« SebelumnyaLanjutkan »
or encouraging the various systems of charlatanry, under the mask of reform, and thereby undervaluing the science and skill of regular physicians, and thus bringing the profession into disfavour with the community.
Many of our oldest and most respected physicians reside in the district mentioned, and their association for such praisworthy objects cannot but be productive of good, especially to their junior brethren, who will by this means be admitted to their more intimate fellowship.
TO CORRESPONDENTS AND PUBLISHERS. We have received several books, tracts, and introductory lectures, which we shall endeavour to notice in our next number.
RECORD OF MEDICAL SCIENCE.
Delegates to the National Medical Convention.—The Medical Faculty of the University of Pennsylvania, have appointed of their number, Drs. Chapman, Jackson, and Wood, to represent them in che Convention in May next.
The Philadelphia Medical Society, at a meeting held November 21st, elected the following gentlemen as delegates to the Convention : Drs. Bell, Emerson, Isaac Parrish, West, Ashmead, Norris, B. H. Coates, Bond, S. G. Morton, Yardley, and Griscom. There is stili a vacancy to be filled up by the election of a delegate, so as to complete the number, twelve, authorised by the Society.
The College of Physicians of Philadelphia, at a meeting, Dec. 1st. appointed a delegation to consist of Drs. Hewson, J. W. Moore, S. Jackson (formerly of Northumberland County), Hays, A. Stillé, J. R. Paul, Pepper, Fox, Randolph, C. Morris, Condie, and Bridges.
The Medical Society of New Jersey, which dates its origin from the 23d of July, 1766, and to age adds the merit of high standing among similar associations in the United States has elected delegates to the Convention. The list consists of Drs. Smith and Peirson of Essex County, Marsh of Passaic, Stewart of Morris, Forman of Mercer, Parrish of Burlington, Taylor and Cooper of Camden, Garrison of Gloucester, and Howell of
The District Medical Society of Burlington County has appointed, as delegates, Drs, Cole, Stration, and Read.
The delegates of the Philadelphia Medical Society, and of the College of Physicians, have been directed, respectively, to make arrangements, in connexion with the delegates that may be appointed by other institutions in the city, for the reception and a suitable place of meeting of the Convention.
The Vermont Medical Society has appointed Drs. Charles Hall, C. W. Horton, A. G. Dana, and Dyer Storer, as its delegates to the Convention.-Bulletin of Medical Science.
Report on the Protective Powers of Vaccination.-In April, 1842, the undersigned were appointed by the College, a committee to investigate the protective powers of vaccination ; the phenomena resulting when those who have been already vaccinated are again subjected to the disease, and the subject of re-vaccination generally. Various obstacles, beyond their control, prevented their performing, at an earlier period, the task submitted to them, in a manner that would have proved at all commensurate with its importance; they have, however, been enabled, at length, to bring their labours to a close, the result of which is here submitted.
The first object embraced in the resolution, under which the committee was appointed, is one of acknowledged interest; it refers to the protective powers of vaccination.
The most obvious and conclusive mode of determining the degree of protection imparted by vaccination against the influence of smallpox, is to inoculate, with variolous matter, the persons who have been previously vaccinated.
At the close of 1801, the first successful efforts were made at vaccination in this city. In the early periods of this practice, until the year 1812, every mean was employed which, at the time, was deemed best calculated to determine whether the process of vaccination would afford full protection against the small-pox. The first step generally taken, after having observed the genuine character of this vaccine pock, was to insert a portion of variolous matter, and to note its progress.
Where due attention had been paid to the selection and insertion of this matter, a small red pimple appeared about the third day. On the fifth day this was converted into a purulent crust, surrounded by inflammation, generally of no great extent, which, after this period, began to fade, and was rarely perceptible beyond the eighth day; it left no trace beyond the tenth. The full and distinctive character of the variolous pock was not observed on these occasions. The persons thus treated were not affected with fever, or any general disarrangement of the system, nor was any eruption observed on the skin. The persons having been submitted to this test, were next exposed to the small-pox in the most direct manner, often by placing them in the beds with those labouring under the disease, even in its most virulent form. A like immunity attended this experiment.
From repeated observations thus conducted, observing that no instance of small-pox had been communicated to those on whom the operation of vaccination had been duly performed, the profession ventured, in 1603, to announce the process as one affording equal protection with variolous inoculation.
The reasons for preferring the process of vaccination to that of variolous inoculation could not fail to be appreciated, and were strongly urged in the circulars issued for the public information.
Under the most favourable circumstances, and where every attention had been paid to insure success, many of those who had been inoculated for the small-pox were known to have fallen victims to the disease. The estimate most generally received, and founded on a large experience was, that one in four hundred of the inoculated fell victims to the process ; some practitioners were stated to have been
more fortunate, and to have lost not more than one in a thousand. . On the other hand, of the thousands that had been vaccinated, not a
death had been recorded, which could be imputed to this process. The age of the individual, or the physical condition of the other members of the family, constituted no objection to the operation, as the cow-pock could be communicated by the direct application of the virus only ; while in the instance of the small-pox, the effluvia ema. nating from the infected, were known to impart the disease to the unprotected, and under circumstances when it was likely to prove fatal. In addition to the loss of life, caused by the small-pox, even when the result of inoculation, the mutilations which were so often consequent, even when life was preserved, must have been familiar to every one acquainted with the disease, whether casually received or by inoculation.
Unfortunately, the reputation of the Jennerian process has been materially affected by the ignorance of the persons by whom the operation has been frequently undertaken, and by the want of attention on the part of some of the profession in visiting at the proper periods, and recording the phenomena observed. The period when the areola may be expected ought never to be neglected. The evidence that may be obtained from such circumstantial records, will tend to dispel many of the idle reports so freely circulated to the disparagement of vaccination. By consulting such recorded docuinents, it has been clearly ascertained that the majority of the cases of smallpox ascribed to the failure of the protective process were, in reality, owing to the imperfect manner in which the operation had been con. ducted. There is abundant evidence recorded in medical books, of persons having suffered from small-pox more than once; where such a peculiarity of constitution exists, it cannot be a matter of surprise that the disease should be occasionally observed after vaccination, even in cases where the genuine and perfect character of the vaccine process has been fully developed. A careful examination of these bis. tories does not exhibit any appreciable difference in the proportional number of such cases, whether after small-pox or after vaccination.
By an act of the Legislature, passed in 1811, 10 communicate the infection of small-pox by inoculation, or otherwise, has been prohibi. ted, under certain pecuniary penalties. For the four succeeding years, the disease is not recorded in the bills of mortality ; and the
mode of most conclusively testing the protective powers of vaccination necessarily ceased. And hence the profession have, since then, been deprived of a measure so intimately connected with the inquiries to which the attention of your committee has been directed.
Touching this very important question, it must be acknowledged that the documents at command are but few; nevertheless those that have been preserved, afford the evidence that, after the lapse of three years, the vaccinated were found no longer susceptible of small-pox by inoculation. Among the persons thus treated, it has been ascertained that an infant, vaccinated within a month, resisted the variolous infection after an interval of the same number of years.
For the want of that full and comprehensive information which our more immediate resources fail to afford, it may prove acceptable if we here present the experiments made by that distinguished and accurate observer, Biot :
“ In August, 1826, a number of boys, between the ages of twelve and sixteen years, were inoculated in four places with small-pox virus by Dr. Biot, one of the physicians to the hospital St. Louis, at Paris. A part of these had been vaccinated, and a part had never been protected from the small-pox. In those who had been vaccinated, the insertion of the variolous virus had no other effect than to produce a slight inflammation for two or three days at the points where the matter was introduced. Those who had never been protected were affected differently, and contracted the variolous disease.”
In this stage of the inquiry, it appears not irrelevant to notice the diminished mortality from small-pox, as observed in this city, since the introduction of vaccination. Whenever that disease has appeared, it has been viewed as among the severest scourges inflicted on mankind, and the most appalling apprehensions have been entertained by every community which it has visited. The sufferings of those affected with this malady have at all times awakened the niost painsul and anxious feelings in friends and connections, and called forth the assiduous and unremitting care of the attendants and those administering to the sick. In seasons of epidemic small-pox, the mortality has been observed to be great. In 1721-22, in the town of Boston, five thousand seven hundred and fifty-nine persons were affected with the disease, of whom eight hundred and forty-four came to an untimely death, as publicly announced by the municipal authority of that city. This was a fearful mortality, particularly when we advert to the number of persons in habiting Boston at that period. In the succeeding year, 1722, the census was taken, indicating a population of ten thousand five hundred and sixty-seven; if, to this, there be added the number who died of small-pox, eight hundred and fortyfour, the sum will be eleven thousand four hundred and eleven, as the total population previous to the ravages of the small-pox having commenced. One-half of the inhabitants of the city were affected with the disease. Of those, between one-sixth and one-seventh came to an untimely death, and the city lost nearly one-thirteenth of its population.-Zubdial Boylston, on Small-pox, p. 33,
Of those who survived the loathsome disease, many, from the hideous aspect and mutilations caused by the disease, continued through life the objects of commiseration, and too often of disgust.
Laws have been enacted, and rigid quarantines enforced, with the view of preventing the introduction and spreading of the small-pox. In small communities, having little intercourse with other portions of the world, these efforts have proved successful for a season ; but the temporary immunity ihus enjoyed has only rendered the subsequent ravages of the disease the more disastrous. The nations engaged in commerce soon experienced the futility of every attempt to insure exemption from the disease ; for though the infected were secluded, and denied all intercourse with those deemed liable to the disease, the poison was found to be frequently conveyed by means of the clothing, and articles taken froin the chamber of the sick. For successive ages, the pestilence was submitted to as an inevitable evil, and allowed to extend its baneful influence, annually destroying large portions of the inhabitants of the earth, and in some instances depopu. lating whole districts.
The deaths from casual small-pox have varied, from circumstances not in our power to appreciate. The character of the seasons, the peculiarity of position and the nature of the intercourse between the infected and those liable to take the disease, have had their influence in determining the malignity and mortality observable in different years.
The materials having relation to the medical statistics of Philadelphia, that can be gleaned from its early history, are extremely scanty and defective. It is only within the present century, and for the period of barely forty years, that any of the reports of the deaths have been publicly made. Prior to this period the records of the interments were confined to particular religious societies, necessarily disficult of access, and, generally, ill adapted to the present purpose. Though restricted to a narrow sphere, and not embracing the entire population comprehended within the city and districts, the registers kept at the Dispensary afford a document which may constitute a proper basis to found the estimate of the advantages gained by vaccination. From the foundation of the institution to the close of 1801, including a period of sixteen years, when variolous inoculation was considered as the only protective process available against casual small-pox, fifty-one persons are stated to have died of this disease, while the entire number of deaths, from various diseases, were seven hundred and one, establishing the proportion to be seventy-three in one thousand, which accords with the most favourable estimates made in Europe, and will hardly be excepted against by those who are the least favourable lo vaccination.
In 1907, by an act of the Legislatute of the State, every death within the city and districts, must be reported to the Board of Health, the certificate expressing the disease of which the person has died. From this source, clear and positive evidence may be obtained. From the annual reports during the period of four years, variolous