VIII. INOCULATION ABROAD
Before proceeding to relate how Inoculation was superseded and ultimately suppressed in England, it may be expedient to make some notes on the prevalence of the practice in other lands.
And first in New England where, as we have seen, Cotton Mather had precedence in subjecting the reports of eastern inoculation to the test of western practice. Mather and his coadjutor, Boylston, did not propose to make inoculation habitual, but to reserve it for use in epidemics. Sometimes years elapsed in New England without smallpox: there were no dense urban populations to constitute seats of zymotic disease: and to provide perpetually against what was occasional was obviously unnecessary. Nevertheless the colonists shared the common disposition of the time for pottering in remedies, and their slaves afforded convenient opportunities for experiments in which temerity had the sanction of beneficence. With the Whites, cleanliness, ventilation, drainage, and pure water, were conditions of accident rather than of providence, but with the Blacks life was that of the stye, and the consequences in smallpox were thought to be sufficiently accounted for by the assertion that Negroes were constitutionally pre-disposed to that disorder. Wherefore the Blacks from Boston to the Spanish Main were from time to time remorselessly inoculated, and all of them who afterwards escaped smallpox had their immunity ascribed to their inoculation.
Jonathan Edwards, the prince of Calvinistic divines, was killed by inoculation. There was an epidemic of smallpox in New Jersey, and, for security, Edwards was inoculated. The result was the generation of smallpox in a severe form, of which he died, 22nd March, 1758, in his 54th year. In search of a superfluous safety was he slain. A man of the age of Edwards had little to fear from smallpox; for the disease, in the vast majority, was an affection of the young, concerning which, as having attained middle life, Edwards might have maintained comparative indifference.
The colonists usually ascribed any outbreak of smallpox to importation by shipping from Europe, if not manifestly, then covertly; for, it was held that smallpox could never be evolved spontaneously. Great pains were therefore taken to isolate patients, and Boston and other sea-ports had hospitals erected on sites remote from habitation, from which a flag was displayed whenever occupied by the sick. A physician who visited an hospital was required to take off his wig, to change his shoes, and to put on a gown which hung from his neck to his ankles; and, when he came out, to wash his hands, and be fumigated with frankincense. In setting forth these precautions, Professor Waterhouse of Cambridge, Massachusetts, observed in a letter to Dr. Haygarth of Chester--
I cannot believe them altogether unnecessary. Our towns are small, our houses scattered, most of them having a garden between them, so that we have been able to trace the action of contagion. We have tried many experiments with smallpox in New England, and persuade ourselves that we have some pretensions of knowing more of that disease than you in Europe.
During the war with England, smallpox broke out in the American army, and inoculation was so freely resorted to that scarcely a man escaped the lancet. Washington had his New England soldiers inoculated at Cambridge in 1776, and it was difficult to find men to keep guard over the sick; that is to say, men who had passed through smallpox and were not considered liable to infection, a curious evidence of the rarity of the natural disease in the communities from which the army had been recruited.[64]
Cotton Mather’s triumph over Boston was complete--complete beyond his intention; for it came to be as thoroughly inoculated as any town in these days is vaccinated. Dr. Waterhouse, writing on 28th October, 1788, said--
We find that in 1752 there were but 170 persons liable to smallpox in Boston, and in 1754, when there was a general inoculation in the town, I question whether there was a quarter of that number that did not receive the infection viâ naturæ vel artis. In the years 1776, ’77, and ’78 they inoculated pretty freely throughout the State. Two days ago, I was at the review of part of the militia of the county of Suffolk, and of 520 men, I scarcely think there were a hundred above twenty-five years of age that had not passed through smallpox by means of inoculation; and of 2000 reviewed a week or two before, in the county of Middlesex, there was not a greater proportion of the same age liable to take the disease. Since 1764 the dread of smallpox has lessened considerably; and since 1778 we meet the disorder with as little fear as any people you can mention.
In another letter, dated 15th October, 1787, the Doctor said--
I do not believe there is at present a single person infected by smallpox in all the four New England Governments, that is, not one in a million of people.[65]
However it may have been elsewhere, inoculation was conducted in Boston with a formality and deliberation that might have satisfied Dimsdale himself. There was an inoculation hospital erected on Sewell’s Point, which juts into Charles River, remote by a mile and a half from the common road, and situated in pleasant grounds with trees and walks. Three weeks were devoted to inoculation and the subsequent sickness, and before dismissal, wrote Dr. Waterhouse--
The patients are washed all over in soap suds, then rubbed with brandy, and lastly washed in vinegar; they put on fresh clothes, and bury those they wore during their stay in the hospital. But even then they are smoked and fumigated with sulphur in the smoke-house, which is about twice the size of a common sentry-box. This smoke-house has a hole in its side for the patient to put his head out of during the operation. Although this seems formidable on paper, yet patients submit cheerfully, and with no slight merriment.
There are perhaps 150 under inoculation at present at Sewell’s Point, not one of them paupers. They are principally children, perhaps thirty or forty of them of the first people in the commonwealth. The charge for the whole process is 8 dollars, or 36s. sterling, including every expense from incision to dismission. In some places they inoculate for half that sum. You must conceive the whole business conducted with a good deal of gaiety, where a patient, when ill, is as apt to be pitied as if sea-sick with a sailing party. The established system of mirth and good humour contributes not a little to the welfare of the patients.
It is a curious story, and stands in broad contrast to the rough and ready practice of Turkey, and of many inoculators in England and elsewhere. Dr. Waterhouse adds--
There were a considerable number of persons in Boston to whom smallpox could not be communicated by inoculation. In some the operation was repeated two, three, and four times with fresh matter. Several of these have had the disease severely since in the natural way, and some have died of it.
France was slow to accept inoculation. After its introduction in 1723, about thirty years elapsed without any serious movement in its favour, when Voltaire, Diderot, and their set began to recommend the practice, which had the merit of being English and disliked by those who held change and improvement in aversion. La Condamine read an eloquent paper on the advantages of inoculation before the Academy of Sciences; and Turgot, the ardent and sagacious lover of his kind, procured the inoculation of a child in Paris, 1st April, 1755; which was followed on 14th May by a young man, named Chastellux, submitting himself to the operation in the interest of the common welfare. Then Dr. Hosty was sent to London to investigate and report, and on his return issued these statements--
1. That out of 463 cases inoculated in the London Hospital, only one had been unsuccessful; whereas in the Smallpox Hospital nearly one in four had died.
2. That Mr. Ranby, principal surgeon to his majesty, had inoculated 1600 persons, and Mr. Bell 903, without the loss of one.
3. That to form a just comparison between the fatality of natural and artificial smallpox, it is only necessary to visit the London Smallpox Hospital and then the Inoculation Hospital: the difference between the two is so remarkable that the most incredulous must be convinced.
4. Lastly, with respect to the asserted insemination of other diseases with inoculated smallpox: no instance of the kind has ever been produced. Persons have been inoculated with variolous matter taken from patients afflicted with venereal disease, yet they have received no infection save that of smallpox only.
It would be superfluous to deal with the fallacies involved in these statements: they served to satisfy those who were disposed to be satisfied, and inoculation became the fashion among the scientific and enlightened. Dr. Tronchin, a well-known inoculator, was summoned from Geneva to Paris in 1756 to operate upon the children of the Duke of Orleans, and his success was pronounced decisive. Nevertheless inoculation did not extend beyond people of leisure and culture, and in 1763 an outbreak of smallpox in Paris made an end of the practice. An inquiry was instituted by the authorities, and the evidence left no doubt that the epidemic had been diffused, if it did not originate, with the artificially poxed; and inoculation was thenceforth prohibited in Paris. Any citizen who was resolved to have the induced disease had to retire to country quarters.
Here we may observe that the confidence of the inoculator was grounded on the assumption that whoever had once passed through smallpox, whether natural or artificial, could never again contract the disease. Nevertheless the inoculated did contract the disease, and the disaster was uniformly accounted for as due to some imperfection in the inoculation. There were also instances of smallpox after smallpox, but these, too, were discredited; the first smallpox could not have been smallpox, but chickenpox, measles, or some other eruptive disorder. There was a conspicuous confutation of these evasions in the case of Louis XV. He had smallpox unquestionably in his 14th year, and of unquestionable smallpox he died in 1774 in his 64th year. Notwithstanding, the assertion was perpetuated that there was no possibility of smallpox after smallpox, and it was only when it became necessary to maintain the credit of vaccination that the facts were admitted; and in this form--Smallpox after vaccination is no more common or extraordinary than smallpox after smallpox--a falsehood on the back of a former falsehood.
We have seen under what safeguards inoculation was practised in Boston, and now we shall turn to Geneva and discover how all the American precautions were set at naught in that city with apparent impunity. The details are from a letter of the Council of Geneva, dated 24th December, 1791, addressed to Dr. Haygarth in answer to his inquiries and suggestions. Des Gouttes, secretary to the Geneva Syndic, wrote--
I.--The Republic of Geneva contains about 35,000 inhabitants, of whom 26,000 dwell in the city, and 9,000 in the adjacent country.
II.--The city is of small extent, and ill adapted to so large a population; and its extension is not easy on account of the fortifications wherewith it is surrounded. There are little more than 1200 houses in the city, which are built in many storeys of many apartments like the ancient part of Edinburgh, each house sheltering on an average twenty-one inhabitants.
III.--A great part of the population consists of strangers, not only because most of our servants and labourers are natives of other countries, but because Geneva being a frontier city, girt about by Savoy, Switzerland, and France, and situated on the highways of intercourse between these states, travellers are always coming and going.
IV.--Notwithstanding this continual resort of strangers within our walls, an epidemic of smallpox is of almost regular occurrence every five years; and between the epidemics it frequently happens that we have no natural smallpox whatever, either in the city or its vicinity.
V.--Inoculation began to be practised here in 1751, since which date we have inoculated a very large number of children annually, and with such marked success that the deaths have but slightly exceeded 1 in 300. Although we have often had to inoculate with pus brought from a distance at times when there was no smallpox to be found in the city, and although children so inoculated have gone freely into the streets, walks, and other public places, before, during, and after the eruption, we have never observed that they were sources of contagion, nor that they produced any intermediate epidemic, nor that they accelerated the return of the periodical epidemic.
VI.--Lastly, our citizens enjoy a republican constitution which requires us to pay most scrupulous regard to the liberty of every individual. No coercive measures to hinder the introduction or communication of smallpox are here practicable; and we believe we ought to limit our action to advice, and to simple precautions of police, which must not, nor even seem to be, oppressive to the citizens.
This glimpse into old Geneva is not only instructive as concerns inoculation, but it is another exposure of the monstrous fable that represents European cities as decimated with smallpox until Jenner’s advent as saviour--a fable that vanishes like smoke whenever brought into contact with matter-of-fact.
Inoculation was introduced to Rome and Florence during a severe epidemic in 1754; and attention being drawn to the remedy, it was discovered that the Italian peasantry had long practised voluntary smallpox just as did the peasantry of Wales and the Highlands of Scotland. In Spain, inoculation made little headway: in the words of Moore--
Some inoculations were effected in a few trading cities, which held communication with England; but these efforts were of short duration, and from the distinguished inaction of the Spaniards, inoculation was soon relinquished; and no other country in Europe has suffered so little from smallpox.[66]
In Holland and Denmark inoculation acquired a certain vogue among the upper classes, and in Germany the like was true to a less extent. In Sweden inoculation was encouraged by the Court, and Dr. Schultz was deputed to visit the London Hospital. His report was so favourable that in 1755 inoculation houses were opened in several parts of the kingdom, and the benefits of the practice were commemorated by a medal in 1757--a curious trophy of illusion under prepossession.
Perhaps the most notable event in the story of inoculation was its introduction into Russia: how it was brought about is thus described by Mr. Morley--
As soon as Catharine came into power (1762), she at once applied herself to make friends in this powerful region [French letters and philosophy]. It was a matter of course that she should begin with the omnipotent monarch at Ferney. Graceful verses from Voltaire were as indispensable an ornament to a crowned head as a diadem, and Catharine answered with compliments that were perhaps more sincere than his verses. She wonders how she can repay him for a bundle of books that he had sent to her, and at last bethinks herself that nothing will please the lover of mankind so much as the introduction of inoculation into the great Empire; so she sends for Dr. Dimsdale from England, and submits to the unfamiliar rite in her own sacred person.[67]
One day in the summer of 1768, at his house in Hertford, Dimsdale received an unexpected message from Pouschin, the Russian minister in London, to wait upon him; and in his presence he learnt that he was required to proceed at once to St. Petersburg to inoculate the Empress. There was of course some hesitation about undertaking so long a journey, but Pouschin had been authorised to overcome all obstacles. What would the Doctor require in the way of expenses? The Doctor discreetly answered that he would leave that to her Imperial Majesty, whereon Pouschin handed him £1000 to pay his way to St. Petersburg. Dimsdale summoned his son from his medical studies in Edinburgh, and the two set off for the North on the 28th of July.
At St. Petersburg Dimsdale was received with every mark of respect and liberal hospitality. He was introduced to the Empress, who was charming and gracious; and he was instructed to make the requisite preparations for the serious duty before him. He had to find pus, and to obtain pus he had to lay hands on a suitable sufferer from smallpox--a task which proved by no means easy. Having discovered a case to his mind, he had then to overcome an obstinate objection to the abstraction of virus. He had, at the same time, to find a couple of healthy young men, who had not had smallpox, on whom to raise secondary virus, for the Empress could not be expected to run the risk of smallpox without mitigation. His first attempt was a complete failure, and he had to report accordingly to his expectant patient. Catharine heard his report with philosophical equanimity, and left him to try again. At last he was successful, and at the palace of Czarscoe Selo on Saturday, 11th October, 1768, the Empress swallowed five grains of mercurial powder, and late on Sunday evening Dimsdale inoculated her with fluid matter by one puncture in each arm. She did well. From the time of the inoculation to the commencement of the eruption, she walked every day for two or three hours in the open air, and, on the 1st November, she returned to St. Petersburg “in perfect good health, to the great joy of the whole city.”[68] The Grand Duke was inoculated on the 30th October, and by the 22nd November had “perfectly recovered.”
The Empress having played, the nobility had to follow suit, and Dimsdale was requested to proceed to Moscow to take them in hand; but at this time there was a new difficulty. There was said to be no smallpox in Moscow, and as Dimsdale could not inoculate without fresh virus, he had to inoculate two girls in St. Petersburg, designing so to time their disorder that he should arrive with them in Moscow in prime condition for business. One girl was a failure, and mishaps and delays on the sledge journey almost made a failure of the other. He did, however, reach Moscow in time enough to communicate the requisite infection to fifty patients, and in Moscow he remained for two months operating and playing the lion. Then he set off for home, and on his route through St. Petersburg found Catharine suffering from pleurisy, for which he bled her, drawing eight ounces of imperial blood. Then came the reckoning. In substantials he had--
£10,000 down; £2,000 for travelling expenses; £500 a year for life, to be paid in net English cash, and A superb gold snuff-box set with diamonds for Mr. Dimsdale.
In honours he had the appointments of--
Counsellor of State; Physician to her Imperial Majesty; and Baron of the Russian Empire with descent of title to his eldest son.
It was a barbarian’s style of recompense, paid under the eye of Europe. It cost Catharine nothing, for it is subjects who suffer for the extravagance of despots.
Dimsdale had plans for the systematic inoculation of Russia, but they resulted in little. Catharine’s purpose was sufficiently served in the display she had made; and possibly she came to consider Dimsdale an appendage of that deceiver Voltaire, whose busts, that had adorned her saloons and corridors, were by her orders thrown into the cellars when the French revolution opened her eyes to the consequences of French philosophy.
In perusing the literature of inoculation, nothing impresses a reader, enlightened by sanitary science, so much as the manner in which smallpox was regarded as something like hail or lightning that might be averted, but could not be prevented. So far, I have not met with even a hint in that literature that smallpox was either induced by unwholesome modes of life, or that it could be avoided by wholesome modes. In conjunction with this blindness was the amazing assumption of the inoculators, that every one inoculated was to be placed to their credit as saved from smallpox; as if (granting inoculation to be prophylactic) smallpox was ever a universal epidemic, and as if multitudes did not pass through life without smallpox before inoculation was heard of. The true problem to be set and solved in all epidemics, whether of influenza or smallpox, is why some are susceptible and some insusceptible, and whether it is not practicable so to modify conditions as to carry over the susceptible to the ranks of the insusceptible.
FOOTNOTES:
[64] Humphries’s Life of General Putnam, p. 151.
[65] These letters of Benjamin Waterhouse, M.D., Professor of Physic at Cambridge, Mass., appear in Haygarth’s Plan to Exterminate Smallpox. London, 1793.
[66] The History of the Smallpox. By James Moore. London, 1815. P. 288.
[67] Diderot and the Encyclopædists. By John Morley. Vol. ii. p. 114.
[68] Dimsdale: Tracts on Inoculation.
IX. INOCULATION SUPERSEDED AND SUPPRESSED
The illusory character of human testimony is graphically illustrated in the case of inoculation. Suppose an inquirer wished to ascertain the ratio of deaths to inoculations, he would be completely bewildered. We have seen what Dr. Buchan wrote--
In the natural way, one in four or five generally dies of smallpox; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient.
John Birch, an eminent London surgeon, said--
Not one in three hundred dies of inoculation in the general irregular mode of proceeding, and not one in a thousand among observant practitioners; and if the inoculated patient die, he dies of smallpox and of nothing but smallpox.[69]
In the Edinburgh Review, October, 1806, we read--
Of those who have smallpox naturally, one is found to die in six. Of inoculated patients, only one dies in two hundred and fifty. This at least is Dr. Willan’s calculation; and we are persuaded that it is very near the truth. In London, where it ought to be best ascertained, some eminent practitioners have stated the proportion to be so high as one in the hundred. The zealous anti-vaccinists have denied it to be greater, under judicious treatment, than one in a thousand. It cannot be denied, however, that besides the risk to life, the disease, even under the mitigated form, has frequently proved an exciting cause of scrofula and other dreadful distempers, and has often been attended with blindness and deformity.
In Reynolds’s System of Medicine, it is stated by Marson that--
The Smallpox and Inoculation Hospital was founded in London in 1746, and inoculation was continued there until 1822. Dr. Gregory went carefully over the records of the Hospital for that period of seventy-six years, and found that only three in a thousand died of inoculation. The inoculated disease was usually very mild, but not invariably so.
Scores of such testimonies might be adduced, twitching the reader from conclusion to conclusion; and in the conflict of authorities what is to be said? It is true that if we select what evidence we like, and call it sound, and reject what we dislike, and call it unsound, we may prove anything; but it is also true, that if we are to be fettered by evidence we shall stand paralysed amid contradictions. When men who are competent, and obviously honest, deliver varying testimony, we are driven to seek some method of reconciliation; and in this matter of Inoculation wherein our resort is to books, and about which we can have no immediate experience, we may derive much light from the corresponding practice of Vaccination. Thus, what is commoner than for vaccinators to assert, that never within their sphere of observation have they witnessed a single case of injury resulting from Vaccination--not one! Subject any dozen ordinary practitioners to judicial examination, and they would thus testify with scarcely a note of variation. On the other hand, take any dozen mothers of families, especially from among the poor, and they would tell of illness, disease, and death following the vaccinators’ lancets. The men are more or less competent and honest, and the women likewise, and how shall we account for their variance? In the first place, the men have been drilled from the outset of their profession into the conviction that Vaccination is absolutely harmless, and if any disaster follows, it is coincidence, not consequence. Occasionally a practitioner of more vigorous intelligence than the average, like Mr. Henry May of Birmingham, sees what the mothers see, but does he report accordingly? Not at all. In Mr. May’s own words--
A death from Vaccination occurred not long ago in my practice, and although I had not vaccinated the child, yet in my desire to preserve Vaccination from reproach, I omitted all mention of it from my certificate of death.[70]
Mr. May recognised the fact and concealed it: a duller man would have ascribed the death mechanically to erysipelas or pyœmia. Indeed, it is a commonplace with medical men, that no child dies of Vaccination; and hence Vaccination is not an admitted cause of death; and when the fact is insisted upon, there is no limit to the hardihood wherewith the truth is crushed down and covered up. Coroners refuse to hold inquests on children slain by Vaccination, and Dr. Lankester, as coroner for Middlesex, did not hesitate to authorise a false certificate of death in order, like Mr. May, “to preserve Vaccination from reproach.”[71] As for mothers, poor creatures, few of them have minds of their own, and if only they were adequately assured that it was for the good of their offspring that their noses should be slit, they would believe, weep, and submit.
But it will be pointed out that inoculators of the more reasonable sort admitted a certain mortality from the practice. It is so; but the admission was unavoidable. Inoculation communicated smallpox, and there was no evasion of the fact that occasionally the malady assumed a severe form, and the patient died. For such mishaps, however, there were always excuses. The patient was not in a suitable condition of body; he had been eating improperly; he had caught cold; and so on. There remained, nevertheless, the sequelæ of Inoculation, which were just as persistently denied as are those of Vaccination, although there were always clear-sighted observers who maintained that it was impossible to infect the blood with a complex organic virus, and that it should exhaust its effects in a single and definite issue. We all remember how we used to be assured with contemptuous emphasis that it was utterly impossible to communicate Syphilis by Vaccination, and that assertions to the contrary were the fables of ignorance and malice; yet, we see that what was fabulous a few years ago, is now accepted as medical matter-of-fact. Nowhere is scepticism so useful as among physicians; for whenever they protest most, suspect most.
With the close of the 18th Century, Inoculation with smallpox to avert smallpox was accepted as sound practice throughout England. Its safety and efficiency were extolled by medical writers in terms curiously identical with those applied to Vaccination. The objectors were few, and for pious rather than physiological reasons; and the question that exercised practical and benevolent minds was how to universalise the remedy, which, on account of its troublesome accompaniments, was chiefly confined to the upper and middle classes. On this point it may be well to cite the words of Dr. Haygarth of Chester, who, in a letter to the Council of Health of Geneva, dated 10th February, 1792, thus sets forth the position of affairs--
In Chester, and, I believe, in most of the large towns of England, the casual smallpox is almost constantly present. All the children of the middle and higher ranks of our citizens are inoculated in early infancy. The populace, very generally regarding the distemper as inevitable, neither fear nor shun it; but much more frequently by voluntary and intentional intercourse, endeavour to catch the casual infection. All the difficulties of our Smallpox Society in Chester proceeded from this strange delusion and perversity of disposition. With us the smallpox is seldom or never heard of except in the Bills of Mortality; but there its devastation appears dreadful indeed.
The strong objection to Inoculation was, that it diffused the disease generally which it was supposed to avert individually. Inoculators tried to minimise and deny the danger, but in vain; and nothing so contributed to the supersession of the practice by Vaccination as the expectation of escape from the artificially propagated disease. How extensive was that propagation, we leave the writer in the Edinburgh Review of 1806 to describe--
The inoculated smallpox is an infectious disease, and those who take it naturally from an inoculated patient have it as violently as if they had been infected from a case of spontaneous disease; it is to all intents and purposes the natural smallpox again in them. Now, if it be considered that several hundred thousand persons have been annually inoculated in these Kingdoms for the last fifty years, it will be easy to calculate the immense addition that must have been made in that period to the cases of actual disease, and the increase of natural smallpox that may be supposed to have arisen from this constant multiplication of the sources and centres of infection.
Unless this culture and this traffic in smallpox throughout the United Kingdom be realised, the potent cause of the immediate and extravagant success of Vaccination will be left out of reckoning. When we are harassed, anxious and impatient under some course of conduct, our ears are open to any promise of relief; and it was to a generation so afflicted and so receptive that Jenner in 1798 made his revelation of the virtue of cowpox. No more need, said he, to inoculate with smallpox. Substitute cowpox; and whilst it will protect as effectually, it will inflict no injury and diffuse no infection. The revelation was received with acclamation, and within eighteen months of its delivery (without due experience, and without any warrant that could pass muster in the severe realm of science) the leading physicians and surgeons of London subscribed and published the following manifesto in the newspapers of 1800--
We, the undersigned physicians and surgeons, think it our duty to declare our opinion, that those persons who have had the Cowpox are perfectly secure from the infection of the Smallpox, provided this infection has not been previously communicated.
I do not wish to anticipate the wondrous tale of Jenner--my present purpose is to show how Inoculation was set aside; and it suffices to state that cowpox rapidly made an end of inoculation with smallpox. Indeed, I question whether a revolution in practice was ever effected with similar facility. Within eight years of the delivery of Jenner’s revelation, the writer in the Edinburgh Review of 1806, already cited, was able to testify--
The bitterest enemies of Vaccination will not deny, that more than nine-tenths of the medical world are decidedly and zealously in favour of it, and that all their demonstrations of its dangers and terrors have been insufficient to convert a single one of their brethren from so damnable and dangerous a heresy. Testimonies, it may be said, should be weighed, and not numbered; and in this respect the vaccinators, we are afraid, will have a splendid and indisputable triumph. We give the anti-vaccinists all the advantage in our power when we assign to them a few members of the profession in London; for in the country at large, we believe, they have not one respectable practitioner on their side in five hundred. In this great city and school of medicine [Edinburgh] we are assured, they are without a single public adherent.
The resistance to Vaccination was almost entirely confined to the resistance of inoculators, who were too deeply compromised by their own disloyalty to Nature, to make effective resistance. They were steadily borne down by the vaccinators, many of whom had been energetic inoculators, and displayed the usual ardour of apostates in condemning what they had formerly approved. Indeed, when we consider how Inoculation was commended for its efficiency and harmlessness by the same medical authorities who, within a year or two after Jenner’s appearance, denounced the practice for its difficulties and dangers, their tergiversation appears little short of shameless. Dr. Lettsom had been an inoculator, yet on 2nd July, 1805, he felt warranted in writing--
What have not the abettors of Variolous Inoculation to answer for? To shoot a dozen or two innocent people in the public streets of London would not be half so injurious as allowing the murderers to kill the rising generation, the future hope of the State. Nothing can show the supineness and ignorance of the Government more than legalising these Variolous Murders.
How far the conquest of the inoculators by the vaccinators had advanced, appeared in a debate in the House of Commons in 1806, when Wilberforce urged that Inoculation should be suppressed, or at least that those who insisted on Inoculation should be compelled to place their patients in quarantine. Mr. Windham admitted the scandal of wretched and miserable subjects of Inoculation being carried about in the streets, but he hesitated to recommend coercive legislation until persuasion had been fully tried and had failed. Dr. Matthews, M.P. for Hereford, took occasion at the same time to run with the hounds. Inoculation, he said, was a frequent cause of disfigurement and of death in its most awful form; it was a magazine of the most dreadful evils; a magnifier of mortality; and a means of introducing scrofula, a more dangerous and pernicious disorder than smallpox itself--facts which it would have been more creditable to have proclaimed when Inoculation was in fashion. It is so easy to kick when a foe has fallen, and where all are kicking. Human nature is never so despicable as when thus engaged.
The question of restraining Inoculation came again before the House of Commons in 1807, when the practice of inoculating out-patients at the London dispensaries and hospitals was energetically condemned. “I think that the legislature,” said Mr. Sturges Bourne, “would be as much justified in taking a measure to prevent this evil by restraint, as a man would be in snatching a fire-brand out of the hands of a maniac just as he was going to set fire to a city.”
No one was more eager to suppress Inoculation by force than Jenner himself, and in July 1807, he sought an interview with the Premier for the purpose. In a letter to Dr. Lettsom he thus describes his mortification--
You will be sorry to hear the result of my interview with the Minister, Mr. Perceval. I solicited this honour with the sole view of inquiring whether it was the intention of Government to give a check to the licentious manner in which Smallpox Inoculation is at this time conducted in the metropolis. I instanced the mortality it occasioned in language as forcible as I could utter, and showed him clearly that it was the great source from which the pest of smallpox was disseminated through the country as well as through the town. But, alas! all I said availed nothing, and the speckled monster is still to have the liberty that the Smallpox Hospital, the delusions of Moseley, and the caprices and prejudices of the misguided poor, can possibly give him. I cannot express to you the chagrin and disappointment I felt at this interview.
We are not accustomed to regard politicians of Perceval’s order as favourable to liberty; and yet it is refreshing to remark in even the Tories of the Georgian age a jealous regard for the personal freedom of Englishmen, and a hearty contempt for the plausible quacks who were always contriving to circumscribe it. Perceval was not opposed to Vaccination, but he would not consent to give it an illicit advantage over Inoculation. If it were the good thing it was asserted to be, it might be left to prevail by reason of its own quality.
Under medical and social pressure, the practice of Inoculation at public institutions was gradually abandoned. On 5th May, 1808, the inoculation of out-patients was discontinued at the London Smallpox Hospital, but not until 20th of June, 1822, did the inoculation of in-patients cease. In 1816 the Colleges of Surgeons of London and Dublin pledged themselves against the practice. A formal attempt at coercive legislation, often called for, was at last made by the directors of the National Vaccine Establishment. They framed and promoted a bill, which was introduced to the House of Lords in 1813 by Lord Boringdon, but it was ignominiously withdrawn in 1814--a choice example of grand-motherly legislation. Among its provisions was the enactment that whenever an inoculation took place, the clergyman of the parish should receive notice, and that red flags should be displayed from the house where the patient lay! As Earl Stanhope observed, instead of being a measure of humanity, it would, if passed into law, be one of the most troublesome, inconvenient, and mischievous ever enacted.
In the discussion on this foolish project, Lord Eldon pointed out that the common law was already sufficient to arrest the exposure of sufferers from infectious disease; and acting on the hint the Vaccine Establishment prosecuted a woman, 27th April, 1815, for carrying her inoculated child covered with pustules through the streets of her neighbourhood. Evidence was adduced that she had thus infected eleven persons with smallpox of whom eight had died. The Court of King’s Bench pronounced her conduct illegal and criminal, but as it was the first prosecution for such an offence, she was let off with a sentence of three months’ imprisonment.
A practice thus banned could not long survive in England, and by and by a medical man who would consent to inoculate became a rarity, or was accounted disreputable. Yet there remained old-fashioned folk who would have nothing to do with cowpox, and insisted on having genuine human pox for their children and grandchildren. Hence Dr. Epps writing in 1831 had to say--
There is a class of medical practitioners who inoculate for the smallpox. Society should utter its voice of moral indignation against such individuals, who glory in anything by which they can claim singularity, or by which they can increase their pecuniary means. Let not society be deceived into any parley with such practices upon the plea, that parents will have their children inoculated with the smallpox.[72]
Gradually the inoculating practitioner ceased, and the practice remained in the hands of “ignorant and unqualified persons, old women, and itinerant quacks;”[73] and then the end came. An Act of Parliament was passed in 1840 wherein it was enacted that--
Any person who shall produce or attempt to produce in any person by inoculation with variolous matter, or by wilful exposure to variolous matter, or to any matter, article, or thing impregnated with variolous matter, or wilfully by any other means whatsoever produce the disease of smallpox in any person in England, Wales, or Ireland, shall be liable to be proceeded against and convicted summarily before any two or more justices of the peace in petty sessions assembled, and for every such offence shall, upon conviction, be imprisoned in the common gaol or house of correction for any term not exceeding one month.
The Government did not at first intend to make the prohibition absolute, but Mr. Wakley insisted that the time had arrived to suppress the nuisance summarily, and that not a voice would be raised in opposition. Nor was there any opposition. Mr. Goulburn expressed some hesitation, but the House was practically unanimous.
Outside the House few regrets were expressed. Dr. George Gregory, physician of the Smallpox Hospital at St. Pancras, was, however, a man of philosophic turn, and he did not see the old idol cast down unmoved.
On 23rd July, 1840 [he wrote], the practice of inoculation, the introduction of which has conferred immortality on the name of Lady Mary Wortley Montagu, which had been sanctioned by the College of Physicians, which had saved the lives of many kings, queens, and princes, and of thousands of their subjects, during the greater part of the preceding century, was declared illegal by the English Parliament, and all offenders were to be sent to prison, with a good chance of the tread-mill. Such are the reverses of fortune to which all sublunary things are doomed.[74]
Gregory was not blind to the extravagant claims made for Vaccination, and evidently had a lurking conviction that all was not gain in the substitution of the new practice for the old, saying--
Had not the discovery of Jenner interfered to interrupt its extension and improvement, Inoculation would have continued to this day increasing yearly in popularity.[75]
Yet was not Inoculation abolished. Sometimes when we get the devil out at the door, he presently re-enters by the window; and thus while Parliament was making an end of Inoculation in one form, it was reviving in another.
It is to be understood that Jenner’s cowpox, whatever it might be, was an uncommon and erratic disease, and its discovery and maintenance difficult. To provide a substitute, cows were from time to time inoculated with smallpox, and the resulting virus was used instead of the Jennerian specific. Lest one should be accused of questionable witness, let us refer to Dr. Seaton’s Handbook of Vaccination. There we read--
Mr. Ceely of Aylesbury in February, 1839, succeeded in inducing vaccine vesicles on two sturks by inoculation with variolous lymph, and in thus establishing lymph-stocks, which passed at once into extensive use, so that, in a few months, more than 2000 children had been vaccinated from them. In December, 1840, Mr. Badcock succeeded in variolating a cow at Brighton, and deriving therefrom a stock of genuine vaccine lymph. In this manner he has raised stocks of vaccine lymph for use on no fewer than thirty-seven separate occasions. The lymph thus obtained by him is now largely employed; it has been supplied to many hundreds of practitioners, and very many thousands of children have been vaccinated with it. Mr. Ceely’s experiments were repeated in America in 1852 by Dr. Adams of Waltham, and Dr. Putnam of Boston, who were able, it is said, to furnish the city and neighbourhood of Boston with all the vaccine matter used there since that period.
Again, Sir John Cordy Burrows, a surgeon, speaking as a magistrate, at Brighton on 5th February, 1876, observed--
The public seem scarcely to understand what Vaccination means. The vaccine lymph taken from a child is nothing more than what has passed from a smallpox patient through a cow. In 1856-58 I took an active part in inoculating seventeen cows with smallpox, producing in three cases vaccine lymph, and from these the world has been supplied.
Thus, as asserted, has Inoculation been revived, and Jenner’s specific set aside. When Dimsdale had Russian nobles to operate upon, he tried to mollify the smallpox by passing it through healthy children. Cows have now taken the place of children, and the virus in its passage from arm to arm may still further be reduced in virulence, when it does not take up fresh malignities such as syphilis; but it is inoculation with smallpox all the same.
FOOTNOTES:
[69] Serious Reasons for Uniformly Objecting to the Practice of Vaccination. By John Birch. London, 1806.
[70] Birmingham Medical Review, January, 1874.
[71] The facts are set forth in Vaccination Tracts, No. 14, p.7.
[72] Life of John Walker, M.D. London, 1831, p. 326.
[73] Letter of Poor Law Commissioners, 20th August, 1840.
[74] Lectures on Eruptive Fevers. London, 1843, p. 39.
[75] Ib., p. 93.
X. AS TO THE PREVALENCE OF SMALLPOX IN THE 18TH CENTURY
The exact truth as to the prevalence of smallpox in the 18th Century is not attainable; vital statistics were undeveloped; and in the absence of precision the imaginative revel. M.D.’s and M.P.’s shut their eyes, tilt their noses skyward, and prophesy concerning the frightful ravages, and the salvation wrought by the revered and immortal Jenner. Any extravagance, as to the ravages, or as to the salvation, is accepted as laudable zeal for humanity. “Decimation” is a favourite word in this connection without any sense of its definite meaning. “What family before 1800 ever escaped decimation from smallpox?” asks Dr. Granville. “Smallpox decimated the country in olden times,” says Dr. Chavasse; “it ravaged like a plague, whilst Inoculation caused the disease to spread like wild-fire;” adding as a sequence, “Vaccination is an important cause of our increasing population.” In the same temper, Lord Chief Justice Cockburn described an unvaccinated infant as “a centre of contagion;” and as the folly of the great is intensified in the little, Mr. Bompas, Q.C., informed the electors of Marylebone, that “a person not vaccinated is like a flaming fire-brand among the people.” Thus the infants of last century were “centres of contagion;” the adults were “flaming fire-brands;” whilst England was “decimated” with smallpox diffused like wild-fire by inoculation. What a picture of 18th Century England painted by Rant and illuminated by Delirium!
The tendency of excess on one side is to provoke to excess on the other, but the extravagance of these popular fables ought to put us in love with homely matter-of-fact--wherein indeed is the true extreme of these frantic inventions. What was the extent of smallpox in England last century is the question. With accuracy, we do not know. The common estimates (when not evolved from inner consciousness) are based on the London Bills of Mortality, and when these Bills are scrutinised we find nothing to justify the opinion that the community was harassed and devastated by smallpox over other ailments. In the first place, we have to remark that the exact population of the metropolis was unknown. Some say it was 500,000 in 1701, and others 700,000. In 1751 it was generally reckoned at 750,000, and in 1801 it was said to be 958,863. Then we have to consider that the increase, whatever it might be, lay only partially within the Bills of Mortality, for several rising quarters were outside the boundaries, and there were extensive exemptions within. Thus, so late as 1818, we find Dr. Burrows writing--
The parishes of Marylebone, Pancras, Chelsea, Kensington, and Paddington, now forming an integral part of the metropolis, and containing a population of 160,000 are not within the Bills of Mortality, and make no returns. Neither are there any returns from St. Paul’s Cathedral, Westminster Abbey, the Temple Church, the Rolls and Lincoln’s Inn Chapels, the Chapter House, the Tower Church, and various other places of worship of the Established Church. Besides, neither Dissenters, Papists or Jews who have burying places of their own, are included in the Bills. Many of the wealthier classes when they die are removed for interment into the country; nor do they appear in the Bills.
With omissions so serious, the Bills are obviously worth little as registers of the number of deaths in any year in London; and when we inquire how far they may be trusted as indicating the relative prevalence of certain forms of disease, we find them equally questionable. Dr. Burrows thus describes the method by which the causes of death were ascertained--
Diseases as specified in the Bills are a disgrace to the medical science and civilisation in which as a nation we are acknowledged pre-eminent; nor can any effective reform take place while the sources of information are so ignorant and venal as at present. The information as to the disease of which any person dies is collected and verified in the following way.--The Churchwardens of each parish within the Bills of Mortality appoint two old women to the office of Searchers. These women as soon as they hear the knell for the dead, repair to the sexton of the parish to learn the residence of the deceased. They demand admittance into the house to examine the body in order that they may see that there is nothing suspicious about it, and judge of what disease the person died; and they report to the parish clerk. The regular charge for the performance of this office is 4d. to each Searcher; but if an extra gratuity be tendered, they seldom pass the threshold or hall of the house, and are content with whatever account is given; or should they actually view the corpse, it is easy to imagine what credit is due to the judgment they pronounce.[76]
In presence of defects so grave as to the number of the dead, and of diagnosis so grotesque as to the causes of death, it would be unwise to argue with any confidence from the data of these Bills; yet, such as they are, we have nothing else to appeal to. The variations of mortality from year to year were of wide irregularity; and whatever influence smallpox might have had, it does not appear to have had much in magnifying the annual totals. Let us take a dozen years when smallpox was heaviest from the last seventy years of the century, and observe its relation to the entire mortality, and to that from fevers--
Burials from From From Year. all Diseases. Smallpox. Fevers. 1736 27,581 3014 3361 1740 30,811 2725 4003 1746 28,157 3236 4187 1749 25,516 2625 4458 1752 20,485 3538 2070 1757 21,313 3296 2564 1762 26,326 2743 3742 1763 26,143 3582 3414 1768 23,639 3028 3596 1772 26,053 3992 3207 1781 20,709 3500 2249 1796 19,288 3548 1547 ------- ------ ------ 296,021 38,827 38,398
Again, let us take twelve years when the death-rate from smallpox was at its lowest. Here they are--
Burials from From From Year. all Diseases. Smallpox. Fevers. 1745 21,296 1206 2690 1750 23,727 1229 4294 1751 21,028 998 3219 1753 19,276 774 2292 1773 21,656 1039 3608 1780 20,517 871 2316 1782 17,918 636 2552 1786 20,454 1210 2981 1788 19,697 1101 2769 1795 21,179 1040 1947 1797 17,014 522 1526 1799 18,134 1111 1784 ------- ------ ------ 241,896 11,737 31,978
We thus see that in twelve years when the death-rate from smallpox was highest, as many died of fevers as of smallpox; and in twelve years when the death-rate from smallpox was lowest, there died thrice as many of fevers as of smallpox. Again, we have to remark, that, on an average of all the years, smallpox was accountable for something less than a tenth of the total mortality. Also we have to note, that the mortality from smallpox was in great part infant mortality, and that there is reason to believe measles was extensively confounded with smallpox. The infant mortality was prodigious. Rarely a year passed in which a fourth of the deaths was not set down to Convulsions--that is, to babes killed by improper feeding. In 1772 (the worst smallpox year of the century when 3,992 died) there were, 6,605 ascribed to Convulsions, the total mortality being 26,053.
Now I have no wish to minimise the London smallpox of last century, nor even to set 1797, when 522 died, against 1796, when 3548 died. I yield to none in detestation of smallpox as a preventible and therefore disgraceful affliction. Let so much pass for granted; but do not let us in any access of sanitary fury lose alike eyes and reason and rave like maniacs. If smallpox was bad, fevers were worse, and as both had a common origin, why should we make a wanton and unscientific distinction between them?
That smallpox should have been constantly present in London throughout last century was in nowise surprising. The citizens lived in a manner to invite and maintain fevers. I shall refer to their food and drink presently, and would now call attention to the fact that they were a stay-at-home generation almost beyond present-day belief. Cowper did not violate credibility when he sang--
John Gilpin’s spouse said to her dear, “Though wedded we have been These twice ten tedious years, yet we No holiday have seen.”
They had no ready means of locomotion, and indeed did not think of fresh air and exercise. An apprentice or maid from the country entered London and was immured as in a prison. We know how the lower orders in our own time huddle together like pigs, unless so far as restrained by lodging-house law, but middle-class Londoners a century ago utilised their apartments, with more decency perhaps, but with equal ignorance of the virtue of oxygen. The Londoners were a densely compacted community, and at night the streets and lanes of the city were almost as thickly tenanted as a man-of-war, but without benefit of sea-air. A Quaker told me that he served his apprenticeship to a grocer in Cheapside between 1786 and 1793, that the shop was opened at seven in the morning and closed at ten at night, that he slept under the counter, that his ablutions were limited to his countenance, and that he never went out except to meeting on First Days; adding, that he had no sense of being hardly dealt with; it was the custom of the time, and he was as his fellows. Memoirs of the 18th century prove that he spoke the simple truth. Bishop Wilson of Calcutta records that he served in the house of a silk merchant in Milk Street from 1792 to 1797, that he was occupied from six or seven in the morning till eight at night; that there was supper at 8.30, followed by prayers, and that all went to bed at ten. An apprentice in the same house said that he never put on his hat for weeks together, and that more than three years elapsed before his first holiday was granted. William Cobbett in 1783 got into a lawyer’s office in Gray’s Inn where, he relates, “I worked like a galley slave from five in the morning till eight or nine at night, and sometimes all night long. I never quitted this gloomy recess except on Sundays when I usually took a walk to St. James’s Park.” Such instances might be multiplied to any extent; and in short it comes to this, that the Londoners of last century lived from year to year in their houses, and had no outdoor exercise. If they were careless about air, they were equally careless about light, and, but for the cost of candles, might have disregarded it altogether. Water was chiefly brought from wells or conduits, and was used sparingly; and it is needless to add, there were no water-closets. Even in well-ordered households, stenches were dreadful; and where there were slatterns, the condition of affairs may be faintly imagined. Horrible cesspools lay behind or beneath most of the houses, evolving pestiferous effluvia. Out of doors, the streets were scarcely less noisome. Rain was the chief scavenger. Swift, in his description of a City Shower, sets before us as graphically as Hogarth, the offices of the rain--
Now in contiguous drops the flood comes down Threatening with deluge this devoted town.... Now from all parts the swelling kennels flow, And bear their trophies with them as they go: Filths of all hues and odours seem to tell What street they sailed from by their sight and smell. They, as each torrent drives with rapid force, From Smithfield or St. ’Pulchre’s shape their course, And in huge confluence joined at Snowhill ridge, Fall from the conduit prone to Holborn Bridge. Sweepings from butchers’ stalls, dung, guts, and blood, Drowned puppies, stinking sprats, all drenched in mud, Dead cats, and turnip-tops, come tumbling down the flood.
Nor in estimating the sanitary condition of 18th Century London is the influence of the dead on the living to be forgotten. The twenty thousand who died annually remained to poison the survivors. The city grave-yards were places of decomposition rather than of interment, and an odour of corpses pervaded many neighbourhoods. Mr. Samuel Gale wrote in 1736--
In the church-yard of St. Paul, Covent Garden, the burials are so frequent that the place is not capacious enough to contain decently the crowds of dead, some of whom are not laid above a foot under the loose earth. The cemetery is surrounded every way with close buildings; and an acquaintance of mine, whose apartments look into the churchyard, hath averred to me that the family have often rose in the night-time and been forced to burn frankincense and other perfumes to dissipate and break the contagious vapour. This is an instance of the danger of infection proceeding from the corrupt effluvia of dead bodies.[77]
Church-goers were subjected to cadaverous influences from the dead in the yard without and from the dead in the vaults below; and pious thoughts acquired an indescribable savour of the sepulchre. Many illnesses originated in church; and families who led wholesome lives at home were brought into deadly peril when they turned out on Sundays to public worship.
It is necessary to enter into these details if we would know what manner of people the Londoners were who suffered from smallpox, and what sort of place London was wherein they suffered. Londoners have been taken for the standard of 18th century smallpox, in forgetfulness of the fact that there did not then exist in England a town of a hundred thousand inhabitants--perhaps only two or three of fifty thousand; whilst the rural population bore a far larger proportion to the urban than is the case at this day. In so far as the sanitary conditions of Bristol, Norwich, or York resembled those of London, the analogy between them held good; but to convert the London rate of smallpox into the common rate of England, of Europe, and of the world, and to use the appalling result as a whip of terror wherewith to enforce universal inoculation, and afterwards vaccination, was sheer absurdity, if not something worse.
Whilst smallpox was always present in London, its appearance in the country was irregular and usually epidemic. The Bills of Mortality of towns as large as Northampton were sometimes clear of smallpox for years. Sir Gilbert Blane, in his advocacy of Vaccination versus Inoculation, said, that previous to the practice of inoculation there were many parts of the country where smallpox was unknown for periods of twenty, thirty, and even forty years. Mr. Connah, a surgeon of Seaford, Sussex, with a population of 700, informed Dr. Haygarth in 1782, that one person had died of smallpox in Seaford about eleven years before, and he could not ascertain that any other death from the disease had occurred subsequently; and that there was reason to believe that a like immunity prevailed throughout the smaller towns and villages of the southern counties. Wherever we inquire, we are driven to the conclusion that the prevalence and fatality of smallpox in the 18th century were grossly exaggerated by quacks and panicmongers. Nor should we forget in this connection how Professor Waterhouse, of Boston, an ardent inoculator, had to write in 1787--
I do not believe there is at present a single person infected by smallpox in all the four New England Governments; that is, not one in a million of people.
What we have to say of London smallpox during last century is, that prevalent as it was, our wonder is that it was not more prevalent; that the disease was bred in the circumstances and habits of the citizens; and that if it were possible to reproduce the same conditions, we should reproduce the same smallpox. On the contrary, say our valiant vaccinators, the same conditions might be reproduced, but if the citizens were universally and efficiently vaccinated and re-vaccinated, there would be no smallpox. Thus we are taught that people may eat and drink as they like, live in darkness, neglect personal cleanliness, take little exercise, breathe air polluted by respiration, filth, and putrefaction, and that whatever disease overtakes them, they will be proof against smallpox. The promise is deceptive, but it was the promise of the inoculator, and it is the promise of the vaccinator; and Dr. Drysdale, describes the practice which warrants the promise as “the greatest triumph of hygienic science--I repeat, by far the greatest triumph of positive hygienic science ever made.”[78]
Some share in the fatality of 18th century smallpox must be charged to the treatment of the disease. What was described as the cool regimen was no secret, yet its practice appears to have been limited to few; whilst with the multitude, patients were confined to close and heated rooms, under heavy bed-clothes, plied with hot drinks, cordials, and alcohol, and kept in foul linen until killed or cured. Frequently, when symptoms of smallpox appeared, bleeding, blistering, and purging were energetically resorted to. If a family of children were affected, they were commonly stowed away in one bed, and their skins would stick together with pus and sweat. It was much the same in hospitals and workhouses. “I have seen above forty children,” says Dr. Buchan, “cooped up in one apartment, all the while they had this disease, without any of them being admitted to breathe the fresh air.” The same course was pursued with other fevers, and the effluvia of the sick-room was overpowering. Take this instance from Jenner’s own household. His nephew, Henry, and a maid-servant, were seized with typhus, and Jenner wrote--
The stench from the poor girl is so great as to fill the house with putrid vapour; and I shall remove Henry this morning, by means of a sedan chair, to an adjacent cottage.[79]
Indeed, the cleanliness and ventilation we consider so salutary were sedulously avoided. Cold air was accounted specially pernicious, and occasionally when the poor, afflicted with smallpox, were exposed to the weather, astonishment was expressed that recovery instead of death was the issue. It is related in Hutchins’s History of Dorset that Blandford was burnt down in 1731, and several patients in smallpox were laid under the arches of the bridge as a place of refuge, and, to the general surprise, all got well, although many had died in their beds before the fire. John Birch a London surgeon of high repute, writing in 1814, sums up the case for us on this head in saying--
I consider the natural smallpox a mild disease, and only rendered malignant by mistakes in nursing, in diet, and in medicine, and by want of cleanliness, which last is the fomes of hospital fevers, and all camp and contagious disorders.
It would hardly be too bold to say, that the fatal treatment of this disease, for two centuries, by warming the chamber, and by stimulating and heating cordials, was the cause of two-thirds of the mortality which ensued.[80]
We now come to an interesting question. If the reader refers to the list of twelve years of greatest smallpox, and to the list of twelve years of least smallpox in London, it will be observed that the years of least smallpox predominate in the last quarter of the century, and this in spite of the diffusion of the disease by Inoculation. The inoculators when charged with increasing smallpox appealed to the London Bills of Mortality. “Let us,” they said, “take the last ninety years of the century, and we shall find that there died in London of smallpox in the thirty years--
From 1711 to 1740 inclusive 65,383 1741 to 1770 ” 63,308 1771 to 1800 ” 57,268
Here we see, that the number of deaths was greater in the first thirty years by 2075 than in the second thirty years during which Inoculation had acquired some stability, and greater by 8115 than in the last thirty years, during which Inoculation was the established practice of most prudent families.[81] We are therefore unjustly accused. These figures leave no doubt that smallpox is decreasing, and we claim that the decrease is due to our practice.”
The decrease was certain, but I cannot allow that it was due to Inoculation; on the contrary I assume that the decrease would have been greater but for the culture of the disease by the inoculators. The fact is extremely distressing to the more rabid vaccinators, and Dr. Corfield tries to curse it out of existence as “the falsest of falsehoods;” but there it abides. It is hard for those who represent Jenner as the saviour of mankind from smallpox to have it shown that Londoners, at least, were in process of salvation before his intervention; but facts, alas! are cruelly unkind to theorists, sentimentalists, and quacks of all sorts. In the words of Dr. Farr--
Smallpox attained its maximum mortality after Inoculation was introduced. The annual deaths from smallpox from 1760 to 1779 were on an average 2323. In the next twenty years, 1780 to 1799 they declined to 1740. The disease, therefore, began to grow less fatal before Vaccination was discovered; indicating, together with the diminution of fevers, the general improvement of health then taking place.[82]
The decrease of smallpox towards the close of the century, says Dr. Farr, was due to “the general improvement of health then taking place;” but to what was that improvement due? No marked improvement had been effected in the sanitary arrangements of London--why then this change for the better? My answer is, that a great alteration was in progress in the popular diet.
Dr. George Cheyne, in his famous Essay of Health and Long Life, published in 1724, says--
There is no chronical distemper whatsoever more universal, more obstinate, and more fatal in Britain, than the Scurvy taken in its general extent.
And more than fifty years afterwards, in 1783, we have Dr. Buchan bearing similar testimony--
The disease most common to this country is the Scurvy. One finds a dash of it in almost every family, and in some the taint is very deep.
It is scarcely necessary to cite authority for what was so generally known and confessed; but in this question of smallpox and its prevention we have to deal with many who appear to be destitute of any historic sense; who argue as if what Englishmen are to-day, they always were; and who contend that as there was more smallpox in London before Jenner than since Jenner, therefore Jenner must be the cause of the diminution. It is necessary to condescend to such feeble folk.
The cause of the general scorbutic habit of the people was widely recognised by medical men, and Buchan merely repeated their common opinion in saying--
A disease so general must have a general cause, and there is none so obvious as the great quantity of animal food devoured by the natives of this island. As a proof that Scurvy arises from this cause, we are in possession of no remedy for that disease equal to the free use of vegetables.[83]
Cheyne said much the same at the earlier date. He complained that the upper classes gorged themselves with animal food, and slaked their thirst with wine, “which is now [1724] become common as water, and the better sort scarce ever dilute their food with any other liquor.” Beer had the place of wine among the middle and lower orders. In the words of Buchan--
The English labourer lives chiefly on bread, which being accompanied with other dry, and often salt food, fires his blood and excites an unquenchable thirst, so that his perpetual cry is for drink.
He adds--
If men will live on dry bread, poor cheese, salt butter, broiled bacon, and such like parching food, they will find their way to the alehouse--the bane of the lower orders, and the source of half the beggary in the nation.
Were we to say that the diet of the English for the greater part of last century consisted of Bread, Beef, and Beer, we should not go far wrong. The London bread was then, as now, poor stuff; “spoiled,” says Buchan, “to please the eye, artificially whitened, yet what most prefer, and the poorer sort will eat no other.” Whenever it could be obtained, beer was the beverage that went with bread, and was drank by young and old. Salt beef and mutton, bacon, salt fish, and butchers’ offal completed the dietary of the multitude. The feeding of the poor in hard seasons exercised the beneficent severely, for the baker’s bill often went far to exhaust the working-man’s earnings.
It was easy to recommend the rich to get rid of their scurvy by a resort to vegetable food, but to the poor with their obstinate prejudices, shiftlessness, and ignorance, such a recommendation was a sort of mockery. Deliverance, however, came in a form recommended by pleasantness and economy, namely, in the potato. It is true the tuber had been known long before, but not as an article of free and ordinary consumption. Toward the middle of the century it was discovered that potatoes could be grown cheaply in large quantities, and supply and demand developed together. Women and children especially rejoiced in the new food, whilst the benevolent exulted in the liberal accession to the poor man’s fare. It became a point of duty with Lord and Lady Bountiful to recommend the culture and consumption of potatoes everywhere; and to see how far the substitution of potatoes for bread had extended early in the nineteenth century, we need only refer to the pages of Cobbett, who denounced the change with unwearied virulence as a degradation of humanity. Certainly potatoes are inferior to bread in nutritive value, but in food we have to look for more than mere nutriment; and the general use of the potato went far to purify and ameliorate the blood of the English people.
The appearance of the potato as a cheap constituent of common fare, was an argument wherewith Jenner endeavoured to allay apprehensions, that, having stopped smallpox, there would soon be more mouths than food to fill them. To Dunning he wrote, 10th February, 1805--
I have often urged the following argument when too numerous a population has been thrown in my teeth, as one of the ill effects likely to attend vaccination. Who would have thought a century ago, that providence had in store for us that nutritious and excellent vegetable, the potato--that ready made loaf, as it were, which is prepared in higher perfection in the garden of the cottager than in the highly manured soil of the man of opulence.
And again to Worthington, 25th April, 1810--
What a gift from Heaven was this extraordinary vegetable--a ready made loaf; reserved, too, till the hour when population, in these realms at least, began first to increase; and then coming we scarcely know how. Away with Malthus and his dreary speculations! The skies are filled with benevolence, and let population increase how it may, let us not distrust and suppose that men will ever pick the bones of each other.[84]
Nor was the change in the people’s diet limited to the introduction of the potato; with it came tea. Of course we know that tea was drank in England long ere George III. was King, but it was in his days that tea came into popular use. Here again we may refer to Buchan, who was strongly opposed to the innovation. He wrote--
It is said the inhabitants of Great Britain consume more tea than all the other nations of Europe together. The higher ranks use tea as a luxury, while the lower orders make a diet of it. The lowest woman in England must have her tea, and the children generally share it with her. The mischiefs occasioned by tea arise chiefly from its being substituted for solid food, and had I time to spare, I think it could not be better employed than in writing against the destructive drug. Its use will induce a total change in the constitutions of the people of this country. Indeed, it has gone a great way towards effecting that evil already.
What Buchan had not time to do, Cobbett subsequently did, and some of his most racy patches of vituperation were applied to tea and tea-drinkers. In Bacon, Bread and Beer, according to Cobbett, consisted the strength of the English working-man, whilst tea and potatoes he held in abomination.
To this partial substitution of potatoes and tea for salted animal food and malt liquor, we may justly attribute the reduction of the scorbutic habit of the people, and that improvement of health which were coincident with the close of last century and were continued into the present. What every student of vital statistics has to remember is, that conditions have to be identical to yield identical results. The lives of the majority of the English people last century, and notably so in London, were hard and sordid to a degree which in these times is difficult to realise. Their sanitary conditions have been indicated, and I would now enforce the observation, that they were ill fed and insufficiently fed; consequently their diseases were malignant, and smallpox not unfrequently scarred deeply its scorbutic victims. Wherefore to run a parallel between the Londoners of the 18th century and the English of the 19th in the matter of smallpox, and to ascribe any difference between them to Jenner’s specific, is to display ignorance that is inexcusable, or craft unscrupulous.
FOOTNOTES:
[76] “On the Uses and Defects of Parish Registers.” By G.M. Burrows, M.D. In London Medical Repository, No. 58, October 1818.
[77] Nichols’s Illustrations of Literary History, vol. iv. p. 499.
[78] The Times, 23rd Oct. and 4th Dec., 1879.
[79] Baron’s Life of Jenner, vol. i. p. 107.
[80] An Appeal to the Public on Vaccination. By John Birch.
[81] Dr. Adams in Medical Journal, 1810, p. 31. Dr. Gregory in his treatise on Eruptive Fevers, 1843, cites and endorses this argument.
[82] Article, “Vital Statistics: Epidemics,” in M‘Culloch’s Statistical Account of the British Empire.
[83] Domestic Medicine. Chap. lvi. Concerning the Diet of the Common People.
[84] Baron’s Life of Jenner, vol. ii. pp. 348 and 410.
I. JENNER’S EARLIER YEARS
The competent biographer, it is said, must be an admirer of his subject, for only so far as he sympathises can he understand. Tout comprendre c’est tout pardonner. But I neither propose to write a Life of Jenner, nor do I believe it essential to insight to sympathise where compelled to reprobate. In Jenner’s case we have to deal with an accident rather than with a vigorous personification of evil. It was his fate to have a happy (or unhappy) thought, adapted to the humour and practice of his time, which was immediately caught up and carried to world-wide issues. In himself, he was as ordinary a character as was ever thrust into greatness. For the mischief of his thought, some of his contemporaries were as responsible as himself--some, indeed, more blameworthy. With Bishop Butler I may ask, “Why may not whole communities be seized with fits of insanity, as well as individuals?” and with him aver, “Nothing else can account for a great part of what we read in history.” The common mind passes at times into unwholesome conditions, wherein the words of Paul are exemplified, “For this cause shall God send them a strong delusion, that they should believe a lie.”
Edward Jenner, the son of a clergyman, was born at Berkeley, Gloucestershire, on 17th May, 1749. After the usual education of a youth of his class, he was apprenticed to Mr. Ludlow, surgeon and apothecary, of Sodbury, near Bristol; and on the completion of his time (1770) was sent to London, where he resided for two years with Dr. John Hunter, who increased his means for scientific inquiry by the reception of pupils, caring much more for his menagerie at Brompton than for patients, and utilising his pupils as assistants in his researches. Captain Cook returned from his first voyage of discovery in 1771, and his collection of specimens of natural history was assigned to Hunter for arrangement, who set Jenner to work upon them; and, it is said, he did his duty so well that he was offered the appointment of naturalist in Cook’s next expedition. Jenner was, however, eager to commence business as country surgeon, and in 1772, at the age of 23, he returned to his native vale, legally qualified by his experience at Sodbury, and his two years with Hunter, to practise at discretion on the good folk of Berkeley.
It may be said that Jenner’s was a poor sort of training for a medical man, but it is to be questioned if he lost much by his ignorance; for a century ago medical knowledge was largely absurdity, and practice mischief; and he did best who stood most frequently helpless in the presence of Nature. Sir Benjamin Brodie relates how he served when a young man with a general practitioner near Leicester Square--
His treatment of disease seemed to be very simple. He had in his shop five large bottles, which were labelled Mistura Salina, Mistura Cathartica, Mistura Astringens, Mistura Cinchonæ, and another, of which I forget the name, but it was some kind of white emulsion for coughs; and it seemed to me that out of these five bottles he prescribed for two-thirds of his patients. I do not, however, set this down to his discredit; for I have observed that while young members of the medical profession generally deal in a great variety of remedies, they commonly discard the greater number of them as they grow older, until at last their treatment of diseases becomes almost as simple as that of my Æsculapius of Little Newport Street.[85]
Hunter’s name is often used as a sort of consecration of Jenner, but for no obvious reason. Hunter confirmed, if he did not beget in Jenner a strong liking for natural history; and when Jenner was settled in the country, he often availed himself of his services as observer and collector, writing to him for information about the habits of the cuckoo, the breeding of toads and frogs, and the sexes of eels; for cuckoos’ stomachs, crows and magpies’ nests, for bats, hedgehogs, blackbirds, lizards, hares, and fossils; for a cock salmon, for salmon spawn and fry, for a large porpoise, “for love or money;” for the arm of a certain patient when he dies; suggesting horrible experiments on hedgehogs, bats, and dogs, and describing one of special atrocity upon an ass. The most serious proposition in their correspondence was that Jenner should come to London as a teacher of natural history, but Hunter threw out the suggestion with hesitation, the qualification for the appointment being 1000 guineas down. Jenner had improved, or supposed he had improved, the preparation of tartar emetic, and Hunter wrote--
DEAR JENNER,--I am puffing off your tartar as the tartar of all tartars, and have given it to several physicians to make a trial of, but as yet have had no account of their success. Had you not better let a bookseller have it to sell, as Glass of Oxford did his magnesia? Let it be called Jenner’s Tartar Emetic, or anybody’s else you please.
Hunter died in 1793, and there is no evidence that Jenner submitted to his judgment the question of Vaccination, if even we allow that prior to that date the project had occurred to Jenner himself. It is certain that he mentioned to Hunter that country folk believed that to catch cowpox was to be secure from smallpox, and that Hunter repeated the fact in his conversation and lectures; but there is no reference to the matter in Hunter’s writing and correspondence.
It is the habit of Jenner’s admirers to represent him as a patient investigator to whom a great thought dawned in boyhood, which was brought forth in the maturity of life. In conformity with this legend, it is related that when an apprentice at Sodbury, a young woman came to his master’s surgery, and smallpox being mentioned, she said, “I cannot take that disease, for I have had cowpox;” and her observation was pondered in his heart; whereon Dr. Baron, his biographer, ecstatically launches forth--
Newton had unfolded his doctrine of light and colours before he was twenty: Bacon wrote his Temporis Partus Maximus before he attained that age: Montesquieu had sketched his Spirit of Laws at an equally early period of life: and Jenner, when he was still younger, contemplated the possibility of removing from among the list of human diseases one of the most mortal that ever scourged our race. The hope of doing this great good never deserted him, though he met with many discouragements; his notions having been treated with scorn and ridicule by some, and with indifference by almost all.
Against such a paragraph we may write, Sheer romance! Jenner was by no means reticent, and that the prevention of smallpox was for any length of time the burden of his soul, nowhere appears. The romance came into being after date in order to make much of little, and to justify payment in cash and reputation. For, taking Vaccination at the utmost, it was a slight advance upon existent knowledge and practice. In the first place, it was a notorious belief in many dairy districts, that to contract cowpox was equivalent to smallpox in averting a subsequent attack of smallpox. In the second place, inoculation with smallpox was the custom of the time; and if infection with cowpox prevented smallpox, why should not inoculation with cowpox do so as effectually as inoculation with smallpox? The intelligence requisite to reach a conclusion so obvious was not great, and therefore it was no cause for surprise that when Jenner’s claim as originator of Vaccination was brought forward, his priority should be disputed from several quarters; as by Benjamin Jesty of Yetminster, who inoculated his wife and sons with cowpox in 1774; by Nash of Shaftesbury; Mrs. Rendall, and others. Jenner was not insensible to the force of these claims, but evaded them under the plea that there was cowpox and cowpox, and that he had discovered and defined the right sort.
In parts of Holstein, too, cowpox was regarded as good against smallpox, and on more than one occasion was deliberately employed for the purpose. Plett, a village schoolmaster, near Kiel, inoculated three children with the disease in 1791, who were afterwards credited with resisting variolous infection in consequence of their vaccination.[86]
How thoroughly the asserted prophylaxy of cowpox was known, Jenner himself was accustomed to bear witness. He was a member of two clubs, the Medico-Convivial which met at Rodborough, and the Convivio-Medical which met at Alveston; and he used to bring cowpox so persistently under discussion, that, he said, he was threatened with expulsion if he did not desist. “We know,” said the jovial doctors, “that an attack of cowpox is reputed to prevent smallpox, but we know that it does not, and that should end the matter.”[87]
In pursuance of the tactics that would represent Vaccination as the outcome of the labour of many years, we have the following extraordinary narrative from Baron, Jenner’s biographer--
It was not till 1780 that Jenner was enabled, after much study and inquiry, to unravel many of the perplexing obscurities and contradictions with which the question of cowpox was enveloped, and which had impressed those who knew the traditions of the country with the opinion that it defied all accurate and satisfactory elucidation. In the month of May of the year just mentioned, 1780, he first disclosed his hopes and his fears, respecting the great object of his pursuit, to his friend Edward Gardner. By this time Jenner’s mind had caught a glimpse of the reputation which awaited him, but it was still clouded by doubts and difficulties. He then seemed to feel that it might, in God’s good providence, be his lot to stand between the living and the dead, and that through him a plague might be stayed. On the other side, the dread of disappointment, and the probability of failing to accomplish his purpose, restrained that eagerness which otherwise would have prompted him prematurely to publish the result of his inquiries, and thereby, probably, by conveying insufficient knowledge, blight forever his favourite hope.[88]
Many are the marvellous relations in ancient and modern history, but in the records of the supernatural it is questionable if there be anything to match the preceding. Painters depict the runaway apprentice listening on Highgate Hill to the bells as they pealed, “Turn again Whittington, twice Lord Mayor of London,” but they might find a finer subject in the young Gloucestershire surgeon, aged 31, habited “in blue coat and yellow buttons, buckskins, well polished jockey boots with handsome silver spurs, a smart whip with silver handle, and hair done up in a club under a broad-brimmed hat,”[89] with eye fixed in vision, contemplating his glorious destiny, through clouds of doubt and difficulty, full twenty years ahead; standing like another Aaron, censer in hand, between the living and the dead until the plague was stayed! Verily, if we do not see miracles, it is because we do not choose to look for them.
The chapter of the wonderful is not exhausted; yet greater things remain. Says Baron, and recollect the year was 1780 and Jenner aged 31--
Jenner was riding with Gardner, on the road between Gloucester and Bristol, near Newport, when the conversation passed of which I have made mention. He went over the natural history of cowpox; stated his opinion as to the origin of this affection from the heel of the horse; specified the different sorts of disease which attacked the milkers when they handled infected cows; dwelt upon the variety which afforded protection against smallpox; and with deep and anxious emotion mentioned his hope of being able to propagate that variety from one human being to another, till he had disseminated the practice all over the globe, to the total extinction of smallpox--
Which is to say, that in 1780, Jenner, aged 31, had arrived at the conclusion which he offered to the world in 1798 at the mature age of 49; and in the meanwhile allowed mankind to perish from smallpox, he having their salvation in his hands!
The miraculous conversation, says Baron, was concluded by Jenner in words to the following effect--
Gardner, I have entrusted a most important matter to you, which I firmly believe will prove of essential benefit to the human race. I know you, and should not wish what I have stated to be brought into conversation; for should anything untoward turn up in my experiments I should be made, particularly by my medical brethren, the subject of ridicule--for I am the mark they all shoot at.[90]
Gardner, Jenner’s friend, who played the part of alter ego in the asseveration of an early date for Vaccination, was a dealer in wines and spirits. Charity believeth all things, but even charity would exhibit a sceptical countenance when what it is a man’s interest to prove and have placed to his credit, is in itself improbable; which, if true, might be proved by documents and witnesses; but which is merely supported by his own word and that of a friend. Let me repeat, there was never a vestige of evidence adduced for the revelations of 1780 beyond the bare assertions of Jenner and Gardner; and further, that they are radically at variance with the tenor and dates of Jenner’s first publication--The Inquiry of 1798.
The next date to which we come is 1787, in which year Jenner is represented as having taken his nephew, George, into a stable to look at a horse with diseased heels--
“There,” said he, pointing to the horse’s heels, “is the source of smallpox. I have much to say on that subject, which I hope in due time to give to the world.”[91]
Baron gives no authority for this anecdote. It is probably ante-dated six or seven years.
In 1788 Jenner married Catherine Kingscote. In his domestic relations, he was devotedly affectionate, even uxorious; ready to defer any duty and to surrender any advantage to the pleasures of home.
As the phrase ran, Jenner was a good hand at a “copy of verses,” and one of these, “Signs of Rain,” commencing--
The hollow winds begin to blow, The clouds look black, the glass is low--
has a place in nearly all poetical collections.
In 1792 Jenner applied to the University of St. Andrews for the degree of Doctor of Physic. It cost £15, and nothing more.
Hunter used to say to speculative pupils, “Don’t think, but try; be patient, be accurate;” and Jenner, in relation to cowpox, required the advice; for, by his own account, he was content to think of cowpox for at least a quarter of a century, whilst he knew by intuition its true origin, its magical efficacy, and future triumph without any trial. His first experiment was made in November, 1789, upon his son Edward, his first-born, an infant of eighteen months.
“He was inoculated with cowpox?”
O, no!
“Then with grease from a horse’s heel?”
Not at all!
“With what then?”
Why, with swinepox; and it answered!
The child sickened on the eighth day; a few pustules appeared; they were late and slow in their progress, and small, but they proved sufficient. The poor child was then put through what was styled the Variolous Test: not once or twice, but five or six times at various intervals, he was inoculated with smallpox without other obvious effect than local inflammation and erysipelas. Nothing ever claimed for cowpox turned out more satisfactorily than this experiment with swinepox--supposing we trust Jenner.
Arguing from the records (and we have nothing else to argue from) it was not until about 1795 that Jenner turned his attention with serious purpose to cowpox. This Baron allows, saying--
Many years elapsed before Jenner had an opportunity of completing his projected experiments in Vaccination, and he encountered numerous difficulties in carrying on the preliminary part of his inquiry.[92]
But Baron fails to specify what were the projected experiments, or the difficulties which hindered their performance. It is a common nuisance in “sympathetic” biographies to have unlimited drafts made upon one’s credulity. The evidence of example would go to prove that Jenner placed his trust in swinepox rather than cowpox, at least as late as 1789.
In April, 1795, a general inoculation took place at Berkeley on Dimsdale’s plan; that is to say, all in the district who had not had smallpox were inoculated with the disease, so that they might sicken together and do no mischief. Among the Berkeleyans was one Joseph Merret, who, 1770, had attended horses with greasy heels and at the same time milked cows, and from the cows had contracted cowpox. Jenner inoculated him repeatedly with smallpox on this occasion, but with no effect; whence he concluded that the attack of cowpox in 1770 had maintained Merret secure from smallpox for five-and-twenty years.[93]
Jenner’s aim was now directed to demonstrate that the common faith in cowpox as a defence against smallpox was well-founded; and to do so it was necessary to clear away two objections--
FIRST, That some who had caught cowpox had subsequently suffered smallpox.
To which he answered--
Various eruptions occur on the teats of cows, which are confounded with cowpox, and infect the milkers; and these, I admit, do not protect from smallpox.
In a letter to Edward Gardner in 1798 he remarked--
The true has many imitations by the false on the cow’s udder and nipples; and all is called cowpox whether on the cow or communicated to the human.[94]
SECOND, That some who had contracted true cowpox had nevertheless fallen victims to smallpox.
To which he answered--
Admitted: but then the milker had not received infection from the cow at the proper time, but at a stage of the eruption too early or too late.
If the reader will set these points clearly before him, he will have the measure of Jenner’s claim. It was a claim to define the truth there was in a popular belief--not to make an independent discovery.
Jenner at this juncture had staked his hope on the identification of horsegrease with cowpox. Yet even in this identification he does not seem to have been original.
It was a persuasion among the farmers that pox on the cows was derived from grease on the horse; and that infection with horsegrease was just as good against smallpox as infection with its derivative cowpox. The fact, however, of this derivation of cowpox from horsegrease was contested, but Jenner was positive. Writing in 1794 he said--
At our last meeting our friend treated my discovery of the origin of cowpox as chimerical. Farther investigation has convinced me of the truth of my assertion beyond the possibility of a denial.[95]
Challenged to produce direct evidence that grease from the horse produced pox in the cow, he met with considerable difficulty, so that on 2nd August, 1797, he had to write--
The simple experiment of applying the matter from the heel of the horse, in its proper state, to the nipples of the cows, when they are in a proper state to be infected by it, is not so easily made as at first sight may be imagined. After waiting with impatience for months in my own neighbourhood, without effect, I sent a messenger to Bristol, in vain, to procure the true virus. I even procured a young horse, kept him constantly in the stable, and fed him with beans in order to make his heels swell, but to no purpose.[96]
In the matter of horsegrease, it is to be observed as Dr. Mason Good informs us, “that for ages blacksmiths and farriers, who had been infected with grease, were considered as generally insusceptible of variolous contagion.”[97] Wherefore, to Jenner is not to be ascribed the discovery of horsegrease as good against smallpox; but merely that he held with certain farmers that it was the cause of cowpox, and one in constitution with cowpox; and thus endeavoured to combine the tradition of the stable with that of the dairy.
It was not until 1796 that Jenner made any experiment with cowpox--up to that date, whatever his visions, he was in Hunter’s phrase a thinker, not a trier. On 14th May of that year, he took matter from the hand of Sarah Nelmes, who had been infected by her master’s cows, and inserted it by two incisions in the arm of James Phipps, a child of eight years of age. The boy went through the disease in a regular manner, and on the 1st July was inoculated with smallpox without effect, to Jenner’s intense satisfaction. He communicated the event to Gardner in the following letter--
BERKELEY, 19th July, 1796.
DEAR GARDNER,--As I promised to let you know how I proceeded in my inquiry into the nature of that singular disease the Cowpox, and being fully satisfied how much you feel interested in its success, you will be gratified in hearing that I have at length accomplished what I have been so long waiting for, the passing of the Vaccine Virus from one human being to another by the ordinary mode of inoculation.
A boy of the name of Phipps was inoculated in the arm from the pustule on the hand of a young woman who was infected by her master’s cows. Having never seen the disease but in its casual way before, that is when communicated from the cow to the hand of the milker, I was astonished at the close resemblance of the pustules, in some of their stages, to the variolous pustules.
But now listen to the most delightful part of my story. The boy has since been inoculated for the smallpox, which, as I ventured to predict, produced no effect. I shall now pursue my experiments with redoubled ardour.
But the experiments could not be pursued, for, from July, 1796 till the spring of 1798, Cowpox disappeared from the dairies around Berkeley, and, as we have seen, horsegrease was also unattainable. Jenner had, however, resolved on publication. Life was advancing; he had made no mark in the world; and, as he wrote to Gardner--
Added to all my other cares, I am touched hard with the reigning epidemic--Impecuniosity.
At first he proposed to embody his views in a paper for the Royal Society, but on second thoughts determined to issue a pamphlet. Having read his manuscript to Dr. Worthington, Mr. Paytherus, and Mr. H. Hicks, assembled round the table of Mr. Thomas Westfaling, at Rudhall, near Ross, Herefordshire, and having secured their approval, the matter was put to press, and about the end of June, 1798, appeared--
AN INQUIRY INTO THE CAUSES AND EFFECTS OF THE VARIOLÆ VACCINÆ, A DISEASE DISCOVERED IN SOME OF THE WESTERN COUNTIES OF ENGLAND, PARTICULARLY GLOUCESTERSHIRE, AND KNOWN BY THE NAME OF THE COW POX.
FOOTNOTES:
[85] Autobiography of Sir B. C. Brodie, p. 38.
[86] Simon’s Papers on Vaccination, p. xii.
[87] Baron’s Life of Jenner, vol. i. pp. 48 and 126.
[88] Ib., vol. i. p. 127.
[89] Thus described by Gardner. Baron’s Life of Jenner, p. 15.
[90] Baron’s Life of Jenner, vol. i., pp. 127-129.
[91] Ibid., p. 135.
[92] Baron’s Life of Jenner, vol. i., p. 131.
[93] Jenner’s Inquiry, case i., p. 9.
[94] Baron’s Life of Jenner, vol. i., p. 297.
[95] Baron’s Life of Jenner, vol. i, p. 136.
[96] Ibid. p. 141.
[97] Study of Medicine, vol. iii. p. 59, 3rd ed. London, 1829.
II. JENNER’S INQUIRY, 1798
The curious tradition among the dairy folk of Gloucestershire, that persons who had suffered from Cowpox were thereby rendered insusceptible of Smallpox, was made known to Edward Jenner when a doctor’s apprentice, and was never afterwards absent from his mind. Thirty years elapsed before the fruit was borne to the public; but incessantly he thought, and watched, and experimented on the subject, and the work in which at length he recorded the incomparable results of his labour may well have commanded the confidence of reflecting persons.
Little would ever be heard of objections to Vaccination, if all who undertake the responsibility of its performance, and all who feel disposed to resist its adoption, would but thoroughly study that masterpiece of medical induction, and imitate the patience and caution and modesty with which Jenner laid the foundations of every statement he advanced.
In the first Inquiry into the Causes and Effects of the Variolæ Vaccinæ, Jenner set on a scientific basis the popular belief to which I have referred; and the close of the 18th Century, which had much to darken it, will be remembered till the end of human history for the greatest physical good ever yet given by science to the world.--Papers relating to the History and Practice of Vaccination. Pp. xi. and xii. London, 1857.
These are the words of Mr. John Simon, and in them we have the Jennerian legend with the morsel of fact to the mass of fable which characterises legendary matter, ancient and modern. The recommendation to “study thoroughly that master-piece of medical induction,” Jenner’s Inquiry, is a mere flourish of panegyric; for, as Mr. Simon was well aware, the book had been out of print for half a century, and was practically inaccessible; whilst its reproduction has usually been considered undesirable in the interests of Vaccination, inasmuch as it reveals more than is expedient for common knowledge. An idol that is good to swear by is always fortified by a convenient obscurity.
The Inquiry is a quarto of less than seventy pages in large type, set in broad margins in the grand style of the period, and illustrated with four coloured plates. There are eight pages of Introductory Matter, followed by thirty-four pages of Cases, concluding with twenty-six pages of General Observations.
It is to the Cases as the ground of the argument, that I would first direct attention. They are twenty-three, and may be thus assorted--
13 of Cowpox communicated by accident.
4 of Horsegrease communicated by accident and inoculated by design.
6 of Cowpox inoculated by design or transferred from arm-to-arm.
It may be tedious, but I should like to go with the reader over these Cases, for they are highly instructive. Let us take the first twelve of Cowpox communicated by accident.
I.--JOSEPH MERRET, Gardener.
In 1770 attended to Horses, milked Cows, and caught Cowpox. Afterwards his family had Smallpox, but he escaped. In 1795 Jenner repeatedly inoculated him with Smallpox without effect.
II.--SARAH PORTLOCK, Farm Servant.
In 1771 had Cowpox. In 1792 nursed her child in Smallpox “conceiving herself secure,” and was at the same time inoculated with Smallpox in both arms without effect.
III.--JOHN PHILLIPS, Tradesman.
Had Cowpox when nine years old. Was inoculated with Smallpox by Jenner at the age of 62 without effect.
IV.--MARY BARGE, Farm Servant.
In 1767 had Cowpox. In 1791 was inoculated with Smallpox without effect. Had also acted as nurse to Smallpox patients without catching the disease.
V.--MRS. H----, Gentlewoman.
Had Cowpox when very young, contracted by handling dairy utensils. Was subsequently exposed to Smallpox, “where it was scarcely possible for her to have escaped;” and in 1778 was inoculated with Smallpox by Jenner without effect.
* * * * *
At this point, I would draw attention to the ages of the persons set forth in these Cases: they were past middle life when the susceptibility to Smallpox was either low or extinct. The reason given by Jenner for their production was that he “wished to show that the change produced in the constitution by Cowpox is not affected by time”--a claim which vaccinators at this day surrender, insisting on the necessity of re-vaccination to maintain “the benign influence;” but apart from that consideration, there was nothing extraordinary in resistance to inoculated Smallpox. Without the intervention of Cowpox, inoculators were constantly meeting patients who would not “take,” even with repeated attempts, and especially among elderly people; and some who obstinately resisted inoculated Smallpox, subsequently contracted the disease in the ordinary way. So much Jenner himself allowed, saying--
There are many who from some peculiarity in habit resist the common effects of variolous matter inserted into the skin, and in consequence are haunted through life with the distressing idea of being insecure from subsequent infection. (P. 60.)
Yet he was pleased to refer this well recognised resistance to variolation in those who had had Cowpox to Cowpox, allowing nothing for habit of body!
VI.--SARAH WYNNE, Dairymaid.
In 1796 had Cowpox in May, and “in so violent a degree, that she was confined to her bed, and rendered incapable for several days of pursuing her ordinary vocation.” On 28th March, 1797, she was inoculated with Smallpox by Jenner without effect.
Under this Case Jenner observes, that “among our dairy farmers those who have had Smallpox either escape Cowpox, or are disposed to have it slightly; and as soon as the complaint shows itself among cattle, assistants are procured, if possible, who are thus rendered less susceptible of it, otherwise the business of the farm could scarcely go forward.” At the farm where Sarah Wynne was employed, all had had Smallpox except Sarah, and all save Sarah, escaped.
VII.--WILLIAM RODWAY, Dairyman.
In 1796 had Cowpox. In 1797 was inoculated with Smallpox by Jenner without effect.
Under Rodway’s Case Jenner showed that the farmers were at fault in supposing that Smallpox kept off Cowpox. In the dairy where Rodway was employed, all the milkers had passed through Smallpox, except Rodway, and all contracted Cowpox; “but there was no comparison in the severity of the disease as it was felt by them and by Rodway. While he was confined to bed, they were able, without much inconvenience, to follow their ordinary business.” Thus Jenner argued that though Smallpox might not keep off Cowpox, it made Cowpox milder.
VIII.--ELIZABETH WYNNE, Dairymaid.
In 1759 had Cowpox slightly when 19 years of age. “As the malady had shown itself in so slight a manner,” observed Jenner, “and as it had taken place at so distant a period of her life, I was happy with the opportunity of trying the effects of variolous matter upon her constitution, and on the 28th of March, 1797, I inoculated her” without effect. Nevertheless in the following year, 1798, she again caught Cowpox, having a “large pustulous sore” accompanied with “general lassitude, shiverings, alternating with heat, coldness of extremities, and a quick and irregular pulse.”
IX.--WILLIAM SMITH, Farm Servant.
Although [wrote Jenner as preface to this Case] the Cowpox shields the constitution from the Smallpox, and the Smallpox proves a protection against its own poison, yet it appears that the human body is again and again susceptible of the infectious matter of the Cowpox.
In 1780, when attending to Horses with sore heels, Smith conveyed the equine infection to Cows, “and from the Cows it was communicated to Smith. In 1791, the Cowpox broke out at another farm where he then lived as a servant, and he became affected with it a second time; and in 1794 he was so unfortunate as to catch it again. The disease was equally as severe the second and third time as it was on the first.” He was twice inoculated with Smallpox in 1795, and exposed to Smallpox without effect.
X.--SIMON NICHOLS, Farm Servant.
In 1782 was employed in dressing the sore heels of Horses, and at the same time assisted in milking Cows, thereby infecting them and generating Smallpox. Changing his situation, he communicated the disease to other Cows, and was himself severely affected. Some years afterwards, he was inoculated with Smallpox by Jenner without effect.
XI.--WILLIAM STINCHCOMB, Farm Servant.
In 1782 had Cowpox severely on the same farm with Nichols. In 1792 he was inoculated with Smallpox along with a large party, but in his case without result. “During the sickening of some of his companions, their symptoms so strongly recalled to his mind his own state when sickening with the Cowpox, that he very pertinently remarked their striking similarity.”
XII.--HESTER WALKLEY, Farm Servant.
In 1782 had Cowpox when she was attended by Jenner. In 1795 she, and seven other pauper women of Tortsworth, who also had had Cowpox, were inoculated with Smallpox by Henry Jenner without effect. “This state of security proved a fortunate circumstance,” observed Jenner, “as many of the poor women were at the same time in a state of pregnancy.” Why then, it might have been asked, did Henry Jenner try to variolate them?
* * * * *
These Twelve Cases illustrate Jenner’s procedure; and those familiar with scientific methods, and the scrutiny and caution requisite to arrive at trustworthy physiological data, will view with some astonishment his free and easy induction. In the majority of the Cases he was without proof that his subjects had suffered Cowpox; and the absence of this certainty was the more remarkable as he knew that the dairy-folk described as Cowpox several varieties of eruption. The same rural observers who held that Cowpox averted Smallpox, also held that Smallpox averted Cowpox; and yet Jenner had to show in Rodway’s Case No. vii., that they were mistaken; although, granting the thesis that Smallpox and Cowpox were equivalents and mutually preventive, the rural faith ought to have stood justified, and Smallpox shown to be good against Cowpox. Again Jenner allowed that an attack of Cowpox did not prevent a subsequent attack of Cowpox, saying--
It is singular to observe that the Cowpox virus, although it renders the constitution insusceptible of the variolous, should nevertheless leave it unchanged with respect to its own action.
Singular indeed! The observation in presence of the principle to be established was nothing short of imbecile. If Smallpox prevented Smallpox, and Cowpox was one with Smallpox, and Cowpox did not avert Cowpox, how was Cowpox to avert Smallpox? The insusceptibility of Jenner’s subjects to variolous inoculation was, as observed, of little account. Resistance to inoculated Smallpox was of common occurrence, and inoculators practised various dodges to overcome it. To have made such experiments approximately conclusive would have required the inoculation with Smallpox of subjects of corresponding ages and temperaments who had not passed through Cowpox; and the probability is that the results would not have been dissimilar.
We must not, however, proceed farther until Cowpox is described; and for that purpose I cannot do better than cite Jenner verbatim.
JENNER’S DESCRIPTION OF COWPOX.
Cowpox appears on the nipples of the Cows in the form of irregular pustules. At their first appearance they are commonly a palish blue, or rather of a colour somewhat approaching to livid, and are surrounded by an inflammation. These pustules, unless a timely remedy be applied,[98] frequently degenerate into phagedenic [spreading] ulcers, which prove extremely troublesome. The animals become indisposed, and the secretion of milk is much lessened.
Inflamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and sometimes on the wrists, which run on to suppuration, first assuming the appearance of the small vesications produced by a burn. Most commonly they appear about the joints of the fingers, and at their extremities; but whatever parts are affected, if the situation will admit, these superficial suppurations put on a circular form, with their edges more elevated than their centres, and of a colour distantly approaching to blue. Absorption takes place, and tumours appear in each axilla [arm-pit].
The system becomes affected, the pulse is quickened; shiverings, succeeded by heat, general lassitude and pains about the loins and limbs, with vomiting, come on. The head is painful, and the patient is now and then even affected with delirium. (P. 3.)
And Jenner might have added, with convulsions.
Having drawn this alarming picture of the effects of Cowpox, he interposes--
These symptoms arise principally from the irritation of the sores, and not from the primary action of the vaccine virus upon the constitution. (P. 5.)
If Cowpox meant all this, some might prefer, at least, the risk of Smallpox; hence the judicious explanation--the irritation of the sores, and not the poison in the blood, was the cause of the distressing symptoms. Jenner went on--
These symptoms, varying in their degrees of violence, generally continue from one day to three or four, leaving ulcerated sores about the hands, which, from the sensibility of the parts, are very troublesome, and commonly heal slowly, frequently becoming phagedenic, like those from whence they sprang. During the progress of the disease, the lips, nostrils, eyelids, and other parts of the body, are sometimes affected with sores; but these evidently arise [How evidently?] from their being heedlessly rubbed or scratched with the patient’s infected fingers. (P. 5.)
It was this serious disease, this communicated Cowpox, which the subjects of the foregoing Cases were assumed to have passed through; and Jenner, in conformity with the opinion of the dairies, held that they were thereby rendered proof against Smallpox. Whilst his Twelve Cases make a show of inquiry, they bear no trace of extensive or critical research. In the general inoculations then prevalent, those who had undergone Cowpox were not treated as protected (as were those who had had Smallpox) but were “cut” with their neighbours--as, in Case xii., were the eight cowpoxed paupers of Tortworth. Yet Jenner was at no pains to collect and set forth the evidence of other Gloucestershire practitioners, who, in the course of duty, must have known as much of Cowpox as himself, and might have set scores of Cases alongside his perfunctory dozen.
Having perused Jenner’s description of Cowpox, let us now turn to his account of its origin.
GENERATION OF COWPOX IN HORSEGREASE.
There is a disease to which the Horse, from his state of domestication, is frequently subject. The Farriers have termed it THE GREASE. It is an inflammation and swelling in the heel, accompanied in its commencement with small cracks or fissures, from which issues a limpid fluid, possessing properties of a peculiar kind. This fluid seems capable of generating a disease in the human body (after it has undergone the modification I shall presently speak of) which bears so strong a resemblance to the Smallpox, that I think it highly probable it may be the source of that disease.
In this Dairy Country a great number of Cows are kept, and the office of milking is performed indiscriminately by Men and Maid Servants. One of the former having been appointed to apply dressings to the heels of a Horse affected with the malady I have mentioned, and not paying due attention to cleanliness, incautiously bears his part in milking the Cows, with some particles of the infectious matter adhering to his fingers. When this is the case, it frequently happens that a disease is communicated to the Cows, and from the Cows to the Dairy-maids, which spreads through the farm until most of the cattle and domestics feel its unpleasant consequences. This disease has obtained the name of THE COWPOX.
Thus the disease makes its progress from the Horse (as I conceive) to the nipples of the Cow, and from the Cow to the Human Subject. (Pp. 2 and 6.)
This conception of the origin and progress of the disease was not Jenner’s specially: he shared it with the farmers to whom it was a novelty--
The rise of Cowpox in this country may not have been of very remote date, as the practice of milking Cows might formerly have been in the hands of women only; which I believe is the case now in some other dairy countries; and consequently that the Cows might not in former times have been exposed to the contagious matter brought by the men servants from the heels of Horses. Indeed a knowledge of the source of infection is new in the minds of most of the farmers in this neighbourhood, but has at length produced good consequences; and it seems probable from the precautions they are disposed to adopt, that the appearance of the Cowpox here may either be entirely extinguished or become extremely rare. (P. 56.)
Thus Cowpox was to be extinguished by forbidding milkers to handle Horses’ greasy heels. Jenner himself tried to produce Cowpox in the manner described, but without success--
It is very easy [he wrote] to procure pus from old sores on the heels of Horses. This I have often inserted into scratches made with a lancet on the sound nipples of Cows, and have seen no other effects from it than simple inflammation. (P. 45.)
What was requisite for success, he concluded, was the limpid fluid from the Horse’s heel at an early stage of the disease, and that it should be applied to the Cow’s nipples at a certain season--
The virus from the Horses’ heels is most active at the commencement of the disease, even before it has acquired a pus-like appearance; indeed I am not confident whether this property in the matter does not entirely cease as soon as it is secreted in the form of pus. I am induced to think it does cease, and that it is the thin darkish-looking fluid only, oozing from the newly formed cracks in the heels, similar to what sometimes appears from erysipelatous blisters, which gives the disease. Nor am I certain that the nipples of the Cows are at all times in a state to receive the infection. The appearance of the disease in the spring and the early part of the summer, when they are disposed to be affected with spontaneous eruptions so much more frequently than at other seasons, induces me to think, that the virus from the Horse must be received upon them when they are in this state in order to produce effects. Experiments, however, must determine these points. (P. 45.)
Whilst thus explicit as to what was requisite for the infection of the Cow by the Horse, Jenner did not succeed in producing Cowpox from Horsegrease. He had to write--
The spring of the year 1797, which I intended particularly to have devoted to the completion of this investigation, proved from its dryness remarkably adverse to my wishes. No Cowpox appeared in the neighbourhood; for it most frequently happens that while the farmers’ Horses are exposed to the cold rains of spring their heels become diseased. (P. 44.)
Yet without proof, he argued as if he had proof, saying--
With respect to the opinion adduced, that the source of the infection is a peculiar morbid matter arising in the Horse, although I have not been able to prove it from actual experiments conducted immediately under my own eye, yet the evidence I have adduced appears sufficient to establish it. (P. 43.)
Evidence adduced! Of evidence there was none. The farmers might be right in their opinion that Cowpox sprang from Horsegrease, but opinion was not evidence, nor even such assurance as this of Jenner’s--
I feel no room for hesitation respecting the common origin of the disease, being well convinced that it never appears among the Cows unless they have been milked by some who at the same time has the care of a Horse affected with diseased heels. (P. 44.)
But not even to this conviction did he adhere. “It was highly probable,” he thought, “that not only the heels of the Horse, but other parts of the body of that animal, are capable of generating the virus which produces the Cowpox”--
An extensive inflammation of the erysipelatous kind appeared without any apparent cause upon the upper part of the thigh of a sucking Colt, the property of Mr. Millet, a farmer at Rockhampton, the inflammation continued several weeks, and at length terminated in the formation of three or four small abscesses. The inflamed parts were fomented, and dressings were applied by some of the same persons who were employed in milking the Cows. The number of Cows milked was 24, and the whole of them had the Cowpox. The milkers, consisting of the farmer’s wife, a man and a maid-servant, were infected by the Cows. The man servant had previously gone through the Smallpox, and felt but little of the Cowpox. The servant maid had some years before been infected with the Cowpox; and she also felt it now in a slight degree. But the farmer’s wife, who had never gone through either Smallpox or Cowpox felt its effects very severely.
That the disease produced upon the Cows by the Colt, and from thence conveyed to those who milked them, was the True and not the Spurious Cowpox, there can be scarcely any room for suspicion; yet it would have been more completely satisfactory had the effects of variolous matter [Inoculation with Smallpox] been ascertained on the farmer’s wife; but there was a peculiarity in her situation which prevented my making the experiment. (P. 62.)
Spurious Cowpox! What was Spurious Cowpox? Here is Jenner’s answer--
Pustulous sores frequently appear spontaneously on the nipples of the Cows, and instances have occurred, though very rarely, of the hands of the servants employed in milking being affected with sores in consequence, and even of their feeling an indisposition from absorption. These pustules are of a much milder nature than those which arise from that contagion which constitutes the True Cowpox. They are always free from the bluish or livid tint so conspicuous in the pustules of that disease. No erysipelas attends them, nor do they show any phagedenic disposition, as in the other case, but quickly terminate in a scab without creating any apparent disorder in the Cow. This complaint appears at various seasons of the year, but most commonly in the spring, when the Cows are first taken from their winter food and fed with grass. It is very apt to appear also when they are suckling their young. But this disease is not to be considered as similar in any respect to that of which I am treating, as it is incapable of producing any specific effects upon the Human Constitution. However, it is of the greatest consequence to point it out here, lest the want of discrimination should occasion an idea of security from the infection of the Smallpox, which might prove delusive. (Pp. 7 and 8.)
Nothing could be more explicit. COWPOX was of two kinds--True and Spurious. The Spurious consisted of pustular sores which appeared spontaneously on the nipples of Cows, and was of no avail against Smallpox: the True Cowpox, on the other hand, was not a disease of the Cow, but of the Horse transmitted to the Cow.
It is of prime importance to bear this distinction in mind; for if it is not borne in mind, much that remains to be told must appear confused or unintelligible. As we have seen, it was the belief of the dairymaids that if they caught Cowpox they would never afterwards catch Smallpox. Medical men in practice in Gloucestershire ridiculed the dairymaids’ belief. They said--
“We know that such is the dairymaids’ faith, but it is mistaken; for we know dairymaids who have had Cowpox and afterwards had Smallpox in spite of their Cowpox.”
At this point Jenner intervened, saying--
“Let us distinguish. Eruptions contracted in milking are indiscriminately described as Cowpox by dairy-folk; but there is an eruption attended with erysipelas and fever which has all the virtue they claim for it. This variety of eruption does not originate on the Cow, but is communicated to the Cow from the Horse. Thus the dairymaids are right and they are wrong. They are right when the pox they catch is derived from the Horse through the Cow: they are wrong when the pox they catch originates on the Cow without the Horse. In short Cowpox proper is of no avail against Smallpox. It is Horsegrease Cowpox that is of sovereign and infallible virtue. Any maid who receives HORSEGREASE COWPOX into her veins is, as she believes, for ever after secure from the infection of Smallpox.”
Let us therefore bear in mind that Jenner’s prescription was not Cowpox but HORSEGREASE COWPOX. It is a point to be insisted upon; for, as we shall see, it was lost from sight, and kept out of sight, to the utter confusion of the question.
* * * * *
We now come to Jenner’s Cases of Horsegrease--for not only were farm-folk reputed secure from Smallpox by reason of Cowpox, but farriers likewise in consequence of infection with Horsegrease.
XIII.--THOMAS PEARCE, son of a Farrier.
In consequence of dressing Horses with sore heels at his father’s when a lad, had sores on his fingers which suppurated, and occasioned pretty severe indisposition. Six years afterwards, Jenner inoculated him repeatedly with Smallpox, but only produced slight inflammation, and exposed him to the contagion of Smallpox without effect.
On this Case Jenner observed--
It is a remarkable fact, and well-known to many, that we are frequently foiled in our endeavours to communicate Smallpox by inoculation to blacksmiths, who in the country are farriers. They often, as in the above instance, either resist the contagion entirely, or have the disease anomalously. Shall we not be able now to account for this on a rational principle?
XIV.--JAMES COLE, Farmer.
Was infected with Horsegrease in the same way as Pearce. Some years afterwards was inoculated with Smallpox, but only a few eruptions appeared on his forehead, which passed away without maturation.
XV.--ABRAHAM RIDDIFORD, Farmer.
Was affected with very painful sores in both hands, tumours in each arm-pit, and severe and general indisposition, in consequence of dressing a Mare that had sore heels. He was attended by a surgeon, who recognising a similarity of the sores upon his hands with those of Cowpox, and knowing the effect of Cowpox on the human constitution, assured him that he never need fear Smallpox; but, twenty years afterwards, he caught the disease, which ran its regular course.
From these Cases Jenner drew this conclusion--
Although the absorption of matter from sores on the heels of Horses, secures, or nearly secures, the system from variolous infection, yet it is possible that this cannot be entirely relied upon, until a disease has been generated by morbid matter from the Horse on the nipple of the Cow, and passed through that medium to the human subject.
Which conclusion he repeated thus--
The active quality of the virus from the Horse’s heels is greatly increased after it has acted on the nipples of the Cow; as it rarely happens that the Horse affects his dresser with sores; and as rarely that a milkmaid escapes infection when she milks infected Cows. (P. 45.)
From this conclusion, Jenner at a subsequent period withdrew. The virus from the Horse was employed for inoculation without transmission through the Cow, and with results equally satisfactory. As we shall find, Jenner used and distributed Equine Virus neat, which he certified as “the true and genuine life-preserving fluid.”
So far the Cases set forth described no more than ordinary Gloucestershire experience; but we now come upon ground regarded as peculiarly Jennerian.
XVI.--SARAH NELMES, Dairymaid.
In 1796 was infected with Cowpox, receiving the virus on a part of her hand scratched by a thorn. From the large pustulous sore on Sarah’s hand Jenner, on the 14th May, inoculated--
XVII.--JAMES PHIPPS, eight years old.
Said Jenner, “The more accurately to observe the progress of the infection, I selected a healthy boy, about eight years old, for the purpose of INOCULATION FOR THE COWPOX.” The matter was inserted into his arm by two incisions, barely penetrating the cutis, each about half an inch long. The inoculation “took,” and was followed by a chill, loss of appetite, headache, and restless sleep. On the 1st of July, the poor lad was inoculated with Smallpox, and again several months afterwards, it is said, without effect.
Here [wrote Jenner] my researches were interrupted till the spring of the year 1798, when, from the wetness of the early part of the season, many of the farmers’ Horses were affected with sore heels, in consequence of which Cowpox broke out among several of our dairies, which afforded me an opportunity of making further observations upon the curious disease.
About the latter end of February, 1798, William Haynes and Thomas Virgoe, having to wash a Mare with sore heels, were infected with Grease, and described their sensations as much the same as when they were inoculated with Smallpox. Their infection proved that if Grease was good against Smallpox, Smallpox was not good against Grease. Haynes was employed as a milker, and Pox broke out among his master’s Cows about ten days after he had first assisted in washing the Mare’s heels.
XVIII.--JOHN BAKER, five years old.
Inoculated, 16th March, 1798, with matter taken from a pustule on the hand of the aforesaid Thomas Virgoe poisoned with Grease from the Mare’s heels. “He became ill on the sixth day with symptoms similar to those excited by Cowpox, and on the eighth was free from indisposition.”
On this case of Horsegrease inoculation, Jenner observed--
We have seen that the virus from the Horse is not to be relied upon as rendering the system secure from variolous infection, but that the matter produced by it on the nipple of the Cow is perfectly so. Whether the virus passing from the Horse through the human constitution, as in the present instance, will produce a similar effect remains to be decided. This would have been effected, but the boy was rendered unfit for Smallpox Inoculation from having felt the effects of a contagious fever in a work-house soon after this experiment was made.
Mark the assumption, “The virus from the Horse is not to be relied upon as rendering the system secure from variolous infection, but the matter produced by it on the nipples of the Cow is perfectly so!” Such was Jenner’s method of induction! How could he leave the question undecided? Why not have waited until little Baker recovered from his fever? or why not have inoculated another work-house child with Horsegrease? The true sons of science do not rush into print in such shameless deshabille.
XIX.--WILLIAM SUMMERS, aged five and a half.
Inoculated 16th March, 1798, from the nipple of one of the Cows infected with Horsegrease by Haynes. Subsequently inoculated with Smallpox without effect.
XX.--WILLIAM PEAD, aged eight.
Inoculated, 28th March, from Summers. Subsequently inoculated with Smallpox without effect.
XXI.--HANNAH EXCELL, aged seven.
And several children and adults were inoculated from the arm of Pead on 5th April. “The greater part of them sickened on the sixth day, and were well on the seventh; but in three of the number a secondary indisposition arose in consequence of an extensive erysipelatous inflammation which appeared on the inoculated arms. By the application of mercurial ointment to the inflamed parts (a treatment recommended under similar circumstances in the inoculated Smallpox) the complaint subsided without giving much trouble.”
Excell was inoculated in three places on her arm. “This,” said Jenner, “was not done intentionally, but from the accidental touch of the lancet, one puncture being always sufficient.” The resulting pustules so much resembled those arising from inoculation with Smallpox, “that an experienced inoculator would scarcely have discovered a shade of difference.”
XXII.--FOUR CHILDREN.
On 12th April virus was taken from Hannah Excell and inserted in the arms of--
Robert F. Jenner, aged 11 months, John Marklove, ” 18 ” Mary Pead, ” 5 years, Mary James, ” 6 ”
R. F. Jenner did not “take.” The arms of the others inflamed, and Jenner fearing erysipelas, as in the preceding cases, applied a caustic of soap and quick-lime to Marklove and James, “which,” he says, “effectually answered my intention in preventing erysipelas.” The disease was suffered to take its course in Pead, and no erysipelas appeared.
XXIII.--JOHN BARGE, aged seven.
Inoculated from Mary Pead, and successfully. Was subsequently inoculated with Smallpox without effect.
“These experiments,” said Jenner, “afforded me much satisfaction; they proved that the matter in passing from one human subject to another, through five gradations, lost none of its original properties, John Barge being the fifth who received the infection successively from Wm. Summers, the boy to whom it was communicated from the Cow.”
* * * * *
These are Jenner’s Cases. In them we have his “Masterpiece of Medical Induction”--the fruit of thirty years of incessant thought, of watching, and of experiment! Let us carefully observe the dates. Until 1796, when he operated on Phipps, he never made an experiment in Horsegrease Cowpox Inoculation; and not until the middle of March, 1798, a few weeks before going to press with the Inquiry, did he repeat the experiment; and though his later cases were complicated with erysipelas, he did not stay to dispose of the difficulty and alarm thereby excited. He got together his scratch lot of Cases, as if under some over-mastering compulsion, and consigned the concern, crude and incomplete, to the public. By-and-by the hasty performance came to be spoken of as the result of thirty years of incessant thought, of patient research, and of unwearied labour. It is unnecessary to argue the matter. Whilst there is nothing too great for the credulity of those who are in the disposition of belief, yet facts are facts, and there is the stone-wall of the Inquiry with its authentic details whereon to crack the skulls of romancers. In Jenner’s story as recited to the vulgar, we have the advantage of witnessing the development of myth in the light of our own age under our own eyes.
Taking Jenner’s Inquiry at the utmost, What was it? A suggestion to substitute Horsegrease Cowpox for Smallpox in inoculation. That was all. Beyond this there was no point of novelty. Some have credited Jenner with originating the transfer of virus from arm to arm; but in this respect he followed the example of many variolators. There was a mild form of Smallpox occasionally prevalent in London called “pearly pox,” and Dr. Adams and others kept it going from patient to patient; and the virus from the body of a healthy variolated child was in constant request by timid folk, who fancied the virulence of the original infection might thereby be abated in transmission.
So much for Jenner’s data. Now for a word or two as to the speculation that invested his prescription.
He considered that some of the diseases which afflict men are derived from their domestication of animals, and that thus several diseases might have a common origin. “For example,” he asked, “Is it difficult to imagine that measles, scarlet fever, and ulcerous sore throat with a spotted skin, have all sprung from the same source?”
About the imagination, there might be little difficulty: the difficulty lay in the production of proof that any disease in man was derived from disease in animals, and that disease so derived was variously manifested. Jenner wished to have it believed that a variety of Cowpox was generated from Horsegrease, which Cowpox was the source of Smallpox. He adduced no evidence, however, to connect outbreaks of Smallpox with Cowpox; nor did he ever suggest that dairymaids caught Smallpox from Cows, or farriers from Horses. His identification of Horsegrease Cowpox with Smallpox was the resemblance of their pustules, and on the ground of this resemblance he affirmed the equivalence of the diseases. Thus in describing his first inoculation of Cowpox, that of Phipps from the hand of Sarah Nelmes on the 14th of May, 1796, he wrote--
The appearance of the incisions in their progress to a state of maturation was much the same as when produced in a similar manner by variolous matter. This appearance was in a great measure new to me, and I ever shall recollect the pleasing sensations it excited; as, from its similarity to the pustule produced by variolous inoculation, it incontestably pointed out the close connection between the two diseases, and almost anticipated the result of my future experiments. (P. 30.)
The similarity of the Cowpox and Smallpox pustules incontestably pointed out the close connection between the two diseases! The observation and the conclusion are worth notice, being characteristic of Jenner’s loose and illogical mind. He was familiar with Tartar Emetic, and he might have observed that it produced pustules on the skin exactly like those of Cowpox and Smallpox; wherefore would it have been fair to argue that the pustules being alike, their causes were incontestably identical? Dr. Hamernik of Prague observes--
Some years ago the theory was brought forward, under the auspices of the great alchemistical artist, Hufeland, that Vaccination from Tartar Emetic pustules was a perfect substitute for Vaccination with Cowpox, and had the same beneficent effect. With this I fully agree; and I remark further, that if Tartar Emetic pustulation is produced in Cows and Calves, and vaccine matter is then taken from them, such Vaccination is also perfectly harmless. The most convincing proof of the beneficent and identical action of such Vaccination with that of Cowpox, is furnished by the fact that it presents pustules similar in size and form, therefore, necessarily of identical value.[99]
Having identified Horsegrease Cowpox with Smallpox, by reason of similarity of pustules, he went on to assert that such Horsegrease Cowpox was equivalent to Smallpox for inoculation, and was attended with the like prophylaxy, saying--
What renders the Cowpox virus so extremely singular is, that the person affected with it is forever after secure from the infection of the Smallpox; neither exposure to the variolous effluvia, nor the insertion of the matter into the skin producing this distemper. (P. 7.)
It is curious also to observe, that the virus, which, with respect to its effects, is undetermined and uncertain previously to its passing from the Horse through the medium of the Cow, should then not only become more active, but should invariably and completely possess those specific properties which induce in the human constitution symptoms similar to those of the variolous fever, and effect in it that peculiar change which for ever renders it insusceptible of the variolous contagion. (P. 48.)
And so on. The assurance was absolute, and the warrant for the assurance was the Cases adduced, and the similarity of Horsegrease Cowpox pustules and Cowpox pustules! But if the pustules were similar, the effects were not similar. Inoculation with Smallpox produced Smallpox, mild or otherwise, with pustules few or many; but inoculation with Horsegrease Cowpox was attended with no eruption beyond the points of incision--
It is an excess in the number of pustules which we chiefly dread in the Smallpox; but in the Cowpox no pustules appear, nor does it seem possible for the contagious matter to produce the disease from effluvia; so that a single individual in a family might at any time receive it without the risk of infecting the rest, or of spreading a distemper that fills a country with terror. (P. 58.)
Very good; but where are we? If similarity of pustule proved the identity of Smallpox and Horsegrease Cowpox, what did those graver dissimilarities between the diseases prove? That an objection so obvious should never have occurred to Jenner indicates the extent of his logical capacity.
Jenner’s expectation from the issue of the Inquiry had nothing of the prophetic character described by his enthusiastic biographers. It is only necessary to peruse its pages and note the dates in order to perceive the impossibility of the vision of 1780 described by Baron when Jenner exhibited to Gardner his future glory, and how he was destined to stand like Aaron between the living and the dead until the plague was stayed. Alas! how many similar fables may we entertain because the means of detection are not, as in Jenner’s case, available.
When Jenner was writing, the English people were committed to Smallpox Inoculation, or more accurately Smallpox culture, and it was in competition with Smallpox that he advanced Cowpox. “If asked,” he said, “whether his investigation be matter of mere curiosity, or whether it tend to any beneficial purpose,” he replied by setting forth the draw-backs to the existing practice, and contrasting them with the advantages of his own.
Notwithstanding [he wrote] the happy effects of Inoculation, with all the improvements the practice has received since its first introduction into this country, it not very unfrequently produces deformity of the skin, and sometimes, under the best management, proves fatal. (P. 57.)
On the contrary, he said--
I have never known fatal effects arise from the Cowpox, even when impressed in the most unfavourable manner, producing extensive inflammations and suppurations on the hands; and as it clearly appears that this disease leaves the constitution in a state of perfect security from the infection of the Smallpox, may we not infer that a mode of Inoculation may be introduced preferable to that at present adopted, especially among those families, which, from previous circumstances, we may judge to be predisposed to have the disease unfavourably?
Inoculation was freely charged with exciting scrofula; thus Jenner observed--
In constitutions predisposed to scrofula, how frequently we see the inoculated Smallpox rouse into activity that distressful malady; and the issue does not seem to depend on the manner of the inoculation, for it as often occurs in those who receive it mildly as in those who receive it severely. (P. 60.)
Happily he had the grace to refrain from the explicit assertion that Cowpox was exempt from similar hazard; yet with characteristic inconsistency, was disposed to advance a claim for it as an expulsive irritant--
As we have seen [though he never showed] that the constitution may at any time be made to feel the febrile attack of Cowpox, might it not, in many chronic diseases, be introduced into the system, with the probability of affording relief, upon well-known physiological principles? (P. 60.)
A reader of the Inquiry in 1798 could never have supposed that it was an attempt to displace the existing practice of Inoculation. Nor is there any sign that Jenner at the time contemplated such an issue. He referred to Variolous Inoculation with respect, and was satisfied to suggest that in certain cases inoculation with Horsegrease Cowpox might be substituted with advantage. As to the permanent existence of Horsegrease Cowpox he was doubtful. Since, he said, the farmers had traced the infection to the Horse, “the appearance of the Cowpox may either be entirely extinguished or become extremely rare.” It may be replied that this behaviour on the part of Jenner was due to reserve and tact, but the reserve and tact are invisible. The Inquiry was simply what it appears--a hasty performance, which, in other hands, developed to more, far more, than its author contemplated. Subsequently he, and his friends for him, laid claim to years of research under the influence of supernatural foresight; but, with the Inquiry before us, I ask where is the evidence? I take the date, 14th May, 1796, when Jenner inoculated Phipps from the hand of Sarah Nelmes, as the time when the project of inoculation with Horsegrease Cowpox began to assume form, and I maintain that the character, order and dates of the Cases set forth in the Inquiry plainly show that they were got together to sustain the conclusion then arrived at. When Mr. John Simon descants on Jenner’s thirty years of incessant thought, watching and experimenting which resulted in the production of that Masterpiece of Medical Induction--The Inquiry, the answer is, Peruse the Inquiry, and then say where the fruit of thirty years of labour is to be found. The assertion is too absurd for discussion, whatever it may be as an article of faith.
The single point of originality in the Inquiry was the definition of the disease for which prophylactic efficacy was asserted. The dairymaids said Cowpox: the farriers said Horsegrease. Jenner said neither Cowpox nor Horsegrease, but their combination in Horsegrease Cowpox, which variety of Pox alone ensured life-long security from Smallpox. We shall see as we proceed how this position was surrendered and resumed, modified and confused beyond recognition. Let it suffice at present to say that the note of Jenner’s Inquiry was HORSEGREASE COWPOX and nothing else. Strike out HORSEGREASE COWPOX, and the affair is reduced to nonentity.
THE VARIOLOUS TEST.
What was called the Variolous Test worked wonderfully for Jenner; and as we shall have to refer to it repeatedly, it may be well to describe and dispose of it at once.
We have seen how the Test was practised in the Cases in the Inquiry. Those who had undergone Cowpox were inoculated with Smallpox, and as the Smallpox did not “take,” they were assumed to be proof against that disease. Hence the absolute conclusion proclaimed Urbi et Orbi, that none inoculated with Cowpox could ever afterwards contract Smallpox.
It was replied, that some who had suffered from Cowpox had contracted Smallpox, and that others had received the disease by inoculation; to which Jenner’s summary answer was, “There must have been some mistake about the Cowpox; for no one can have genuine Cowpox and subsequently incur Smallpox, either by infection or inoculation.”
Cowpox was inoculated and propagated from arm to arm; and, in proof that the constitution was fortified against Smallpox, it was common to inoculate with Smallpox, which usually did not “take”; whereon the operator exclaimed, “Behold! the patient is insusceptible of Smallpox for ever!”
Such was the Variolous Test. It was to multitudes absolutely conclusive; and to question its validity was to exhibit a contentious and unphilosophic disposition.
What shall we now say concerning it?
First, that failures were numerous in Variolous Inoculation apart from Vaccination, and that it was not supposed that when a patient did not “take,” he was therefore insusceptible of Smallpox; nor even when he did “take,” that he was thereby rendered proof against Smallpox. So many of the successfully inoculated did subsequently fall victims to Smallpox, that Variolators at the end of last century were compelled to argue (like Vaccinators at the end of this) that Variolation was a guard, but not an absolute guard; and that when it did not altogether avert Smallpox, it modified and mitigated an attack. The excuse for failure was as artful as the motive was urgent: Variolation was too good a trade to be imperilled for lack of a little ingenuity.
Nevertheless, if we make full allowance on the score of frequent incapacity to receive Variolation, we have yet to explain, on a candid view of the whole evidence, how it was that in numerous cases Inoculation with Smallpox was ineffective after Inoculation with Cowpox.
“What can you urge against the Variolous Test?” was a frequent and imperious demand.
The explanation in general lay in the fact, that Variolation was attempted before the complete subsidence of the vaccine fever. The inoculation with Cowpox had set up a serious constitutional disturbance, and during that disturbance the Smallpox virus could not develop its malign energy. Let me show what I mean from the testimony of Jenner himself.
On 15th March, 1800, the Duke of York requested Jenner to proceed to Colchester to the 85th Regiment. Jenner was unable to go, and sent his nephew, George, instead, who had to report a complete failure. The reason of the failure was, that the entire Regiment, with women and children, had the itch! Jenner was then driven to the conclusion which, says Baron, “he adopted and invariably maintained to the last hour of his life, namely, that any cutaneous disease, however slight in appearance, was capable of interfering with the regular course of the Cowpox and of preventing it from exercising its full protecting influence.”[100]
Just so: and mark how the same logic applies to the Variolous Test, which “nobody could get over.” If any cutaneous disorder, however slight, could nullify Cowpox, was it not equally probable that the cutaneous disorder induced by inoculated Cowpox would nullify inoculated Smallpox until the effects of the Cowpox had time to subside? When the itch at Colchester was cured, then inoculation with Cowpox was found to be practicable. Thus worthless was the Variolous Test on Jenner’s own principle; yet with such evidence under his eyes and among his fingers, he failed to discern its significance. Nor apparently did he inquire whether the influence of Cowpox was perpetuated over specified periods of six months, nine months, one year, two years, and so on. As trader and adventurer, it suited him better to be not over inquisitive, and to avow boldly that his specific conferred life-long immunity from Smallpox.
Vaccinators at this day rarely refer to the once famous Variolous Test: to do so would be absurd. The fact of Re-Vaccination, of Vaccination after Vaccination at short intervals, proves, that whatever the influence of the operation, it is transient and not permanent; and the cases of Smallpox after Vaccination, and of Smallpox in its most malignant forms after Re-Vaccination, as if induced thereby, leave the Variolous Test, which so widely impressed and imposed upon our forefathers, an exploded piece of jugglery.
FOOTNOTES:
[98] Such timely remedies were solutions of sulphate of zinc or sulphate of copper--a hint for those in quest of antidotes for Vaccination.
[99] Remarks on Certain Medical Principles. London, 1882.
[100] Baron’s Life of Jenner, vol. i. p. 380.
III. JENNER IN 1798
Jenner, with his wife and daughter, left Berkeley for London on 24th April, 1798, in order to see the Inquiry through the press. He remained in London until 14th July, and failed, if he tried, to induce any inoculator to substitute cowpox for smallpox. In the Jenner legend, it is usual to find some touching remarks on this trip to town: genius unrecognised: truth turned from every door: the great soul abiding in patience and courage invincible. Dates, however, are again merciless. The Inquiry was not in the booksellers’ hands until the end of June, and, within a fortnight after publication, Jenner was on his way to Berkeley. There was no occasion for the virtues specified.
Among Jenner’s acquaintance was Henry Cline, teacher of surgery in St. Thomas’s Hospital; and with Cline he left some virus in a quill that he had taken from the arm of Hannah Excell, at Berkeley on 5th April. Cline had a patient, a child named Richard Weller, with an affection of the hip-joint, and intending to create an issue by way of counter-irritation, he inoculated the hip with Excell’s virus, and thus described the experiment in a letter to Jenner--
LINCOLN’S INN FIELDS, 2nd August, 1798.
The Cowpox experiment has succeeded admirably. The child sickened on the seventh day; and the fever, which was moderate, subsided on the eleventh day. The inflammation extended to about four inches diameter, and then gradually subsided without having been attended with pain or other inconvenience. The ulcer was not large enough to contain a pea; therefore, I have not converted it into an issue as I intended. I have since inoculated him with smallpox in three places, which were slightly inflamed on the third day, and then subsided.
Dr. Lister, who was formerly physician to the Smallpox Hospital, attended the child with me, and he is convinced that it is not possible to give him the smallpox.
I think the substituting of cowpox poison for the smallpox promises to be one of the greatest improvements that has ever been made in medicine; for it is not only so safe in itself, but also does not endanger others by contagion, in which way the smallpox has done infinite mischief. The more I think on the subject, the more I am impressed with its importance.
Cline then attempted to vaccinate with virus taken from Weller’s hip, but failed. He wrote to Jenner--
LINCOLN’S INN FIELDS, 18th August, 1798.
Seven days since I inoculated three children with cowpox matter, and I have the mortification of finding that the infection has not taken, and I fear I shall be entirely disappointed unless you can contrive to send me some fresh matter. I think it might come in a quill in a letter, or enclosed in a bit of tin-foil.
Jenner was unable to comply with Cline’s request: he had no cowpox to transmit: and readers of the Inquiry who addressed to him similar requests had to submit to similar disappointments, out of which some suspicion was naturally developed. The recommendation of a remedy whereof there was no available supply was not a passport to confidence.
Baron relates, that “Mr. Cline perceiving at once from the success of his first trial, what incalculable blessings were connected with the diffusion of the new practice, immediately advised Jenner to quit the country, and to take a house in Grosvenor Square, and promised him £10,000 per annum as the result of his practice; in which opinion Mr. Cline was supported by Sir W. Farquhar; but that all these splendid prospects of wealth and distinction could not move Jenner.”[101]
The story is either an invention, or it does little credit to Cline’s judgment. Jenner had neither the means for a house in Grosvenor Square, nor was there any likelihood of his earning £10,000 a year by cowpox. Nevertheless it would appear that at this juncture some one was advising him to try London (one’s vanity is never without a prompter), and that Jenner replied--
CHELTENHAM, 29th September.
My perplexity really amounts to agitation. On the one hand, unwilling to come to town myself for the sake of practice, and, on the other, fearful that the practice I have recommended may fall into the hands of those who are incapable of conducting it, I am thrown into a state that was not at first perceptible as likely to happen to me; for, believe me, I am not callous to all the feelings of those wounds which, from misrepresentation, might fall on my reputation; on the contrary, no nerves could feel more acutely; and they now are actually in a tremor from anticipation.
How very few are capable of conducting physiological experiments! I am fearful that before we thoroughly understand what is cowpox matter, and what is not, some confusion may arise, for which I shall, unjustly, be made answerable.[102]
If his correspondent had been a man of sense, he might have replied--
Why so much ado about nothing! You recommend that horsegrease cowpox be substituted for smallpox in cases of inoculation. It is a simple prescription, easily determined altogether apart from you, and there is no reason why you should work yourself into such a flutter.
But Jenner was not the unimpassioned man of science, who can leave truth to take care of itself, and submit when truth contradicts his prepossessions. Dr. Ingenhousz, an Anglicised Dutchman (born at Breda, 1730), with reputation as electrician and chemist, read the Inquiry with considerable amazement. He was himself an inoculator of mark, having been selected by the Empress Maria Teresa to operate upon the imperial family of Austria; and by her had been rewarded (after the pattern of Catharine of Russia and Dimsdale) with a pension of £600 a year, and the titles of Aulic Councillor and Imperial Physician. Naturally, therefore, Ingenhousz had a lively interest in Jenner’s project, and being on a visit to the Marquis of Lansdowne at his seat in Wiltshire, addressed him as follows--
BOWOOD PARK, 12th October, 1798.
As soon as I arrived at Bowood, I thought it my duty to inquire concerning the extraordinary doctrines contained in your publication, as I knew the cowpox was well known in this county.
The first gentleman to whom I addressed myself was Mr. Alsop, an eminent practitioner at Calne, who made me acquainted with Mr. Henry Stiles, a respectable farmer at Whitley, who, thirty years ago, bought a cow at a fair, which he found to be infected with what he called the cowpox. This cow soon infected the whole dairy; and he himself, by milking the infected cow, caught the disease which you describe, and that in a very severe way, accompanied with pain, stiffness, and swelling of the axillary glands. Having recovered from the disease, and all the sores dried, he was inoculated with smallpox by Mr. Alsop. The disease took place, a great many pox came out, and he communicated the infection to his father who died of it.
This being an incontrovertible fact, cannot fail to make some impression on your mind, and excite you to inquire further on the subject before you venture finally to decide in favour of a doctrine, which may do great mischief should it prove erroneous.
The impression made on Jenner’s mind was simply one of annoyance. He fell back on the assertion that all was not cowpox that was supposed to be cowpox, and that Farmer Stiles could not have had the genuine distemper, or he would not have received smallpox by inoculation. It did not even occur to him that it was necessary to investigate and account for the evidence adduced by Ingenhousz, which was every whit as valid as much of his own. He was content to protest--
In the course of my inquiry, not a single instance occurred of any one having the disease, either casually or from inoculation, who on subsequent exposure to variolous contagion received the infection of smallpox.... Should it appear in the present instance that I have been led into error, fond as I may appear of the offspring of my labours, I had rather strangle it at once than suffer it to exist, and do a public injury. At present, I have not the most distant doubt that any person, who has once felt the influence of perfect cowpox matter, would ever be susceptible of that of the smallpox.
Could universal conclusion be deduced from more questionable premisses? and this, too, by one who had just exclaimed, “How very few are capable of conducting physiological experiments!” Always, as we shall see; ungenerous toward those who questioned his assertions, Jenner wrote to his friend, Gardner--
This man, Ingenhousz, knows no more of the real nature of the cowpox than Master Selwyn does of Greek: yet he is among philosophers what Johnson was among the literati, and, by the way, not unlike him in figure--
When, in fact, what provoked him was that Ingenhousz knew too much about cowpox, and had laid his finger on the point of error at the outset. Inquiry on the part of Ingenhousz brought to light several other instances of smallpox after cowpox; and Dr. Pulteney of Blandford reported that Dorsetshire inoculators were familiar with the one sort of pox after the other sort. Jenner’s constant answer to such objections was, “Yes; but it could not have been true cowpox to start with”--a style of argument maintained with parrot-like persistency when smallpox followed vaccination. “Ah!” it was said, “there must have been some mistake about the vaccination; for no one can be thoroughly vaccinated and have smallpox.”
Looking back on the final years of last century, it is much to be regretted that more pains were not taken to hold Jenner fast to his position that smallpox never followed cowpox, and to demonstrate beyond contention that it was not true. It certainly was not true; the evidence to that fact was indisputable; but few were disposed to follow Ingenhousz into the West of England and search for the requisite proof; and Ingenhousz was cut out of the controversy by his death at Bowood on 7th September, 1799. Presently Jenner managed to have the contention shifted from the experience of the dairies to vaccination from arm to arm and the illusory variolous test, and the advantage of a decision at the springs of fallacy was lost. In the general confusion which ensued Jenner came to be taken for a discoverer, and he posed diligently in the character, when he was nothing more than the advertiser of the vulgar opinion of his neighbourhood, with the modification that not Cowpox but Horsegrease Cowpox was the true and infallible specific. The fact is so clear, that he was a mere advertiser, that it would not be worth repetition, were it not so systematically treated as unseen. How distinctly it was at first recognised appears in a letter of thanks for a copy of the Inquiry addressed to Jenner by Francis Knight, a London surgeon, wherein he observed--
CLIFFORD STREET, 10th September, 1798.
I have read your publication with much satisfaction; and, from a long residence in the dairy part of Wiltshire, as well as in Gloucestershire, I know the facts to be well supported; at least, it was a general opinion among the dairymen, that those who had received the cowpox were not susceptible of the variolous disease. The cowpox pustule is very familiar to my eye, and I am quite charmed with the delineation of it in your plates. You have opened to the world a very curious field of investigation, and it is too interesting a subject to die with the day.[103]
In these remarks of Knight, we have Jenner’s position accurately defined. He made himself responsible for “the general opinion among the dairymen”; and had some one at that time shown in perspicuous and emphatic fashion that the dairymen were wrong, Jenner would have been summarily disposed of. Vain, however, are such regrets; and we may find comfort in the reflection that there is an order in the universe which converts misfortune into means for greater and rarer good.
Another letter to Jenner from Dr. Hicks contains these remarks--
BRISTOL, 3rd October, 1798.
I wish you had been able to have communicated the cowpox to the cow by means of inoculation from a greasy horse’s heel, for your work would then have been more complete and satisfactory.
I do not see that you need hesitate to accept the invitation given you to inoculate with the cowpox, convinced as you are that it will secure the persons so inoculated from ever being infected with the smallpox.
Everlasting security from smallpox! Such was the unqualified promise, and with how little warrant! In presence of a Socratic inquirer with his persistent, how do you know? Jenner must have stood confounded.
A letter to Jenner from Dr. Percival, also contains some remarks worth notice. He wrote--
MANCHESTER, 20th November, 1798.
The facts you have adduced incontestably prove the existence of the cowpox, and its ready communication to the human species. But a larger induction is yet necessary to evince that the virus of the Variolæ Vaccina renders the person who has been affected with it secure during the whole of life from the infection of the smallpox.
Mr. Simmons, an ingenious surgeon of this town, has inoculated a human subject with the ichor issuing from what is termed the grease in horses; but the fluid introduced, though eight punctures were made, neither occasioned inflammation nor eruption; yet the same child was soon afterwards inoculated with success for the smallpox. Mr. Simmons has now engaged a herd of cows, and is busily employed in making such experiments as your publication has suggested.
It is very remarkable, that the cowpox has been hitherto unnoticed in Cheshire, which is not less a dairy county than Gloucestershire, and where the office of milking is performed also by men and maid servants indiscriminately.
The frequent statement that Jenner’s Inquiry was at first received with indifference is entirely untrue: on the contrary, it was read with interest from the outset, and the only check he met was due to his inability to supply the demands of correspondents for samples of the precious virus. Cowpox was absent for awhile from the dairies, and great was his relief and delight when toward the end of 1798 some matter was obtained from a farm at Stonehouse wherewith on the 27th November he vaccinated the children of his friend, Henry Hicks of Eastington; “the first gentleman,” says Baron, “who had the merit of submitting his own children to the new practice.”
Ere 1798 had passed away, Jenner had secured an energetic ally in Dr. George Pearson, F.R.S., Physician to St. George’s Hospital, London.[104] Pearson entered into the cowpox question with his whole heart, and constituted himself a sort of partner in Jenner’s project. He wrote to him--
LEICESTER SQUARE, 8th November, 1798.
Your name will live in the memory of mankind, as long as men possess gratitude for services and respect for benefactors; and if I can but get matter, I am much mistaken if I do make you live for ever.
And in a more decided strain on 13th November--
I wish you could secure me matter for inoculation, because, depend upon it, a thousand inacurate but imposing cases will be published against the specific nature of the disease by persons who want to send their names abroad about anything, and who will think you and me fair game.
In the same letter he told Jenner what some were saying about the suggested practice--
You cannot imagine how fastidious the people are with regard to this business of the cowpox. One says that it is very filthy and nasty to derive it from the sore heels of horses. Another, that we shall introduce the diseases of animals among us, and that we have already too many of our own. A third sapient set say, it is a strange odd kind of business, and they know not what to think of it. All this I hear very quietly, and recollect that a still more unfavourable reception was given to inoculation for the smallpox.
Such observations were natural and to be expected. Jenner wrote to Gardner that “brick-bats and hostile weapons of every sort were flying thick around him,” but they were chiefly imaginary. His revelation was communicated to a ready world. It was no revolutionary project, but a seductive modification of existing practice. Inoculation with smallpox was the order of the day among all respectable people. The operation was troublesome and uncertain, perilous to patients and to those in contact with them; and, when all was done, it afforded no unquestionable security against the disease it was designed to avert. To a community thus harassed and anxious, came Jenner with his prescription and his promise--Substitute cowpox for smallpox and you will escape from this distress, danger, doubt. You will have a harmless fever without pustules and without risk of infection, and the security from smallpox will be absolute and perpetual. What wonder that in such circumstances Jenner’s message was heard gladly and accepted with grateful enthusiasm. That he should have encountered some resistance was inevitable, for what change is ever effected without opposition and ominous prediction? But the change Jenner proposed was the slightest of changes with the largest prospects of advantage. Unless these conditions are borne in mind, we shall never rightly understand the reception accorded by our forefathers to inoculation with cowpox.
FOOTNOTES:
[101] Baron’s Life of Jenner, vol. i. p. 154.
[102] Ibid. p. 155.
[103] Baron’s Life of Jenner, vol. i. p. 159.
[104] Born at Rotherham, 1751. Graduated M.D., Edinburgh, and practised at Doncaster until 1784, when he removed to London. Died at his house in Hanover Square from a fall down stairs, 9th November, 1828.
IV. PEARSON’S INQUIRY
Dr. Pearson’s Inquiry concerning the History of the Cowpox[105] is a remarkable proof of the alacrity and energy with which Jenner’s project was entertained. As observed, Jenner’s Inquiry was published at the end of June, 1798, and ere six months were over, in November, 1798, appeared Pearson’s Inquiry, a masterly review of Jenner’s; and not only a review, but a record of investigation, personal and by correspondence with country physicians and farmers; the entire work displaying a capacity for business to which Jenner was wholly unequal.
Cowpox did not come before Pearson as a novelty, nor Jenner in connection therewith. He relates--
When I was in company with the late Mr. John Hunter, about nine years ago, I heard him communicate the information he had received from Dr. Jenner, that in Gloucestershire an infectious disorder frequently prevailed among the milch cows, named the Cowpox, in which there was an eruption on their teats; that those who milked such cows were liable to be affected with pustulous eruptions on their hands, which were also called the cowpox; that such persons as had undergone this DISEASE COULD NOT BE INFECTED BY THE VARIOLOUS POISON; and that as no patient had been known to die of the Cowpox, the practice of the inoculation of the poison of this disease, to supersede the Smallpox, might be found, on experience, to be a great improvement in physic.
I noted these observations, and constantly related them, when on the subject of Smallpox, in every course of lectures which I have given since that time. (P. 5.)
The communication of Jenner to Hunter was nothing of a discovery. There was no secret in the existence of Cowpox, nor in the belief that inoculation therewith fortified the sufferer against Smallpox. Dr. Pulteney, of Blandford, informed Pearson that--
Cowpox is well known in Hampshire, Dorsetshire, Somersetshire, and Devonshire. It is not unknown in Leicestershire, and other midland counties; but dairymen keep it a secret as much as possible, as it is disreputable to the cleanliness of their produce. (P. 8.)
In the northern counties and in Wales, Cowpox was either rarely seen or unknown. In Cheshire, as much of a dairy county as Gloucestershire, where also men acted as milkers, the disease was never met with. Where, however, Cowpox was recognised, the faith in its efficacy against Smallpox appeared to be general, and inoculators regarded it as a bar to their success. Thus Mr. Giffard, surgeon, Gillingham, wrote to Pearson, 9th August, 1798--
Cowpox is more known in Dorsetshire than in most counties. Last winter I inoculated three parishes, and some of the subjects told me they had had the Cowpox, and that they should not take the Smallpox; but I desired to inoculate them, and did so two or three times, but without effect. Persons never take the Smallpox after they have had the Cowpox. (P. 14.)
At a milk-farm on the Hampstead Road, Pearson found a man who had often seen Cowpox in Wiltshire and Gloucestershire. He said that--
He had known many who had had Cowpox, and they never suffered from the Smallpox, although it prevailed in their own families. To use his own words, they who have had the Cowpox “are hard to take the Smallpox.” (P. 29.)
Mr. Rolph, surgeon, Peckham, who had practised in Gloucestershire, informed Pearson that--
Cowpox was very frequently epizootic in the dairy-farms in the spring.... A great number of instances of the Cowpox in milkers had fallen under his observation, but not a single mortal, or even dangerous, case occurred. There was not a medical man in Gloucestershire, or scarce a dairy-farmer, who did not know from his own experience, or that of others, that those who have suffered the Cowpox are exempt from the agency of the variolous poison. (P. 95.)
Dr. Croft likewise told Pearson--
That in Staffordshire to his knowledge, the fact had been long known of the Cowpox, which prevails in that county, affording an exemption of the human subjects from the Smallpox. (P. 35.)
Nor did what was so widely believed escape mention in medical literature. Thus Dr. Beddoes, in Queries concerning Inoculation, had written in 1795--
I have learnt from my own observation, and the testimony of some old practitioners, that susceptibility to the Smallpox is destroyed by the Cowpox, which is a malady more unpleasant than dangerous.
And Dr. Adams, in his treatise on Morbid Poisons, 1795, observed--
Cowpox is a disease well known to the dairy-farmers in Gloucestershire. What is extraordinary, as far as facts have hitherto been ascertained, a person infected with Cowpox is rendered insensible to the variolous poison.
And Dr. Woodville in his History of Inoculation, 1796, argued--
It has been conjectured that the Smallpox might have been derived from some disease of brute animals; and, if it be true that the mange affecting dogs, can communicate a species of itch to man; or that a person, having received a certain disorder from handling the teats of cows, is thereby rendered insensible to variolous infection ever afterwards--then, indeed, the conjecture is not improbable.
The belief, moreover, that Cowpox was good against Smallpox, had tempted several to court the disease. The Rev. Herman Drewe wrote to Pearson of himself and Mr. Bragge, surgeon, Axminster, 5th July, 1798--
Mr. Bragge and I endeavoured to try the experiment of inoculating with the matter of the Cowpox, but from the scarceness of the disease, and unwillingness of patients, we were disappointed. (P. 39.)
Mr. Dolling of Blandford related that--
Mr. Justings, of Axminster, inoculated his wife and children with matter taken from the teats of a cow that had the Cowpox. In about a week afterwards their arms were very much inflamed, and the patients were so ill that the medical assistance of Mr. Meach, of Cerne, was called for. The patients did well. They were afterwards inoculated for the Smallpox by Mr. Trobridge without effect. (P. 42.)
Dr. Pulteney of Blandford informed Pearson that--
A respectable practitioner inoculated seven children for the Smallpox, five of whom had been purposely infected with the Cowpox by being made to handle the teats and udders of cows under the disease, and in consequence contracted the distemper. These five, after inoculation for the Smallpox, did not sicken, whilst the other two did. (P. 39.)
These cases were examples of many; and if it be asked, why were not such inoculations repeated, we may take an answer from Mr. Fewster, surgeon, of Thornbury, who, in a practice of thirty years in Gloucestershire, inoculated thousands with Smallpox, and had known “numberless instances of Cowpox.” He wrote, 11th October, 1798--
In general, I think, Cowpox is a much more severe disease than the inoculated Smallpox; nor do I see any great advantage from its inoculation. Smallpox inoculation seems to be so well understood that there is very little need of a substitute. It is curious, however, and may lead to other improvements. (P. 104.)
To show still further how Jenner’s communication was “in the air” ready for descent. Mr. Downe, surgeon of Bridport, wrote to Pearson, 1st August, 1798--
A few years ago when I inoculated a great number for the Smallpox, I remarked that I could not by any means infect one or two of them; and, on inquiry, I was informed that they had previously been infected with the Cowpox. I know that a medical man in this part of the country was injured in his practice by a prejudice raised unjustly that he intended to substitute the Cowpox for the Smallpox in inoculation. So great an enemy to improvement are the prejudices of the public in the country, that I think experiments of importance can only be made in hospitals. (P. 10.)
Thus popular scandal anticipated what was called Jenner’s discovery!
Nor was Pearson content simply to inquire of others: he experimented himself, and put Cowpox to the test a week or so before the appearance of Jenner’s Inquiry. He wrote--
Happening, on the 14th of June, to be with Mr. Lucas, apothecary, on professional business at Mr. Willan’s farm, adjoining the New Road, Marylebone, where from 800 to 1000 milch cows are kept, I availed myself of the opportunity to make inquiry concerning the Cowpox. I was told it was a pretty frequent disease among the cows of that farm, especially in winter, and that it was supposed to arise from sudden change from poor to rich food. It was also well known to the servants, some of whom had been affected with the malady from milking the diseased cows. On investigation, I found that three of the men-servants, namely, Thomas Edinburgh, Thomas Grimshaw, and John Clarke had been affected with the Cowpox, but not with the Smallpox. I induced them to be inoculated for the Smallpox, and, with the view of ascertaining the efficacy of the variolous infection employed, William Kent and Thomas East, neither of whom had either the Cowpox or the Smallpox, were also inoculated. (P. 14.)
The result conformed to expectation: Edinburgh, Grimshaw, and Clarke did not take Smallpox, even though inoculation was repeated, whilst Kent and East did. Pearson set forth his experiments much more philosophically than Jenner, but his bias was pronounced, and it blinded him to some obvious considerations; and it is marvellous how easily we may accumulate details for which we have a fancy. Summing up the testimonies he had collected, he held that--
The body of evidence is numerous and respectable, declaring that a person who has laboured under the Cowpox fever and local eruption, is not susceptible of the Smallpox. It does not appear that a single well authenticated contravening instance has fallen under observation. But I do not apprehend that accurate and able reasoners will consider the fact as completely established, though, I doubt not, they will allow that the testimonies now produced greatly confirm the probability, and that the cautious appropriation of it in practice is warrantable. (P. 64.)
In this summary we perceive the limit and imperfection of Pearson’s Inquiry. Smallpox did follow Cowpox: it was well known that it did: and Dr. Ingenhousz ascertained the fact as soon as he looked for it. Moreover Pearson showed himself ignorant of Jenner’s position, who, recognising the fallacy of the rural superstition, was compelled to discriminate Cowpox as genuine and spurious--the genuine being the variety derived from Horsegrease.
Upon Jenner’s assertion that Cowpox was unaltered by transmission from arm to arm, Pearson remarked, “The fact remained to be proved.” That Cowpox produced a harmless ailment was not, he thought, to be hastily assumed. Dr. William Heberden had recently inoculated 800 poor persons at Hungerford without a mishap, and 1700 had passed through Dr. Woodville’s hands in the current year (1798) with only two deaths; yet how erroneous would be to argue that variolous inoculation was harmless from such special experience!
Such instances of success can only be attributed to a certain favourable epidemic state of the human constitution itself, existing at particular times, for the proportion of deaths from inoculation is usually much greater, owing, probably, to certain unfavourable epidemic states. (P. 67.)
If Cowpox remained unchanged in transmission from arm to arm, it would be no harmless ailment; for the evidence was distinct that it was frequently a severe one. For example, Edinburgh told Pearson that when suffering from Cowpox he had to give up work and go into an hospital; and Grimshaw that the disease was uncommonly painful, with swellings in his armpits, sore to the touch; and the servant at Rhodes’s farm in the Hampstead Road, who had seen much Cowpox in Wiltshire and Gloucestershire, said the milkers were sometimes so ill that they had to keep their beds for several days, though none ever died of the Cowpox fever. If, however, by transmission from arm to arm, Cowpox became milder, it was not improbable that at the same time it would lose more or less of its protective efficacy.
Pearson might have seen and added, that resistance to inoculated Smallpox, when the constitution was in no humour for Smallpox, was no proof that the same constitution would resist Smallpox when epidemic, or in condition for the evolution of the disease.
Pearson likewise took objection to Jenner’s evidence (such as it was) that it was possible to take Cowpox after Cowpox, but not Smallpox after Cowpox; saying--
Most of professional men are extremely reluctant in yielding assent to this statement. Some, indeed, reject it in the most unqualified terms. That Cowpox follows Cowpox appears certain, but that Cowpox should avert Smallpox, and not avert itself appears incredible. (P. 44.)
Here we see Pearson on the verge of discovery of the illusion, but with all his training and Yorkshire shrewdness he lost the scent, and allowed himself to be deceived; and not only deceived, but to become a prime mover in the deception of the world. Jenner felt the difficulty and replied--
CHELTENHAM, 27th September, 1798.
MY DEAR SIR,--You may be assured that a person may be repeatedly affected, both locally and generally, by the Cowpox, two instances of which I have adduced, and have many more in my recollection; but, nevertheless, I have some reason to suspect that my discriminations have not been, till lately, sufficiently nice.... Certain it is, that the skin is always subject to the ulcerative effects of the virus; but whether the constitution can repeatedly feel the primary effects of it, I have experiments in view to determine. (P. 99.)
This passage is commended to those who hold with Mr. John Simon that Jenner delivered to the world “a Master-piece of Medical Induction,” the fruit of thirty years of incessant thought, watching and experiment. It is plain that in 1798 the very elements of the problem were by him undetermined, and the most obvious objections unforeseen and unconsidered.
Pearson’s strongest opposition was reserved for the asserted origin of Cowpox in Horsegrease. He said--
It has no better support than the coincidence in some instances of the two diseases in the same farm in which the same servants are employed among the Horses and Cows.
I have found that in many farms the Cowpox breaks out although no new-comer has been introduced to the herd; although the milkers do not come in contact with the Horses; although there are no greased Horses; and even although there are no Horses kept on the farm.
It appears that the Cowpox does not break out under the most favourable circumstances, if it be occasioned by the Grease. “I have had,” writes Sir Isaac Pennington, Cambridge, 14th September, 1798, “Dr. Jenner’s book some weeks, and the particulars stated in it are really astonishing. I have made inquiries upon the subject at Cottenham and Willingham, in which two parishes 3000 milch Cows are kept; also a great many Horses of the rough-legged cart kind (much liable to the scratches or grease) half the parishes being under the plough, and the men much employed in milking. But I cannot find that any pustulous eruptions on the teats of the Cows, or on the hands of the milkers, have ever been heard of.” (P. 82.)
In the opening of his Inquiry, Pearson was good enough to say of Jenner, “I would not pluck a sprig of laurel from the wreath that decorates his brow”; but, disputing the origin of genuine Cowpox in Horsegrease, he might have asked himself, what sprig of laurel he had left. That Cowpox originated in Horsegrease was not Jenner’s discovery. As Pearson ascertained in the London milk farms, “There was such a notion entertained in several parts of the country, whatever might be its foundation.” (P. 86.) But the definition of Horsegrease Cowpox as the form of Cowpox that justified the faith of the country-folk in the power of the disease to avert Smallpox, was Jenner’s solitary distinction--the principle and motive of his Inquiry, which, to prove fallacious, was to extinguish his title to regard. Cowpox apart from Horsegrease was clearly taught by Jenner to have no influence on the constitution, and to be attended with no erysipelas. “Let me call your attention,” he wrote to Pearson, 27th September, 1798, “to a similarity between the Smallpox and the Cowpox when inoculated. The symptoms of absorption first disturb the system, and, secondly, the system feels the consequences of the local sores. Exactly so with the Cowpox; and as the Cowpox inflammation is always of the erysipelatous kind, when it spreads over the skin to any great extent, it produces symptoms not unlike the confluent Smallpox.” (P. 100.)
Pearson foresaw that if the principle of inoculation with Cowpox were established it would lead to other applications--
The Cow Poison appears to alter the human constitution, so as to render it insusceptible of a different morbific poison, namely, the variolous in producing the Smallpox. This fact is, I believe, quite a novelty in physiology and pathology: it indicates a new principle in the mode of prophylactic practice. And we now see a principle upon which diseases from various other morbific poisons may possibly be prevented from taking place, such as the Measles, Ulcerous Sore Throat, Hooping Cough, Syphilis, etc., namely, in consequence of destroying the excitability of the constitution to such poisons by the agency of different, and perhaps less hurtful ones. Whether the Cowpox preserves the constitution from other morbific poisons, besides the variolous, is an undecided question. (P. 79.)
Like Jenner, he also recognised in Cowpox a counter-irritant--a safe sort of fever that might be used to drive off other diseases--
If it be true that the same constitution is liable to undergo repeatedly the Cowpox, to which distemper no one has fallen a victim, practitioners may avail themselves of this means of exciting an innocent fever as a remedy of various disorders; it being a truth, admitted by men of experience, that fevers are occasionally efficacious remedies, especially for inveterate chronic maladies, such as Epilepsy, Hysteria, Insanity, St. Vitus’s Dance, Tetanus, skin deformities and diseases, etc. (P. 81.)
Nor was the notion without warrant, for Smallpox itself was credited with a double action as a generator and exterminator of disease--
A disposition to certain diseases, and even diseases themselves, are not rarely brought on by the Smallpox; but sometimes also dispositions to diseases, and diseases themselves of the most inveterate kind are removed by the Smallpox. (P. 77.)
In one respect, Jenner showed himself superior to Pearson, namely, in offering some explanation of Cowpox. Pearson accepted the disease on the rural terms--as an eruption on Cows attended with no serious illness. If in any way such Pox was equivalent to Smallpox, it was inexplicable that it should be limited to the udder and teats of milch cattle, and that males, and females not in milk, should be exempt from infection. A disease so unique wanted accounting for; but Pearson made no attempt to account for it, nor gave any sign that he apprehended the difficulty. Jenner, on the other hand, accounted for Pox on the Cow by referring it to infection from the Horse conveyed by the milkers, which explanation Pearson rejected. But in giving Jenner credit for so much, let it not be for over much. Whilst he ascribed Cowpox to a credible cause, he did not recognise his advantage and summon gainsayers to explain how Cowpox, as described by them, could exist without Bullpox. On the contrary, as we shall see, Jenner submitted to be silenced on this point for reasons far from creditable.
FOOTNOTE:
[105] An Inquiry concerning the History of the Cowpox, principally with a view to supersede and extinguish the Smallpox. By George Pearson, M.D., F.R.S., Physician to St. George’s Hospital, etc. London, 1798, 8vo., pp. 116.
V. WOODVILLE, PEARSON AND JENNER
Another early and earnest examiner of Jenner’s Inquiry was Dr. William Woodville, physician to the London Smallpox and Inoculation Hospital. He was a Cumberland man, born at Cockermouth, 1752; a member of the Society of Friends. An ardent botanist, he turned two acres of the ground around the Hospital at King’s Cross into a botanic garden, which he maintained at his own expense. He died of a chronic pulmonary complaint in 1805, and in his last illness had himself removed from his house in Ely Place to the Hospital for the sake of the garden and the country air.
Woodville was eager to try cowpox, but Jenner had no supply, nor could any be had elsewhere. He therefore resorted to horsegrease, but could make nothing of it. In his own words--
Conceiving that the distemper might be produced by inoculating the nipples of Cows with the matter of the grease of Horses, I proceeded to try whether the Cowpox could be actually excited in this manner. Numerous experiments were accordingly made upon different Cows with the matter of grease, taken in the various stages of that disease, but without producing the desired effect.
Neither were inoculations with this matter, nor with several other morbid secretions in the Horse, productive of any effects upon the human subject.[106]
Thrice in person did Woodville submit to inoculation with horsegrease, but in vain. Others in London and elsewhere attempted to raise pox on cows in the same way without result save malediction on Jenner for originating such a troublesome quest.
Thus closed 1798 with many anxious to try the new prescription whenever there was a chance. Early in the new year, there was a cry in London, ’Tis found! ’tis found! In Harrison’s dairy, Gray’s Inn Road, close by the Smallpox Hospital, cowpox was discovered, and thither hastened Woodville, Pearson, Sir Joseph Banks, Sir William Watson, Dr. Garthshore, Dr. Willan, and other medical men; and in their presence, on 19th January, Woodville inoculated six patients with the pox.[107] The eruptions on the cows’ teats were diligently compared with the description and plates in Jenner’s Inquiry, and pronounced identical. Four-fifths of the 200 cows in the dairy became affected, those not in milk escaping the disease; likewise some of the milkers, the first being Sarah Rice, who had undergone smallpox in childhood--a proof that smallpox did not prevent cowpox. “At the same time,” wrote Dr. Pearson, “I received the agreeable intelligence that the disease was also raging in the largest stock of cows on the New Road, near Paddington, to which no one could gain admittance but myself.”
With cowpox thus provided in abundance, Pearson and Woodville set to work--Woodville at his Hospital, and Pearson in private practice. Be it observed, however, that this London cowpox was not Jenner’s cowpox. It was not horsegrease cowpox, but the variety stigmatised by Jenner as spurious. How Pearson and Woodville pressed forward with their enterprise appears from the following letter, enclosing cowpox threads, sent by Pearson to two hundred medical practitioners throughout the United Kingdom--
LEICESTER SQUARE, 12th March, 1799.
Sir,--I hope you will pardon me for taking the liberty to inform you (by way of additional evidence to the testimonies I have published on the subject of the Cowpox) that upwards of 160 patients, from two weeks to forty years of age, principally infants, have been inoculated since the 20th January last by Dr. Woodville and myself, separately....
Not one mortal case has occurred.
Not one of the patients has been dangerously ill....
None of the patients, namely above 60, inoculated with the Smallpox, subsequently to the Vaccine Disease, took the infection....
In many of the cases eruptions of the body appeared, some of which could not be distinguished from the Smallpox.
I have sent the matter of Cowpox pustules on the thread enclosed, in order, if you approve of the inquiry, to inoculate with it; and I entreat you to favour me with the result of your trials: but I must trouble you to apply the test of inoculating with variolous matter subsequently to the vaccine disorder.
GEORGE PEARSON, M.D., F.R.S.
P.S.--I am happy to be able to state that at Berkeley, Dr. Jenner has continued his trials of inoculation with vaccine matter sent from London with good success.
Jenner was of an indolent disposition, but the part Pearson was playing stung him to action. His nephew, Rev. G. C. Jenner, wrote to him from London, and thus roused his jealousy--
NORFOLK STREET, 11th March, 1799.
After what Mr. Paytherus has written to you it will be needless for me to say anything to urge the necessity of your coming to town to wear the laurels you have gained, or to prevent their being placed on the brows of another....
Dr. Pearson is going to send circular letters to medical gentlemen to let them know that he will supply them with Cowpox matter upon their application to him, by which means he will be the chief person known in the business, and consequently deprive you of that merit, or at least a great share of it, which is so justly your due. Dr. Pearson gave a public lecture on the Cowpox on Saturday, and adopted your opinions, except with regard to the probability of the disease originating in Horses’ heels.... All your friends agree that now is your time to establish your fame and fortune; but if you delay taking a personal active part any longer, the opportunity will be lost for ever.--Your affectionate nephew, G. C. JENNER.
Jenner at once communicated the alarming intelligence to his friend Gardner with a sly suggestion for counter-action--
BERKELEY, Wednesday.
A letter just received from G. Jenner informs me that Dr. Pearson on Saturday gave a public lecture on the Cowpox, and that it was publicly exhibited at Sir Joseph Banks’s on Sunday evening. He has also given out that he will furnish any gentleman at a distance with the virus.
As this is probably done with the view of showing himself as the first man in the concern, should not some neatly drawn paragraphs appear from time to time in the public prints, by no means reflecting on the conduct of P., but just to keep the idea publicly alive that P. was not the author of the discovery--I mean of Cowpox Inoculation.--Yours truly, E. J.
As human nature exists, it was not extraordinary that Jenner should feel anxious over the occupation of ground he considered his own; but at the same time it is obvious, that Pearson had done nothing wrong, nothing that was not allowable, nothing indeed that was not praiseworthy. He allowed Jenner full credit for having advertised the Gloucestershire faith in cowpox, and for the production of certain evidence for that faith; but he set aside Jenner’s prescription of horsegrease cowpox, and was making use of a form of cowpox that Jenner had explicitly condemned. Whilst Jenner, too, had excited curiosity, he did nothing, or could do nothing, to satisfy it; and it was idle to expect the world to await his convenience: nor was Pearson the man to rest content where action was possible. As he said--
From the time of the publication of the Inquiry in June, 1798, the author contributed no further inoculated cases to the end of that year; nor could I do more than investigate the history of the Cowpox principally by inquiries among provincial physicians and farmers, from whom I was enabled to confirm some of the facts in Dr. Jenner’s book, and to render doubtful or disprove others, and to bring to light new observations.[108]
Jenner was not slow to respond to his nephew’s summons to London. He left Berkeley on the 21st of March, and remained in town until the 11th of June, visiting medical men, asserting his own claims, and counter-acting the operations of Pearson and Woodville.
In Dr. Pearson’s circular, it will be observed, that he described inoculation with cowpox as attended with eruptions in some cases, which could not be distinguished from smallpox. So far as Pearson and Woodville were concerned, it was an unfortunate statement, and gave Jenner an advantage over them which he used unsparingly to their discredit.
Jenner’s claim for inoculation with cowpox was, that it excited a fever that was not infectious and was without pustular eruptions; and here was Dr. Pearson setting up as his critic, and Dr. Woodville assuming to develop his practice, and producing a disorder that was indistinguishable from smallpox! Such presumption and ignorance deserved to be hooted.
What was the explanation? Simply this: that Woodville conducted some of his cowpox inoculations in the variolous atmosphere of his Hospital, and that he thereby communicated smallpox and cowpox simultaneously. In a scientific sense, the experience was valuable; it proved that it was possible to have cowpox and smallpox at the same time--that neither disease superseded or nullified the other.
Woodville tried to vindicate himself, and in his failure magnified Jenner’s triumph still further. Yet he had much that was reasonable to say for himself. For example, he had transmitted to Jenner some of the virus from one of the first of his cowpox inoculations in January, and with it Jenner operated on twenty persons, reporting to Woodville--
BERKELEY, February, 1799.
The rise, progress, and termination of the pustules created by the virus were exactly that of the true Cowpox.
Nevertheless, wrote Woodville--
This virus which Dr. Jenner declared to be perfectly pure and genuine was taken from the arm of an hospital patient who had 310 pustules, all of which suppurated.
Woodville also argued, that “Cowpox, as casually produced by milking infected cows, differs considerably from that which is the effect of inoculation”; which Jenner attested in saying--
Four or five servants were inoculated at a farm contiguous to Berkeley last summer with matter just taken from an infected Cow. A little inflammation appeared on all their arms, but died away without producing a pustule; yet all these servants caught the disease within a month afterwards from milking the infected Cows, and some of them had it severely.[109]
Others maintained that the cowpox which saved milkmaids from smallpox was a much severer affection than that induced by Jenner’s lancet, and that it was folly to assume their equivalence. There was force in the argument; for every one then knew how much the issue of smallpox inoculation depended on the mode of its performance. The infection when communicated through the skin was usually much less severe than when communicated by incision; and Jenner related how a country inoculator, who liked to “cut deep enough to see a bit of fat,” was the death of his patients on every side. The human body is of infinite delicacy and complexity, and we are sure to find ourselves at fault when we deal with its mysteries according to our crude and inanimate logic. It is by experiment and not by syllogism that physiological truth is verified.
Whatever might be the perils, immediate or remote, of inoculation with cowpox, it was not attended with smallpox eruption; and at last it became manifest to Woodville himself, that the virus he had used, and the virus he had distributed, which had produced such eruption, was the virus of smallpox.
After much controversy and many experiments these conclusions were arrived at--
1. That when a person was inoculated with smallpox and cowpox about the same time, both inoculations proved effective. There was a pustular eruption on the skin from the smallpox, and the cowpox vesicle reached maturity in the usual number of days.
2. These effects took place, without much variation, in all cases where the interval between the two inoculations did not exceed a week; but--
3. When the smallpox matter was inserted on the ninth day after the inoculation with cowpox, its action seemed to be wholly precluded.[110]
That is to say, for a time--until the influence of the vaccine fever had worn off. Some fancied that smallpox when inoculated with cowpox generated a hybrid pox that was more efficacious than either. There was occasionally some interaction of the diseases, as of a subdued activity in each, but generally they proceeded together unaffected, the cowpox maintaining its characteristics in the midst of a crop of smallpox.
One point of great significance in Woodville’s experience was overlooked. He inoculated with cowpox in the Smallpox Hospital, and some of his patients there contracted smallpox, who certainly were not inoculated with smallpox, either accidentally or by design. The lesson of this experience was unperceived, and though it has been repeated again and again, is rarely acknowledged. Vaccination in presence of smallpox, or in an epidemic of smallpox, is often a means of inducing the disease it is intended to prevent. It lights the fire; and when the fire is lighted, it is said, “Ah! it must have been a-light before.” When we have a mind for an excuse, our sophistry is usually equal to the requisition.
The New Inoculation, as it was called, grew in favour daily. Woodville and Pearson did the real work of publicity and promotion--Pearson especially. Within seven months, January to August, 1799, they performed 2000 inoculations. In the Philosophical Journal, August, 1799, Pearson observed--
In Scotland the New Inoculation has not been less successful. Dr. Anderson, of Leith, informs me that he has inoculated above 80 persons; that Dr. Duncan has begun the practice in Edinburgh and that it has been introduced in Dundee, Paisley, and Dalkeith.
Nor did Pearson limit his efforts to his native land. He wrote--
In the course of the same year, 1799, I extended the dissemination of the vaccine matter to Germany, for the Princess Louisa at Berlin, to Hanover, Vienna, Geneva, Lisbon, Paris, and Boston, and into the British Army through Mr. Keats.
Jenner regarded much of this activity with a jealous eye: it did not sufficiently make for his glory. He was anxious, fretful, helpless. “It is impossible for me, single-handed, to combat all my adversaries,” was his whine. “I am beset on all sides with snarling fellows, and so ignorant withal that they know no more of the disease they write about than the animals which generate it.” In order to keep his name to the fore, he published a second pamphlet in the spring of 1799, in which are several details of biographical interest.
FOOTNOTES:
[106] Reports of a Series of Inoculations for the Variolæ Vaccinæ or Cowpox. London, 1799.
[107] J. C. Wachsel in London Medical Repository, 1819, p. 257.
[108] Examination of Report of Committee of House of Commons, 1802.
[109] Further Observations on the Variolæ Vaccinæ, 1799.
[110] On Vaccine Inoculation. By Robert Willan, M.D. London, 1806.
VI. JENNER’S FURTHER OBSERVATIONS.[111]
This pamphlet appears to have been produced with many pains and extraordinary apprehensions. Jenner wrote to Gardner, 7th March, 1799--
Every sentence must be again revised and weighed in the nicest balance that human intellect can invent. The eyes of the philosophic and medical critic, prejudiced most bitterly against the hypothesis, will penetrate its inmost recesses, and discover the minutest flaw were it suffered to be present. Language I put out of the question: it is the matter I refer to.[112]
These words betray excitement for which there was no warrant; and when we turn to the treatise that was to be weighed sentence by sentence in the nicest of balances, it is clearly seen that its author was a weak-minded creature. It is little more than a gossip about Cowpox without advance upon the statements of the Inquiry. Indeed, he sets out with the admission--
Although it has not been in my power to extend the Inquiry into the causes and effects of the Variolæ Vaccinæ much beyond its original limits, yet, perceiving that it is beginning to excite a general spirit of investigation, I think it is of importance, without delay, to communicate such facts as have since occurred, and to point out the fallacious sources from whence a disease resembling the true Variolæ Vaccinæ might arise, with the view of preventing those who may inoculate from producing a spurious disease; and further, to enforce the precaution suggested in the former Treatise on the subject, of subduing the inoculated pustule as soon as it has sufficiently produced its influence on the constitution. (P. 69.)
Sometimes when it is objected that the evidence adduced in the Inquiry was hastily collected, meagre and inconclusive, it is replied, “Yes, but recollect, it was merely a selection, if a poor one, from the author’s stores”--a reply which Jenner thus renders nugatory in recording--
My late publication contains a relation of most of the facts which had come under my own inspection at the time it was written, interspersed with some conjectural observations--(P. 70)--
Which is exactly what any perspicacious reader would infer from the cases adduced in the Inquiry. They were Jenner’s best and his all. Meanwhile, as observed, he had been able to do little in extension of the Inquiry; but if idle and helpless, Dr. Pearson had been active--
Since then Dr. George Pearson has established an inquiry into the validity of my principal assertion, the result of which cannot but be highly flattering to my feelings. It contains [Pearson’s Inquiry] not a single case which I think can be called an exception to the fact I was so firmly impressed with--that the Cowpox protects the human body from the Smallpox. (P. 70.)
Here we have a distinct mis-statement. It was not Jenner’s “fact” that Cowpox protected the human body from Smallpox--that was a widespread superstition. His contribution to the question was a definition of the Cowpox effective against Smallpox, namely Horsegrease Cowpox, other Cowpox being adjudged spurious. Pearson so far from confirming Jenner’s position, deliberately set it aside. He not only accepted the rural faith in Cowpox (which Jenner knew to be unwarrantable), but, when he proceeded to practice, made use of Cowpox which owed nothing to Horsegrease. If therefore Pearson’s procedure was “highly flattering” to Jenner’s feelings, he was either easily pleased, or an adept in dissimulation.
The truth is, the publication of Further Observations was designed by Jenner to loosen himself from what was definite in the Inquiry, so that he might be able to appropriate whatever might result from the investigations and experiments then going on. He had defined prophylactic Cowpox as Horsegrease Cowpox, but Horsegrease did not meet with favour, nor appear likely to answer; and it might be expedient to drop it; and thus he described the ground of his attachment to that form of specific--
Firstly.--I conceived that Horsegrease was the source of Cowpox from observing that where the Cowpox had appeared among the dairies here [Berkeley] (unless it could be traced to the introduction of an infected cow or servant) it had been preceded at the farm by a Horse diseased in the manner described, which Horse had been attended by some of the milkers.
Secondly.--From its being a popular opinion throughout this great dairy country, and from its being insisted on by those who here attend sick cattle.
Thirdly.--From the total absence of the disease in those countries where the men servants are not employed in the dairies.
Fourthly.--From having observed that morbid matter generated by the Horse frequently communicates, in a casual way, a disease to the human subject so like the Cowpox, that in many cases it would be difficult to make the distinction between one and the other.
Fifthly.--From being induced to suppose from experiments, that some of those who had been thus affected from the Horse resisted the Smallpox.
Sixthly.--From the progress and general appearance of the pustule on the arm of the boy whom I inoculated with matter taken from the hand of a man infected by a Horse; and from the similarity to the Cowpox of the general constitutional symptoms which followed. (P. 91.)
The boy inoculated with secondary Horsegrease was Baker, Case xviii. of the Inquiry. He died of fever in the parish workhouse before he could be subjected to the variolous test.
Jenner’s drift in the foregoing propositions was obviously to lighten his responsibility for the advocacy of Horsegrease as the origin of Cowpox; but in doing so he deprived himself of any vestige of claim as a discoverer. Cowpox and Horsegrease as preventives of Smallpox were in common repute; but their combination as Horsegrease Cowpox was supposed by some to be Jenner’s peculiar specific. “Not so,” he said. “It is the popular opinion throughout the country that Cowpox is begotten of Horsegrease;” and proceeded to justify his prescription by the popular authority. He produced a letter from Parson Moore of Chalford Hill to prove how in November, 1797, his Horse had the Grease, with which his boy-servant infected the Cow, which in turn infected the lad with Cowpox, although eighteen months before he had been inoculated, and severely too, with Smallpox; the parson adding--
I am firmly of opinion that the disease in the heels of the Horse, which was a virulent Grease, was the origin of the Servant’s and the Cow’s malady. (P. 94.)
To the objection that attempts to raise Cowpox from Horsegrease had, so far, proved failures, Jenner replied--
The experiments published by Mr. Simmons of Manchester and others on the subject, with the view of refuting the origin of Cowpox in Horsegrease, appear to have but little weight, as even the Cowpock Virus itself, when repeatedly introduced into the sound nipples of Cows by means of a lancet, was found to produce no effect. (P. 93.)
Having reached this point, I would beg the reader to pause and ask, What was Jenner’s discovery? It was not Cowpox; it was not Horsegrease; it was not Horsegrease Cowpox; all of which by his own admission were recognised by those familiar with them as preventives of Smallpox. What was it then?
Nothing is more conspicuous in the Further Observations than the condition of ignorance and imbecility they reveal. As we have seen, critics of the order of Mr. John Simon represent Jenner’s Inquiry as a Masterpiece of Medical Induction, the fruit of thirty years of incessant thought, observation and experiment; whilst the patience, the caution, and the modesty of the author are commended for imitation. Those who have been subjected to Mr. Simon’s homily cannot but suffer disenchantment when they come face to face with the facts. Not after his thirty years of asserted research could Jenner answer the simple question, What is Cowpox? Incredible as it may appear, the following was his deliverance in presence of the doubts excited by the discussion of his original communication--
To what length pustulous diseases of the udder and nipples of the Cow may extend, it is not in my power to determine; but certain it is, that these parts of the animal are subject to some variety of maladies of this nature; and as many of these eruptions (probably all of them) are capable of giving a disease to the human body, would it not be discreet for those engaged in this investigation to suspend controversy and cavil until they can ascertain with precision what is and what is not the genuine Cowpox? Until experience has determined which is the true Cowpock, and which is spurious, we view our object through a mist. (P. 73.)
Consider this declaration after thirty years of incessant thought, observation and experiment! The Masterpiece of Medical Induction with the essential fact undetermined! The discovery undiscovered! And the reputed discoverer sitting ready to appropriate any praise or profit from the execution by others of his proper business! Was there ever such an exhibition of self-satisfied futility?
Among the gossip adduced to show that the country folk called eruptions Cowpox that were not Cowpox, we learn that the affection induced by Horsegrease was thus designated--
From the similarity of symptoms, both constitutional and local, between the Cowpox and the disease received from the morbid matter generated by a Horse, the common people in this neighbourhood, by a strange perversion of terms, frequently call it the Cowpox. (P. 95.)
Wherefore, he argued, many thus affected may fancy themselves secure from Smallpox, supposing they have suffered Cowpox, when they have undergone nothing but Horsegrease; and in the event of incurring Smallpox, would bring discredit on the virtue of true Cowpox. How easy it was to confound the two diseases, he illustrated from the case of William Morris, a servant, aged 32, who applied to him on 2nd April, 1798--
His symptoms and the sores on his hands were so exactly like the Cowpox, that I pronounced he had taken the distemper from milking Cows. He assured me he had not milked a Cow for more than half a year, and that his master’s Cows had nothing the matter with them. I then asked him if his master had a Greasy Horse, which he answered in the affirmative; and further said, that he had constantly dressed him twice a day for the last three weeks or more, and remarked that the smell of his hands was much like that of the Horse’s heels. (P. 97.)
Thus Horsegrease sores so simulated those of Cowpox, or of Horsegrease Cowpox, as to be indistinguishable from them. At this time it was Jenner’s opinion that Horsegrease, per se, afforded no protection from Smallpox: it had to pass through the Cow to acquire its sovereign efficacy. The opinion is noteworthy in view of its absolute surrender at a later period, when the virus from the Horse’s heel came to be described by him as “the true and genuine life preserving fluid,” and was used by him for inoculation without any reference to the Cow.
One of the aims of Further Observations was “to enforce the precaution of subduing the inoculated pustule as soon as it had sufficiently produced its effect on the constitution.” True Cowpox, according to Jenner, was a serious affection. “The sores ate into the flesh.” (P. 77.) They were capable of producing violent effects. They were attended with erysipelas. “They closely resembled Smallpox of the confluent sort.” (P. 111.) To prolong such suffering he considered useless, for the virus conferred its protective influence on the constitution as soon as received--
The symptoms which (as in the accidental Cowpox) affect the patient with severity, are entirely secondary, excited by the irritating processes of inflammation and ulceration; and it appears to me this singular virus possesses an irritating quality of a peculiar kind; but as a single Cowpox pustule is all that is necessary to render the variolous virus ineffectual, and as we possess the means of allaying the irritation, should any arise, it becomes of little or no consequence. (P. 110.)
The means for allaying the irritation were mercurial ointment, acetate of lead, caustic potash, or any suitable escharotic--
After the pustule has duly exerted its influence, I should prefer the destroying it quickly and effectually to any other mode. The term caustic to a tender ear (and I conceive none will feel more interested in this Inquiry than the anxious guardians of a nursery) may sound harsh and unpleasing, but every solicitude that may arise on this account will no longer exist when it is understood that the pustule in a state fit to be acted upon is then quite superficial, and that it does not occupy the space of a silver penny. (P. 104.)
I would not, however, recommend any application to subdue the action of the pustule until convincing proofs had appeared of the patient having felt its effects for at least twelve hours. No harm indeed could ensue were a longer period to elapse before the application was made use of. In short, the pustule should be suffered to have as full an effect as it could, consistently with the state of the arm. (P. 109.)
Horsegrease annoyed Pearson--it was like to damn the whole thing; and this treatment of the Cowpox pustule was scarcely less objectionable to him and to Woodville.[113] It gave the public, they thought, a sense of the virulence of Cowpox that was wholly unwarrantable; and they did not stay to consider whether what Jenner called Cowpox in Gloucestershire and what they called Cowpox in London were the same virus. Jenner’s virus was Horsegrease Cowpox; Pearson and Woodville’s was Cowpox; and such being the case, the diversity of symptoms might have been accounted for. Anyhow, the difference between Jenner and Pearson and Woodville, as to a detail so elementary, shows in what an unfinished condition the Cowpox prescription was shot upon the world, and affords a curious commentary on the Masterpiece of Medical Induction, the fruit of thirty years of incessant thought, observation and experiment. At the same time we have to do Jenner the justice of allowing that at this date, 1799, he made no pretence to a finished Masterpiece, but ingenuously ascribed the prevalent uncertainty to “the present early stage of the Cowpox Inquiry; for early,” he wrote, “it must be deemed.” (P. 115.) Early it was: not a point firmly determined: the reverse of what might have been expected after thirty years of incessant thought, observation and experiment.
FOOTNOTES:
[111] Further Observations on the Variolæ Vaccinæ. By Edward Jenner, M.D., F.R.S. London, 1799. 4to pp. 73. Reprinted with the third edition of the Inquiry in 1801, to which edition my references apply.
[112] Baron’s Life of Jenner, vol. i. p. 322.
[113] Baron’s Life of Jenner, vol. i. p. 315.