eadily be admitted by those acquainted with the history of inoculation for the smallpox. Vaccination is now, however, well understood, and its character accu- rately described. Some deviations from the usual course have occasionally occurred, which the author of the practice has called spurious cowpox, by which the pub- lic have been misled, as if there were a true and a false cowpox; but it appears, that nothing more was meant, than to express irregularity or difference from that com- mon form and progress of the vaccine pustule from which its efficacy is inferred. Those who perform vac- cination ought therefore to be well instructed, and should have watched with the greatest care the regular progress of the pustule, and learnt the most proper time for taking the matter. There is little doubt that some of the failures are to be imputed to the inexperience of the early vaccinators, and it is not unreasonable to ex- pect that farther observation will yet suggest many im- provements that will reduce the number of anomalous cases, and furnish the means of determining, with great- er precision, when the vaccine disease has been effec- tually received.

Though the college of physicians have confined them- selves in estimating the evidence to such facts as have occurred in their own country, because the accuracy of them could best be ascertained, they cannot be infini- ble to the confirmation these receive from the reports of the successful introduction of vaccination, not only into every part of Europe, but throughout the vast continents of Asia and America.

IV. Several causes have had a partial operation in retarding the general adoption of vaccination; some writers have greatly undervalued the security it affords, while others have considered it to be of a temporary nature only; but if any reliance is to be placed on the statements which have been laid before the college, its power of protecting the human body from the smallpox, though not perfect indeed, is abundantly sufficient to recommend it to the prudent and dispassionate, especially as the smallpox, in the few instances where it has subsequently occurred, has been generally mild and transient. The opinion that vaccination affords but a temporary security is supported by no analogy in nature, nor by the facts which have hitherto occurred. Although the experience of vaccine inoculation be only of a few years, yet the same disease, contracted by the milkers of cows, in some districts has been long enough known to ascertain that in them, at least the susceptibility of the smallpox contagion does not wear out by time.

Another cause, is the charge against vaccination of producing various new diseases of frightful and monstrous appearance. Representations of some of these have been exhibited in prints in a way to alarm the feelings of parents, and to instil dread and apprehension into the minds of the uninformed. Publications with such representations have been widely circulated, and though they originate either in gross ignorance, or wilful misrepresentation, yet have they lessened the confidence of many, particularly of the lower classes, in vaccination; no permanent effects, however, in retarding the progress of vaccination, need be apprehended from such causes, for, as soon as the public shall view them coolly and without surprise, they will excite contempt, and not fear.

Though the college of physicians are of opinion that the progress of vaccination has been retarded in a few places by the above causes, yet they conceive that its general adoption has been prevented by causes far more powerful, and of a nature wholly different. The lower orders of society can hardly be induced to adopt precautions against evils which may be at a distance; nor can it be expected from them, if these precautions are attended with expense. Unless therefore, from the immediate dread of epidemic smallpox, neither vaccination nor inoculation appear at any time to have been general, and when the cause of terror has passed by, the public have relapsed again into a state of indifference and apathy, and the salutary practice has come to a stand. It is not easy to suggest a remedy for an evil so deeply imprinted in human nature. To inform and instruct the public mind may do much, and it will probably be found that the progress of vaccination in different parts of the united kingdom will be in proportion to that instruction. Were encouragement given to vaccination, by offering it to the poorer classes without expense, there is little doubt but it would in time supersede the inoculation for the smallpox, and thereby various sources of various infection would be cut off; but till vaccination becomes general, it will be impossible to prevent the constant recurrence of the natural smallpox by means of those who are inoculated, except it should appear proper to the legislature to adopt, in its wisdom, some measure by which those who still, from terror or prejudice, prefer the smallpox to the vaccine disease, may, in thus consulting the gratification of their own feelings, be prevented from doing mischief to their neighbours.

From the whole of the above considerations, the college of physicians feel it their duty strongly to recommend the practice of vaccination. They have been led to this conclusion by no preconceived opinion, but by the most unbiased judgement, formed from an irresistible weight of evidence which has been laid before them. For when the number, the respectability, the disinterestedness, and the extensive experience of its advocates, is compared with the feeble and imperfect testimonies of its few opposers; and when it is considered that many, who were once adverse to vaccination, have been convinced by further trials, and are now to be ranked among its warmest supporters, the truth seems to be established as firmly as the nature of such a question admits; so that the college of physicians conceive that the public may reasonably look forward with some degree of hope to the time when all opposition shall cease, and the general concurrence of mankind shall at length be able to put an end to the ravages at least, if not to the existence, of the smallpox.

LUCAS PEPYS, PRESIDENT.

Royal College of Physicians,

16th April, 1807.

JA. HERVEY, Register.

APPENDIX.

No. I.

To the Royal College of Physicians of London.

GENTLEMEN,

I am ordered by the King and Queen's College of Physicians, in Ireland, to thank the Royal College of Physicians of London for the communication they have had the honour to receive from them, of certain propositions relative to vaccination, wherein his majesty has been pleased to direct an inquiry to be instituted, and in the prosecution of which, the co-operation of the college in Ireland is requested.

And I am directed to acquaint you, that the said college having referred the investigations of these propositions to a committee, have received from them a report, of which the inclosed is a copy; and that they desire the same may be considered as containing their opinion upon the subject.

I have the honour to be,

Gentlemen,

Your most obedient humble servant,

By order of the King and Queen's College of Physicians in Ireland.

Hugh Ferguson, Register.

Dublin, 11th Nov. 1806.

"The practice of vaccination was introduced into this..." Practice.

Examin the mists.

MEDICINE.

this city about the beginning of the year 1801, and appears to have made inconsiderable progress at first. A variety of causes operated to retard its general adoption, amongst which the novelty of the practice, and the extraordinary effects attributed to vaccination, would naturally take the lead.

"Variolous inoculation had been long, almost exclusively, in the hands of a particular branch of the profession, whose prejudices and interests were strongly opposed to the new practice; and by their being the usual medical attendants in families, and especially employed in the diseases of children, their opinions had greater effect upon the minds of parents. The smallpox is rendered a much less formidable disease in this country by the frequency of inoculation for it, than it is in other parts of his majesty's dominions, where prejudices against inoculation have prevailed; hence parents, not unnaturally, objected to the introduction of a new disease, rather than not recur to that, with the mildness and safety of which they were well acquainted.

"In the beginning of the year 1804, the cowpox institution was established under the patronage of the earl of Hardwicke, and it is from this period that we may date the general introduction of vaccination into this city, and throughout all parts of Ireland.

"The success of the institution, in forwarding the new practice, is to be attributed in a great measure to the respectability of the gentlemen who superintend it, and to the diligence, zeal, and attention of Dr Labatt, their secretary and inoculator. In order to show the progress which has been made in extending vaccination, your committee refer to the reports of the Cowpox Institution for the last two years, and to extracts from their register for the present year.

| Year | Patients Inoculated | Packets Issued to Practitioners in General | Packets to Army Surgeons | |------|---------------------|------------------------------------------|-------------------------| | 1804 | 578 | 776 | 236 | | 1805 | 1032 | 1124 | 178 | | 1806 | 1356 | 1340 | 220 | | Total| 2966 | 3240 | 634 |

"In the above statement, the numbers are averaged to the end of the present year, on the supposition of patients referring to the institution as usual. The correspondence of the institution appears to be very general throughout every part of Ireland, and by the accounts received, as well from medical practitioners as others, the success of vaccination seems to be uniform and effectual. At the present period, in the opinion of your committee, there are few individuals in any branch of the profession, who oppose the practice of vaccination in this part of his majesty's dominions.

"It is the opinion of your committee, that the practice of cowpox inoculation is safe, and that it fully answers all the purposes that have been intended by its introduction. At the same time, your committee is willing to allow that doubtful cases have been reported to them as having occurred, of persons suffering from smallpox, who had been previously vaccinated. Upon minute investigation, however, it has been found, that these supposed instances originated generally in error, misrepresentation, or the difficulty of discriminating between smallpox and other eruptions, no case having come to the knowledge of your committee, duly authenticated by respectable and competent judges, of genuine smallpox succeeding the regular vaccine disease.

"The practice of vaccination becomes every day more extended; and, when it is considered that the period at which it came into general use in Ireland is to be reckoned from so late a date, your committee is of opinion, that it has made already as rapid a progress as could be expected.

(Signed) "James Cleghorn. "Daniel Mills. "Hugh Ferguson."

N°. II.

Physicians Hall, Edinburgh, 26th Nov. 1806.

Gentlemen,

THE Royal College of Physicians of Edinburgh have but little opportunity themselves of making observations on vaccination, as that practice is entirely conducted by surgeon apothecaries, and other medical practitioners not of their college, and as the effects produced by it are so inconsiderable and slight, that the aid of a physician is never required.

The College know that in Edinburgh it is universally approved of by the profession, and by the higher and middle ranks of the community; and that it has been much more generally adopted by the lower orders of the people than ever the inoculation for smallpox was, and they believe the same to obtain all over Scotland.

With regard to any causes which have hitherto prevented its general adoption, they are acquainted with none except the negligence or ignorance of parents among the common people, or their mistaken ideas of the impropriety or criminality of being accessory to the production of any disease among their children, or the difficulty or impossibility, in some of our country districts, of procuring vaccine matter, or a proper person to inoculate.

The evidence in favour of vaccination appeared to the Royal College of Physicians of Edinburgh so strong and decisive, that in May last, they spontaneously and unanimously elected Dr Jenner an honorary fellow of their college—a mark of distinction which they very rarely confer, and which they confine almost exclusively to foreign physicians of the first eminence.

They did this with a view to publish their opinion with regard to vaccination, and in testimony of their conviction of the immense benefits which have been, and which will in future be derived to the world, from inoculation for the cowpox, and as a mark of their sense of Dr Jenner's very great merits and ability in introducing and promoting this invaluable practice.

I have the honour to be

Gentlemen,

Your most obedient humble servant,

TH. SPENS, C. R. M. Ed. Pr.

To the Royal College of Physicians of London.

N°. III. At a special court of assistants of the Royal College of Surgeons, convened by order of the Master, and held at the College on Tuesday the 17th day of March 1807;

Mr Governor Lucas in the chair:

Mr Long, as chairman of the board of curators, reported, that the board are now ready to deliver their report on the subject of vaccination.

It was then moved, seconded, and resolved, that a report from the board of curators, on the subject of vaccination, which was referred to their consideration by the court of assistants, on the 21st day of November last, be now received.

Mr Long then delivered to Mr Governor Lucas (presiding in the absence of the master) a report from the board of curators.

It was then moved, seconded, and resolved, that the report, delivered by Mr Long, be now read; and it was read accordingly, and is as follows:

To the Court of Assistants of the Royal College of Surgeons in London.

THE report of the Board of Curators, on the subject of vaccination, referred to them by the court, on the 21st day of November 1806; made to the court on the 17th of March 1807.

The court of assistants having received a letter from the Royal College of Physicians of London, addressed to this college, stating, that his majesty had been graciously pleased, in compliance with an address from the honourable House of Commons, to direct his Royal College of Physicians of London to enquire into the state of vaccination in the united kingdom, to report their observations and opinion upon that practice, upon the evidence adduced in its support, and upon the causes which have hitherto retarded its general adoption; that the college were then engaged in the investigation of the several propositions thus referred to them, and requesting this college to co-operate and communicate with them, in order that the report thereupon might be made as complete as possible.

And having, on the 21st day of November last, referred such letter to the consideration of the board of curators, with authority to take such steps respecting the contents thereof as they should judge proper, and report their proceedings thereon, from time to time, to the court: the board proceeded with all possible dispatch to the consideration of the subject.

The board being of opinion, that it would be proper to address circular letters to the members of this college, with a view of collecting evidence, they submitted to the consideration of the court, holden on the 17th day of December last, the drafts of such letter as appeared to them best calculated to answer that end; and the same having been approved by the court, they caused copies thereof to be sent to all the members of the college in the united kingdom, whose residence could be ascertained, in the following form; viz,

"Sir,

"The Royal College of Surgeons being desirous to co-operate with the Royal College of Physicians of London, in obtaining information respecting vaccination, submit to you the following questions, to which the favour of your answer is requested.

"By order of the Court of Assistants,

"Okey Belfour, Secretary."

Lincoln's-Inn Fields, Dec. 15, 1806.

"1st. How many persons have you vaccinated? "2nd. Have any of your patients had the smallpox after vaccination? In the case of every such occurrence, at what period was the vaccine matter taken from the vehicle? How was it preserved? How long before it was infected? What was the appearance of the inflammation? And what the interval between vaccination and the variolous eruption? "3rd. Have any bad effects occurred in your experience in consequence of vaccination? And if so, what were they? "4th. Is the practice of vaccination increasing or decreasing in your neighborhood; if decreasing, to what cause do you impute it?"

To such letters the board have received 426 answers: and the following are the results of their investigation:

The number of persons, stated in such letters to have been vaccinated, is 164,381. The number of cases in which smallpox had followed vaccination is 56.

The board think it proper to remark under this head, that, in the enumeration of cases in which smallpox has succeeded vaccination, they have included none but those in which the subject was vaccinated by the surgeon reporting the facts.

The bad consequences which have arisen from vaccination are, eruptions of the skin in 66 cases, and inflammation of the arm in 24 instances, of which three proved fatal.

Vaccination, in the greater number of counties from which reports have been received, appears to be increasing; it may be proper however to remark, that, in the metropolis, it is on the decrease.

The principal reasons assigned for the decrease are,

Imperfect vaccination, Instances of smallpox after vaccination, Supposed bad consequences, Publications against the practice, Popular prejudices.

And such report having been considered, it was moved, seconded, and

Resolved, That the report now read, be adopted by this court, as the answer of the court to the letter of the Royal College of Physicians, of the 23rd day of October last, on the subject of vaccination.

Resolved, That a copy of these minutes and resolutions, signed by Mr Governor Lucas (presiding at this court in the presence of the master) be transmitted by the secretary to the register of the Royal College of Physicians.

(Signed) Wm Lucas.

No. IV. Sir,

Edinburgh, March 3, 1807.

I mentioned in my former letter, that I would take the earliest opportunity of laying before the Royal College of Surgeons of Edinburgh, the communication with which the Royal College of Physicians of London had honoured them, on the 23rd of October last:

I am now directed by the Royal College to send the following answer on that important subject.

The practice of vaccine inoculation, both in private, and at the vaccine institution established here in 1801, is increasing so rapidly, that for two or three years past, the smallpox has been reckoned rather a rare occurrence, even among the lower orders of the inhabitants of this city, unless in some particular quarters about twelve months ago; and, among the higher ranks of the inhabitants, the disease is unknown.

The members of the Royal College of Surgeons have much pleasure in reporting, that, as far as their experience goes, they have no doubt of the permanent security against the smallpox which is produced by the constitutional affection of the cowpox; and that such has hitherto been their success in vaccination, as also to gain for it the confidence of the public, inasmuch that they have not been required, for some years past, to inoculate any person with smallpox who had not previously undergone the inoculation with the cowpox.

The members of the Royal College have met with no occurrence in their practice of cowpox inoculation which could operate in their minds to its disadvantage; and they beg leave particularly to notice, that they have seen no instance of obstinate eruptions, or of new and dangerous diseases, which they could attribute to the introduction among mankind this of mild preventive of smallpox. The Royal College of Surgeons know of no causes which have hitherto retarded the adoption of vaccine inoculation here; on the contrary, the practice has become general within this city; and from many thousand packets of vaccine matter having been sent by the members of the Royal College, and the vaccine institution here, to all parts of the country, the Royal College have reason to believe that the practice has been as generally adopted throughout this part of the united kingdom as could have been expected from the distance of some parts of the country from proper medical assistance, and other circumstances of that nature.

I have the honour to be,

Sir,

Your most obedient servant,