MEMORIAL mxi of t> -i.2. Countries in which ^g gjjg ^s g S|^ records havfl been £ £ ~^«1 gCs 3.2?*- B+* P s.2feo «» n •— A o Poo cs^ h& • Inmates. 0 a a a "o £ fc £ 1851 1,854 2,0S7 3,441 1852 1,419 1,794 3,213 1853 1,811 1,729 8,040 1854 1,305 1,385 2,690 1855 1,156 1,222 2,878 1856 1,062 959 2,021 1857 879 1,276 2,155 1858 1,407 1,169 2,576 1859 1,320 1,148 2,468 1860 1,142 1,897 2,539 1861 1,153 1,877 3,030 13,508 16,043 13,508 29,551 29,551 Remarks. 1 1 • 4 13 8 11 8 6 8 10 5 60 24 1 3 i 1st year of vaccination on admission. No case contracted in the institution Bince commenced to vaccinate on arrival. 6 whole number contracted in the institution. Whole number of inmates during a period of 11 years..............29,551 Whole number of cases of Small-pox during that period............. 60 Of which there were contracted and brought to the institution........ 24 Average yearly number of inmates............................... 2,686 " " cases of Small-pox............................... 5£ Contracted elsewhere.......................................... 2£ HOUSE OF REFUGE STATISTICS BY DR. WHITTELSEY. Since 1855 all children, deemed unprotected, have been vaccinated on their arrival. There were in the Refuge January 1st, 1855 .............. 419 children. There have been admitted up to January 1st, 1862..........2,021 " Total number...................................2,440 children. During this period of 7 years no cases of Small-pox or varioloid has occurred in the Refuge, notwithstanding there were children admitted, during the time, suffering with the disease, necessarily exposing the inmates to contagion. \\ Dr. J. G. Balfour,* Surgeon to the Royal Military Hospital, Chelsea, states that the Small-pox mortality of the British Navy has not reached a third, nor that of the British Army, a fourth of the London rate; and lie says, " that in the experience of the Royal Military Asylum for forty-eight years (within which time 5,774 boys have been received for training) only four deaths by Small-pox occurred, and these all in un- vaccinated boys, who were believed already to have suffered Small-pox before becoming inmates of the school." And the reviewer of these papers states, that " the combined weight of testimony from all sources of evidence is to show, that in proportion as vaccination is general and efficient, so is the exclusion of Small pox from the community, and the mortality greatly lessened P Although from the above statistics it is abundantly proved that vaccination will prevent Small-pox, yet it is now gener- ally admitted that its protecting influence is not of life long duration ; but that it diminishes in proportion to the lapse of time from the vaccination, until it has been several times repeated, or until the system has been so thoroughly infected with the vaccine poison, that it will then act as a permanent protection equally as well, as if the person had previously suffered from the Small-pox itself. Dr. G. B. Wood f says: "It can not now be denied that a single vaccination does not afford the permanent security it was supposed to do. Probably nearly one-half of those vaccinated successfully are liable to more or less effect from the variolous contagion; though it is asserted, that when the operation is performed writh four or more insertions instead of one, the proportion of the protection is much greater." Mr. Simon in his celebrated report says, that he was much struck witli the fact, "that persons who had been vaccinated ten or fifteen years ago, and who during this interval had, perhaps, repeatedly resisted Sinall-pox, would at length, in a certain proportion of their number, yield to the infection.";}; This had most frequently happened during the times when Small-pox was severely epidemic among the unvaccinated, * Brit, and For. Med.-Chir. Rev., Oct., 1857. ■j- Practice of Medicine, Vol. I, p. 410. % Med.-Chirurg. Trans, xxxvi., 388. 10 and when large masses of persons, with vaccination df many years, were exposed to the test of a strong epidemic influence. Under this ordeal, it became evident that, for some vacci- nated persons, the insusceptibility conferred by cow-pox was not of life-long duration, and from a careful analysis of cases it was shown, that this lessened security of certain vaccinated persons bore at least some proportion to the number of years which in each case had elapsed since vaccination, but there were not materials to prove any uniform rate of increase, from year to year, and the increase, such as it was, apparently continued up to thirty years of age, after which period it seemed that the liability to contract Small-pox underwent a continuous decline. We therefore see the absolute necessity to perform re- vaccination in order to insure permanent protection. In proof of the practical value of re-vaccination, Mr. Simon states, on the authority of Professor Heim, that in Wirtem- burg,* " during the five years, 1833-37, though Small-pox infection had been sixteen times imported into different regiments of the army, there had ensued among the 14,384 re-vaccinated soldiers only—in the person of one whose re. vaccination two years before had been followed by ' modified success'—a single instance of varioloid." In Prussia, just as in Wirtemburg, the practice of re- vaccination grew out of the knowledge that Small-pox would ultimately attack a certain proportion of those who had been vaccinated only in infancy. This knowledge, too, had been dearly purchased in the Prussian Army; for during the ten years preceding 1831, cases of post-vaccinal Small-pox were increasing in number and fatality; attacks were counted annually by many hundreds; and within the three years 1831-33, there had occurred no fewer than 312 deaths by Small-pox. "For the last twenty years the Prussian Army has represented an almost entirely re-vaccinated population, and what has been the contrast? 104 annual deaths by Small-pox was the last experience of the former system; two annual * Royal Ministry of War. 11 deaths by Small-pox has been the average for the re-vaccinated Army." From 1843 re-vaccination has been compulsory in the Bavarian Army; and from that date to the present time (1857) neither a single death by Small-pox, nor even a single case of unmodified Small-pox, has occurred in that popula- tion."" Many other statistics from Sweden, Denmark, Baden, and the British Army, could be cited equally striking as the above, proving conclusively the absolute necessity for re- vaccination. But as enough has been given to prove its efficacy, I will conclude my report by giving the'average number of deaths that have occurred annually in the city of Xew York by Small-pox for the last ten years, showing the absolute necessity of some action being taken to arrest its frightful progress. In the City of New York, for the last ten years, there has been an annual average death by Small-pox of more than 400 persons. In view of this fact, and of the statistics I have presented above, we see the immense importance of some Legislative action for the better protection of our citizens from this most dreadful of all diseases. And I should therefore recommend the enactment of such laws, as will properly enforce efficient and universal vaccina- tion, and that it be repeated as often as every five years, until the age of twenty-one, and that each person shall be compelled to have a certificate testifying the same, and which shall be renewed every five years until twenty-one years of age. The census being taken every five years will render this law easy of enforcement as the Marshal in taking the number of inmates in each house, can at the same time, inspect the date of their vaccine certificate, and the penalty for neglect, shall be. that if they are taken with the disease, and have not the proper certificate with its date, then they shall at once be remove! to the Small-pox Hospital on Blackwell's Island, nolens rohn*. or such other County Hospital as may be designated for such purpose by the Supervisors of any County where the disease may occur. 12 That any Physician failing to report any case of Small-pox under his charge, within twenty-four hours, to the Resident Physician, in order that it be removed, (unless they have the proper certificate) shall be fined $100. That any Hotel proprietor or keeper of a boarding or lodging house, or head of any family, failing to report any and every case of Small-pox occurring in his, her, or their house within twenty-four hours to the Resident Physician, shall be fined $50. No child should be admitted into any public school without first presenting his certificate of vaccination. All private schools, colleges, and benevolent institutions should be urged to make, this a requisite necessary for admission. In all Penal institutions and Public Hospitals the law can be enforced, and therefore made obligatory. Every family on engaging a servant, every merchant on hiring a clerk, every captain when shipping a sailor, every mechanic on receiving an apprentice, every officer enlisting a recruit, should compel the applicant to exhibit his certificate of vaccination with its proper date, and so through all the different ramifications of society the attention of the com- munity would be drawn to this important object, and its beneficial effects would soon be so apparent as to render no laws necessary for its continued enforcement. The Physician at Quarantine should be compelled to vaccinate every person on arrival at this port, who has not the necessary certificate, or who does not present evidences of having had the disease. It* these suggestions can be practically carried into effect, I confidently believe that in a few years at most, we will perfectly eradicate from our city this most disgusting and loathsome scourge. All of which is respectfully submitted, LEWIS A. SAYRE, M.D., Resident Physician.