42

not be diminished. In cases that are toend fatally, the patient may die duringthe paroxysm ; but in most cases he be-comes languid and heavy, and expires inthe intei vats between the spasms. It isa curious fact, that after one of these

spasms he will tell you that he feels bet-ter, that hisjaws admit of greater motion,so that an inexperienced person mightsuppose that the patient was about to

recover ; but immediately these fallacioussymptoms often prove the certain prectir-sors of death. I forgot to mention thatyou should keep a piece of wood, or corkwill answer the purpose still better, be-tween the teeth from the commencement,that medicine and food may be introducedwhen necessary.

It has been said that the body of onewho dies of this disease runs sooner intoa state of putrefaction, but J have notfound this to be the case, though I havehad mnic of them in the dissecting room.An examination of the body throws nolight whatever upon the pathology of thedisease. You may find effusion of bloodm the brain, and other morbid appear-ances in other parts, but all these arecommon in other spasmodic affectionswhich have terminated fatally. As tothe nature of the disease, it possessessome of the characters of spasm ; but yet iit is the only disease in which the muscularrigidity is constantly present. This cha-racter has been overlooked in classing itwith other spasmodic affections ; for itstrikes me that in classing any diseaseunder a particular head, we should chieflylook to its permanent symptoms. In the

progress of the disease the muscles are

affected in regular succession, but youare not to suppose that all the musclesmust first become engaged before thecase terminates fatally, for the patient willsometimes be carried off a day before thedisease will reach the extremities.

REVIEW.

Small-pox and Cow-pox ; comprehending aconcise history of those diseases, and aconcise history of those diseases, and a

comparison between Inoculation for Small.pox, and Vaccination, &c.&c.—By JOHN

JENNINGS CRIBB, Member of the RoyalCollege of Surgeons. 8vo. pp. 80.

Deighton, Cambridge ; Longman & Co.and Underwoods, London. 1825.

As the histories of small-pox and vaccina-

tion, are either known to every one, or

contained incyclopoedias and dictionaries,we pass over that part of the work which

is devoted to those subjects, and pro-

ceed to the inquiry into the prevalenceof small-pox amongst the inhabitants

of Cambridge, during the twenty-fiveyears which preceded the summer of

1824. In the autumn of 1823 it appearedat Cambridge, and ravaged the town and

neighbourhood until the following April.There, as in other places under a similar

visitation, many exaggerated reports of

the inefficacy of vaccination were circu-lated, which led the author to investigatethe subject, and to the results which he

has stated in the little work now under

analysis. He chiefly endeavoured to

ascertain in what manner and to what

degree the practice of vaccination hadinfluenced the irruption of small-pox ; or

to what extent, under what circumstances,and with what degree of severity, small-pox had occurred in persons previously

vaccinated. His inquiries were there-

fore limited to the twenty-five yearswhich had elapsed since the promulgationof Dr. Jenner’s discovery, and the results

which he obtained are exhibited in the

following table

43

TABLE, -

Showing, the number of Cases of Small-pox and Cow-pox in Camoriage, for Twenty-fiveYears preceding the Summer of 1824. ,

.... o Epidemic ofS . 1823-4

PARISHES.

1,635 364 143 34 371 15 83 110 32 20St. Giles’s ..... 1 ,635 364 143 34 371 15 83 110 32 20

St. Peter’s .... 481 97 46 9 86 7 24 45 9 4

St. Clement’s .. 772 154 51 9 i 185 10 41 34 1 4

St.Bepulehre’s.. 642 93 67 8 180 11 27 19 3 3

All Saints’ .... 938 118 97 11 301 15 15 23 0 5

St. Michael’s .. 379 57 45 8 115 17 10 3 3 0

Tripity ........ 1,793 253 139 24 511 46 80 72 13 11

St. Mary’s (Grt.) 880 70 73 3 299 7 26 9 0 1

St. Edward’s 810 40 40 2 210 11 13 1 0 0

St. Bene’t’s .. 967 111 88 9 251 12 18 34 2 4

St. Botolpli’s 716 81 43 13 183 12 12 14 3 2

St. Mary’s (Less) 648 78 55 5 196 2 13 7 0 i 2

St Andrew’s 1,267 163 109 32 318 16 51 25 1 2(Great ) }

1,267 163 109 32 318 16 51 25 1 2

St.Andrew’s(Less) 2,211 528 151 38 747 43 186 188 35 28

TOTAL.... 14,142 2,207 1,129 205 3,953 224 599 584 102 86

Thus it appears that of 2207 cases of ca-

sual small-pox 192, or 1 in 11½, proved fatal. ’,That of 1129 persons who received the

disease by inoculation 10, or 1 in 1l3,died;and of 224 in whom it appeared after

supposed vaccination, 3, or 1 in 74. The

author’s means of canvassing the subjectwere, however, extremely imperfect, andthe results he has arrived at, as to the whole

period, far from the truth ; but as they

relate to the epidemic of 1823-4, they

probably approach very near it.* In that

* The author, accompanied by an over-3eer of each of the parishes, called at

every house and interrogated the inha-bitants, by which it is obvious he ob-tained a pretty correct account of thenumber of persons afflicted with small-pox, &c., at the time or recently, but

not of those so affected twenty yearsago.

44

epidemic, 84 out of 584 died of casual,and 2 of 102 of inoculated small-pox, or1 in 7 of the former, and 1 in 51 of the

latter; while of 1613 who had casual

small-pox previous to 1823-4, only 108,or 1 in 15, died, and of 1129 who receivedthe disease by inoculation, 8, or only 1 in141. But, a priori, so great a differencein the mortality of the disease cannot

be admitted, and nothing, a posteriori, is

adduced to support it.

" It must be considered," says the an-thor, " that the returns here made arenot those of a regular and current regis-ter, in which the events would be noteddown at the time and in the order of theiroccurrence ; but it was taken at the ter-mination of a given period, and that aperiod of no less than twenty-five years.The accounts it contains must conse-

quently depend on the testimony of theindividuals of whom the inquiry was made,and upon their memory and veracity. Re-ports resting on such a foundation mustalmost necessarily be short of the truth;in some instances the memory may befallacious ; although the death of a member of a family from small-pox is certainlyan event of amemorable nature. There isalso reason to doubt the veracity of somepersons on such an occasion ; for sincethe introduction of inoculation, and moreespecially of vaccination, the death of achild from small-pox is considered to acertain degree disreputable, inasmuch asit implies neglect or prejudice on the partof the parents; and in many instances areluctance to make the communication wasobvious.

The circumstance, however, whichwould chiefly operate in rendering thereport detective, is the dispersion of famz-lies which must have taken place in thecourse of so long a period. In every in -stance where death from small-pox hadtaken place in a family, out of severalother members probably who survivedthe disease, and that family had becomesnbsequently dispersed, the case of deathwould not be recorded, although the casesof the survivors would ; they being stillliving to give an account of themselves.The report then, as respects the numberof deaths, is much less likely to be cor-rect than as respects the living ; and,indeed, with regard to the latter, it maybe depended upon with a considerabledegree of confidence, as the number ofinnrates in each houe was easily ascer-

tained and each individual was to be ac.counted for.

From these considerations, it appearsextremely probable that the report is de.Qcient iuthe number of deaths which oc-cllrred in former years. There would bebut little danger of the same incorrect-ness in the report of those deaths whichtook place recently; for it is impossiblethat any could have been forgotten ; mis-representation would have been easilydetected ; and the dispersion of familiesin so short a space of time must have beenvery inconsiderable."

The average number of deaths amongthose who partook of the epidemic of1823-4, was as we have seen 1 in 7, whichaccords pretty well with what has beengenerally observed of the small-pox undersimilar circumstances. There being noreason, therefore, to suppose that the lateepidemic at Cambridge was more malig-nant or fatal than those which had pre.ceded it, we may infer that 315, or 1 in 7died of small-pox within the last 25 years,instead of 192, the number brought out

by the author’s inquiry. His results, asfar as they relate to the late epidemic are,as we have already observed, worthy onrattention, but the remainder of the tablemust be considered a vague and fallaciotii

document-

To adduce much proof of the efficacyof vaccination may now be deemed a

labour of supererogation, but the followingparticulars, unsatisfactory as they may be,are not altogether uninteresting.

C4 lf," says the author ," vaccination bea preventive of small-pox, we should ofcourse expect to find, that in proportionto the extent of its diffusion, small-poxwould be diminished ; and to ascertain

whether this be really the case among thesubjects of this inquiry, the several pa-rishes have been divided, in the followingtable, into two divisions ; the first con-

sisting of those parishes which containthe largest proportion of vaccinated per-sons ; and the second, of those containingthe smallest.

TABLE

45

46

In the first division, in which it will beseen that the proportion of vaccinatedpersons amounts to 58 in 100, that ofthe subjects of natural small-pox is only21 in 100 ; and in 1823-4, fonr in 100.Whereas in the second division, in whicht-he mean number of vaccinated cases isonly 44 in 100, that of small-pox amountsto 31 in 100; and in 1823 4, to 8 in 100;evincing, in a striking manner, the influ-ence of vaccination in the prevention ofsmall-pox. That this difference is attri-butable to vaccination, and not to ino-culation with small-pox, is shown bythe last colnmn, by which it appears, thatthe number of the inoculated in each di-vision is nearly eqnal, the first having 15in 100, and the second 16 in 100. Thenatural and obvious inference from thiscalculation is, that in proportion to theprevalence of vaccination has been theprevention of small-pox."

Of the 224 cases which are said to have

occurred after vaccination, the author has’obtained the following particulars, eitherfrom the individuals concerned, or fromtheir friends, and classed them under

four general divisions, as follow :

Class.

1. Slight-The patient not confinedto bed, and in most cases, notso ill as to be induced to applyfor medical assistance........ 163

2. Severe—Patient confined more orless to bed, either the fever orthe eruption, or both, severe,but no danger apprehended .. 33

3. Dangerous—Producing blinduess,leaving pits on the skin, andfor a time recovery doubtful .. 9

4. Died ....................... 3

208

The symptoms of the other sixteen

cases could not be ascertained; and

the author could obtain no satisfactoryevidence that the three persons in whom

the disease proved f?tal, had been per-

fectly vaccinated. Some having conjec-tured that the efficacy of the vaccine virusmay have been impaired by time, and thenuinbers through whom it has passed, theauthor has endeavoured to ascertain the

year in which vaccination was performed

in those who subsequently took small-pox;since, if the hypothesis be true, the numberof failures would have diminished the morenearly we approach to its introduction.

For this purpose he has constructed a

table, showing the year in which vaccina-tion was performed on those who after-wards took the small-pox, from which welearn, that out of 126 cases, 18 were vac-cinated previously to 1806; 37 more (or55) previous to 1812; 41 more (or 99)before 1918; and 27 within the last

six or seven years. When it is considered

that vaccination has been so much ex-

tended, and that the chances of failuremust have been proportionably increased,there is strong reason for believing,that those who were vaccinated in the

early years of the practice, have takensmall-pox in the same proportion with

those on whom the operation has beenmore recently performed. The author

has another table, which exhibits the yearin which small-pox occurred after vacci-

nation, and the number of cases in each

year, from which it appears, that the for-

mer has supervened after the latter

more frequently of late than in formeryears. Dividing the time which has

elapsed since 1800 into periods of six

years, the number in the first, or till 1806,is 1 ; for the second, or until 1812, 8 ; for

the third, to 1818, 43 ; (33 of which werein the year 1818 ;) and the fourth, 92,84 of which occurred during the epidemicof 1823-4; whence it appears, that of 744cases of small-pox after vaccination, 125,or nine-tenths, have happened within thelast seven years. From another table

the author endeavours to show that the

notion which some have entertained, thatthe protecting influence of cow-pox en.dores for a limited period, is a mere pre-judice ; for, of 164 cases, 97, or consider-ably more than half, took place withinsix years from the time of vaccination,and 34 more, or 141 within twelve years.

47

But here it must be objected, that thesmall-pox is very eccentric in its visits

and ravages, and that consequentlythe time at which persons partially or

wholly unprotected may have the disease

must at least be equally uncertain ; andthat the tables which have furnished these

data, are, as to remote periods, no guidewhatever ; as may be seen by comparingNos. 2 and 7, from the former of which it

appears, that 224 had small-pox after

vaccination since the year 1800, while inthe Idtter, 144 only are enumerated ; andwe cannot find that this discrepancy hasbeen cleared up. From these precedingdetails, however, the author has arrivedat the following conclusions :-

" 1. It is very probable, that morethan 300 individuals have died with na-tural small-pox in Cambridge in thecourse of 25 years preceding the summerof 1824.

2. Ten have died in the same period ofsmall-pox from inoculation.

3. Three have died of small-pox sub-sequent to supposed vaccination.

4. From the joint influence of vaccina-tion and small-pox inoculation, it is veryprobable that 713 deaths from natural

small- pox have been prevented.5. If all who have been affected within

the given period with either of these dis-eases, (viz. natural small-pox, inoculatedsmall-pox, or cow-pox,) had been inocu-lated with the small-pox, 64 only wouldhave died.

6. Had all undergone vaccination, fiveor six only would have died of small-pox.

7. Where one person has died of small-pox after vaccination, 11 or 12 have diedof inoculated small-pox.

8. In the several parishes of Cam-bridge, in propotton to the diffusion ofvaccination, has been the prevention ofsmall-pox.

9. Two hundred and twenty-four casesof small-pox have occurred after stip-posed vaccination.

10. In these cases the disease was slightin 163 ; more severe, but not dangerous,in 33 ; dangerous in 9; and iatal in 3. ’,

11. In two of the three fatal cases, the

history of the vaccine disease is imper-fect, in the thit d, the vaccine vesiclewas injured, and its natural progress in-

terrupted.

12. The supervention of small-pox inpersons previously vaccinated, has beenincomparably more frequent of late thanin former ve,irs.

13. Lapse of time does not impair theprotecting influence of cow-pox, in thepersons of those who have once under-gone the disease.

14. The vaccine virus has lost none ofits efficacy from the time which has trans-pir’ d, and the number of individuals

through whom it has passed, since it wasfirst taken from its original source."

The author remarks, that the means

employed to extend the practice of vac-cination in the town of Cambridge havebeen very inadequate, and that, when the

small-pox made its appearance in 1823-4,nearly 600 persons took the infection,b! sides 12 to whom it was communicated

by inoculation. After the epidemic hadterminated its ravages, he still found 600

unvaccinated persons who had escapedthe contagion, and who of course are opento receive it on its next visit. The means

of extending vaccination which he pro-poses, consist,

" 1. In the provision of means for theeffectual performance and universal ex-tension of vaccination.

2. In securing a constant supply ofvaccine virus.

3. In exciting and perpetuating theattention of the public to the subject.

4. In affording better opportunitiesthan have heretofore existed, for observ-ing the phenomena of the cow-pox, andthe diseases connected with it."

We think the inhabitants of Cambridge!had better begin by discouraging those! practitioners who so materially extended,

if they did not introduce the late epidemicby inoculating within a short period no

less than 102 individuals; for while such

practices are tolerated, it is idle to ex-

pect that the full benefits of Jenner’s dis.covery can be realized.