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Dr. Geo. E. Walton, of Cincinnati, in a recent paper upon the

16 COMPARATIVE MERITS OF ANIMAL AND HUMANIZED VIRUS."

Summarizes the subject as follows:

1. "It is certain that humanized virus produces immunity from small-pox for a number of years."

2. "It is certain that humanized virus may convey syphilis."

3. "It is possible that humanized virus may convey other diseases."

4. "It is probable that humanized virus degenerates."

5. "It is certain that many persons oppose humanized vaccination."

6. "It would not be right to compel vaccination with humanized virus."

1. "It is certain that bovine virus produces immunity from smallpox for a number of years."

2. "It is certain that bovine virus cannot convey syphilis."

3. "It is not probable that bovine virus conveys any disease."

4. "It is not probable that bovine virus degenerates."

5. "It is certain that few persons will oppose bovine vaccination."

6. "It would be right to compel vaccination with bovine virus."

WE ADD,

7. It is not possible to procure humanized virus in sufficient quantity to meet a great emergency.

7. It is possible to procure, on short notice, bovine virus in quantity to meet any emergency.

3. THE OPERATION SHOULD BE REPEATED AS OFTEN AS NECESSARY TO TEST THE RETURNING SUSCEPTIBILITY OF THE SYSTEM TO THE SMALL-POX CONTAGION.

It is quite evident that the public mind is uninformed and unsettled in its convictions upon the protective range of a primary vaccination and the necessity of a re-vaccination. Jenner taught that protection from vaccination was life-long. The expectations begotton by him and the early teachers that a successful primary vaccination in infancy or early childhood would give security against an attack of small-pox for the remainder of life, are cherished, through ignorance of facts, by a great many at the present time, and this supposed security becomes their greatest source of danger. "Best safety lies in fear."

Less than twenty years had passed after the discovery and promulgation of the practice of vaccination, when it began to be observed that some of the vaccinated took on a mild form of smallpox. The experience of three-quarters of a century has proved, beyond all question, that the protection afforded by this practice is not life-long. Though most effective in mollifying the disease, it is not to so great an extent a preventive as was once believed.

The question as to how long will the protective influence of a perfect vaccination in infancy or early childhood last, cannot with certainty be answered. All careful observers are agreed that this protection is for a few years, certainly, reliable and complete. It

is certain that one person may be protected for a longer time than another. The range of susceptibility to any contagion is very wide in the human family. One individual will contract disease while another equally exposed will escape. The evidence is very abundant, that, apart from all faults in the operation or of any enfeeblement in the virus used, there occurs, from natural causes, a tendency towards a return of the susceptibility to small-pox contagion, commencing probably not very long after primary infantile vaccination, increasing with the growth of the child, gaining intensity at about the puberic period, which does not diminish again except under advancing age. After infancy is passed the period of life in which most persous are liable to contract small-pox is from fifteen to twenty-five years of age. It is the same with the vaccinated and the unvaccinated, although the degree of liability is not the same. [Ballard.] Hence it is that revaccination is recommended, not because it is absolutely necessary for all, but because it is impossible to predicate who among the multitude vaccinated in infancy has re-acquired a receptivity to the contagion.

Comparatively few, in this country, at least, entertain doubts as to the necessity or propriety of a primary vaccination, but with regard to revaccination it is feared that the great bulk of the people have no intelligent and well settled convictions as to the time when a revaccination should be performed or the absolute necessity for such an operation. I wish it were possible to bring home to the minds and belief of the general public an intelligent and abiding conviction regarding revaccination-that it is a means by which we may secure almost absolute protection against any form of small-pox, and reduce the death rate from that disease to an absolute zero. In those countries in Europe where vaccination has been thoroughly performed, followed by universal revaccination, small-pox is all but annihilated, and deaths from it unknown.

"It is unfortunate," says Bousquet, "that art or nature has no sign to distinguish between those who need vaccinating and those who do not." Hence the practice should be universal.

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A small portion of vaccinated persons are protected through life by one operation; an indefinite number only for a certain period of time. The length of time they are thus protected is undetermined. Hence we are forced to admit that as a means of protection, revaccination is as important as a primary operation.'

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Since there is no known law governing the duration of the protective influence of a single vaccination, and since this period of protection varies widely in different individuals, it is safe, with our present knowledge, to advise that revaccination should be practiced every five years. It is better that the period should be needlessly short than too long. If small pox is prevalent in a community, the circumstances of the case should dictate the operation rather than the period of time only.

In reviewing the great mass of testimony upon this subject there is but one conclusion at which we must arrive, when considering the utility and desirableness of revaccination. While it is not wise to subject the individual or the public to any useless incon

venience, it is better to err, however, in making the periods between too short than too long.

By a careful and universal observance of these conditions, we believe that this disease can be absolutely banished from the State. Until these conditions are conscientiously and carefully observed by the people, and by all having especially in charge the health of the citizens, small pox will continue to appear in many localities every year, causing great apprehension, distress and sorrow among the people, while in the larger cities, it will often appear as an epidemic and take from the productive force of the State a large tribute in human life.

In reply to special circulars issued to some two hundred physicians practicing in different localities in the State, asking for an estimate of the proportion of the citizens of the State who are thoroughly protected by vaccination, the average ratio, taken from all those heard from, sums up less than one-half. My own opinion, formed from an extended observation, is that less than one-third of the population of the State are thus protected, leaving two-thirds, or 725,000 persons, in the State liable, upon exposure, to some form of variǝlous disease. The fact is cause for great amazement that so large a number neglect so cheap, so safe, and so beneficent a measure, and forces the mind of the political economist and the student of sanitary science to seriously consider the duty of the State to adopt measures which shall be so far compulsory in their nature as to secure a more general observance of the practice of thorough vaccination.

This question of enforced vaccination has occupied the attention of nearly every civilized nation, and wherever such regulations have been instituted the results of the procedure have shown the wisdom. of such measures. A considerable class in every community remain unvaccinated through ignorance, through indifference, through neglect, though prejudice and through willfulness, and thereby become the medium by which small-pox may be indefinitely kept alive in every community. This class of persons cannot be reached but by authority, and the question of compulsory procedures has for years past demanded the attention of our legislators.

If it is "the duty of our rulers and those responsible for public measures to protect every member of society from preventable disease, then surely in a measure of such utility and general beneficence as vaccination is conceded to be," the State would seem to be justified in exercising its authority for the general observance of this practice.*

"We are aware that upon this subject there is much diversity of opinion. It is claimed that forced activity, even in the most noble field or self hygiene, is repugnant to the genius of the American people.' That they will not be driven blindly to the performance of any act dictated to them by some authority assuming a power not emanating from or conferred by, their sovereign will, for they are justly jealous of their rights to rule and reign over them

*See paper on compulsory vaccination by the writer, in transactions of Wisconsin State Medical Society, June, 1875.

selves.' But it must be remembered that we already have many laws enacted which restrain the freedom of individual action in a variety of ways and compel the performance of certain acts that many would be otherwise unwilling to perform, and only submit to for the purpose of escaping fines and imprisonments. In all civilized governments there is a principle running through and underlying all law which secures the greatest good to the greatest number. And this principle should meet with the least resistance when it finds its beneficent expression in those hygienic measures which aim to secure the health of the individual while equally protecting that of the whole community. In this particular instance all would be benefited and none injured.

"Our English friends are as strongly disposed to resist interference with their personal liberty as we are, yet by judicious legislalation, beginning with the vaccination act of 1840, and followed by the vaccination extension act of 1853, the public opinion of that country was educated by degrees to the necessity and justice of a law that should be comprehensive enough to reach every individual Such an act was passed in 1867.

"If we examine the record during these periods as compared with similar period before these enactments, and see what have been the results, we find that in the city of London one hundred yeare ago, with but a fourth part of its present population, the average annual mortality from small-pox was 2,200, being about one-tenth of the deaths from all causes. From 1800 to 1810 the average was 1,250, or about one-sixteenth of all the deaths occurring. From 1830 to 1840, the yearly average was 573, or one-forty-third of all the deaths. From 1850 to 1860, the average yearly deaths from small-pox was reduced to one-ninetieth of all deaths from all causes; and although the population is rapidly increasing the death rate from small-pox has continued to decrease.

"In Scotland, vaccination was made compulsory in 1864. For the ten vears previous the yearly average of deaths from small-pox was 1,054. In 1865 it fell to 175. In 1867 to 124. In 1868 to 25.

"In Ireland, vaccination was made compulsory in the same year. The average mortality from small-pox had been from 1830 to 1840, 5,800 annually. From 1840 to 1850, 3,827. From 1850 to 1860, 1,272. In 1867 it was reduced to 20. In 1868 to 19. In the first quarter of 1869 there were but 3 deaths from it. In the second quarter none. This very nearly demonstrates that by the universal application of the vaccine prophylactic the disease would very nearly be banished from human society or become of very rare occurrence under the efficient operation of legislative enactment.

"The pecuniary value of the lives annually lost by this disease, it may not be possible to estimate, but we may form some conception of the cost to families and towns, of the attendance and care incident to such loss of life. If we assume that for each death occurring there are five cases of sickness, and each case of sickness requires the services of at least one attendant for three weeks, and add to this the destruction of clothing generally incident, together with the interruption of the occupation of other members of the

family, we shall find that each case involves a probable loss or money outlay of $150-at least upon a low estimate, $100."

By report of Dr. James Johnson, health officer of the city of Milwaukee, it appears that from July 1871, to April 1873, there were in that city 1388 cases of small pox, of which number 480 proved fatal. During the year 1874, only 33 deaths from this cause are reported. For the year 1875, not any. At the present writing-December 2, 1876, there have been reported by the health officer of that city 120 deaths from August 1, to December 1, 1876. As a very large proportion of the deaths from this cause in the State occur in that city, it will be seen that for all practical purposes it would be safe to assume that the average annual deaths by small pox in the State, will not fall below the United States Census Report of 1870-namely 104.

That we have not overestimated the average cash outlay of each case of small pox which occurs in any locality, we refer to the report of the health officer of the city of Toledo, Ohio, for June 1876, by which report it appears that in the care and treatment of seventeen cases, that city was required to expend the sum of nearly $1,600. During the winter of 1873-4 the city of Fond du Lac expended something over $1,500, in the care, in part or wholly, of eleven cases of this disease. Upon the estimated basis of cash cost of each case above stated we are brought to the round sum of $15,600, the annual cash cost of the presence of this disease in the State; and if we add to this sum the value of these lives to the State as a productive force, upon the estimated basis of political economists, namely, $3,000 each, we reach the additional sum of $312,000 annual loss to the State. These figures teach us that the true econony of the State looks to the saving of life-the saving of health and time and working power as of paramount importance to the saying of money.

It hardly admits of a doubt that if what is actually expended, together with that which is lost, directly and indirectly, in the loss of time, destruction of property and derangement of business, in one year, could be appropriated to the thorough vaccination and revaccination of all the unprotected citizens of the State, it would be amply sufficient to put all in a condition of absolute protection.

It is not alone the death rates which show the losses sustained by small-pox. According to the estimates of the Board of Health of the city of Philadelphia there were 25,000 cases of small-pox in that city during the winter of 1871-72. In a very able paper read before the Public Health Association upon

66 THE COST OF A GREAT EPIDEMIC,"

Dr. Benjamin Lee furnishes an approximate determination of the loss sustained by that city in dollars and cents by this great epidemic, and contrasts with this the degree in which this loss might have been prevented by judicious legislation, rigidly and fearlessly enforced.

The total loss sustained during the epidemic of those years is placed at the enormous sum of nearly twenty-three millions of 2*- -S. B. H.

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