truth of some of these, so I must earnestly beg of you to trust the rest, without thrusting your fingers, like a child, into those flames in which your father hath formerly been burnt, and so add to the multitude of inconveniences he is forced to leave you by inheritance.

Now you are taught to Live; there's nothing I
Esteem worth learning, but the way to Die.

There let us leave him; he has long been resting in the haven he desired, but he ought not to be wholly forgotten, for though his other merits may be disputed, at least he can express himself in good English. Peace be to his ashes; he had but little ease in life.

SIDNEY PEEL.

THE

SUPERFLUOUS VACCINATION COMMISSION

THE Report of the Royal Commission on Vaccination can hardly be said to have justified its existence. It is, indeed, in more senses than one, a weighty document, and it embodies the results of a most painstaking inquiry, in the course of which an enormous mass of evidence from almost every witness who had a fact, or an opinion however foolish, to communicate was sifted with the most scrupulous care. And what is the outcome of all this labour? In its scientific aspect vaccination is left precisely as it was. The medical profession, which alone is competent to judge in the matter, is practically unanimous in looking upon the question as absolutely settled; as far as it is concerned, therefore, nothing is changed by the Report; it is but one blue-book the more. The opponents of vaccination, who are, for the most part, incapable of appreciating scientific evidence, will certainly not be converted by the Report; it gives them, indeed, arguments of the most convincing nature, but it cannot give them understanding. As regards the political aspect of the question the Report is a compromise, and as such pleases no one. The tenderness shown for conscientious objectors is not enough for the stalwarts who denounce vaccination as an unclean thing, and appears mere weakness to the advocates of a policy of Thorough in its enforcement. The majority of the Commissioners evidently thought that it would be impolitic to carry their conclusions on the scientific reference to their logical issue, and they seem, if I may use a metaphor appropriate to the subject, to have attenuated their recommendations to a degree which they considered adapted to the tolerance of their recalcitrant colleagues. The virus was made as benign as possible, but Dr. Collins and Mr. Picton showed themselves naturally insusceptible.'

To my mind the appointment of the Commission was a mistake. It was not needed; it was badly constituted for the purpose in view; and its deliberations were protracted to a degree that deprived the ultimate findings of much of the value that would have been attached to them had they been arrived at with less apparent doubt and hesitancy. In saying that it was badly constituted, I mean that although

the members were undoubtedly most capable men in their several spheres, they did not collectively form a body particularly well fitted to deal with the question submitted to them. The medical members were, with one or two exceptions, chosen rather on the ground of general eminence than of any special knowledge of the subject. In particular there was not a single one who could be regarded as a representative of pathology. It has been said that this is the day of old men. However this may be in politics and in other departments of intellectual activity, it is emphatically not the case in medicine. Hence 'general eminence' is an inadequate equipment for the solution of problems of pathology—a science which in its modern form has grown up within the last twenty years. Fortunately in so plain a case as that submitted to the Commission it was impossible for any body of men trained in scientific methods and in the weighing of evidence to come to any but one conclusion. Their outrageously protracted deliberations, however, not unnaturally unsettled people's faith in vaccination, and kept the law in a state of suspended animation; and the evil they have thus done lives after them. It now rests with the Legislature to decide whether the law shall be quickened anew into vigorous life or become practically a dead letter. My own view as to the duty of the Government in the matter is clear, and will be frankly stated later. But something must first be said about the Report and the conclusions to be drawn therefrom.

After so unconscionable a length of incubation, there was reason to fear that the Report might prove to be an addled egg. This, however, is not the case as far as facts and deductions are concerned. The case for vaccination has been reinforced by modern instances; some doubtful points have been elucidated; and, above all, the antivacks,' if I may be allowed to use a word which has the sanction of Edward Jenner himself, have been allowed to have their say to an extent which testifies to the almost superhuman power of endurance of the Commissioners. The case for anti-vaccination was, in fact, presented as it never has been before, and the presence upon the Commission of an advocatus diaboli of such knowledge and ability as my friend Dr. W. J. Collins ensured that every scrap of evidence against vaccination should be given its full weight. These circumstances make the fact that eleven out of thirteen Commissioners-including men accustomed to sift and weigh evidence, like Lord Herschell, Mr. Dugdale, and Mr. MeadowsWhite-gave their decision unequivocally in its favour of special significance.

It is important that this point should be set in the clearest possible light. The antivaccinists profess to see in the Report a victory for their cause. One is not surprised to read this kind of stuff in certain inconsiderable quarters; but one did not expect to find it in respectable newspapers. Yet the chief organ of Radicalism

went so far as to say: Our own reading of the Report is that the Commissioners have been heartily glad to escape from the intolerable position of spreading by force a faith which has lost its hold on them.' Any one who can read such a meaning into the plain language of the Report must be gifted with the exegetic ingenuity of an Ignatius Donelly, or afflicted with that worst form of mental blindness which will not see.

The Commissioners themselves express the hope that their Report 'will stimulate belief in the efficacy of vaccination.' It is, indeed, well calculated to do so; and it would have been strange if faith in Jenner's discovery had lost its hold on men who had had before them so irresistible an array of evidence as to the good which it has done to mankind.

Before summarising the evidence, it will be instructive to glance backwards for a moment at small-pox as it was before Jenner drew its fangs. About the middle of the eighteenth century the celebrated mathematician Daniel Bernouilli estimated that it claimed fifteen millions of victims every twenty-five years, giving an annual holocaust of six hundred thousand. Haygarth, a careful writer, computed that only 5 per cent. of mankind escaped the disease. But that which to my mind is more convincing than statistics is the fact that our forefathers looked upon small-pox as a scourge from which there was practically no hope of escape. As early as the ninth century we find a Jewish physician stating that the disease fere omnibus accidit. The Arabian physician Rhases, who is mentioned by Dr. Collins as the writer to whom we owe the first description of the disease, says that hardly any one escapes it. At the end of the sixteenth century. Kellwaye, the author of the first systematic treatise on the disease in the English language, quoted by Dr. C. Creighton in his History of Epidemics in Great Britain, says he 'need not greatly stand upon the description of this disease, because it is a thing well known unto most people.' Buchan, writing towards the end of the last century, in his Domestic Medicine, so long the medical oracle of the British household, says that small-pox is now become so general that very few escape it at one time or another;' and adds, 'This disease is so generally known that a minute description of it is unnecessary.' To appreciate the full force of this testimony, it must be borne in mind that Buchan was writing, not for medical readers, but for the general public.

Sir Gilbert Blane stated to a Committee of the House of Commons that in the closing years of the last century an adult person who had not had small-pox was scarcely to be met with or heard of in the United Kingdom. Other countries were not less afflicted. In Russia it was calculated that one out of every seven children born died of small-pox. In France it was computed to cause one-tenth of the

deaths from all causes. In Germany, the popular belief in the practical impossibility of escaping small-pox found expression in the proverb 'Von Pocken und Liebe bleiben nur Wenige frei.' Thanks to vaccination, that proverb is now decidedly musty in the land of its birth.

With the passing away of the eighteenth century came the dawn of a new era. In England, in Sweden, in Denmark, and in other countries of Western Europe, and in the United States the first quarter of the present century was marked by a striking decrease in the number of deaths from small-pox. It is needless to quote authorities or to give statistics in proof of this statement, for it is admitted by Dr. Collins and Mr. Picton themselves. The only question is whether the decrease was due to vaccination or to some other cause. On this point the Commissioners speak with no uncertain sound. They find that the cause of the decline was the protective influence of vaccination, which made itself felt more and more as the practice came into more general use; and they find strong confirmation of this view in the fact that such information as is available goes to show that in the countries where vaccination did not become general, small-pox prevailed in the first quarter of the nineteenth century very much as it had prevailed in the eighteenth.'

It is not till 1837 that what may be termed the modern history of the disease begins, as far as England is concerned. In that year the present system of registration of deaths came into existence. As regards Scotland a similar record dates only from 1855, and as regards Ireland from 1864. The legislative enactments relative to vaccination in the several parts of the United Kingdom correspond roughly to these periods. If vaccination is an effective protection against small-pox, one would expect to find that in proportion as it is more strictly enforced, the more marked is the decrease in the prevalence of the disease.

In England Acts to extend the practice of vaccination' were passed in 1840 and 1841; in 1853 it was made compulsory, but the provisions for carrying out the intention of the Legislature were very imperfect; in 1867 the laws relating to vaccination were consolidated and amended, and power was given to Unions to appoint paid officers whose duty it should be to vaccinate free of charge all children brought to them for the purpose. In a number of Unions, however, the power was not exercised, and in the early part of 1871 there were still a great many Unions in which vaccination officers had not been appointed. In that year an Act was passed making the appointment of such officers in all Unions compulsory, and providing for the better carrying out of the law.

Taking the period from 1837 to 1894 as a whole the official records show a very marked decline in the death-rate from small-pox.

VOL. XL-No. 238

3 S