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unvaccinated there were 20 deaths, of which 14 were adults 
and 6 under 5 years of age. Of the total deaths therefore 
from both classes only 19 per cent were under 5 years of age 
and the remaining 81 per cent were all adults. In my 
paper I have shown that in the 5 years 1848-52 the deaths 
of males from small-pox at ages under 5 years were 6 6 ’5 per 
cent of the total deaths at all ages, and of females 72*2 per 
cent, hut in the 5 years 1869-73 the proportions had fallen 
to 31 and 36’1 per cent; and now Dr. Rice's returns give a 
ratio of only 19 per cent, and of course a corresponding 
increase in the percentage of deaths of adults, thus showing 
that the causes which produced the extraordinary increase 
in the mortality from small-pox among adults during the 
20 years 1854-73 are not only still in operation but have 
apparently become intensified. 
Dr. Rice states that of the 51 unvaccinated persons there 
were some who stated that vaccination had been performed 
but on careful examination no evidence of it could be found ; 
it is however well known to those who have a moderate 
acquaintance with the literature of the subject and who 
have themselves made careful inquiries and observations, 
that the marks left by a really successful vaccination not 
unfrequently entirely disappear in a few years, and in 
numerous cases they become so indistinct that on the slight- 
est attack of small-pox it is impossible to discern them. 
J enner himself regarded with suspicion all those cases of 
so-called vaccination which disfigured the arms and there- 
fore left marks which were likely to be permanent, and he 
contended that in such cases true vaccination had not taken 
place owing to the lymph used being impure or in a bad state, 
and in this view he was supported by some of the most 
eminent of his medical brethren. Now bearing this in 
mind, it is not at all unreasonable to assume that great 
numbers of cases have been recorded in the hospitals as 
