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572 year, the additional deaths from atmospheric causes have been at the rate of 20,000 a year. Thus, if smallpox and fever are allowed to grow up of themselves in dark and close corners, they come out and sweep off, in such years as this, 20,000 more of us than die in ordinary seasons.

Next; it is everybody’s business to see that the Vaccination Act is obeyed: but how many of us do look to it? It is a case in which we should all be health-officers. Look at the facts stated in the “Times” by Mr. Clarke, the Inspector of the Norwich Board of Health. In 1861, there were 3000 or more cases of smallpox in Norwich, among high and low; and it was so virulent, that great alarm prevailed. The Inspector set to work to make out how many of the people were unvaccinated, and to get them to do what had been so long neglected. In the last half of that year, he caused 1843 children of the poor to be vaccinated, and in a little while, no more was heard of the smallpox. In the corresponding half of the next year, while there had been 1500 births, the vaccinations were only 102. This shows us what may be expected in Norwich when smallpox appears there again. Negligent and careless up to last New Year’s day, the people will be half crazy with terror when the disease is upon them; and they will again have 3000 or more of the citizens down in smallpox, and trains of funerals in their streets.

Mr. Clarke advises that the Act should be amended in this way:—that the notices issued by the registrar of births to parents that their infants must be vaccinated within three months should be required to be given in again, when the vaccination has taken place, bearing the certificate of the surgeon that the process had taken effect. The failures in the return of the notice would show the amount of neglect, and would indicate to the officers of health where the Act needed enforcing.

Meantime, we can all be health-officers in our own houses and neighbourhoods. We can at once cause every member of our own households to be vaccinated a second time, if it has not been done for a long course of years; and we must put forth our whole influence to get it done wherever our neighbours are lazy, thoughtless, or ignorant.

But much of the omission proceeds from downright disapprobation of the practice, and a conscientious objection on the part of parents. Here is a difficulty: and it is all the greater from the objections being too often well founded. We may pity and coax an ignorant mother who thinks it is cruel to make her little infant ill for a day or two, and to give it an ugly sore on its pretty arm: and we may reason with the scrupulousness which fears to meddle with “the natural course” of the diseases supposed to be appointed to all living; but what can we say to the objection that the local surgeon does not know or care whether he does the thing properly, and never inquires what comes of the experiment; or that particular diseases have followed upon vaccination; and that it has been proved to be no security against smallpox itself? These things have all been, or seemed, too true, in one place or another; and we cannot be offended at parents who had rather their children should take their chance than be thrust among these risks.

Here is a strong call upon us to look well to the character and qualifications of the surgeons charged with the vaccination of the people. It is intolerable that unfit men should hold the appointment by local favour, or because they are cheap. Which costs most—a batch of 3000 smallpox patients requiring nursing or burial, or both, or a surgeon who understands his business?

The great anxiety and difficulty of such a surgeon is about obtaining good vaccine matter. It is out of the question for ninety-nine in a hundred to get it fresh from the cow; and indeed, among the varying accounts that have been given to me, I hardly know what to think of the true matter being now ever obtained from its proper source. Meantime, the lymph is often ineffective, so that there is a wide-spread belief that its efficacy wears out by long transmission from person to person. Cannot some of us help in these difficulties? Are surgeons duly informed whenever healthy cows show an eruption which looks like the true pock? And are they told in time to make sure of their seeing the pock at the right stage? Cannot we aid the over-busy surgeon of our parish to obtain a fresh supply from proper sources? The first appearance of sympathy and appreciation on our part works wonders on the medical officers in our neighbourhood. It animates the zeal and comforts the heart of the conscientious man, and gives him weight and influence among his ignorant and reluctant clients; and, on the other hand, it is a tacit rebuke to the indolent or reckless vaccinator, making him look to his ways, and rousing him to his work. It may be safely believed that if the educated part of society were to choose and decide that society should be secured against smallpox by vaccination, the thing would be done.

We have a straight and easy course before us in regard to what to do when smallpox actually appears. A house should be ready to receive the patients, the moment the nature of their complaint is understood. We must everywhere have a house at command for a hospital, with airy rooms, proper fittings, and a sensible woman and the local surgeons in charge of it. We must have a vehicle set apart for the smallpox patients; and they must not be left to infect the people about them for a minute longer than cannot be helped. Clear as this duty is, hundreds of the sick of our great towns, in the most loathsome condition are shut in with their families or fellow-lodgers, with the worst chance for their own recovery, and the best chance of bringing down everybody about them to their own condition.

How different to the management in some places! In New England, for one. Friends of mine in Boston, a middle-aged clergyman and his wife, asked me one day what I could suppose to have been the pleasantest fortnight of their married life. I certainly should never have guessed; for it was the time when the lady had the smallpox! After a day or two of slight indisposition, she was told by her physician that a pimple on her hand looked suspicious: and the next day he pronounced it smallpox. He at once informed the authorities that there was a case of smallpox in the city; and immediately the city coach came to carry away the patient to the