of this -practice, the adoption of Vaccination, though in a degree so incomplete, -in consequence of public prejudice, created entirely by mischievous -publications, has been unable to prevent a considerable, though -fluctuating, mortality from Small Pox. The late mortality from Small -Pox, though little more than one half of what it was in former times, -might have been entirely saved, if Vaccination had been carried to the -same extent as in many cities and whole districts on the continent of -Europe, in Peru, and Ceylon. - -In the summer of 1811 the author was called to visit, professionally, -Don Francisco de Salazar, who had arrived a few days before in London, -on his route from Lima to Cadiz, as a deputy to the Spanish Cortes. He -informed him, that Vaccination had been practised with so much energy -and success in Lima, that for the last twelve months there had occurred, -not only no death from, but no case of, Small Pox; that the new-born -children of all ranks are carried as regularly to the Vaccinating House -as to the font of baptism; that the Small Pox is entirely extinguished -all over Peru; nearly so in Chili; and that there has been no compulsory -interference on the part of the government to promote Vaccination. - -It is now matter of irrefragable historical evidence, that Vaccination -possesses powers adequate to the great end proposed by its meritorious -discoverer, in his first promulgation of it in 1798, namely, the total -extirpation of Small Pox. The first proof of this was at Vienna, where, -in 1804, no cases occurred, except two strangers who came into the city -with the disease upon them. In 1805 there did not occur a single death -from it in Copenhagen[2]. Dr. Sacco, the indefatigable superintendent of -Vaccination in Lombardy, stated, in his Annual Report, 3d January, 1808, -that the Small Pox had entirely disappeared in all the large towns in -that country; and that in the great city of Milan it had not appeared -for several years. Dr. Odier, of Geneva, so favourably known for his -high professional, scientific, and literary acquirements, testifies, -that, after a vigorous perseverance in Vaccination for six years, the -Small Pox had disappeared in that city and the whole surrounding -district; and that, when casually introduced by strangers, it did not -spread, the inhabitants not being _susceptible_. The Central Committee -in Paris testify, in their Report of 1809, that the Small Pox had been -extinguished at Lyons and other districts of France. - -These are selected as some of the earliest and most remarkable proofs of -the extirpating power. But it is demonstrable, that if at the first -moment of this singular discovery, at any moment since, at the present -or any future moment, mankind were sufficiently wise and decided to -vaccinate the whole of the human species who have not gone through the -Small Pox, from that moment would this most loathsome and afflicting of -all the scourges of humanity be instantaneously, and for ever, banished -from the earth. - -It is farther manifest, that extirpation being the ultimate aim of this -discovery, and there being the fullest historical and practical evidence -of its being capable of accomplishing this end, all other questions with -regard to its expediency must be futile and irrelevant. It is in the -nature of all morbid phenomena to be liable to exception. One of the -most essential and characteristic laws of Small Pox itself, namely, that -of its affecting the human subject but once in life, is found in rare -cases to be violated. It is, therefore, perfectly conformable to -analogy, and naturally to be expected, that it may not in all cases be a -complete security against Small Pox. But it is obvious, that, admitting -these exceptions to be very frequent, much more so than the recurrence -of Small Pox after Small Pox, this can constitute no objection to the -practice, as long as the extirpating power remains unimpaired and -unimpeached. Nay, it is obviously so far from an objection, that it -ought to operate as a powerful additional incentive on every benevolent -mind, to push Vaccination to the utmost, as rapidly as possible, in -order that those who are still susceptible, either from peculiar natural -constitution, or from the unskillful manner of conducting the operation, -or from defective matter, may not, by any possibility, catch it; for, in -the event of its extirpation, it could nowhere be met with. And in order -to stimulate the good and the wise to aim strenuously at this -consummation, let it be constantly borne in mind, that the adversary -they are contending with is the greatest scourge that has ever afflicted -humanity. That it is so, all history, civil and medical, proclaims: for, -though the term Plague carries a sound of greater horror and dismay, we -should probably be within the truth, if we were to assert, that Small -Pox has destroyed a hundred for every one that has perished by the -Plague. - -It is true that in its last visitation of this metropolis, one hundred -and fifty-four years ago, it carried off 70,000 victims in a few months; -but since that time, the deaths from Small Pox, recorded in the bills of -mortality, have amounted to more than 300,000; and a like number of the -survivors have been afflicted with blindness, deformity, scrofula, or -broken constitutions, which is not the case with the survivors of the -Plague. It appears, by a Report of the Hospital for the Indigent Blind, -that two thirds of those who apply for relief have lost their sight by -the Small Pox. It is alleged by some of the soundest Political -Economists that Small Pox does not diminish the numbers of mankind, nor -Vaccination increase them; for population is determined by subsistence, -and the indefinite powers of procreation soon repair the ravages of -disease. But, however true this may be, the miseries incident to so many -of those who survive Small Pox, whereby they become a burden to -themselves, their families, and to society, render this disease -uncontrovertibly an evil of the first magnitude, not to mention the -intense sufferings and afflictions inseparable from it; and in this view -of the matter the objection seriously adduced against Vaccination by one -of its opponents[3], that _Small Pox is a merciful dispensation of -Providence for the poor man, by diminishing the burden of his family_, -will not hold good, for the burden is not removed. - -And when it is considered that there are large portions of the globe, -India, China, even one whole quarter of it (North and South America), -besides all the tropical and arctic regions, in which the Plague has -never been known; and that in all the countries liable to it, it seldom -appears but at one season of the year, and in some at long intervals, -the ravage which it makes is trifling when compared with the unceasing -havoc of Small Pox, which spares no nation in any climate, or at any -season. Yet the Legislative Regulations for excluding and checking the -Plague are of the most harsh and despotic description, while the law -touches upon Small Pox comparatively with the most lenient hand. It -ought to be generally known, however, that in a late trial and -conviction, it was laid down by the judge to be the law of the land, -that a medical practitioner who neglects to exclude the person whom he -inoculates from communication with others, is liable to fine and -imprisonment. Morally considered, indeed, it is difficult to conceive a -higher degree of flagitious turpitude than that of a professional -person, in the present state of knowledge, exposing his -fellow-creatures, from sordid motives, to one of the most grievous -calamities of which human nature is susceptible. - -The preceding reasoning is grounded on the supposition of extirpation: -but, however demonstrable the _possibility_ of extirpation may be, it -may not in all communities be _practicable_; and may not these alleged -failures so operate, as, in such circumstances, to render the expediency -of the practice questionable? - -In order to decide this, let the nature and amount of these failures be -ascertained and estimated. - -The description of those cases of Small Pox, (if they can be called so,) -which occur in vaccinated subjects, is shortly as follows:—The invasion -and eruption in every respect resembles that of the genuine Small Pox. I -have seen it attended with high fever and a thick crowded crop of -_papulæ_, such as precedes the most severe and dangerous cases of the -confluent kind. This runs on till the fifth day from the eruption, both -days included, at which time some of the _papulæ_ begin to be converted -into small sized pustules. The disorder then abruptly stops short. On -the following day the fever is found to have subsided, with a -shrivelling and desiccation of the eruption, and recovery proceeds -without the least danger or inconvenience. The face is marked, for some -time after, with brown spots, but without pits. It should never be -forgotten, that all morbid _phænomena_ are full of varieties and -exceptions. Accordingly, though the fifth day is the most common limit -of this disorder, it sometimes stops short on the third; sometimes not -till the sixth or seventh; and, in a very few cases, it has been known -to run the common course of Small Pox. What forms the strong line of -distinction from proper Small Pox, is that, with a few exceptions, it -does not advance to maturation and secondary fever, which is the only -period of danger. I am not prepared to deny that death may not have -occurred in a few instances; nay, there seems sufficient evidence that -it actually has; but these adverse cases are so rare, as not to form the -shadow of an objection to the expediency of the general practice. A few -weeks ago at a meeting of this Society, at which forty members and -visitors were present, I put the question whether any of these eminent -and extensive practitioners had met with any fatal cases of this kind. -Two gentlemen had each seen a single case, and two other gentlemen took -occasion to say that they had each seen a case of second Small Pox, both -of which proved fatal. It is evident, therefore, that according to that -maxim which guides mankind in the conduct of life, namely, that of -acting on a general rule and average, and not on exceptions, these -adverse instances ought not to have the least influence on practice, -even though they were much more numerous. Nor indeed do they, except in -the very rare cases here cited, deserve the name of failures; for, -though they fail in preventing _Small Pox_, they do not fail to prevent -_Death_. And let me here, in the name of humanity, beseech practitioners -not to be forward in publishing single cases of failures, real or -supposed; for, when the weak minded and uninformed hear of these -failures, without hearing at the same time that there are hundreds of -cases of permanent security for every single case of failure, they are -guided by the _exception_, which becomes to them the _rule_; their -judgments being thereby most fatally perverted. - -As it is of the utmost consequence to establish the strong and important -distinction between Small Pox, properly so called, and that which takes -place after Vaccination, which may be called the mitigated, or five day -Small Pox, a few of the most impressive testimonies respecting the safe -nature of the latter may be here recited. Mr. Brown[4], of Musselburgh, -gives the detail of forty-eight cases, in none of which did the -secondary fever nor death occur. Here was a saving of at least eight -lives, at the lowest computation; for this is the number which, by the -average mortality of natural Small Pox, would have died if the -constitutions of these forty-eight persons had not been modified by -previous Vaccination. Dr. Dewar, of Edinburgh, hearing that many -vaccinated subjects had been affected with Small Pox at Cupar in Fife, -where the natural Small Pox at the same time prevailed, he most laudably -repaired to the spot to investigate the subject. He found that -fifty-four vaccinated subjects had caught the Small Pox. All these, -except one, had the mitigated or five day eruptive fever, and livid. The -fatal case was that of a child, who had a complication of other -disorders, and having died on the fifth day, the Small Pox, according to -its ordinary course of fatality, could not of itself be the cause of -death. All the rest were safe; while of sixteen cases of the natural -Small Pox at the same time and place, six died; so that, if these -fifty-three cases had not undergone the mitigating process of -Vaccination, nineteen or twenty would have perished. Between thirty and -forty cases of the same kind have occurred at Carlisle, on the testimony -of Dr. Barnes, a respectable practitioner of that city[5]. Many proofs -might be adduced from the oral testimony of private practitioners, which -would overswell this article. The only other to be mentioned is from the -Report of the Central Committee of Vaccination at Paris, made in -December last, in which the description of the disease occurring after -Vaccination corresponds exactly with the mitigated five day cases which -have occurred in Britain. They refuse the name of Small Pox to it; but -as I know from my own observation, as well as from the testimony of -others, that the matter from it does by Inoculation give the Small Pox, -we can hardly, perhaps, with propriety deny it that name; but it should -be distinguished by some strong discriminating epithet, such as is -suggested above. - -As the attack of Small Pox in subjects who have undergone Vaccination, -generally occurs after a long interval, it becomes a question whether -this is owing merely to the chance of such subjects not having been -exposed to variolous contagion, or to the effect of time in diminishing -the antivariolous virtue of vaccination. The former is certainly -conceivable; but when we consider the numberless severe proofs to which -the recently vaccinated were experimentally exposed in the early part of -this practice all over Europe, from which the most satisfactory evidence -resulted; and when it is considered that, in the great majority of -cases, Small Pox has not occurred till several years after vaccination, -it seems by far most probable that the virtue of it is weakened by time. -When parents, therefore, become anxious and apprehensive regarding the -risk of Small Pox after a lapse of years, it seems quite reasonable that -they should be indulged in having the operation repeated. - -Let all this be applied to the case of a community, in which the total -eradication of Small Pox is quite hopeless. Let it be admitted that such -occurrences as have been described do frequently occur: let it even be -admitted, for argument’s sake, that every vaccinated case whatever must -of necessity and unavoidably at some time or other in future life be -affected with this mitigated species of Small Pox, would it not even -under this great abatement be one of the greatest boons that could be -conferred on humanity, being an instrument or remedy which would disarm -Small Pox of its danger? Would not the next greatest benefit to the -total extirpation of Small Pox, be the stripping it of its terrors by -rendering it safe and harmless? - -It may be further remarked, that the benefit derivable from the -different proportions of the persons vaccinated to the total population, -advances in a considerably higher progression than the simple -arithmetical. It is evident that the smaller the relative number of the -vaccinated, the greater their chance of meeting with Small Pox -infection, and that though the disease which they may catch is of a -mitigated nature, it would nevertheless be desirable to avoid it on its -own account, but still more on account of the prejudice it creates. -This, in the eye of general benevolence, constitutes an additional, -though secondary motive for extending the vaccine inoculation as widely -as possible, even though the attainment of the _maximum_, that is, total -extirpation, should be impracticable and hopeless. - -It is of the highest importance to society, that this subject should be -seen in its true light, and in all its bearings; for the frequent -occurrence of these cases of Small Pox, however safe in themselves, have -had a most pernicious effect on the credulous and ignorant, by giving a -check to the practice of Vaccination. It ought never to be forgot that -the power of Vaccination in extirpating Small Pox being established, the -question of its expediency is completely set at rest. How many parents -are there now who, from a weak distrust in the virtue of Vaccination, -have to lament the loss of a child from Small Pox, either casual or -inoculated? Many such are known to myself. It is pleasing, however, to -observe, that though this unmerited discredit into which Vaccination had -fallen, swelled the number of deaths in London from Small Pox to 1051 in -1817, good sense is likely still to prevail, for last year (1818) the -deaths have fallen lower than they have ever been known since the -institution of the bills of mortality, the total number being only -421[6]. - -On the whole matter, I believe I am speaking the language of every man -of good principles and feelings, capable of reflecting seriously and -considerately on the subject, when I say, that whenever he applies his -mind to it, he finds some new and increasing cause of complacency and -satisfaction. Viewed as a mere physical fact in the natural history of -the animal kingdom, the virtue of the vaccine _virus_ in resisting the -action of the _variolous_, is, by its novelty and singularity, highly -striking and interesting to every one whose taste leads him to take -delight in contemplating and exploring the devious ways and varied forms -of Nature, as curious exceptions to the uniformity and constancy of her -laws. One can hardly contemplate with sufficient astonishment, the -extraordinary fact that a morbid poison taken from a domestic animal -should, when inserted into the human body, shield it against the assault -of one of the most fatal and cruel maladies to which it is incident. But -the importance of this, as a physical curiosity, vanishes to nothing -when the unexampled benefits of it to mankind are fairly weighed; -benefits which could never have been dreamt of by the most sanguine -philanthropist, who, in contemplating it, finds himself lost in -astonishment, at a boon to mankind almost beyond the grasp of his mind -duly to appreciate: so that what seems at first sight merely a sportive -aberration from the usual course of things, has, by the wise -dispensation of Providence, become subservient to the most beneficent -purposes: and how many more useful discoveries may there yet be in -reserve for the alleviation of human misery, from obscure and undetected -facts still lurking under the very surface of Nature! It will in the -eyes of future ages be deemed an _epocha_ in the destinies of the world, -and one of the highest boasts of the country in which it took its rise, -with a sense of unrequitable obligation to the individual[7] who first -disclosed and promulgated the secret, by drawing it from the dark -recesses of rural tradition, and rendering it available to the whole -human race. - -Such are the sentiments which must fill every well constituted mind; and -it behoves the whole medical profession, which has already done itself -so much honour by the zealous and disinterested encouragement afforded -to it, to continue its efforts in eradicating every remaining prejudice -against it. It becomes Englishmen, in particular, to cherish it, not -only as the native offspring of their country, of which they have reason -to be proud, but to redeem the character of the nation from the reproach -of having, of all others, whether savage or civilized, done the least -justice to this noble discovery. It is somewhat humiliating to reflect, -that while there is no country which has received more striking and -unambiguous benefits from this discovery, there is none which has prized -it less, nor availed itself of it so little. I here allude to the -unspeakable advantage of it to the public service, both by sea and land, -in the late war, so eventful and portentous in its course, and so -glorious in its termination. Formerly, Small Pox was one of the greatest -embarrassments to the operations of armies; and ships of war were -occasionally under the necessity of quitting the sea, from the -prevalence of this disorder among their crews. Those lately at the head -of the navy and army, with that vigilant wisdom and humanity which -become those who direct the affairs of a great and enlightened nation, -recommended and enforced the practice of Vaccination in both these -departments, to the great furtherance of the public service. Their -example has by no means been followed among the civil population of -England. This is chiefly imputable to the abuse of the press, the -general licentiousness of which may be denounced as one of the most -grievous evils of this age and country, in regard to other subjects -interesting to humanity and public happiness, as well as this; the -votaries of error and depravity being more successful, because they find -more encouragement in disseminating their principles, than the advocates -of truth, virtue, and good order. There is no maxim more true, than that -the best things do become by abuse the worst, and that in proportion to -their excellence. What a mortifying contrast does England form with -Peru, where it was adopted instantly, in consequence of a flash of -conviction from the light of evidence! and was not this conviction fully -justified by the immediate disappearance of Small Pox from that whole -region? To those nations who may feel an envy of the glory attached to -our country by this discovery, it must be no small consolation to -perceive that a large proportion of the English nation has hitherto been -so besotted as not to know how to appreciate it, nor how to avail -themselves of it, and that it has encountered more opposition among -ourselves than in all the world besides. - ------------------------------------------------------------------------- - - TABLE I. - - ┌──────┬──────────┬──────────────┬───────────┬──────────┐ - │Years.│ Total │Mortality from│Proportion.│Proportion│ - │ │Mortality.│ Small Pox. │ │ to 1000. │ - ├──────┼──────────┼──────────────┼───────────┼──────────┤ - │ 1706 │ 22,097 │ 1094 │1 in 20 │ 50│ - │ 1707 │ 21,600 │ 1078 │1 20 │ 50│ - │ 1708 │ 21,291 │ 1687 │1 12-1/2│ 79│ - │ 1709 │ 21,800 │ 1024 │1 21 │ 49│ - │ 1710 │ 24,620 │ 3138 │1 8 │ 127│ - │ 1711 │ 19,833 │ 915 │1 21-1/2│ 46│ - │ 1712 │ 21,198 │ 1943 │1 11 │ 92│ - │ 1713 │ 21,057 │ 1614 │1 13 │ 77│ - │ 1714 │ 26,569 │ 2810 │1 9-1/2 │ 106│ - │ 1715 │ 22,232 │ 1057 │1 21 │ 47│ - │ 1716 │ 24,436 │ 2427 │1 10 │ 100│ - │ 1717 │ 23,446 │ 2211 │1 10-1/2│ 94│ - │ 1718 │ 26,523 │ 1884 │1 14 │ 71│ - │ 1719 │ 28,347 │ 3229 │1 8-3/4 │ 114│ - │ 1720 │ 25,454 │ 1440 │1 17-1/2│ 56│ - ├──────┴──────────┼──────────────┼───────────┼──────────┤ - │ Total—350,503 │ 27,557 │1 12.7 │ 78│ - └─────────────────┴──────────────┴───────────┴──────────┘ - - In this series it appears that the deaths from Small Pox are, to the - total mortality, as 1 in 12.7; that is, 78 in 1000. - ------------------------------------------------------------------------- - - TABLE II. - - ┌──────┬──────────┬──────────────┬───────────┬──────────┐ - │Years.│ Total │Mortality from│Proportion.│Proportion│ - │ │Mortality.│ Small Pox. │ │ to 1000. │ - ├──────┼──────────┼──────────────┼───────────┼──────────┤ - │ 1745 │ 21,296 │ 1206 │1 in 17-3/4│ 56│ - │ 1746 │ 28,157 │ 3236 │1 8-3/4 │ 115│ - │ 1747 │ 25,494 │ 1380 │1 18-1/2│ 54│ - │ 1748 │ 23,869 │ 1789 │1 13-1/2│ 75│ - │ 1749 │ 25,516 │ 2625 │1 9-3/4 │ 103│ - │ 1750 │ 23,727 │ 1229 │1 19-1/4│ 52│ - │ 1751 │ 21,028 │ 998 │1 21 │ 48│ - │ 1752 │ 20,485 │ 3538 │1 5-3/4 │ 172│ - │ 1753 │ 19,276 │ 774 │1 25 │ 40│ - │ 1754 │ 22,696 │ 2359 │1 9-1/2 │ 104│ - │ 1755 │ 21,917 │ 1988 │1 11 │ 91│ - │ 1756 │ 20,872 │ 1608 │1 13 │ 77│ - │ 1757 │ 21,313 │ 3296 │1 6-1/2 │ 155│ - │ 1758 │ 17,576 │ 1273 │1 13-3/4│ 73│ - │ 1759 │ 19,604 │ 2596 │1 7-1/2 │ 132│ - ├──────┴──────────┼──────────────┼───────────┼──────────┤ - │ Total—332,826 │ 29,895 │1 11.2 │ 89│ - └─────────────────┴──────────────┴───────────┴──────────┘ - - In this series it appears that the proportion of deaths from Small Pox - is, to the total mortality, as 1 in 11.2; that is, 89 in 1000. - ------------------------------------------------------------------------- - - TABLE III. - - ┌──────┬──────────┬──────────────┬───────────┬──────────┐ - │Years.│ Total │Mortality from│Proportion.│Proportion│ - │ │Mortality.│ Small Pox. │ │ to 1000. │ - ├──────┼──────────┼──────────────┼───────────┼──────────┤ - │ 1784 │ 20,454 │ 1210 │1 in 17 │ 59│ - │ 1785 │ 18,919 │ 1999 │1 9-1/2 │ 106│ - │ 1786 │ 20,445 │ 1210 │1 17 │ 59│ - │ 1787 │ 19,349 │ 2418 │1 8 │ 125│ - │ 1788 │ 19,697 │ 1101 │1 17-3/4│ 56│ - │ 1789 │ 20,749 │ 2077 │1 10 │ 100│ - │ 1790 │ 18,038 │ 1617 │1 11-1/4│ 89│ - │ 1791 │ 18,760 │ 1747 │1 10-3/4│ 93│ - │ 1792 │ 20,313 │ 1568 │1 13 │ 77│ - │ 1793 │ 21,749 │ 2382 │1 9 │ 11│ - │ 1794 │ 19,241 │ 1913 │1 10 │ 99│ - │ 1795 │ 21,179 │ 1040 │1 20-1/4│ 49│ - │ 1796 │ 19,288 │ 3548 │1 54 │ 18│ - │ 1797 │ 17,014 │ 512 │1 33-1/2│ 30│ - │ 1798 │ 18,155 │ 2237 │1 8 │ 123│ - ├──────┴──────────┼──────────────┼───────────┼──────────┤ - │ Total—293,350 │ 26,579 │1 11 │ 90.9│ - └─────────────────┴──────────────┴───────────┴──────────┘ - - In this series it appears that the proportion of deaths from Small Pox - to the total mortality is 1 in 11, that is, 90.9 in 1000. - ------------------------------------------------------------------------- - - TABLE IV. - - ┌──────┬──────────┬──────────────┬───────────┬──────────┐ - │Years.│ Total │Mortality from│Proportion.│Proportion│ - │ │Mortality.│ Small Pox. │ │ to 1000. │ - ├──────┼──────────┼──────────────┼───────────┼──────────┤ - │ 1804 │ 17,038 │ 622 │1 in 27-1/2│ 36│ - │ 1805 │ 17,565 │ 1685 │1 10-1/2│ 96│ - │ 1806 │ 18,334 │ 1297 │1 14 │ 71│ - │ 1807 │ 17,938 │ 1158 │1 15-1/2│ 65│ - │ 1808 │ 19,964 │ 1169 │1 17-1/4│ 58│ - │ 1809 │ 16,680 │ 1163 │1 14-1/4│ 70│ - │ 1810 │ 19,893 │ 1198 │1 16-1/2│ 60│ - │ 1811 │ 17,043 │ 751 │1 22-3/4│ 44│ - │ 1812 │ 18,295 │ 1287 │1 14-1/4│ 70│ - │ 1813 │ 17,322 │ 898 │1 19-1/4│ 52│ - │ 1814 │ 19,783 │ 638 │1 31 │ 32│ - │ 1815 │ 19,560 │ 725 │1 27 │ 37│ - │ 1816 │ 20,316 │ 653 │1 31-1/4│ 32│ - │ 1817 │ 19,968 │ 1051 │1 19 │ 53│ - │ 1818 │ 19,705 │ 421 │1 47 │ 21│ - ├──────┴──────────┼──────────────┼───────────┼──────────┤ - │ Total—279,404 │ 14,716 │1 18.9 │ 53│ - └─────────────────┴──────────────┴───────────┴──────────┘ - - In this series it appears that the proportion of deaths from Small Pox - to the total mortality is 1 in 18.9, that is, 53 in 1000. - ------------------------------------------------------------------------- - - LONDON: - - PRINTED BY J. MOYES, GREVILLE STREET. - ------ - -Footnote 1: - - This diminished mortality of young children is, like that of fevers - and fluxes, owing chiefly to the improvements in ventilation and - cleanliness, but greatly also to laying aside the custom of exposing - them to the open air in winter and early in spring; either from - inadvertency, or from the false notion of rendering them hardy, - whereas they thereby catch inflammations of the lungs. Nothing tends - more to the health, strength, and growth of children, than genial - warmth. It seems chiefly owing to the great plenty and cheapness of - fuel, that the race of people in Lancashire are so superior in their - form and size. In Buckinghamshire, on the contrary, where fuel is - extremely scanty and dear, the race of people is small and puny, - insomuch that it is provided by Act of Parliament that men shall be - admitted into the militia of a smaller stature in this than other - counties. - -Footnote 2: - - See Pfaff Neuen Nord v. Archiv. B. I. - -Footnote 3: - - See Serious Reasons for uniformly opposing Vaccination. By John Birch. - London, 1807. - -Footnote 4: - - See Inquiry into the Antivariolous power of Vaccination. Ed. 1809. - There is an article in the Edinburgh Medical Journal by the same - gentleman in 1819, in which he mentions that he had heard of several - deaths having occurred from cases of Small Pox after Vaccination. But, - admitting this, it is utterly incomprehensible by what process of - reasoning Mr. Brown could on such premises arrive at the conclusion - that Vaccination ought to be exploded and abandoned. - -Footnote 5: - - See also a clear and able exposition of this subject in the Medical - and Surgical Journal of Edinburgh for July, 1818, by Mr. Dunning, of - Plymouth. - -Footnote 6: - - Since the first publication of this Tract, it has appeared that in the - succeeding year (1819), the deaths from the Small Pox had advanced to - 712; which ought to add to the perseverance, zeal, and vigilance, of - the friends of humanity in prosecuting Vaccination. - -Footnote 7: - - Dr. Edward Jenner. - - * * * * * - - Transcriber’s Notes - -Some inconsistencies in spelling, hyphenation, and punctuation have been -retained. - -This file uses _underscores_ to indicate italic text. - -*** END OF THE PROJECT GUTENBERG EBOOK A STATEMENT OF FACTS TENDING TO -ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND PRESENT STATE OF -VACCINATION *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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border-bottom: thin solid; width: 10%; margin-left: 0; - margin-top: 1em; text-align: left; } - .c014 { border: none; border-bottom: thin solid; margin-top: 0.8em; - margin-bottom: 0.8em; margin-left: 35%; margin-right: 35%; width: 30%; } - .c015 { page-break-before:auto; margin-top: 4em; } - .c016 { margin-top: 2em; margin-bottom: 0.5em; } - </style> - </head> - <body> -<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of A Statement of Facts Tending to Establish an Estimate of the True Value and Present State of Vaccination, by Gilbert Blaine</p> -<div style='display:block; margin:1em 0'> -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: A Statement of Facts Tending to Establish an Estimate of the True Value and Present State of Vaccination</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Gilbert Blaine</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: April 13, 2022 [eBook #67824]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: Charlene Taylor, Daniel Lowe and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive/American Libraries.)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK A STATEMENT OF FACTS TENDING TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND PRESENT STATE OF VACCINATION ***</div> - -<div> - <span class='pageno' id='Page_1'>1</span> - <h1 class='c000'><span class='small'>A</span> <br /> <br /> <span class='xlarge'>STATEMENT OF FACTS,</span> <br /> <br /> <span class='small'>TENDING TO</span> <br /> <br /> <span class='large'>ESTABLISH AN ESTIMATE OF THE TRUE VALUE</span> <br /> <br /> <span class='small'>AND</span> <br /> <br /> <span class='xlarge'>PRESENT STATE</span> <br /> <br /> <span class='small'>OF</span> <br /> <br /> <span class='xxlarge'>VACCINATION.</span></h1> -</div> - -<hr class='c001' /> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='large'><span class='sc'>By</span> SIR GILBERT BLANE, <span class='sc'>Bart.</span></span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'><i>F.R.S. of London, Edinburgh, and Göttingen; Member of the Imperial Academy of St. Petersburgh; and Physician in Ordinary to the King.</i></span></div> - </div> -</div> - -<hr class='c002' /> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='xsmall'>FROM THE TENTH VOLUME OF THE MEDICO-CHIRURGICAL TRANSACTIONS, PUBLISHED BY THE MEDICAL AND CHIRURGICAL SOCIETY OF LONDON;</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='xlarge'>WITH ADDITIONS.</span></div> - </div> -</div> - -<hr class='c002' /> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='large'>LONDON:</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>PRINTED FOR THOMAS AND GEORGE UNDERWOOD, 32, FLEET STREET.</div> - </div> -</div> - -<hr class='c003' /> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>1820.</div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='pageno' id='Page_2'>2</span><span class='small'>J. MOYES, GREVILLE STREET, LONDON.</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>Transcriber’s Note:</div> - </div> -</div> - -<p class='c005'>The cover image was created by the transcriber and is placed in the public domain.</p> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='pageno' id='Page_3'>3</span><span class='small'>A</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='xlarge'>STATEMENT OF FACTS,</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>TENDING TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND</span></div> - <div><span class='small'>PRESENT STATE OF</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='xlarge'>VACCINATION.</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='large'><span class='sc'>By</span> SIR GILBERT BLANE, <span class='sc'>Bart.</span> F.R.S. Lond. &c.</span></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><i>Physician in Ordinary to the King.</i></div> - </div> -</div> - -<hr class='c002' /> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><i>Read Nov. 10, 1819.</i></div> - </div> -</div> - -<hr class='c002' /> - -<p class='drop-capa0_25_0 c005'>It is now twenty-one years since Vaccination was promulgated -in this country by Dr. Jenner, and fifteen years since -it began to produce a sensible effect in diminishing the mortality -from Small Pox. In regard to the latter period, it is -coeval with this Society; yet, though no discovery in nature -nor in medicine has been more important to the interests of -humanity, nor any which has ever so rapidly and universally -won the assent and practical adoption of mankind, there are -no notices of it on our records, except in our second volume, -in an article by Dr. Bateman, in which he relates a case of a -mother who was affected with the Small Pox a second time, -by being exposed to infection, from some of her own children -who had caught it casually; while her other children, who -had been vaccinated, resisted it. As it is to be hoped that -our labours will prove to posterity some of the principal -sources of reference regarding the medical and chirurgical -discoveries and improvements of the age; as it is one of the -reproaches of our country, that it has not availed itself so -much as any other of the benefits of Vaccination; and as -there are writers among us who still allege that the failures -are so numerous that the value of the discovery is very -ambiguous, it seems one of the duties of the Society to lend -its aid in placing these important points in their true light.</p> - -<p class='c005'>It seems almost needless to premise, that the Small Pox -is of all maladies that, which, during the last thousand years, -has destroyed the largest portion of the human species, and -been productive of the largest share of human misery. There -<span class='pageno' id='Page_4'>4</span>is, perhaps, no disease over which medical art has less power; -and this power, such as it is, has consisted more in abolishing -pernicious practices, than in ascertaining any positive methods -of controlling its fatality, unless we except the inoculation -of it with its own <span lang="la" xml:lang="la"><i>virus</i></span>. But, though the beneficial effect of -this on those on whom it is actually practised is undeniable, -it has no tendency like Vaccination to extirpate the disease; -and from the impossibility of rendering it universal, it has -actually been found to add to the general mortality of Small -Pox, by opening a new source for the diffusion of its <span lang="la" xml:lang="la"><i>virus</i></span>.</p> - -<p class='c005'>It ought to be stated also, with a view to a decision on -this question, that Vaccination itself is attended with no -danger, and frequently takes effect without any visible -disturbance in the system. There is even reason to believe, -that in its process it wards off other diseases, by -pre-occupying the constitution.</p> - -<p class='c005'>In order to bring this matter to the test of calculation, in -order also to institute a comparison of the mortality of Small -Pox as influenced by Vaccination, as well as by Inoculation -from itself, I have selected from the bills of mortality four -periods, each of fifteen years, for the purpose of exhibiting -the mortality of Small Pox in each of these series in regard -to each other. These are thrown into the form of Tables, -and annexed to this article.</p> - -<p class='c005'>The first series, is the fifteen years immediately preceding -the introduction of Inoculation; that is, from 1706 to 1720, -both included. Previous to this period, no account that -could be depended upon regarding the Small Pox, could be -derived from the bills of mortality; for down to the beginning -of last century such was their imperfect construction, that -Small Pox, Measles, and Flux were blended under one head. -Exception may be taken against the accuracy of these bills, -even in this improved state, particularly with regard to the -discrimination of diseases. This objection, however, is certainly -less applicable to Small Pox than any other disorder, -its character being so striking as not to be mistaken by the -most ignorant and careless observer.</p> - -<p class='c005'>The second series is taken at the middle of the last century, -when Inoculation had made considerable progress; that is, -from 1745 to 1759, both included. In comparing this with -the preceding series, with regard to absolute numbers, it -ought to be taken into account, that eleven parishes were -added to the bills of mortality, between the years 1726 and -1745, both included: so that the progressive improvement of -general salubrity ought to be estimated still higher than what -is indicated by the diminished mortality, as it stands in the -Tables.</p> - -<p class='c005'><span class='pageno' id='Page_5'>5</span>The third series comprises the fifteen years previous to the -introduction of Vaccination, when Inoculation had made still -greater progress; that is, from 1785 to 1798, both included.</p> - -<p class='c005'>The fourth series comprises the time in which the vaccine -Inoculation has been so far diffused as to produce a notable -effect on the mortality of Small Pox; that is, from 1804 to -1818, both included.</p> - -<p class='c005'>The result of these computations stands as follows:—</p> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><i>Ratio of the Mortality of Small Pox to the total Mortality.</i></div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>From 1706 to 1720, one in 12.7; that is, 78 in 1000.</div> - <div>From 1745 to 1759, one in 11.2; that is, 89 in 1000.</div> - <div>From 1785 to 1798, one in 10.6; that is, 94 in 1000.</div> - <div>From 1804 to 1818, one in 18.9; that is, 53 in 1000.</div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>Fractions are not noticed in the last column of numbers.</span></div> - </div> -</div> - -<p class='c005'>It appears from this statement, that the proportion of -deaths from Small Pox to the total mortality, increased in -the course of last century; so that Inoculation appears to -have added to the mortality. It is but fair to mention, however, -that this total mortality is not quite a just scale whereby -to measure the relative mortality of Small Pox; for in the -course of that century, the general mortality itself was greatly -diminished in relation to the population. This diminution of -general mortality was chiefly owing to the diminished mortality -of children under two years of age, which, at the time -when the account began to be kept, 1729, averaged about -9000; but at the end of the century not more than 5000<a id='r1' /><a href='#f1' class='c006'><sup>[1]</sup></a>; -also to the decrease of fevers, and still more of fluxes. The -relation of the mortality of Small Pox to the population, -would therefore be a more fair criterion of its increase or -decrease. In this view it might, at first sight, be thought that -it had decreased; for the population of the metropolis nearly -doubled in the course of the last century. But it is to be -remarked, that there has been little increase of population in -that portion of the metropolis which is included in the bills of -<span class='pageno' id='Page_6'>6</span>mortality; the great increase having been in the parishes of -Mary-le-bone and St. Pancras, which are not included in -these bills. It is computed in the remarks subjoined to the -last parliamentary returns of population, that the population -of London, within the walls, had decreased more than three-fifths -in the course of last century, from the widening of -streets, the erection of public buildings and warehouses, and, -it might have been added, from the migration of mercantile -families to the west end of the town. As a set-off to this, -there has certainly been a great addition, in the same time, to -those parishes within the bills, which stand on the verge of -the metropolis, such as St. George’s Hanover Square, St. -George’s Bloomsbury, Poplar, and Stepney. But the addition -to the population, if any, within the bills of mortality, does not -seem to be so considerable as to affect the computation. And, -if this is admitted, the absolute numbers of the deaths from -Small Pox, estimated in relation to the population, that is, -exactly as they stand on the Tables, afford a fair comparative -statement of the mortality in the last century, and seem to -prove that Inoculation has not added so much to it as has -been alleged. It was in the rural population that the effect -of Inoculation in diffusing Small Pox was chiefly felt. In this -situation there is much less intercourse of persons with each -other than in towns, so that not only many individuals escaped -from their not being exposed to infection during their whole -lives, but whole districts were known to have been exempt -from it for a long series of years, before it was universally -diffused by Inoculation.</p> - -<p class='c005'>But the truly important result from these statements consists -in the clear, undeniable, and great diminution of it since -the introduction of Vaccination. It appears, that in the last -fifteen years, the mortality from Small Pox, in the bills of -mortality, has not been much more than one-half of what it -was in the two like series of years in the middle and latter -end of the last century. Nor does this comprise the whole -benefit derived from this discovery in the metropolis; for, -besides that the sixth part of it lies without the bills, it was -found, in levying the tax on burials for the last six months -of 1794, that the number of unregistered deaths, chiefly those -of dissenters, amounted in that half year to 3148; and the -reporter of the parliamentary enumeration thinks that, as -besides these there were undiscovered interments, the unregistered -deaths may be computed at one-third of the total -mortality, that is, about 7000. (<cite>See Abstract of the Parish -Registers, 1811, printed by authority of Parliament, page 200.</cite>)</p> - -<p class='c005'>Assuming, therefore, that Vaccination had not been practised -the last fifteen years, and that the mortality from Small -<span class='pageno' id='Page_7'>7</span>Pox, within the bills, had in that time, that is, from 1804 to -1818, been the same as from 1784 to 1798, that is, 27,569 in -place of 14,716; and assuming that there has been the same -proportional diminution of deaths in the districts without the -bills, and among the unregistered subjects, the account of -lives saved in this metropolis by Vaccination in the fifteen -years, will stand as follows:—</p> - -<table class='table0' summary=''> -<colgroup> -<col width='83%' /> -<col width='16%' /> -</colgroup> - <tr> - <td class='c007'>Within the bills of mortality</td> - <td class='c008'>12,853</td> - </tr> - <tr> - <td class='c007'>Without the bills of mortality</td> - <td class='c008'>2,570</td> - </tr> - <tr> - <td class='c007'>Unregistered cases</td> - <td class='c008'>7,711</td> - </tr> - <tr> - <td class='c007'> </td> - <td class='c008'>------</td> - </tr> - <tr> - <td class='c009'>Total</td> - <td class='c008'>23,134</td> - </tr> -</table> - -<p class='c005'>The first of these numbers is found by subtracting the -amount of deaths by Small Pox, in the bills of mortality, -during the practice of Vaccination, from the amount of them, -during the same number of years, immediately before the -discovery of Vaccination.</p> - -<p class='c005'>The second number is found by dividing the first by 5. -The population of the metropolis without the bills is stated -at one-sixth of the whole, which is evidently one-fifth of that -within the bills.</p> - -<p class='c005'>The third number is found by dividing the sum of the two -others by 2; the unregistered cases being, as before stated, -one-third of the whole.</p> - -<p class='c005'>It appears, therefore, that, even under the very imperfect -practice of Vaccination which has taken place in this metropolis, -23,134 lives have been saved in the last fifteen years, -according to the best computation that the <i>data</i> afford. It -will be seen, by an inspection of the Table, that in that time -there have been great fluctuations in the number of deaths. -This has been owing partly to the Small Pox Inoculation of -out-patients having, by an unaccountable infatuation, been -kept up at the Small Pox Hospital for several years after -the virtue of Vaccination had been fully confirmed. The -greater number of deaths in 1805 may chiefly be referred to -this cause. Since the suppression of this practice, the adoption -of Vaccination, though in a degree so incomplete, in -consequence of public prejudice, created entirely by mischievous -publications, has been unable to prevent a considerable, -though fluctuating, mortality from Small Pox. The -late mortality from Small Pox, though little more than one -half of what it was in former times, might have been entirely -saved, if Vaccination had been carried to the same extent -as in many cities and whole districts on the continent of -Europe, in Peru, and Ceylon.</p> - -<p class='c005'>In the summer of 1811 the author was called to visit, -<span class='pageno' id='Page_8'>8</span>professionally, Don Francisco de Salazar, who had arrived a -few days before in London, on his route from Lima to Cadiz, -as a deputy to the Spanish Cortes. He informed him, that -Vaccination had been practised with so much energy and -success in Lima, that for the last twelve months there had -occurred, not only no death from, but no case of, Small Pox; -that the new-born children of all ranks are carried as regularly -to the Vaccinating House as to the font of baptism; -that the Small Pox is entirely extinguished all over Peru; -nearly so in Chili; and that there has been no compulsory -interference on the part of the government to promote Vaccination.</p> - -<p class='c005'>It is now matter of irrefragable historical evidence, that -Vaccination possesses powers adequate to the great end proposed -by its meritorious discoverer, in his first promulgation -of it in 1798, namely, the total extirpation of Small Pox. -The first proof of this was at Vienna, where, in 1804, no -cases occurred, except two strangers who came into the city -with the disease upon them. In 1805 there did not occur a -single death from it in Copenhagen<a id='r2' /><a href='#f2' class='c006'><sup>[2]</sup></a>. Dr. Sacco, the indefatigable -superintendent of Vaccination in Lombardy, stated, -in his Annual Report, 3d January, 1808, that the Small Pox -had entirely disappeared in all the large towns in that -country; and that in the great city of Milan it had not -appeared for several years. Dr. Odier, of Geneva, so -favourably known for his high professional, scientific, and -literary acquirements, testifies, that, after a vigorous perseverance -in Vaccination for six years, the Small Pox had disappeared -in that city and the whole surrounding district; and -that, when casually introduced by strangers, it did not spread, -the inhabitants not being <em>susceptible</em>. The Central Committee -in Paris testify, in their Report of 1809, that the -Small Pox had been extinguished at Lyons and other districts -of France.</p> - -<p class='c005'>These are selected as some of the earliest and most remarkable -proofs of the extirpating power. But it is demonstrable, -that if at the first moment of this singular discovery, -at any moment since, at the present or any future moment, -mankind were sufficiently wise and decided to vaccinate the -whole of the human species who have not gone through the -Small Pox, from that moment would this most loathsome -and afflicting of all the scourges of humanity be instantaneously, -and for ever, banished from the earth.</p> - -<p class='c005'>It is farther manifest, that extirpation being the ultimate -aim of this discovery, and there being the fullest historical -<span class='pageno' id='Page_9'>9</span>and practical evidence of its being capable of accomplishing -this end, all other questions with regard to its expediency -must be futile and irrelevant. It is in the nature of all -morbid phenomena to be liable to exception. One of the -most essential and characteristic laws of Small Pox itself, -namely, that of its affecting the human subject but once in -life, is found in rare cases to be violated. It is, therefore, -perfectly conformable to analogy, and naturally to be expected, -that it may not in all cases be a complete security -against Small Pox. But it is obvious, that, admitting these -exceptions to be very frequent, much more so than the recurrence -of Small Pox after Small Pox, this can constitute no -objection to the practice, as long as the extirpating power -remains unimpaired and unimpeached. Nay, it is obviously -so far from an objection, that it ought to operate as a powerful -additional incentive on every benevolent mind, to push Vaccination -to the utmost, as rapidly as possible, in order that -those who are still susceptible, either from peculiar natural -constitution, or from the unskillful manner of conducting the -operation, or from defective matter, may not, by any possibility, -catch it; for, in the event of its extirpation, it could -nowhere be met with. And in order to stimulate the good -and the wise to aim strenuously at this consummation, let it -be constantly borne in mind, that the adversary they are -contending with is the greatest scourge that has ever afflicted -humanity. That it is so, all history, civil and medical, proclaims: -for, though the term Plague carries a sound of greater -horror and dismay, we should probably be within the truth, -if we were to assert, that Small Pox has destroyed a hundred -for every one that has perished by the Plague.</p> - -<p class='c005'>It is true that in its last visitation of this metropolis, one -hundred and fifty-four years ago, it carried off 70,000 victims -in a few months; but since that time, the deaths from Small -Pox, recorded in the bills of mortality, have amounted to -more than 300,000; and a like number of the survivors have -been afflicted with blindness, deformity, scrofula, or broken -constitutions, which is not the case with the survivors of the -Plague. It appears, by a Report of the Hospital for the -Indigent Blind, that two thirds of those who apply for relief -have lost their sight by the Small Pox. It is alleged by some -of the soundest Political Economists that Small Pox does not -diminish the numbers of mankind, nor Vaccination increase -them; for population is determined by subsistence, and the -indefinite powers of procreation soon repair the ravages of -disease. But, however true this may be, the miseries incident -to so many of those who survive Small Pox, whereby they -become a burden to themselves, their families, and to society, -<span class='pageno' id='Page_10'>10</span>render this disease uncontrovertibly an evil of the first -magnitude, not to mention the intense sufferings and afflictions -inseparable from it; and in this view of the matter the -objection seriously adduced against Vaccination by one of -its opponents<a id='r3' /><a href='#f3' class='c006'><sup>[3]</sup></a>, that <i>Small Pox is a merciful dispensation of -Providence for the poor man, by diminishing the burden of his -family</i>, will not hold good, for the burden is not removed.</p> - -<p class='c005'>And when it is considered that there are large portions of -the globe, India, China, even one whole quarter of it (North -and South America), besides all the tropical and arctic -regions, in which the Plague has never been known; and -that in all the countries liable to it, it seldom appears but at -one season of the year, and in some at long intervals, the -ravage which it makes is trifling when compared with the -unceasing havoc of Small Pox, which spares no nation in any -climate, or at any season. Yet the Legislative Regulations -for excluding and checking the Plague are of the most harsh -and despotic description, while the law touches upon Small -Pox comparatively with the most lenient hand. It ought to -be generally known, however, that in a late trial and conviction, -it was laid down by the judge to be the law of the -land, that a medical practitioner who neglects to exclude the -person whom he inoculates from communication with others, -is liable to fine and imprisonment. Morally considered, -indeed, it is difficult to conceive a higher degree of flagitious -turpitude than that of a professional person, in the present -state of knowledge, exposing his fellow-creatures, from sordid -motives, to one of the most grievous calamities of which -human nature is susceptible.</p> - -<p class='c005'>The preceding reasoning is grounded on the supposition of -extirpation: but, however demonstrable the <em>possibility</em> of -extirpation may be, it may not in all communities be <em>practicable</em>; -and may not these alleged failures so operate, as, in -such circumstances, to render the expediency of the practice -questionable?</p> - -<p class='c005'>In order to decide this, let the nature and amount of these -failures be ascertained and estimated.</p> - -<p class='c005'>The description of those cases of Small Pox, (if they can -be called so,) which occur in vaccinated subjects, is shortly -as follows:—The invasion and eruption in every respect -resembles that of the genuine Small Pox. I have seen it -attended with high fever and a thick crowded crop of <span lang="la" xml:lang="la"><i>papulæ</i></span>, -such as precedes the most severe and dangerous cases of the -confluent kind. This runs on till the fifth day from the -<span class='pageno' id='Page_11'>11</span>eruption, both days included, at which time some of the -<span lang="la" xml:lang="la"><i>papulæ</i></span> begin to be converted into small sized pustules. The -disorder then abruptly stops short. On the following day -the fever is found to have subsided, with a shrivelling and -desiccation of the eruption, and recovery proceeds without -the least danger or inconvenience. The face is marked, for -some time after, with brown spots, but without pits. It -should never be forgotten, that all morbid <span lang="la" xml:lang="la"><i>phænomena</i></span> are -full of varieties and exceptions. Accordingly, though the -fifth day is the most common limit of this disorder, it sometimes -stops short on the third; sometimes not till the sixth -or seventh; and, in a very few cases, it has been known to -run the common course of Small Pox. What forms the -strong line of distinction from proper Small Pox, is that, -with a few exceptions, it does not advance to maturation and -secondary fever, which is the only period of danger. I am -not prepared to deny that death may not have occurred in a -few instances; nay, there seems sufficient evidence that it -actually has; but these adverse cases are so rare, as not -to form the shadow of an objection to the expediency of the -general practice. A few weeks ago at a meeting of this -Society, at which forty members and visitors were present, I -put the question whether any of these eminent and extensive -practitioners had met with any fatal cases of this kind. Two -gentlemen had each seen a single case, and two other gentlemen -took occasion to say that they had each seen a case -of second Small Pox, both of which proved fatal. It is evident, -therefore, that according to that maxim which guides -mankind in the conduct of life, namely, that of acting on a -general rule and average, and not on exceptions, these adverse -instances ought not to have the least influence on practice, -even though they were much more numerous. Nor indeed -do they, except in the very rare cases here cited, deserve the -name of failures; for, though they fail in preventing <em>Small -Pox</em>, they do not fail to prevent <em>Death</em>. And let me here, -in the name of humanity, beseech practitioners not to be forward -in publishing single cases of failures, real or supposed; -for, when the weak minded and uninformed hear of these -failures, without hearing at the same time that there are -hundreds of cases of permanent security for every single case -of failure, they are guided by the <em>exception</em>, which becomes to -them the <em>rule</em>; their judgments being thereby most fatally -perverted.</p> - -<p class='c005'>As it is of the utmost consequence to establish the strong -and important distinction between Small Pox, properly so -called, and that which takes place after Vaccination, which -may be called the mitigated, or five day Small Pox, a few of -<span class='pageno' id='Page_12'>12</span>the most impressive testimonies respecting the safe nature of -the latter may be here recited. Mr. Brown<a id='r4' /><a href='#f4' class='c006'><sup>[4]</sup></a>, of Musselburgh, -gives the detail of forty-eight cases, in none of which -did the secondary fever nor death occur. Here was a saving -of at least eight lives, at the lowest computation; for this -is the number which, by the average mortality of natural Small -Pox, would have died if the constitutions of these forty-eight -persons had not been modified by previous Vaccination. -Dr. Dewar, of Edinburgh, hearing that many vaccinated -subjects had been affected with Small Pox at Cupar in Fife, -where the natural Small Pox at the same time prevailed, he -most laudably repaired to the spot to investigate the subject. -He found that fifty-four vaccinated subjects had caught the -Small Pox. All these, except one, had the mitigated or five -day eruptive fever, and livid. The fatal case was that of a -child, who had a complication of other disorders, and having -died on the fifth day, the Small Pox, according to its ordinary -course of fatality, could not of itself be the cause of death. -All the rest were safe; while of sixteen cases of the natural -Small Pox at the same time and place, six died; so that, if -these fifty-three cases had not undergone the mitigating process -of Vaccination, nineteen or twenty would have perished. -Between thirty and forty cases of the same kind have occurred -at Carlisle, on the testimony of Dr. Barnes, a -respectable practitioner of that city<a id='r5' /><a href='#f5' class='c006'><sup>[5]</sup></a>. Many proofs might -be adduced from the oral testimony of private practitioners, -which would overswell this article. The only other to be -mentioned is from the Report of the Central Committee of -Vaccination at Paris, made in December last, in which the -description of the disease occurring after Vaccination corresponds -exactly with the mitigated five day cases which have -occurred in Britain. They refuse the name of Small Pox to -it; but as I know from my own observation, as well as from -the testimony of others, that the matter from it does by Inoculation -give the Small Pox, we can hardly, perhaps, with -propriety deny it that name; but it should be distinguished -by some strong discriminating epithet, such as is suggested -above.</p> - -<p class='c005'><span class='pageno' id='Page_13'>13</span>As the attack of Small Pox in subjects who have undergone -Vaccination, generally occurs after a long interval, it -becomes a question whether this is owing merely to the -chance of such subjects not having been exposed to variolous -contagion, or to the effect of time in diminishing the antivariolous -virtue of vaccination. The former is certainly conceivable; -but when we consider the numberless severe proofs -to which the recently vaccinated were experimentally exposed -in the early part of this practice all over Europe, from which -the most satisfactory evidence resulted; and when it is considered -that, in the great majority of cases, Small Pox has -not occurred till several years after vaccination, it seems by -far most probable that the virtue of it is weakened by time. -When parents, therefore, become anxious and apprehensive -regarding the risk of Small Pox after a lapse of years, it -seems quite reasonable that they should be indulged in having -the operation repeated.</p> - -<p class='c005'>Let all this be applied to the case of a community, in -which the total eradication of Small Pox is quite hopeless. -Let it be admitted that such occurrences as have been -described do frequently occur: let it even be admitted, for -argument’s sake, that every vaccinated case whatever must -of necessity and unavoidably at some time or other in future -life be affected with this mitigated species of Small Pox, -would it not even under this great abatement be one of the -greatest boons that could be conferred on humanity, being -an instrument or remedy which would disarm Small Pox of -its danger? Would not the next greatest benefit to the total -extirpation of Small Pox, be the stripping it of its terrors by -rendering it safe and harmless?</p> - -<p class='c005'>It may be further remarked, that the benefit derivable from -the different proportions of the persons vaccinated to the -total population, advances in a considerably higher progression -than the simple arithmetical. It is evident that the -smaller the relative number of the vaccinated, the greater -their chance of meeting with Small Pox infection, and that -though the disease which they may catch is of a mitigated -nature, it would nevertheless be desirable to avoid it on its -own account, but still more on account of the prejudice it -creates. This, in the eye of general benevolence, constitutes -an additional, though secondary motive for extending the -vaccine inoculation as widely as possible, even though the -attainment of the <em>maximum</em>, that is, total extirpation, should -be impracticable and hopeless.</p> - -<p class='c005'>It is of the highest importance to society, that this subject -should be seen in its true light, and in all its bearings; for the -<span class='pageno' id='Page_14'>14</span>frequent occurrence of these cases of Small Pox, however -safe in themselves, have had a most pernicious effect on the -credulous and ignorant, by giving a check to the practice of -Vaccination. It ought never to be forgot that the power of -Vaccination in extirpating Small Pox being established, the -question of its expediency is completely set at rest. How -many parents are there now who, from a weak distrust in the -virtue of Vaccination, have to lament the loss of a child from -Small Pox, either casual or inoculated? Many such are -known to myself. It is pleasing, however, to observe, that -though this unmerited discredit into which Vaccination had -fallen, swelled the number of deaths in London from Small -Pox to 1051 in 1817, good sense is likely still to prevail, for -last year (1818) the deaths have fallen lower than they have -ever been known since the institution of the bills of mortality, -the total number being only 421<a id='r6' /><a href='#f6' class='c006'><sup>[6]</sup></a>.</p> - -<p class='c005'>On the whole matter, I believe I am speaking the language -of every man of good principles and feelings, capable of reflecting -seriously and considerately on the subject, when I -say, that whenever he applies his mind to it, he finds some -new and increasing cause of complacency and satisfaction. -Viewed as a mere physical fact in the natural history of the -animal kingdom, the virtue of the vaccine <span lang="la" xml:lang="la"><i>virus</i></span> in resisting -the action of the <span lang="la" xml:lang="la"><i>variolous</i></span>, is, by its novelty and singularity, -highly striking and interesting to every one whose taste leads -him to take delight in contemplating and exploring the -devious ways and varied forms of Nature, as curious exceptions -to the uniformity and constancy of her laws. One can -hardly contemplate with sufficient astonishment, the extraordinary -fact that a morbid poison taken from a domestic -animal should, when inserted into the human body, shield it -against the assault of one of the most fatal and cruel maladies -to which it is incident. But the importance of this, as a -physical curiosity, vanishes to nothing when the unexampled -benefits of it to mankind are fairly weighed; benefits which -could never have been dreamt of by the most sanguine philanthropist, -who, in contemplating it, finds himself lost in -astonishment, at a boon to mankind almost beyond the grasp -of his mind duly to appreciate: so that what seems at first -sight merely a sportive aberration from the usual course of -things, has, by the wise dispensation of Providence, become -<span class='pageno' id='Page_15'>15</span>subservient to the most beneficent purposes: and how many -more useful discoveries may there yet be in reserve for the -alleviation of human misery, from obscure and undetected -facts still lurking under the very surface of Nature! It will -in the eyes of future ages be deemed an <span lang="la" xml:lang="la"><i>epocha</i></span> in the destinies -of the world, and one of the highest boasts of the -country in which it took its rise, with a sense of unrequitable -obligation to the individual<a id='r7' /><a href='#f7' class='c006'><sup>[7]</sup></a> who first disclosed and promulgated -the secret, by drawing it from the dark recesses of -rural tradition, and rendering it available to the whole human -race.</p> - -<p class='c005'>Such are the sentiments which must fill every well constituted -mind; and it behoves the whole medical profession, -which has already done itself so much honour by the zealous -and disinterested encouragement afforded to it, to continue -its efforts in eradicating every remaining prejudice against it. -It becomes Englishmen, in particular, to cherish it, not only -as the native offspring of their country, of which they have -reason to be proud, but to redeem the character of the nation -from the reproach of having, of all others, whether savage or -civilized, done the least justice to this noble discovery. It is -somewhat humiliating to reflect, that while there is no country -which has received more striking and unambiguous benefits -from this discovery, there is none which has prized it less, -nor availed itself of it so little. I here allude to the unspeakable -advantage of it to the public service, both by sea and -land, in the late war, so eventful and portentous in its course, -and so glorious in its termination. Formerly, Small Pox -was one of the greatest embarrassments to the operations of -armies; and ships of war were occasionally under the necessity -of quitting the sea, from the prevalence of this disorder -among their crews. Those lately at the head of the navy and -army, with that vigilant wisdom and humanity which become -those who direct the affairs of a great and enlightened nation, -recommended and enforced the practice of Vaccination in -both these departments, to the great furtherance of the -public service. Their example has by no means been -followed among the civil population of England. This is -chiefly imputable to the abuse of the press, the general -licentiousness of which may be denounced as one of the -most grievous evils of this age and country, in regard to -other subjects interesting to humanity and public happiness, -as well as this; the votaries of error and depravity being -more successful, because they find more encouragement in -disseminating their principles, than the advocates of truth, -<span class='pageno' id='Page_16'>16</span>virtue, and good order. There is no maxim more true, than -that the best things do become by abuse the worst, and that -in proportion to their excellence. What a mortifying contrast -does England form with Peru, where it was adopted instantly, -in consequence of a flash of conviction from the light of -evidence! and was not this conviction fully justified by the -immediate disappearance of Small Pox from that whole -region? To those nations who may feel an envy of the glory -attached to our country by this discovery, it must be no -small consolation to perceive that a large proportion of the -English nation has hitherto been so besotted as not to know -how to appreciate it, nor how to avail themselves of it, and -that it has encountered more opposition among ourselves -than in all the world besides.</p> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='pageno' id='Page_17'>17</span><span class='xlarge'>TABLE I.</span></div> - </div> -</div> - -<table class='table1' summary=''> -<colgroup> -<col width='12%' /> -<col width='20%' /> -<col width='28%' /> -<col width='2%' /> -<col width='4%' /> -<col width='12%' /> -<col width='20%' /> -</colgroup> - <tr> - <th class='btt bbt blt c010'>Years.</th> - <th class='btt bbt blt c010'>Total Mortality.</th> - <th class='btt bbt blt c010'>Mortality from Small Pox.</th> - <th class='btt bbt blt c010' colspan='3'>Proportion.</th> - <th class='btt bbt blt brt c010'>Proportion to 1000.</th> - </tr> - <tr> - <td class='blt c010'>1706</td> - <td class='blt c010'>22,097</td> - <td class='blt c010'>1094</td> - <td class='blt c011'>1</td> - <td class='c010'>in</td> - <td class='c011'>20</td> - <td class='blt brt c012'>50</td> - </tr> - <tr> - <td class='blt c010'>1707</td> - <td class='blt c010'>21,600</td> - <td class='blt c010'>1078</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>20</td> - <td class='blt brt c012'>50</td> - </tr> - <tr> - <td class='blt c010'>1708</td> - <td class='blt c010'>21,291</td> - <td class='blt c010'>1687</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>12-1/2</td> - <td class='blt brt c012'>79</td> - </tr> - <tr> - <td class='blt c010'>1709</td> - <td class='blt c010'>21,800</td> - <td class='blt c010'>1024</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>21</td> - <td class='blt brt c012'>49</td> - </tr> - <tr> - <td class='blt c010'>1710</td> - <td class='blt c010'>24,620</td> - <td class='blt c010'>3138</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>8</td> - <td class='blt brt c012'>127</td> - </tr> - <tr> - <td class='blt c010'>1711</td> - <td class='blt c010'>19,833</td> - <td class='blt c010'>915</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>21-1/2</td> - <td class='blt brt c012'>46</td> - </tr> - <tr> - <td class='blt c010'>1712</td> - <td class='blt c010'>21,198</td> - <td class='blt c010'>1943</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>11</td> - <td class='blt brt c012'>92</td> - </tr> - <tr> - <td class='blt c010'>1713</td> - <td class='blt c010'>21,057</td> - <td class='blt c010'>1614</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>13</td> - <td class='blt brt c012'>77</td> - </tr> - <tr> - <td class='blt c010'>1714</td> - <td class='blt c010'>26,569</td> - <td class='blt c010'>2810</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>9-1/2</td> - <td class='blt brt c012'>106</td> - </tr> - <tr> - <td class='blt c010'>1715</td> - <td class='blt c010'>22,232</td> - <td class='blt c010'>1057</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>21</td> - <td class='blt brt c012'>47</td> - </tr> - <tr> - <td class='blt c010'>1716</td> - <td class='blt c010'>24,436</td> - <td class='blt c010'>2427</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>10</td> - <td class='blt brt c012'>100</td> - </tr> - <tr> - <td class='blt c010'>1717</td> - <td class='blt c010'>23,446</td> - <td class='blt c010'>2211</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>10-1/2</td> - <td class='blt brt c012'>94</td> - </tr> - <tr> - <td class='blt c010'>1718</td> - <td class='blt c010'>26,523</td> - <td class='blt c010'>1884</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>14</td> - <td class='blt brt c012'>71</td> - </tr> - <tr> - <td class='blt c010'>1719</td> - <td class='blt c010'>28,347</td> - <td class='blt c010'>3229</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>8-3/4</td> - <td class='blt brt c012'>114</td> - </tr> - <tr> - <td class='bbt blt c010'>1720</td> - <td class='bbt blt c010'>25,454</td> - <td class='bbt blt c010'>1440</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>17-1/2</td> - <td class='bbt blt brt c012'>56</td> - </tr> - <tr> - <td class='bbt blt c010' colspan='2'>Total—350,503</td> - <td class='bbt blt c010'>27,557</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>12.7</td> - <td class='bbt blt brt c012'>78</td> - </tr> -</table> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>In this series it appears that the deaths from Small Pox are, to the total mortality, as 1 in 12.7; that is, 78 in 1000.</span></div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='xlarge'>TABLE II.</span></div> - </div> -</div> - -<table class='table1' summary=''> -<colgroup> -<col width='12%' /> -<col width='20%' /> -<col width='28%' /> -<col width='2%' /> -<col width='4%' /> -<col width='12%' /> -<col width='20%' /> -</colgroup> - <tr> - <th class='btt bbt blt c010'>Years.</th> - <th class='btt bbt blt c010'>Total Mortality.</th> - <th class='btt bbt blt c010'>Mortality from Small Pox.</th> - <th class='btt bbt blt c010' colspan='3'>Proportion.</th> - <th class='btt bbt blt brt c010'>Proportion to 1000.</th> - </tr> - <tr> - <td class='blt c010'>1745</td> - <td class='blt c010'>21,296</td> - <td class='blt c010'>1206</td> - <td class='blt c011'>1</td> - <td class='c010'>in</td> - <td class='c011'>17-3/4</td> - <td class='blt brt c012'>56</td> - </tr> - <tr> - <td class='blt c010'>1746</td> - <td class='blt c010'>28,157</td> - <td class='blt c010'>3236</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>8-3/4</td> - <td class='blt brt c012'>115</td> - </tr> - <tr> - <td class='blt c010'>1747</td> - <td class='blt c010'>25,494</td> - <td class='blt c010'>1380</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>18-1/2</td> - <td class='blt brt c012'>54</td> - </tr> - <tr> - <td class='blt c010'>1748</td> - <td class='blt c010'>23,869</td> - <td class='blt c010'>1789</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>13-1/2</td> - <td class='blt brt c012'>75</td> - </tr> - <tr> - <td class='blt c010'>1749</td> - <td class='blt c010'>25,516</td> - <td class='blt c010'>2625</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>9-3/4</td> - <td class='blt brt c012'>103</td> - </tr> - <tr> - <td class='blt c010'>1750</td> - <td class='blt c010'>23,727</td> - <td class='blt c010'>1229</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>19-1/4</td> - <td class='blt brt c012'>52</td> - </tr> - <tr> - <td class='blt c010'>1751</td> - <td class='blt c010'>21,028</td> - <td class='blt c010'>998</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>21</td> - <td class='blt brt c012'>48</td> - </tr> - <tr> - <td class='blt c010'>1752</td> - <td class='blt c010'>20,485</td> - <td class='blt c010'>3538</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>5-3/4</td> - <td class='blt brt c012'>172</td> - </tr> - <tr> - <td class='blt c010'>1753</td> - <td class='blt c010'>19,276</td> - <td class='blt c010'>774</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>25</td> - <td class='blt brt c012'>40</td> - </tr> - <tr> - <td class='blt c010'>1754</td> - <td class='blt c010'>22,696</td> - <td class='blt c010'>2359</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>9-1/2</td> - <td class='blt brt c012'>104</td> - </tr> - <tr> - <td class='blt c010'>1755</td> - <td class='blt c010'>21,917</td> - <td class='blt c010'>1988</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>11</td> - <td class='blt brt c012'>91</td> - </tr> - <tr> - <td class='blt c010'>1756</td> - <td class='blt c010'>20,872</td> - <td class='blt c010'>1608</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>13</td> - <td class='blt brt c012'>77</td> - </tr> - <tr> - <td class='blt c010'>1757</td> - <td class='blt c010'>21,313</td> - <td class='blt c010'>3296</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>6-1/2</td> - <td class='blt brt c012'>155</td> - </tr> - <tr> - <td class='blt c010'>1758</td> - <td class='blt c010'>17,576</td> - <td class='blt c010'>1273</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>13-3/4</td> - <td class='blt brt c012'>73</td> - </tr> - <tr> - <td class='bbt blt c010'>1759</td> - <td class='bbt blt c010'>19,604</td> - <td class='bbt blt c010'>2596</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>7-1/2</td> - <td class='bbt blt brt c012'>132</td> - </tr> - <tr> - <td class='bbt blt c010' colspan='2'>Total—332,826</td> - <td class='bbt blt c010'>29,895</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>11.2</td> - <td class='bbt blt brt c012'>89</td> - </tr> -</table> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>In this series it appears that the proportion of deaths from Small Pox is, to the total mortality, as 1 in 11.2; that is, 89 in 1000.</span></div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='pageno' id='Page_18'>18</span><span class='xlarge'>TABLE III.</span></div> - </div> -</div> - -<table class='table1' summary=''> -<colgroup> -<col width='12%' /> -<col width='20%' /> -<col width='28%' /> -<col width='2%' /> -<col width='4%' /> -<col width='12%' /> -<col width='20%' /> -</colgroup> - <tr> - <th class='btt bbt blt c010'>Years.</th> - <th class='btt bbt blt c010'>Total Mortality.</th> - <th class='btt bbt blt c010'>Mortality from Small Pox.</th> - <th class='btt bbt blt c010' colspan='3'>Proportion.</th> - <th class='btt bbt blt brt c010'>Proportion to 1000.</th> - </tr> - <tr> - <td class='blt c010'>1784</td> - <td class='blt c010'>20,454</td> - <td class='blt c010'>1210</td> - <td class='blt c011'>1</td> - <td class='c010'>in</td> - <td class='c011'>17</td> - <td class='blt brt c012'>59</td> - </tr> - <tr> - <td class='blt c010'>1785</td> - <td class='blt c010'>18,919</td> - <td class='blt c010'>1999</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>9-1/2</td> - <td class='blt brt c012'>106</td> - </tr> - <tr> - <td class='blt c010'>1786</td> - <td class='blt c010'>20,445</td> - <td class='blt c010'>1210</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>17</td> - <td class='blt brt c012'>59</td> - </tr> - <tr> - <td class='blt c010'>1787</td> - <td class='blt c010'>19,349</td> - <td class='blt c010'>2418</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>8</td> - <td class='blt brt c012'>125</td> - </tr> - <tr> - <td class='blt c010'>1788</td> - <td class='blt c010'>19,697</td> - <td class='blt c010'>1101</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>17-3/4</td> - <td class='blt brt c012'>56</td> - </tr> - <tr> - <td class='blt c010'>1789</td> - <td class='blt c010'>20,749</td> - <td class='blt c010'>2077</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>10</td> - <td class='blt brt c012'>100</td> - </tr> - <tr> - <td class='blt c010'>1790</td> - <td class='blt c010'>18,038</td> - <td class='blt c010'>1617</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>11-1/4</td> - <td class='blt brt c012'>89</td> - </tr> - <tr> - <td class='blt c010'>1791</td> - <td class='blt c010'>18,760</td> - <td class='blt c010'>1747</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>10-3/4</td> - <td class='blt brt c012'>93</td> - </tr> - <tr> - <td class='blt c010'>1792</td> - <td class='blt c010'>20,313</td> - <td class='blt c010'>1568</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>13</td> - <td class='blt brt c012'>77</td> - </tr> - <tr> - <td class='blt c010'>1793</td> - <td class='blt c010'>21,749</td> - <td class='blt c010'>2382</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>9</td> - <td class='blt brt c012'>11</td> - </tr> - <tr> - <td class='blt c010'>1794</td> - <td class='blt c010'>19,241</td> - <td class='blt c010'>1913</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>10</td> - <td class='blt brt c012'>99</td> - </tr> - <tr> - <td class='blt c010'>1795</td> - <td class='blt c010'>21,179</td> - <td class='blt c010'>1040</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>20-1/4</td> - <td class='blt brt c012'>49</td> - </tr> - <tr> - <td class='blt c010'>1796</td> - <td class='blt c010'>19,288</td> - <td class='blt c010'>3548</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>54</td> - <td class='blt brt c012'>18</td> - </tr> - <tr> - <td class='blt c010'>1797</td> - <td class='blt c010'>17,014</td> - <td class='blt c010'>512</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>33-1/2</td> - <td class='blt brt c012'>30</td> - </tr> - <tr> - <td class='bbt blt c010'>1798</td> - <td class='bbt blt c010'>18,155</td> - <td class='bbt blt c010'>2237</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>8</td> - <td class='bbt blt brt c012'>123</td> - </tr> - <tr> - <td class='bbt blt c010' colspan='2'>Total—293,350</td> - <td class='bbt blt c010'>26,579</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>11</td> - <td class='bbt blt brt c012'>90.9</td> - </tr> -</table> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>In this series it appears that the proportion of deaths from Small Pox to the total mortality is 1 in 11, that is, 90.9 in 1000.</span></div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='xlarge'>TABLE IV.</span></div> - </div> -</div> - -<table class='table1' summary=''> -<colgroup> -<col width='12%' /> -<col width='20%' /> -<col width='28%' /> -<col width='2%' /> -<col width='4%' /> -<col width='12%' /> -<col width='20%' /> -</colgroup> - <tr> - <th class='btt bbt blt c010'>Years.</th> - <th class='btt bbt blt c010'>Total Mortality.</th> - <th class='btt bbt blt c010'>Mortality from Small Pox.</th> - <th class='btt bbt blt c010' colspan='3'>Proportion.</th> - <th class='btt bbt blt brt c010'>Proportion to 1000.</th> - </tr> - <tr> - <td class='blt c010'>1804</td> - <td class='blt c010'>17,038</td> - <td class='blt c010'>622</td> - <td class='blt c011'>1</td> - <td class='c010'>in</td> - <td class='c011'>27-1/2</td> - <td class='blt brt c012'>36</td> - </tr> - <tr> - <td class='blt c010'>1805</td> - <td class='blt c010'>17,565</td> - <td class='blt c010'>1685</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>10-1/2</td> - <td class='blt brt c012'>96</td> - </tr> - <tr> - <td class='blt c010'>1806</td> - <td class='blt c010'>18,334</td> - <td class='blt c010'>1297</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>14</td> - <td class='blt brt c012'>71</td> - </tr> - <tr> - <td class='blt c010'>1807</td> - <td class='blt c010'>17,938</td> - <td class='blt c010'>1158</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>15-1/2</td> - <td class='blt brt c012'>65</td> - </tr> - <tr> - <td class='blt c010'>1808</td> - <td class='blt c010'>19,964</td> - <td class='blt c010'>1169</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>17-1/4</td> - <td class='blt brt c012'>58</td> - </tr> - <tr> - <td class='blt c010'>1809</td> - <td class='blt c010'>16,680</td> - <td class='blt c010'>1163</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>14-1/4</td> - <td class='blt brt c012'>70</td> - </tr> - <tr> - <td class='blt c010'>1810</td> - <td class='blt c010'>19,893</td> - <td class='blt c010'>1198</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>16-1/2</td> - <td class='blt brt c012'>60</td> - </tr> - <tr> - <td class='blt c010'>1811</td> - <td class='blt c010'>17,043</td> - <td class='blt c010'>751</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>22-3/4</td> - <td class='blt brt c012'>44</td> - </tr> - <tr> - <td class='blt c010'>1812</td> - <td class='blt c010'>18,295</td> - <td class='blt c010'>1287</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>14-1/4</td> - <td class='blt brt c012'>70</td> - </tr> - <tr> - <td class='blt c010'>1813</td> - <td class='blt c010'>17,322</td> - <td class='blt c010'>898</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>19-1/4</td> - <td class='blt brt c012'>52</td> - </tr> - <tr> - <td class='blt c010'>1814</td> - <td class='blt c010'>19,783</td> - <td class='blt c010'>638</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>31</td> - <td class='blt brt c012'>32</td> - </tr> - <tr> - <td class='blt c010'>1815</td> - <td class='blt c010'>19,560</td> - <td class='blt c010'>725</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>27</td> - <td class='blt brt c012'>37</td> - </tr> - <tr> - <td class='blt c010'>1816</td> - <td class='blt c010'>20,316</td> - <td class='blt c010'>653</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>31-1/4</td> - <td class='blt brt c012'>32</td> - </tr> - <tr> - <td class='blt c010'>1817</td> - <td class='blt c010'>19,968</td> - <td class='blt c010'>1051</td> - <td class='blt c011' colspan='2'>1</td> - <td class='c011'>19</td> - <td class='blt brt c012'>53</td> - </tr> - <tr> - <td class='bbt blt c010'>1818</td> - <td class='bbt blt c010'>19,705</td> - <td class='bbt blt c010'>421</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>47</td> - <td class='bbt blt brt c012'>21</td> - </tr> - <tr> - <td class='bbt blt c010' colspan='2'>Total—279,404</td> - <td class='bbt blt c010'>14,716</td> - <td class='bbt blt c011' colspan='2'>1</td> - <td class='bbt c011'>18.9</td> - <td class='bbt blt brt c012'>53</td> - </tr> -</table> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>In this series it appears that the proportion of deaths from Small Pox to the total mortality is 1 in 18.9, that is, 53 in 1000.</span></div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c004' /> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='pageno' id='Page_19'>19</span>LONDON:</div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div><span class='small'>PRINTED BY J. MOYES, GREVILLE STREET.</span></div> - </div> -</div> - -<hr class='c013' /> -<div class='footnote' id='f1'> -<p class='c005'><span class='label'><a href='#r1'>1</a>. </span>This diminished mortality of young children is, like that of fevers and -fluxes, owing chiefly to the improvements in ventilation and cleanliness, but -greatly also to laying aside the custom of exposing them to the open air in -winter and early in spring; either from inadvertency, or from the false notion -of rendering them hardy, whereas they thereby catch inflammations of the -lungs. Nothing tends more to the health, strength, and growth of children, -than genial warmth. It seems chiefly owing to the great plenty and cheapness -of fuel, that the race of people in Lancashire are so superior in their -form and size. In Buckinghamshire, on the contrary, where fuel is extremely -scanty and dear, the race of people is small and puny, insomuch that it is -provided by Act of Parliament that men shall be admitted into the militia -of a smaller stature in this than other counties.</p> -</div> -<div class='footnote' id='f2'> -<p class='c005'><span class='label'><a href='#r2'>2</a>. </span>See Pfaff Neuen Nord v. Archiv. B. I.</p> -</div> -<div class='footnote' id='f3'> -<p class='c005'><span class='label'><a href='#r3'>3</a>. </span>See Serious Reasons for uniformly opposing Vaccination. By John -Birch. London, 1807.</p> -</div> -<div class='footnote' id='f4'> -<p class='c005'><span class='label'><a href='#r4'>4</a>. </span>See Inquiry into the Antivariolous power of Vaccination. Ed. 1809. -There is an article in the Edinburgh Medical Journal by the same gentleman -in 1819, in which he mentions that he had heard of several deaths having -occurred from cases of Small Pox after Vaccination. But, admitting this, it -is utterly incomprehensible by what process of reasoning Mr. Brown could -on such premises arrive at the conclusion that Vaccination ought to be -exploded and abandoned.</p> -</div> -<div class='footnote' id='f5'> -<p class='c005'><span class='label'><a href='#r5'>5</a>. </span>See also a clear and able exposition of this subject in the Medical and -Surgical Journal of Edinburgh for July, 1818, by Mr. Dunning, of Plymouth.</p> -</div> -<div class='footnote' id='f6'> -<p class='c005'><span class='label'><a href='#r6'>6</a>. </span>Since the first publication of this Tract, it has appeared that in the succeeding -year (1819), the deaths from the Small Pox had advanced to 712; -which ought to add to the perseverance, zeal, and vigilance, of the friends of -humanity in prosecuting Vaccination.</p> -</div> -<div class='footnote' id='f7'> -<p class='c005'><span class='label'><a href='#r7'>7</a>. </span>Dr. Edward Jenner.</p> -</div> - -<hr class='c014' /> - -<div class='chapter'> - <h2 class='c015'>Transcriber’s Notes</h2> -</div> - -<p class='c016'>Some inconsistencies in spelling, hyphenation, and punctuation have been -retained.</p> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK A STATEMENT OF FACTS TENDING TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND PRESENT STATE OF VACCINATION ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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