to the Secretary of Stale, for the Year IS19. 353 



aJthougli positive orders are given, at every station, to report all 

 such cases as are even suspected. 



This success in London, where the vaccinated are continually 

 exposed to the contagion of small- pox, is strong evidence in 

 favour of t'le practice adopted and inculcated by this Board, and 

 induces us to believe that a deparUae from that practice is one 

 source of the evil which has prevailed in different parts of the 

 kingdom. 



The great principle of that practice is to affect the constitu- 

 tion of each individual very completely with the vaccine disease ; 

 and the Board have thought it right to direct that lymph should 

 never be employed from any vesicle in which the slightest irre- 

 gularity or imperfection can be observed ; nor even from a per- 

 fect vesicle after the areola is formed ; that two punctures be 

 made in each arm, in order to secure at least three perfect vesi- 

 cles ; that one vesicle on each arm should be left unopened, and 

 the lymph be suffered to be aljsorbed or desiccate ; that if the 

 vesicles be accidentally broken, or much injured, or if they pre- 

 sent any irregularity, the patient should be carefully re-vaccinated 

 as at first. 



From extensive experience and numerous reports, the Board 

 have become most earnestly desirous that more rather than fewer 

 vesicles should be produced. We think it especially wrong to 

 confide in one vesicle, and highly imprudent to open all : but no 

 treatment will be effective in certain constitutions ; for twenty- 

 one cases of small-pox occurring after small-pox, have been re- 

 ported to us within the last twelve months, three of which were 

 fatal. 



We have regarded it, mv Lord, as one of our first duties, to 

 consider attentively the different cases of small-pox after vacci- 

 nation, as they have been transmitted to us. We have endea- 

 voured to investigate them, free from the influence of theory, 

 and solely intent on the discovery of truth. And when we take 

 into our view the immense number of the vaccinated, when com- 

 pared with the reported failures; — when we reflect on certain 

 peculiarities of constitution, that will exempt some individuals 

 from all common laws ; — when we think on the ignorance and 

 carelessness which the vaccinator has but too often betrayed ; — 

 when we recollect the mild form which small-pox is reported to 

 have very generally, thougli not universally, assun>ed in the vac- 

 cinated ; — VVc cannot hesitate to assert, that our conviction iu 

 favour of the experiment of un'versal vaccination is unshaken. 



It is a painful duty for us to state to your Lordship, that 712 

 persons are reported, by the bills of mortality of London, to have 

 died of small-pox within the last year ; and that the ravages 

 committed by this disease, in many other cities, and in many 



Vol. .)(]. No. 27 1 . Nov. iy2(). Y y parts 



