NovEMBER 5, 1896] 
NATURE 
17 
very few cases of small-pox are met with, it is impossible (during 
these periods) for medical men to make themselves familiar with 
the exact appearances by which they can accurately diagnose 
small-pox. It is only during periods of epidemic that medical 
students and practitioners are able to become familiar with the 
disease. Efficient sanitary administration is undoubtedly 
valuable because of the greater resistance that patients who are 
in good health undoubtedly exhibit against the attacks of all 
diseases, but it can never be hoped that the directly infectious 
diseases, such as small-pox, measles, and whooping cough, can 
be diminished by the most stringent sanitary measures, in the 
same proportion as typhus and the plague have been, and as 
cholera and typhoid are being reduced. As regards isolation 
and quarantine, it is evident, of course, that if every case of 
small-pox could be isolated at the time that infection took place, 
and if every case could be detained in quarantine-isolation at | 
the part at which it occurred, small-pox might now be stamped 
out; but even this position could only have been reached by 
the aid of vaccination, as without doctors and nurses 
protected by vaccination or previous attacks of small-pox, it 
would be impossible to find attendants for these isolated patients. 
But the whole question of stamping out by these measures with- 
out vaccination, is so utterly absurd when the conditions under 
which the disease is generally spread are taken into considera- 
tion, that it is really startling that they should have been sug- 
gested as capable of taking the place of vaccination, however 
valuable they may be as accessory factors. One writer, com- 
menting on the example which Leicester is stated to afford of 
the value of strict isolation, points out, ‘‘ that vaccination was 
carried to nearly every one who was thought to have any chance 
of coming into contact with the disease, and that nearly every 
member of the hospital staff gladly accepted re-vaccination.” 
The Commissioners reporting on this point state ‘‘ that at 
Leicester, the region of isolation and sanitation, two vaccinated 
children under ten were attacked, neither of whom died ; of 
unvaccinated children of a similar age, 107 were attacked, of 
whom fifteen, or 14 per cent., died. Of vaccinated persons over 
ten years of age, 197 were attacked, of whom two died, or 1 per 
cent. ; of the unvaccinated at a similar age, 51 were attacked, 
of whom 4, or 7°8 per cent., died.” In the case of the hospital 
staff at Leicester, we have a most striking proof of the efficacy 
of vaccination. On page 82 of the Report, par. 319, we have 
the following : ‘* At Leicester, at the end of the year 1892, the 
staff at the hospital consisted of twenty-eight persons. Fourteen 
of these had either previously had small-pox, or had been re- 
vaccinated before the outbreak. Eight others were vaccinated 
at the time of the outbreak. The remaining six, although they 
had not previously been re-vaccinated, refused to submit to the 
operation. During the outbreak there was an addition of twelve 
to the staff dealing with small-pox cases. These were all re- 
vaccinated, and none of them contracted small-pox. Out of the 
twenty-eight, six were attacked by the disease, of whom one 
died. Five of the persons thus attacked, including the one fatal 
case (the person in whose case the disease was fatal was said to 
be of intemperate habits), were amongst the six persons who 
had refused to be re-vaccinated, though in the case of one of the 
five consent was afterwards given to the operation, but it was 
only performed on the day that she showed premonitory 
symptoms of small-pox. The sixth case, a mild one, was that 
of a nurse who had been re-vaccinated ten years before.” Dr. 
Gayton gives a similar but even more striking instance in con- 
nection with the Homerton Small-pox Hospital. 
given in connection with the small-pox ship hospitals in con- 
nection with the Metropolitan Asylums Board during the twelve 
years, 1884-1895, are also very conclusive. Amongst the 
attendants, varying in number from fifty in one year to 300 in 
another, there have only been three years out of the whole 
twelve in which cases of small-pox have occurred. In 1884, 
there were four cases among 283 attendants ; in 1892, two cases 
among 138 attendants; and in 1893, six cases among 230 
attendants. These were in close attendance upon small-pox 
patients in the hospital ship ; all had been re-vaccinated, but in 
six out of the twelve cases where small-pox occurred it developed 
within fifteen days of admission to the ship, so that the small- 
pox infection and the introduction of the vaccine matter had 
taken place at the same time, or, as in at least two cases, the 
vaccination had been preceded by the small-pox infection. These 
are most remarkable figures, and offer evidence that well- 
vaccinated persons may be brought into very close contact with 
small-pox patients without running more than a minimal risk 
NO. I410, VOL. 55 | 
The statistics } 
of contracting the disease ; on the other hand, even the most 
careful isolation cannot prevent the outbreak of small-pox 
amongst the unvaccinated, unless the isolation takes place before 
the disease can be actually recognised, the infectivity making 
itself felt before the disease can be recognised. The report given 
by Mr. Allanson Picton and Dr. Collins certainly makes out a 
strong case for isolation and improved sanitation, but nowhere 
in it, as we have already said, do they put forward any evidence 
which can be accepted as proving that these are only of secondary 
value to vaccination during infancy and re-vaccination at stated 
periods, and we can quite understand how even Mr. Bright and 
Mr. Whitbread, along with others of the Commissioners, have 
been brought to see that it is impossible to contemplate the 
effect of leaving the whole of the population unvaccinated 
“without the utmost dismay.” 
(E) ‘* As to whether any alterations should be made in the 
arrangements and proceedings for securing the performance of 
vaccinations, and, in particular, in those provisions of the 
Vaccination Acts with respect to prosecutions for non-compli- 
ance with the Law.” In this Section we have the crux of the 
whole question. The course that the Commissioners have taken 
affords stronger proof of their belief in the efficacy of vaccination 
than any other recommendation they could have issued. They 
believe that the case for vaccination is so strong, that when 
their report is made public, and when people have had time to 
digest its contents, especially if the stimulus of alleged martyrdom 
be removed, that much of the opposition to vaccination will dis- 
appear, and that, as in Scotland, where proceedings against 
parents for the non-vaccination of their children are compara- 
tively rare, the opposition to vaccination will gradually be broken 
down, and compulsory vaccination will no longer be necessary. 
Going on the principle that failure to comply with the vaccina- 
tion laws is often the result of carelessness and desire to avoid 
trouble, although in justification of this carelessness an objection 
| to vaccination may afterwards be developed, the Commissioners 
suggest that it should be necessary to take at least as much 
trouble to escape vaccination as to allow the child to be 
vaccinated. Conscientious objectors are to be allowed to make a 
declaration before a magistrate ; this would be still more effective 
were it necessary to go before the magistrate in open court. The 
exact nature of the recommendations of the Commissioners, how- 
ever, isa matter of very slight importance, as the general impres- 
sion produced by this report must be overwhelmingly in favour 
of vaccination ; and those who maintain, or rather did maintain, 
that the Commissioners were of opinion that vaccination was a 
failure, had either not read the report or had intentionally mis- 
understood it. As we have pointed out, of those who are 
against compulsory vaccination, even in the modified form 
suggested by the majority of the Commissioners, two are still 
so convinced of its efficacy that they sign the general report ; 
and the other two, although maintaining that isolation and 
improved sanitary administration are sufficient to cope with the 
disease, nowhere lay down as a proposition that vaccination affords 
no protection against small-pox. After a careful perusal of 
the report we are convinced that, although this Commission has 
taken seven years during which to sift evidence and make its 
report, it has, both from the momentous issues at stake, and by 
the judicious nature of its finding, been thoroughly justified from 
beginning to end, and that the report will be accepted as one of 
the best ever presented to our, or to any other, Parliament. 
SOME ENGINEERING ADVANCES IN SIXTY 
VEARS.* 
V E meet this evening under peculiar circumstances, some of 
which are of much interest to every member of the 
empire, and others are specially appertaining to the Institution. 
These circumstances seem to me to mark the year 1896 as an 
epoch, at which your President may offer to you some remarks 
which will be not strictly a review of any of the various recent 
feats of engineering, but rather a retrospective survey of the 
general progress with which engineering has been and is 
intimately connected, and a consideration of some matters past, 
present, and future, which appear to me to touch closely the 
interests of us all as members of the profession. ; 
The material advances which this country has made during 
the Queen’s reign are so remarkable, and have depended so 
1Abstract of the presidential address delivered before the Institution 
of Civil Engineers on November 3, by Mr. J. Wolfe Barry, C.B., F.R.S. 
