130

Preparation taken from a case of ChronicPleuritis, with Hydrothorax in the rightside of the Chest, communicating throughan opening caused by a fractured rib, witha sac situated beneath the muscles and inte-guments near the inferior angle of thescapula.

The subject of this case was an infant four-teen months old, which had been very muchneglected and ill-treated by its nurse. Itwas taken into the St. Pancras Infirmary,where it had been during the last six months.The fracture occurred most probably beforeits admission, but had not been remarked bythe nurse. The movement of the fracturedends of the bones had excited pleuritis andeffusion, and the violent efforts made duringthe spasmodic attacks of hooping-cough hadforced a part of the fiuid through the intervalof the fractured ends of the injured rib intothe cellular tissue beneath the latissimusdorsi muscle, where a sac of the size of asmall orange, and lined with adhesive lymph,had been formed. Pressure upon the tumourforced its contents into the cavity of thechest. The cavity of the chest was foundfull of serum, and the lung very much com-pressed.

THE LANCET.

London, Saturday, April 18, 1840.

THE VACCINATION EXTENSION BILL.

TilE fact that Small-pox destroyed 5811lives in the half year ending Dec. 31st,1837-that it was equally prevalent in 1838- and that it declined but little in 1839-is

sufficient of itself to fix attention on the" Vaccination Extension Bill." It is dis-

creditable to the intelligence and humanityof the country, that the deaths from this

dreadful disease should, in England andWales alone, amount to 10,000 annually,-40 years after the discovery of vaccination !The deaths from Small-pox in Austria

were 11 out of 100 cases, and the averageduration of the cases is about a month ;whence it may be deduced, that if 10,000cases terminate fatally in England, 90,000cases occur annually ; that 90,000 months

of loathsome sickness are incurred every

year ; and that 80,000 persons who escapewith their lives have their countenances

seared by ineffaceable cicatrices, while many

are deprived of hearing, and mutilated, orblinded.

The first attempt to arrest the ravages of

Small-pox was made in the eighteenth cen.

tury. Inoculation induced a milder form

of Small-pox, and, as the disease only occurs

once, sheltered the inoculated from what

was called the Natural Small-pox ; but the

Small-pox of Inoculation was sometimes

fatal, and when left to themselves a largenumber of persons never had an attack of

Small-pox. The question then arose, whe.ther the parent or the medical adviser was

justified in inducing Small-pox by inocula.tion-a disease not unattended with danger- in order to protect the child from a disease

which, if left alone, he may, perhaps, neverincur? If inoculation protected the lives of the

inoculated, it increased the risk of infection,on the part of the great mass of the popula-tion who had never had Small-pox: and ithas been maintained, that the absolute mor.

tality from Small-pox increased after the

introduction of inoculation. The opinionhas been upheld on the authority of theLondon Bills of Mortality ; but we agreewith Dr. GREGORY, in his very interestingLecture, that 11 this is one of those fallacieswhich are received without [due inqniry."The average annual deaths from Small-pox,reported in the London Bills of Mortalityfor the 50 years 1700-49, was 1860; in the

50 years, 1750-49, the average annual deaths

from Small-pox were 2019 ; in the 30 years,

1800-29, the average annual deaths in the

Bills of Mortality fell to 974. In the SO

years, 1700-29, when inoculation was, ex.

cept as a matter of experiment, unknown,the deaths from Small-pox were 1774 yearly;in 1770-99, when inoculation, in the words

of Dr. GREGORY, was extensively practised,the yearly deaths from Small-pox were 1875.The Bills of Mortality were almost equallyimperfect in the beginning and the end of

the century, so that the deaths are compa-

rable ; but the population increased. The

population of the metropolis has latterlyincreased at a rate of 1.8 per cent. annually,and at this rate it would double itself ill

131THE VACCINATION EXTENSION BILL.

39 years. If the population doubled in only when it is watered with tears, and withthe 70 years, 1715 to 1785,the deaths in the blood. JENNER was begrudged £10,000 bylatter period, to have given the same mor- the Governmentof the day,and the Imperialtality, or the same proportion out of the Parliament; while, upon warriors of ordi-same number living, should have been nary talents, and every-day achievements,twice 1774, or 3548; whereas the annual thousands have been lavished for generationsDumber registered was 1875. in succession.

The hygrological circumstances which This is one of the principal causes whyreduce the general mortality, reduce the Governments and Statesmen are so little

deaths from Small-pox ; and it is generally prone in the aspirations of ambition to direct

admitted, that the metropolis underwent their attention to the means of diminishingconsiderable improvements at the close of suffering, of promoting the happiness, andthe 18th century. But after an allowance of improving the physical condition of thehas been made for this, for the inaccuracies mass of the population ; and this is proba-of the Bills, and for the uncertain increase bly one of the causes why Inoculation andof the population, it does seem probable the Small-pox have not been supplanted bythat the absolute mortality from Smali-pox, the universal extension of JENNER’s bene-

far from having been augmented, was con- ficent discovery.siderably diminished by inoculation. The Bill, professing to be a Bill for the

JENNER’S immortal discovery completely "Extension of Vaccination," is a proof ofset aside inoculation. Vaccination induced the little regard paid by at least one brancha modification of Small-pox entirely free of the Legislature to the details of questionsfrom danger, either to the patient, or to the affecting the public health. The Bill, if

persons by whom he was surrounded. The carried in its present form, will be a mise-vaccine pustule is never fatal ; it never gives rable failure ; it will be entirely ineffective.rise to natural Small-pox ; and experience It leaves the evil just where it was. It is

has proved that its protection is as certain not a Bill for the extension of vaccination,and effective as the natural or inoculated but a Bill for insulting the medical pro-

Small-pox. Why, then, is not the blessing fession, and placing them in degradinguniversally diffused? How does it happen subordination to the Poor-Law Commis-

that ten tnousand persons are laid in the sioners.

grave annually in England by Small-pox, Why has the superintendence of the vac-when it is certain that if the entire popula- cination of the people been given to the

tion was sheltered by this tried shield, Poor-Law Commissioners? Why are theywhich genius has wrested from Nature, not to draw up the regulations? Why are the

- ten hundred would fall its victims? Why reports to be made to the Poor-Law Com-are the children of the country offered up missioners? What do the Poor-Law Corn-

on this altar? Why are their countenances missioners know of the matter? Is it for

scorched by this deadly malady ? Why are the high character which these function-

the poor, ignorant, and helpless, but not aries have for humanity, for their scientificheartless mothers, left to bewail their off- attainments, for their tender respect for

-spring cl because they are not," from the human life, for the confidence which the

want of a few sanatory regulations ? Poor have in their kindness, for the provi-It i?, unfortunately, in the present state dent care with which they have supplied

of public opinion, less glorious to save than paupers with remedies and efficient medi-

to destroy human life ; the savers of man- cal advice, that the execution of a measurekind are unhonoured ; the destroyers are of public health is to be given to them? that

heroes ; the tree of earthly immortality flou- the medical practitioners of the country are1’ishes in the ruins of nations, and bears fruit to be placed at their feet ? ? _ _

32 THE VACCINATION EXTENSION BILL.

The Act provides, that it shall be lawful absolutely the rate of medical remunerationfor the Guardians of every parish or union, all over the kingdom.and for the Overseers of every parish in which The Marquis of NORMANDY very consider.relief to the Poor shall not be administered by ately introduced a clause into the Bill toGuardians—and they are thereby directed to prevent the practice of inoculation with

contract with the medical officers of their variolous matter by unqualified persons.

several unions or parishes respectively for But physicians, surgeons, or apothecariesthe vaccination of all persons who may come are not prohibited from inoculating with

to them for that purpose. It is lawful for variolous matter. This is a defect. No

the Guardians and Overseers to contract person should be allowed to inoculate. It

now for the vaccination of paupers. But was contended by JE’NNER that the cow-poxon May 1st, 1839, Manchester, Salford, was a modified small - pox. The beautiful

Liverpool, Lancaster, Exeter, Plymouth, series of experiments by Mr. CEELEY plateBristol, Canterbury, Oxford, Shrewsbury, this beyond doubt. He produced cow-potSouthampton, Brighton, Chichester, Bir- pustules in the cow, with the lymph of

mingham, Coventry, Hull, Marylebone, St. small-pox, taken from the human subject.Pancras, St. George’s Hanover-square, and The lymph of the cow-pox pustules fromother metropolitan districts, comprising a small-pox matter, produced cow-pox in the

population of 2,145,842, were not under the hu tan subject. The cow-pox is, therefore,dominion of the Poor-Law Commission. small-pox ; and, as the observation of 40

The Bill enacts that for the execution of this years has shown, is as efficient a protectionAct, " the overseers and all other officers against the recurrence of small-pox as au

"engaged in the administration of the Laws attack of small-pox itself. The inoculation

for the relief of the Poor, shall conform to with variolous matter should be entirelythe regulations which may from time to prohibited,and additional security be sought"time be issued by the PooR-LAW COMMIS- in re-vaceination.

"SIONERS in that behalf, which regulations The l lth clause enacts that qualified per-’‘ the said Commissioners are hereby ateilaarlsed sons-physicians or surgeons-who do ino-"and required to make and issue." The culate sball transmit reports to the Poor-Law

vaccination of the country is to be en- Commissioners; and that the reports are to

trusted to an incompetent Commission, be drawn up according to the schedule, and

merely to extend the power of that Com- to coatain "such further particulars as themission over the overseers and officers of Poor-Law Commissioners"—those profound

parishes " not yet in union !" vaccine authorities-’, mayfrom time to tim,

The medical officers are to make such "by any regulation published in the 6azeltc,further report " as such Guardians and "require of all persons inoculated." The Vac-

"Overseers zcnder tlae direction af the Poor- cination Board is passed by. The College

"Law Commissioners shall require." of Physicians in London, the College ofLaw Commissioners shall require.’- Surgeons, the medical institutions of Dublin,

The seventh clause enacts that the Guar- arc never noticed,-Scotland is left to shiftdians or Overseers [of parishes not now for itself: could any thing evince more deci-under the Poor-Law Commission] shall sively the low estate to which the medicaltransmit a copy of the contract to the Poor- profession has fallen, in the hands of the

Law Commissioners ; and that it shall be self-elective corporations ? If the medicallawful for such Commissioners to annul the corporations had the slightest regard for thesame if the terms of such contract shall public health, would they stand still and

appear to them to be unreasonable or insuf- see the vaccination of the people entrusted

ficient. Lawyers’ bills are taxed by lawyers, to an usurping, incompetent Board of Poor.but the Poor-Law Commissioners are to fix Law Commissioners?

133MR. WARD 13N DISTORTIONS OF THE SPINE.

The Poor-Law Commissioners have pro-

bably little to do; or, moved by some- pangsof consoience, the Board may feol a sinceresolicitude to repair the injuries which it hasinflicted upon the Poor, by the abrupt intro-duction of the Tender scheme. It may

seek, as a Vaccination Commission, to atonefor the crimes of the Poor-Law Commission,and, in the metempsychosis, fondly hope to i

purge away the dross of its anterior state ofbeing,-to make the cow expiate the cruel-

I

ties of its first incarnation.

A little reflection must convince the Poor-

Law Commissioners-if their contrition be

sincere—that they can only add to the list ofevils which they have committed, by rashlyundertaking duties which they are not quali-fied to perform.The Vaccination Board must be abolished

if the present Bill be carried.The " Vaccination Extension Bill, in its

present form, will inevitably fail. It must

be extensively amended, or it will be inef-fective ; and the committal of its executionto the Poor-Law Commissioners and to Mr.

CHADWICK, will be sufficient to deprive themeasure of the support of the medical

profession.

Practical Observations on Distortions of theSpine, Chest, and Limbs; together withRemarks on Paralytic and other Diseasesconnected with Impaired or Defective Mo-tion. By WILLIAM TILLEARD WARD.London: Renshaw. 1840. 8vo, pp. 202.THE observations-of Mr. Ward on spinal l

deformities are a simple exposé of his owii yviews on the treatment of these affections.We are not, therefore, to expect anything !,like a complete, or even an imperfect historyof spinal distortions. Indeed, almost everypage in Mr. Ward’s book shows that as his

literary citations are drawn, for the mostpart, from the last century, so his ideas, andmany of his doctrines, belong to the dayswhich are gone by. It is better, however,that a man adhere staunchly to his own

opinions, particularly if they bear the stampof originality, than content himself with theservile task of picking up the crumbs fromunder his neighbours’ tables. After some

preliminary observations on muscular exer-cise, Mr. Ward takes up the subject of°° Distortion of the Spine." This he definesto be " an alteration in the natural form ofthe spinal column, without caries of its bonystructure." It is of two kinds, the lateraland the anterior, the former chiefly affectingyoung persons, and the latter the aged. Mr.Ward considers that distortion of the spineis considerably on the increase, and attri-butes its increased frequency to the presentmode of educating females of the upperclasses. It also, frequently, has its founda-tion in improper nursing, and in the had dietof children during weaning; but when incur-vation of the spine occurs after six or sevenyears of age, the chief cause is a want of

proper exercise.

Surgeons, according to Mr. Ward, gene-rally imagine that distorted spine alwayshas its origin in caries of the vertebra?, or ina morbid state of the bone tending to it;this idea he combats. The curvature most

frequently takes place towards the rightside. Mr. Ward is of opinion that this canbe explained by the fact of the right side ofthe body being more heavy than the other.

In order to illustrate the comparative fre-quency of the different forms of spinal cur-vature, Mr. Ward gives a Table of 2b2 caseswhich have fallen under his observation.Of these there were—

Curvature to the right, withoutdisease ...................... 230

Curvature to the left, withoutdisease ...................... 10

I Posterior curvature, without dis-i ease ........................ 9

Posterior curvature, with disease 30

Incurvation of spine ............ 3

It is to be regretted that Mr. Ward hasnot mentioned where the above cases wereobserved, nor amongst what class of patients;at all events, his Table coincides in a veryremarkable manner with the one which was

published in a late Volume of THE LANCET,*by Mr. Hale Thomson, whose views andopinions, although attacked by some wtiters,are thus singularly supported by the experi-ence of Mr. Ward. Thus, of 300 cases ob-served by Mr. Thomson, there were-

Curvature to the right, without

disease ...................... 240Curvature to the left, without

disease ...................... 12

* Vol. ii. 1838-9, p. 132.