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tion with one another. So far as can be ascertained, there was
nothing materially to distinguish the two classes, except that the
one contained, with some possible exceptions, unvaccinated
persons only, whilst the other consisted, certainly for the most
part, of vaccinated persons; unless it be, as suggested, that the
unvaccinated class comprised a larger proportion of weakly
persons. We have already expressed our opinion that this
suggested distinction is not an adequate explanation of the very
different fatality in the two classes if that phenomenon stood
alone. It appears to us in no way to account for the difference in
the attack-rate and type of the disease which equally distinguishes
these same classes. Though a stronger constitution may enable
a patient better to battle against the disease, and so avoid a fatal
result, than a weaker one, we are not aware of any evidence that
strength of constitution would determine the type of the disease.
We believe that confluent cases are frequently found in those
whose constitution is strong, and mild cases in those who are not of
robust health. Nor, again, is there any ground for asserting that
if both came equally within the reach of contagion a person of
good physique would escape its influence, while another less
robust would be attacked by the disease. And yet the distinction
between the vaccinated and unvaccinated is as marked, or even
more marked, when the attack-rate and type of disease are studied
than when the fatality of the disease is in question.
In dealing with the comparison between the attack-rate and
fatality of the classes of vaccinated and unvaccinated persons, no
distinction has hitherto been drawn in respect of the quality or
character of the vaccination. Many (though not a large number
proportionately) have been included in the vaccinated classes
whose arms bore no marks of vaccination. In the case of some
of these the operation of vaccination may have been performed
without success. If vaccinia did not result from the operation,
it could, of course, have no more effect than if it had never been
performed. Amongst those whose bodies showed by the marks
they bore that vaccination had undoubtedly been successful, the