XXVII. THE MEDICAL POSITION IN 1823…

XXVII. THE MEDICAL POSITION IN 1823

When Jenner died in 1823, the judgment of the majority of the people was pronounced against cowpox inoculation; but medical men, who are expected to know something, and do something, against every ailment, rarely surrender a prescription until it can be replaced by another. The doctors therefore held by vaccination, but on modified terms; and the position to which they had been reduced is set forth in an article in the Edinburgh Review, for November, 1822, concerning which Jenner wrote to Gardner, 13th January, 1823, a week before his death--

I have an attack from a quarter I did not expect, the Edinburgh Review. These people understand literature better than physic. It will do incalculable mischief. I put it down at 100,000 deaths at least. Never was I involved in so many perplexities.

What an extraordinary article! working mischief incalculable, and bad for at least one hundred thousand deaths! A criticism in the Quarterly is said to have killed Keats, upon which Byron remarked--

’Twas strange the mind, that very fiery particle, Should let itself be snuffed out by an article.

If, however, Jenner was right, it will be allowed, I think, that the murder of a poet was exceeded in atrocity by the slaughter of at least one hundred thousand ordinary mortals. Wherefore, to discover the manner of the great iniquity, I looked up the Edinburgh Review and discovered the diabolical article. It is entitled “Vaccination and Smallpox”; is obviously written by the editor, Jeffrey; and the rock of offence was at once apparent. Doubt is thrown on the efficacy of vaccination to prevent smallpox; ergo, vaccination thus discredited will be neglected; ergo, vaccination thus neglected will enlarge the domain of smallpox; ergo, at least one hundred thousand persons will perish. Q.E.D. But it will be asked, “What did Jeffrey say?” The article thus opens--

Vaccination, we are perfectly persuaded, is a very great blessing to mankind; but not quite so great a blessing, nor so complete a protection, as its early defenders conceived it to be. The proof of this has been admitted with great reluctance; but it has unfortunately become too strong for denial or resistance. The first answers given to the instances of failure, with which the friends of Vaccination were pressed, were, either that the disease which had occurred after Vaccination was Chickenpox, and not Smallpox; or that the process of Vaccination had been unskilfully or imperfectly conducted; or that it was one of those very rare cases which occurred in the times of Inoculation, and from which Vaccination itself did not pretend to be wholly exempt.

The Report of the Vaccine Pock Institution for 1803 is cited, as follows, to show how absolute was the confidence in vaccination in the days of inexperience--

We have been alarmed two or three times with intelligence of Smallpox occurring several weeks or months after our patients had undergone the Cowpox. We thought it our duty to visit and examine these patients, and also to inquire into their history among their attendants, and by these means we obtained the completest satisfaction that the pretended Smallpox was generally the Chickenpox.

As time went on, cases of smallpox after vaccination kept multiplying, and the various excuses to account for their occurrence, though obstinately asserted, utterly broke down. There remained no doubt whatever that to be vaccinated in the most approved fashion afforded no guarantee against smallpox. In 1820, said Jeffrey, the Board of the National Vaccine Establishment was compelled to make the following melancholy admission--

It is true that we have received accounts from different parts of the country of numerous cases of Smallpox having occurred after Vaccination; and we cannot doubt that the prejudices of the people against this preventive expedient are assignable (and not altogether unreasonably perhaps) to this cause. These cases the Board has been industriously employed in investigating; and though it appears that many of them rest only on hearsay evidence, and that others seem to have undergone the Vaccine Process imperfectly some years since when it was less well understood, and practised less skilfully than it ought to be; yet, after every reasonable deduction, we are compelled to allow that too many still remain on undeniable proof, to leave any doubt that the pretensions of Vaccination to the merit of a perfect and exclusive security in all cases against Smallpox, were admitted at first too unreservedly.

The significance of a confession like the foregoing is not to be estimated literally. It was exacted under irresistible pressure of facts, numerous, definite and undeniable, after every method of excuse and prevarication had been exhausted. In short, it was an authoritative retractation of the flaming medical testimony with which vaccination had been commended to the public in 1800, when the heads of the profession thought it their duty to declare in the newspapers--

That those persons who have had the Cowpox are perfectly secure from the future infection of the Smallpox.

And of Jenner’s emphatic assurance--

That the human frame, when once it has felt the influence of the genuine Cowpox is never afterwards, at any period of its existence, assailable by the Smallpox.

The occasion of Jeffrey’s article was the publication by Dr. John Thomson of a treatise on a violent epidemic in Edinburgh, and other parts of Scotland, in 1818-19.[224] The disease differed from ordinary smallpox in respect of the smallness of the pustules, which contained a milky fluid, and began to dry up on the fourth or fifth day. In Thomson’s words--

The epidemic appeared to exhibit all the varieties of Smallpox from the mildest to the most malignant; and it was curious to observe that the mildest forms, as well as the most malignant, were strictly vesicular eruptions, in which scarcely a trace of purulent matter was to be seen from their commencement to their termination.

Whether this epidemic was smallpox or chickenpox, was the question. It was chickenpox said some. It was modified smallpox said others. It probably was chickenpox said Thomson; and if so, he argued, chickenpox should be accounted a variety of smallpox. The chief cause of uncertainty was, that the vaccinated constituted the majority of sufferers--

Had the unvaccinated alone been attacked [wrote Thomson], nothing, it appears to me, but the most unreasonable scepticism could ever have suggested a doubt of the disease being genuine Smallpox.

Thomson reported 556 cases in Edinburgh of which--

310 had been Vaccinated; 41 had had Smallpox; and 205 had neither been Vaccinated nor had Smallpox.

And William Gibson, surgeon at Robert Owen’s mills, New Lanark, had 322 cases, of which--

251 had been Vaccinated. 11 had had Smallpox, spontaneous or inoculated. 57 had neither been Vaccinated nor had Smallpox. 3 had had Smallpox and Cowpox simultaneously.

As is usual in epidemics of smallpox, it was the young who were the majority of sufferers; Thomson saying--

The epidemic has been observed to attack those chiefly who were under ten years of age; increasing years appearing in general to lessen the susceptibility to Smallpox contagion.

Thomson supported his opinion that chickenpox and smallpox were interchangeable varieties of variola with much cogent evidence and argument. He cited instances in which they occurred together, one constitution bringing forth chickenpox where another brought forth smallpox, whilst the infection of one appeared at times in the manifestation of the other. The controversy is not one on which it is necessary to pronounce judgment beyond saying that the whole drift of philosophic pathology is now in Thomson’s favour; and indeed at the time he wrote, his position would not have been seriously contested, save for the discredit it accumulated upon vaccination. One of Thomson’s correspondents, P. Mudie, M.D., of St. Andrews, stated the difficulty with artless force. He wrote, 18th October, 1818--

Of late years I have remarked, that the disease called Chickenpox has been much more severe than formerly; and many of the cases occurring after Vaccination, so much resembled Smallpox, that if my mind had not been prejudiced against the possibility of such an occurrence, I should have pronounced the eruption to have been of a variolous nature.

Notwithstanding his experience, Thomson held firmly by vaccination. Whilst compelled to admit that it did not avert either form of variola, he maintained with curious fervour that it made the disease milder, as if to excuse his partial surrender of faith. We all see more or less according to our prepossessions, and we need not blame Thomson if with his perspicacity he was unequal to the entire truth. The vaccinated belonged to classes who were better housed, better fed, and better cared for than the unvaccinated; and if their ailment had been measles or pneumonia in place of chickenpox, they would have all the same made better recoveries. Precisely the same error is made at this day: what is due to kindlier conditions of life is ascribed to vaccination.

Some tried to account for the manifest failure of vaccination on the supposition that the original virus had lost its force in transmission from arm to arm, but Thomson would not allow that it had deteriorated. He said--

The Vaccine Virus used in Edinburgh for a series of eighteen years produces exactly the same appearances as are delineated by Dr. Jenner as characteristic of Cowpox. I know, also, that the appearances of the vaccine vesicle produced by this matter, which must have passed through a succession of at least 900 individuals, agree exactly with those exhibited by vesicles produced by inoculation, with the more recent equine matter with which I have been, lately favoured by Dr. Jenner.

The latter words are noteworthy. When Jenner’s ascription of the origin of Cowpox in Horsegrease is referred to, the answer frequently is, that Jenner was mistaken, and that he did not persist in his opinion. It is true that he did preserve a judicious silence about horsegrease when he saw that it would mar rather than make his fortune. But when he obtained all he was likely to get, he resumed the expression of his original opinion, and used and diffused what he described as horsegrease; and the vesicles raised by the virus, and the cicatrices which remained were identical with those induced by so-called Cowpox.

Another point developed in Thomson’s evidence was the mistake made crediting vaccination with the prevention of smallpox where there was no smallpox to prevent. The victories ascribed to vaccination were victories either over an imaginary or a retreating enemy. We cannot too firmly insist upon this point in presence of the claim continually advanced for the subjugation of smallpox by vaccination. For some cause undefined, and, probably in its full extent, undiscoverable, a subsidence of smallpox over the whole of Europe set in toward the close of last century, and continued during the early years of the present; and to this subsidence the favour that vaccination met with was largely due. The decline in the disease concurrently with the introduction of vaccination, was ascribed to vaccination, although the decline prevailed among an overwhelming majority who had never received vaccination. To make good the claim for vaccination it would have been necessary to maintain that the vaccine rite, as applied to 2 or 3 per cent. of Europeans, effected the salvation of 98 or 97 per cent. For example, a great point was made by Jenner and his friends of the extinction of smallpox in Vienna, according to the following table--

TOTAL FROM YEARS. DEATHS. SMALLPOX. 1791-1800 average 14,600 835 or one in 17½ 1801 15,181 164 93 1802 14,522 61 238 1803 14,383 27 582 1804 14,035 2 7,017

Yet it was never pretended that in these years more than a fraction of the Viennese were vaccinated, or that the death-rate of the city was reduced by the disappearance of smallpox. The like fatuity characterised the whole of the vaccinators’ statistics. Smallpox had declined, therefore, they argued, vaccination is the cause of the decline, and multitudes were convinced by the illicit logic. When vaccination was, however, brought to the test of epidemic smallpox, its inefficacy became manifest, and thus Thomson had to avow, as the result of his experience in the Edinburgh epidemic of 1818-19--

It is to the severity of this epidemic, I am convinced, that we ought to attribute the greatness of the number of the vaccinated who have been attacked by it, and not to any deterioration in the qualities of the Cowpox Virus, or to any defects in the manner in which it has been employed. Had a variolous constitution of the atmosphere, similar to that which we have lately experienced, existed at the time Dr. Jenner brought forward his discovery, it may be doubted whether it ever could have obtained the confidence of the public.

Such was the article which Jenner “put down for 100,000 deaths at least.” Yet neither Jeffrey nor Thomson renounced vaccination. They agreed that whilst it could no longer be trusted to prevent smallpox, it made the disease milder in those it attacked. When a cherished belief is surrendered, it is rarely unconditionally: it is only by degrees that full concession is made unto truth.

FOOTNOTE:

[224] An Account of the Varioloid Epidemic which has lately prevailed in Edinburgh and other Parts of Scotland; with Observations on the Identity of Chickenpox with Modified Smallpox. By John Thomson, M.D. London, 1820. Pp. 400.

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XXVIII. INTRODUCTION OF VACCINATION TO THE UNITED STATES

Leaving England for awhile, let us see how it fared with vaccination in some other countries.

As before observed, the introduction of vaccination to practice is sometimes described, as having been a labour of difficulty, a strife with prejudice, a victory of light over darkness; but there was nothing in reality answering to such magniloquence. The battle was won for vaccination by variolation, for which it was exhibited as a harmless and more efficient substitute. Unless the entrance of vaccination into the place of variolation be recognised, its quick and easy triumph is inexplicable. A novelty that King George and Queen Charlotte, the Prince of Wales, and the Royal Dukes accepted without hesitation or reserve, could not in the nature of things have required the exercise of much intelligence. Any serious resistance proceeded from the variolators, who considered their craft in danger when parsons, women, and tradesmen were approved of as vaccinators by Jenner himself. Such opposition to vaccination as is common at this day was not possible in the early years of the present century. We know that health is the best defence of health, and that illness is proof of ill-living; but, to our forefathers, illness was a mysterious dispensation to be encountered with submission, relieved by prescriptions, magical and natural. Hence not only dull Royalty was involved in the cowpox craze, but men of science like Davy, Wollaston, and Darwin, with the whole troop of men of letters, of whom Sir Walter Scott may be taken for spokesman. Describing Queen Caroline in “The Heart of Midlothian,” he says--

The lady had remarkably good features, though somewhat injured by Smallpox, that venomous scourge, which each village Æsculapius (thanks to Jenner) can now tame as easily as his tutelary deity tamed the Python.

For credulity thus expressed there was large excuse. What else, indeed, could one in Scott’s position have been expected to believe? It was only through the hard disenchantment of experience that vaccination did not prevent smallpox, nor mitigate its severity, nor was in itself harmless, that the early delirium abated, and a less rabid persuasion supervened.

The wave of conviction spread from England over the world, and nowhere was the substitution of vaccination for variolation welcomed more enthusiastically than in New England. As Boston led the way in 1721 in the practice of smallpox inoculation, so from Boston in 1800 was announced the project for the extermination of smallpox by cowpox. But ere advancing farther, it may be well to say a word about Boston smallpox.

Boston was an extremely unhealthy town. For fifty years, from 1701 to 1750, the births were exceeded by the deaths. In a population of about 15,000, the annual death rate ranged from 30 to 70 per thousand. There were epidemics of fever and of smallpox; the latter occurring in general at intervals of ten years, when large numbers died, the smallpox as usual displacing other forms of fever, but nevertheless raising the mortality of the year. The most deadly outbreak of smallpox was that of 1721, the year in which Cotton Mather and Zabdiel Boylston introduced variolation. The mortality of that year was 1102, of which 884 were ascribed to smallpox. In 1752 there was an extraordinary epidemic, but how much of its prevalence was due to circumstance and how much to contrivance, it is impossible to divine. Here are the figures, which are of singular interest--

BOSTON in 1752. Population 15,684.

Died in Had Died. Were consequence of Smallpox. Variolated. Variolation. Whites, 5060 470 1985 24 Blacks, 485 69 139 6 ---- --- ---- -- Total, 5545 539 2124 30

Fled from Had neither Had Smallpox Boston for Smallpox by either by safety. nature or art. nature or art. 1843 174 5998

Under these heads the entire population of 15,684 was accounted for, with the important exception of the discrimination of the 5998, whose immunity was presupposed, into subjects of induced and spontaneous smallpox. The deaths, 569, were less numerous than in 1721, when 884 died, but the disease was more widely diffused, upwards of one-third of the inhabitants, 5545, being attacked. The epidemic exhausted itself within four months, the record standing thus--

January, died, 1 February, ” 2 March, ” 2 April, ” 119 May, ” 205 June, died, 203 July, ” 31 August, ” 5 September, ” 1 --- 569

The diffusion of the epidemic was largely due to the extensive variolation that went on, no fewer than 2124 having been inoculated in the panic, and they moving freely about in the assurance of safety, spread the distemper on every side. For every five who had the smallpox, so to say, naturally, two had it artificially, and the one sort was almost as “catching” as the other. It was an instance of a community (excepting the 1843 who fled) rushing into smallpox to escape from smallpox. The deaths of 24 Whites and 6 Blacks from variolation gave rise to much concern, and by some they were spoken of as so many murders. Against this fatality was, however, set the low death rate of the regular sufferers, 539 out of 5545, or less than 1 in 10. The Rev. T. Prince, who communicated an account of the epidemic to the Gentleman’s Magazine for 1753, p. 413, was puzzled to account for the variation from the London standard--

Dr. Jurin computes that there generally die in London in the natural way 2 in 11 or 18 in the 100; but in Boston we see that not more than 1 in 10 died; whilst in the inoculated way the deaths were more numerous than is commonly allowed. What were the natural causes, under their Divine Director, of Smallpox in the natural way being less mortal in Boston than in London, and more mortal in Boston than in London in the inoculated way, may be worthy of our humble inquiries.

The difference was broader than Prince perceived. An outbreak of smallpox in which a third of the population was affected never occurred in London, and a mortality proportionate with that of Boston among a third of the Londoners would have appeared like a recurrence of the Plague. I am in nowise concerned to minimise the ravages of smallpox when conditions are prepared, as of design, for its development; but I do insist on their accurate definition. Boston suffered severely, but was by no means “decimated”--the invariable rhetorical phrase. The deaths were at the rate of 1 in 27, and, as observed, smallpox replaced other forms of fever. The 539 deaths from smallpox were not extra deaths; the excess was less than half that number, and might fairly be attributed to the extraordinary energy displayed in propagating the disease by inoculation.

Spite of such adverse experience, variolation continued to be a common, though intermittent, practice in America, and especially in New England, where the habit of doctoring for the cure of present ailments, and the prevention of anticipated ones, was established and inveterate. In Boston the practice became systematised, and the inoculated were confined for three weeks to an hospital situated on a promontory in the Charles River, where they were treated as veritable centres of infection--a course widely different from that pursued in the epidemic of 1752. Nevertheless, it is not to be supposed that smallpox was ever endemic in New England as it was in London. Dr. Waterhouse writing in 1787 observed--

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.

The disease broke out now and then, and was always traced to some wayfarer, or ship, or parcel of goods--never to bad drainage, or no drainage, or the stenches that pervaded the domestic interiors of last century, whether in America or Europe. In this matter, the exercise of a little imagination is requisite to realise the historic facts: they are disagreeable; but if people will insist on comparing the smallpox of the 18th century with that of the 19th, it may become necessary to be explicit as to certain domestic details concerning which there is a conventional reserve.

It was by Dr. Benjamin Waterhouse, Professor of the Theory and Practice of Physic in the University of Cambridge, Massachusetts, that vaccination was introduced to America. He described the new rite in the Columbian Centinel of 12th March, 1799, as “Something Curious in the Medical Line”; and formally promulgated the novelty a year afterwards in a pamphlet thus entitled--

A Prospect of Exterminating the Smallpox; being the History of the Variolæ Vaccinæ, or Kine-Pox, commonly called the Cowpox, as it has appeared in England: with an Account of a Series of Inoculations performed for the Kine-Pox in Massachusetts. Printed for the Author at the Cambridge Press by William Hilliard and sold by him and other Booksellers in Boston. 1800.

Kine-Pox! Why Kine-Pox? The reason is stated by the Doctor--

From kine the plural of cow; thus in the Scriptures, “And they took two milch-kine, and shut up their calves at home”; a word equally expressive, and, in the opinion of some, more delicate.

There we have it: More delicate! If it had been bull-pox the objection might have been insuperable. Writing to Jenner, 24th April, 1801, Waterhouse says--

Could you believe that not a single inoculation with Cowpox has yet been effected in Philadelphia? It seems that the leading physician there pronounces it too beastly and indelicate for polished society.[225]

The pamphlet on Kine-Pox set forth the mystery of the new inoculation as received from England with a significant omission--there was not a word in it about Horsegrease! Waterhouse was in correspondence with Pearson, and Pearson may have told him how not only the asserted generation of Cowpox in Horsegrease was discredited, but “how it was like to damn the whole thing”; which might have been true enough, but if true, Where then stood Jenner? He knew that cowpox did not prevent smallpox: the fact was notorious among the medical men in cowpox districts: and he had expressly pledged his faith in the Inquiry to Cowpox begotten from Horsegrease and to nothing else. But Horsegrease Cowpox did not suit the market, and it was withdrawn with Jenner’s tacit assent, and spontaneous Cowpox advanced in its stead, and accepted as Jenner’s veritable discovery. It might be good business to drop the horse out of the case, but what was it else?

Cowpox, testified Waterhouse, was unknown in New England, but he received the revelation concerning it at once--but not, be it repeated, Jenner’s revelation: that he suppressed. He had long suspected that smallpox was communicated from brutes to the human race; and now his suspicion was confirmed. And, such being the origin of variola, it seemed to him not unreasonable that the disease as it existed in a mild form in kine might be used for inoculation with all the advantages pertaining to smallpox, whilst attended with neither injury to the inoculated, nor with risk of infection to those about them--

What makes this newly discovered disease so very curious, and so extremely important is, that every person thus affected, is ever after secured from the ordinary Smallpox, let him be ever so much exposed to the effect of it, or let ever so much ripe Smallpox matter be inserted into the skin by inoculation. In other words, a person who has undergone the local disease and specific fever occasioned by the Cowpox Infection is thereby rendered ever after insusceptible of the Smallpox.

How incautious, to say the least, was the acceptance of this prophecy of perpetual security! With less than three years’ experience an absolute prediction was delivered, received, and repeated over the whole earth as if by parrots. Such, however, is the habit of mankind when possessed by a strong delusion.

In justice to Waterhouse it has to be said that he did not commit himself openly until he had gone through the illusory experiments that were then fashionable in England. He had much difficulty in obtaining a supply of active virus. Several remittances failed, but at last he had one, an inch and a-half of infected thread, from Dr. Haygarth which proved, it was thought, effective.[226] His first patient was his son, Daniel Oliver, aged five; then another child aged three; then a servant lad aged twelve; then a weaned infant of one year--all five successful, whilst two domestics failed “to take”--seven experiments in his own household. Then he had the children taken to the Smallpox Hospital, where they were inoculated by Dr. Aspinwall, and issuing scatheless from the test, the truth was taken as demonstrated, and there was no need for further hesitation. Four gentlemen, including a physician, offered themselves for public encouragement--

One of them [says Waterhouse] chose to live pretty freely by way of experiment, and the febrile symptoms, especially headache, were full as much as he could bear and walk about with. This convinced me that the Kine-Pox was a disease not to be trifled with.

Waterhouse then appealed to the pride of his countrymen--

The people of New England, particularly of Boston, set a noble example to their elder brethren of Old England, in adopting the Turkish practice of Inoculation for the Smallpox in 1721. Now the English in their turn, lead the way in a practice still more salutiferous. For though the Inoculation which commenced here in 1721, stripped that horrid disease, the Smallpox, of more than half its terrors, yet it is the Kine-Pox that will effect its extermination.

Following this prophecy came a frank request for business--

Dr. Waterhouse informs those who have applied to him out of Cambridge to inoculate their families that he declined it only until the disorder had gone fairly through his own family, and until some of them had been inoculated by Dr. Aspinwall, and otherwise exposed to Smallpox. But having now confirmed his assertion, that the Kine-Pox protects the constitution from the infection of Smallpox by a fair experiment, he is ready to attend them whenever they choose. Those who live in Boston may rest assured that from the proximity of his residence to the capital, he shall make such arrangements as to be able to attend them as punctually as if he resided there.--CAMBRIDGE, 18th August, 1800.

After an English pattern he published the following table--

NATURAL SMALLPOX. | INOCULATED SMALLPOX. | KINE-POCK. A Contagious Disease. | Contagious. | Non-Contagious. | | Never fatal. One in 6 who take | One in 300 dies. | It is like crossing it dies. It is like | It is like crossing | the stream on a new an attempt to cross | the stream in an old, | and safe bridge. a dangerous stream | leaky boat, where | by swimming, where | one in 300 perishes. | one in six perishes. | |

The operations, so hopefully begun, came speedily to grief. In a letter addressed by Waterhouse to Jenner, 24th April, 1801, we read--

One inch and a-half of infected thread from Dr. Haygarth was the whole stock from whence perhaps 3000 persons have been inoculated, but I fear the greatest part of them have been spurious. I gave out that the winter was an unfavourable season for this new inoculation, and by that means I suspended the practice throughout the country until the arrival of fresh matter and your letter. Now we are going on again, but not with the faith and spirit of the last season. Some unlucky cases have damped the ardour of a people who received this new inoculation with a candour, liberality, and even generosity, much to their credit. The first political and literary characters in our nation are still warm advocates for the practice.[227]

Waterhouse continued to correspond with Jenner, and was regarded as his accredited representative in New England. Writing to Dr. Lettsom, 16th November, 1802, he says--

Dr. Jenner has just sent me a present I highly prize--a silver box inlaid with gold of exquisite taste and workmanship, bearing this inscription--

EDWARD JENNER to BENJAMIN WATERHOUSE.

But Mr. Ring annexed the superscription in rather an hyperbolical style--

From THE JENNER of THE OLD WORLD To THE JENNER of THE NEW WORLD.

Long will it remain among the sacræ relictæ of my family.[228]

Waterhouse was a man of an ingenious turn of mind. When troubled with ill-results from his operations at the end of 1800, he tried what has since been called retro-vaccination, probably for the first time. Here are his words from his letter to Jenner, 24th April, 1801--

I inoculated one of my cows with the Vaccine Virus, and obtained from her a crop of matter on the ninth day, which produced the disease in the human subject to perfection. Is this experiment known among you? As I operated myself there was no avenue opened for deception in the whole experiment.

A sentence which follows is too characteristic to be passed over. Says Waterhouse--

I have invariably found that weakly children have been benefited by the Vaccine Inoculation, and some it has cured of the Hooping Cough.

And this after less than twelve months’ experience!

Waterhouse had also to relate a case of cows having smallpox--

At one of our periodical inoculations, which occur in New England once in eight or nine years,[229] several farmers drove their cows to an hospital near a populous village, that the patients might have the benefit of their milk. The cows were milked by persons in all stages of Smallpox; and in consequence they had an eruptive disorder on their teats and udders that every one in the hospital, as well as the physician who told me, declared was Smallpox. Since Cowpox has been talked of, this account has been revived and credited. Have you found anything like it in England?

Waterhouse had inquiries from Virginia, and wished Jenner to let him have, if possible, a picture of the vaccine vesicle on the negro--

Could I procure two or three coloured plates, delineating the appearances on the skin of the negro, I would send them into such of our Southern States as are blackened by these degraded beings.

“Some in this country, as well as in England,” observed Waterhouse, “having had all their objections to Kine-Pox obviated, persist in asking, ‘Who can tell what may be the consequences in the lapse of years of introducing a bestial humour into the human frame?’ I answer them as does Mr. Ring with a spirit and wit worthy of Franklin, ‘Who can tell what may be the consequences in the lapse of years of introducing milk, beef steaks, or mutton chops, into the human frame?’”

The pertinacity with which this “wit” was employed by the early vaccinators leads us to suppose that they found it effective; but was ever argument by analogy more absurdly misapplied? Milk or steaks from a cow, or chops from a sheep known to be suffering from pox would be rejected with loathing; nor was it ever proposed to cook and eat cowpox; and yet corruption, mere association with which, would render milk, or steaks, or chops loathsome, it was not thought abominable to infuse into the blood!

“The first political and literary characters in our nation are warm advocates of the practice,” said Waterhouse; and it was so. President Adams was quite of a mind with King George in that respect; and Jefferson not only approved of the practice in common with Queen Charlotte, but, as soon as he could obtain virus, set to work with his sons-in-law, and vaccinated their families and neighbours to the number of two hundred. There is a letter from Jefferson to Jenner in 1806, which is remarkable as an absolute confession of faith at a date when much had occurred to shake faith. The President wrote--

MONTICELLO, VIRGINIA, 14th May, 1806.

SIR,--I have received the copy of the evidence at large respecting the discovery of the Vaccine Inoculation, which you have been pleased to send me, and for which I return you my thanks. Having been among the early converts in this part of the globe to its efficacy, I took an early part in recommending it to my countrymen. I avail myself of this occasion to render to you my portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility. Harvey’s discovery of the circulation of the blood was a beautiful addition to our knowledge of the animal economy; but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery. You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived. Future nations will know by history only that the loathsome Smallpox has existed, and by you has been extirpated. Accept the most fervent wishes for your health and happiness, and assurances of the greatest respect and consideration.

TH. JEFFERSON.

That smallpox should be erased from the calendar of human afflictions, and be known only in history as extirpated by Jenner, were vain expectations; but to recognise their vanity did not lie within Jefferson’s possibilities. He had been bred in the belief that inoculation with smallpox prevented smallpox, and it came forth as a corollary, that as cowpox was an equivalent for smallpox, if all were cowpoxed, the disease must be extirpated. His expectations, therefore, were not without plausibility. Nor was it possible for Jefferson in the light of his time to see that smallpox was no specific entity that could be got rid of per se whilst all else remained unaffected. We know that if even vaccination made an end of smallpox, and did no harm of itself, we should reduce neither illness nor mortality (supposing no other change in the conditions of existence were effected), but should have our due allotment of disease in other forms. To attack smallpox as smallpox, and suppose that if suppressed we should be in anywise advantaged, is mere illusion. Zymotic diseases, to be dealt with effectually, must be dealt with as forms of a common malady; to get rid of one, we must get rid of all; and with a graver sense of the difficulties to be encountered we, too, believe with Jefferson, that smallpox may be extirpated, but in company with much else, and by practice that has no affinity with the creation of disease implied in vaccination.

Of all people the English are most abandoned to medical quackery, said Lady Mary Wortley Montagu; and the English characteristic was reproduced and exaggerated in New England. The first resistance to vaccination being overcome, there was a run upon the practice--

The zeal of American medical men [says Baron] was excited to an unparalleled degree; but, unfortunately, their discretion did not keep pace with it. They disregarded the cautions of Dr. Waterhouse, and paid no attention either to the state of the matter with which they inoculated, or to the progress of the pustule. It appears, likewise, that the cupidity of persons not of the medical profession was stimulated, and the manner in which they carried on their traffic was alike indicative of their avarice and their ignorance. The followers of this trade obtained the shirt-sleeves of patients which had been stiffened by the purulent discharge from an ulcer consequent on Vaccination. These they cut into strips, and sold about the country as impregnated with the true Vaccine Virus. Several hundred persons were actually inoculated with the poison, which, in several cases, produced great disturbance in the constitution. A vessel arrived from London at Marblehead with a sailor on board, who was supposed to have Cowpox: matter was taken from him, and was used extensively. It was soon discovered that Smallpox matter had been employed, and that disease spread rapidly through the neighbourhood. These blunders, it is to be feared, were not confined to vagrant quacks, inasmuch as medical men were not quite blameless.[230]

Whilst such doings discredited vaccination in one way, they served it in another: they made it easy to conceal its failures and injuries by ascribing them to the use of spurious virus. Everything is to be gained for truth in the question of vaccination by taking it in what its believers allow to be its unexceptionable form, so as to leave no room for evasion. Smallpox in America as in England soon showed itself indifferent to the art of the vaccinator, and then it was settled that at least it made the disease milder; and under cover of the convenient fiction, it continued to be practised where fees were to be had for the performance.

The attitude of the medical mind to epidemics, and the ignorance of what we now regard as the first elements of sanitary science, are illustrated with touching sincerity in a letter addressed by Dr. Waterhouse, in 1817, to the surgeons of the United States army. Said the Jenner of the New World--

You need not waste your time, or distract your attention by guessing at the remote causes of dysenteries or epidemic fevers. We learn from the highest authority, that the pestilence “walketh in darkness.” The enemy approaches unseen. We are pretty well convinced that epidemic fevers depend not on any of those changes in the air that are pointed out by the thermometer, barometer, or hygrometer. These wide-spreading maladies, as well as endemics, or local disorders, seem as if they arose from some secret movements, or alterations in the earth, or on its surface--that is, on some new combinations in the soil, or some effluvium from a deeper situation, affecting not only the air we breathe, but the water which we use for everything. Epidemics seem to accompany or follow a blighted state of vegetation. They seem also to accompany an abundant harvest; but whether in the series of cause and effect is not fully known. As to myself, I’m weary of conjecture.

Well might he be weary! He does not say so, but neither does he make any reserve in favour of vaccination; and, after seventeen years’ trial of it, the old physician must have included it in his cry of Vanitas Vanitatum!

FOOTNOTES:

[225] Baron’s Life of Jenner, vol. i. p. 442.

[226] “It was Dr. Lettsom who first sent the Vaccine Lymph across the Atlantic, and consigned it to the fostering care of his friend Dr. Waterhouse.”--Pettigrew’s Life of Lettsom, vol. i. p. 121. “Dr. Waterhouse at length succeeded in getting some Cowpox matter from Dr. Haygarth of Bath, who forwarded it from Bristol.”--Baron’s Life of Jenner, vol. i. p. 386.

[227] Baron’s Life of Jenner, vol. i. p. 440.

[228] Pettigrew’s Life of Lettsom, vol. iii. p. 405.

[229] As Dimsdale advised, the inhabitants of a village or district were inoculated with Smallpox simultaneously, so that all being infected none should be unwillingly infected!

[230] Baron’s Life of Jenner, vol. i. p. 387.

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XXIX. INTRODUCTION OF VACCINATION TO INDIA AND THE EAST

The enthusiasm for cowpox in England was reproduced with fury among the English in India. It is always so. What is the fashion at home is an intenser fashion abroad.

When we say India, we speak as of a country when we are dealing with a continent--of not one but many peoples, of races numerous and tongues various: wherefore, in naming India, I would be understood as limiting my remarks to the portion designated, and to the population affected by English influence. In several parts of India smallpox is endemic--begotten in permanently unwholesome conditions of life, and cultivated and propagated by inoculation. When, therefore, it was heard that cowpox might be substituted for smallpox, and that the mild served every purpose of the severe disease, there arose a demand among the English for the virus, alike for their own and for native use. Dr. Underwood, writing to Jenner from Madras, 28th Feb., 1801, observed--

I have read with very great pleasure your publications on Cowpox, and feel particularly anxious to introduce and extend it in this country, under the greatest confidence that it would save many lives. I have hitherto embraced every opportunity of inoculating with variolous matter, but the loss of a beautiful little patient has humbled me, and I confess I never now take up a lancet but with fear and trembling.[231]

It was easier to ask than to obtain. There was no cowpox to be heard of in India, and the long voyage round the Cape, and the tropical heat were fatal to its transmission. Repeated attempts were made, but all ended in failure. Jenner proposed to place a number of picked men on board an East Indiaman, and to have them successively vaccinated in the course of the voyage, so as to land with fresh virus in Bombay or Calcutta; but the East India Company declined the proposal. An attempt was then made to raise a subscription for the purpose, Jenner putting his name down for 1,000 guineas; though it was difficult to imagine where the 1,000 guineas were to come from, unless out of the pockets of some of his admirers.[232]

These efforts were, however, superseded by the energy and ingenuity of Dr. De Carro, of Vienna. Lord Elgin, British ambassador to the Porte, had made acquaintance with De Carro, and had received virus from him with which his infant son and others were vaccinated at Constantinople. The news spreading abroad, Lord Elgin was entreated to meet the Indian demand, sending the vaccine overland to Bombay by way of Bagdad and Bussora. He made several futile attempts, and thereon determined to place the matter in the hands of De Carro; and for that purpose addressed himself to the Hon. Arthur Paget, British ambassador at Vienna, saying--

I have so many applications for Vaccine Virus from Bussora, the East Indies, and Ceylon, that I beg you will immediately apply to Dr. De Carro, and request him to send some by every courier.[233]

De Carro accepted the commission with alacrity. He had already had an application from Bagdad, and, dismissing the vehicles which had been tried and failed, such as lancets of steel, silver, gold, and ivory, and threads enclosed in quills, he saturated lint with virus, and, placing it between glasses, in one of which was a cavity for its reception, tied them together, sealed the edges, and, taking them to a wax chandler, had them dipped until enclosed in a ball of wax, which was packed in a box stuffed with shreds of paper. In this manner virus was conveyed through Constantinople, across the deserts to Bagdad, where it was received on 31st March, 1802, still liquid, and was used “with complete success.” The like success was reported from Bussora, Muscat, and Bushire. From Bussora virus was conveyed to Bombay, arriving, after a three weeks’ voyage, early in June. Twenty or thirty were inoculated with the Vienna virus, but only one “took,” namely, Anna Dusthall, a child about three years of age, who was operated upon by Dr. Helenus Scott. The progress of the case was watched with intense anxiety, and correspondent satisfaction when the symptoms developed according to the recognised description. On the eighth day five children were vaccinated from Dusthall’s arm, and loud was the rejoicing when it was known that for India was secured the genuine Variolæ Vaccinæ. From Bombay “the precious fluid” was in due course conveyed to Ceylon, Madras, Calcutta, and wherever English influence prevailed. De Carro was naturally elated with his success. The virus he transmitted was originally obtained from the stock of Dr. Sacco, of Milan, who had it off some Lombard cows.[234]

Jenner wrote to De Carro to congratulate him, 28th March, 1803--

Since the commencement of our correspondence, great as my satisfaction has been in the perusal of your letters, I do not recollect when you have favoured me with one that has afforded me pleasure equal to the last. The regret I have experienced at finding that every endeavour to send the Vaccine Virus to India in perfection has again failed, is scarcely to be described to you; judge, then, what pleasure you convey in assuring me that my wishes are accomplished.[235]

The imported cowpox was diffused and recommended with energy and with fraud. Jenner, writing to Dunning, 2nd November, 1804, observed--

Conceiving it might be a gratification to you to see how systematically they manage vaccine affairs in India, I have sent you a copy of a paper just transmitted to me from the India House. Would to Heaven we could boast of such arrangements here!

Here is the paper which sets forth the energetic policy pursued--

FORT-WILLIAM, 15th January, 1804.

With a view of extending the practice of Vaccine Inoculation throughout the East India Company’s territories in India, the Governor-General in Council of Bengal has appointed a Superintendent-General of Vaccine Inoculation at the Presidency, and established subordinate superintendents at several of the interior stations of the country; namely, at Decca, Moorshedabad, Patna, Benares, Allahabad, Cawnpore, and Farruckabad. These superintendents are the surgeons of the stations, and are to act under the orders of the Superintendent-General in whatever regards Vaccine Inoculation. The civil surgeons also at the several judicial and revenue stations are to co-operate with these superintendents for the purpose of forwarding the general object.

Vaccine Inoculation has also been introduced with success into Prince of Wales Island, and it is intended to extend the practice to Malacca and other places to the eastward; and a confident expectation is entertained that the benefits of this valuable discovery will be diffused throughout Asia. It is even in contemplation to extend it to China; but as the suspicious disposition of the Chinese might possibly ascribe any attempt to introduce this novel practice to sinister motives, it has been postponed until the opinion of the Company’s servants there can be obtained.

Much of this policy was due to the Marquis Wellesley, the Governor-General, whose habit it was to convert conviction without delay into performance. To what extent it was found practicable to substitute vaccination for variolation among the natives does not clearly appear. It was comparatively easy to operate upon those immediately dependent upon their conquerors; but it was a different matter to disarm the aversion of the external myriads. Supposing the variolators preferred their ancient practice because it was more lucrative, a number of them were brought to Calcutta, and inquiry made as to the amount of their gains, which ascertained, they were offered double pay if they would adopt vaccination. The offer was readily accepted, and other variolators, hearing of it, volunteered their services on similar terms, and were instructed and enrolled as official vaccinators. A declaration was drawn up and signed by twenty-six of these converted variolators, recommending vaccination to the Eastern world. The declaration was published in the Calcutta Gazette, printed in four languages, and widely circulated throughout India.[236]

So much was possible to Government; but other means of persuasion were not neglected. It was at first imagined that pox from the cow would exactly suit people who held that animal in reverence; but, on the contrary, the fact was converted by the Brahmins into an argument against its use, they contending, and justly, that cowpox was impure. To meet this difficulty, various pious frauds were attempted. It was pretended that vaccination was no novelty in India, and that it was known, sanctioned, and practised from time immemorial. Baron, Jenner’s biographer, relates these details without animadversion--

A native physician of Bareilly put into the hands of Mr. Gillman, who was surgeon at that station, some leaves purporting to be an extract from a Sanscrit work on medicine, entitled “Sud’ha Sangreha,” by a physician named Mahadeva, to this effect--

“Take the matter of pustules, which are naturally produced on the teats of Cows, carefully preserve it, and before the breaking out of Smallpox make with a fine instrument a small puncture (like that made by a gnat) in a child’s limb, and introduce into the blood as much of that matter as is measured by a quarter of a ratti. Thus the wise physician renders the child secure from the eruption of the Smallpox.”

The Sanscrit work from which this passage was asserted to be taken was never forthcoming, and by competent authorities was pronounced “nothing more than a well-meant device for the reduction of ignorant prejudices,” the native physician who put the leaves into the hands of Mr. Gillman being included in the fiction. Baron continues--

In order to overcome these native prejudices the late Mr. Ellis, of Madras, who was well versed in Sanscrit literature, actually composed a short poem in that language on Vaccination. The poem was written on old paper, and was said to have been found, that the impression of its antiquity might assist the effect intended to be produced on the minds of the Brahmins while tracing the prevention to their sacred cow.

The late Mr. Anderson, of Madras, adopted the very same expedient, in order to deceive the Hindoos into a belief that Vaccination was an ancient practice of their own. It is scarcely necessary to observe that had any authentic record of such a practice existed these gentlemen would never have resorted to such contrivances to gain their object.[237]

These impostors were not priests, but medical men; not Jesuits, but Protestants; not Levantines, but Englishmen in the service of the Honourable East India Company. To what extent their frauds were operative is not related. They were probably too contemptuous of native acumen. For good and for evil the Hindoo listens to English advice courteously and without contradiction, but persists in his accustomed way of life with the equanimity of indifference. That vaccination was an ancient practice in India came to be repeated in Europe and seriously believed, when, Jenner’s originality being impugned, the truth came out, that old Indian vaccination was a device limited to Indian circumstances, and never designed for Western acceptance.

In Madras vaccination was practised with much energy. Jenner, writing on 7th May, 1808, said, “Wonderful to relate, the numbers vaccinated in that Presidency in the course of last year amount to 243,175.”[238] In Bombay it was claimed that smallpox was extirpated; Dr. Helenus Scott reporting, 5th December, 1806, that “in this island, swarming with mankind, no loss from smallpox has been suffered for several years since the introduction of vaccine inoculation.”[239] It was not pretended that all the inhabitants of Bombay had been vaccinated, or even a considerable portion of them; but the early vaccinators appear to have regarded vaccination as a sort of charm, the possession of which kept off smallpox; that by the vaccination, say, of one-tenth of any population, the unvaccinated nine-tenths were protected. This faith in the vicarious efficacy of vaccination was not expressly avowed, but was implied in the numerous reports of extirpated smallpox in circumstances where no attempt was made, or was indeed possible, to effect universal vaccination.

Confuted and frustrated in England, it was Jenner’s habit to sigh, and turn from his ungrateful country to the vast realms of Europe and Asia and America. Writing to Dunning, on 23rd December, 1804, he observed--

Foreigners hear, with the utmost astonishment, that in some parts of England there are persons who still inoculate for Smallpox. It must, indeed, excite their wonder when they see that disease totally exterminated in some of their largest cities and in wide-extended districts around them.

Mark the words--Smallpox totally exterminated in some of the largest cities in 1804; that was to say, after, at the utmost, five years’ acquaintance with vaccination! A miraculous time--was it not? Jenner went on--

Let us not, my friends, vex ourselves too much at what we see here. Let us consider this country as but a speck when compared with the wide surface of our planet, over which, thank God! Vaccinia has everywhere shed her influence. From the potentate to the peasant, in every country but this, she is received with grateful and open arms. What an admirable arrangement is that made by the Marquis of Wellesley, the Governor-General of India, for the extermination of the Smallpox in that quarter of the globe! Contrasted with our efforts here, what pigmies we appear.[240]

Omne ignotum pro magnifico est. What inference worth a straw could Jenner or anyone else draw from the introduction of vaccination to India? The number of the various Indian peoples was unknown; and the periods and prevalence of smallpox among them; also the extent to which they practised variolation. In the absence of such elementary information, tales of the triumphs of vaccination in India were so much romance.

So far as vaccination displaced variolation, it might be taken as the substitution of a less evil for a greater; and much is accounted for in some of the early records of vaccination when it is remembered that the new practice was welcomed as a deliverance from the inconveniences and horrors of the old; and that the discredited practice was frequently abandoned without resort to its successor. A cessation of variolation was a cessation of the culture and diffusion of smallpox; and vaccination had often the credit of the reduction of smallpox when the credit was due to the abatement of variolation. As to the propagation of smallpox by variolation, no one was more emphatic than Jenner, as for example--

Where Variolous Inoculation is put in practice, Smallpox must necessarily spread.[241]

Smallpox will never be subdued so long as men can be hired to spread the contagion by Inoculation.[242]

If then it be taken as conceded that variolation spread smallpox wherever practised, can it be fair to omit the consideration of the consequences of its abatement when estimating the results of the introduction of vaccination? Yet scarcely an advocate of vaccination permits the fact to enter into his reckoning!

The gratitude of the English in India to Jenner did not evaporate without substantial expression. A subscription was started, and between 1806 and 1812 he received remittances to the amount of £7,383, the contributors being--

Bengal, £4,000 Bombay, 2,000 Madras, 1,383

An amusing instance of Jenner’s ignorance of India is found in a letter to Dunning, 14th March, 1807, wherein he ascribes his English money from India to the gratitude of Hindoo women--

You will be pleased to hear that the dingy Hindoo ladies are convincing me of their grateful remembrance, not merely in words, but by a tangible offering, while my fair Christian countrywomen pass me unheeded by.[243]

Jenner, in returning thanks to Dr. Fleming, of Calcutta, for the first remittance of cash in 1806, took occasion to communicate some English news, which is not without interest at this day. He wrote--

To say the truth, this country has been dreadfully supine in the matter of Vaccination hitherto. Some pamphlets, full of the grossest misrepresentations and forgeries, have been spread; and the common people became so terrified, particularly when told that their children, if vaccinated, would take the similitudes of bulls and cows, that a great dislike to the practice has arisen among them; and these accounts have been circulated through the country with peculiar industry. The consequence has been the re-introduction of Variolous Inoculation, which has produced an epidemic Smallpox through the metropolis and the whole island, except in those parts where Vaccination had previously been so generally adopted as to forbid its approach. This, now too late, has opened their eyes, and they see the powers of the Cowpox. The folly of the oppositionists has gone so far as to exhibit prints of children undergoing transformation from the human being into that of the brute.[244]

These prints were, many of them, intended for fun, and could have no serious influence. The decline of faith in vaccination was due to the general discovery that it did not prevent smallpox, and that it did excite other ailments. “It made smallpox milder” was the apology even then coming into vogue. As for the epidemic of smallpox raised in London and the whole island by the neglect of vaccination and a return to variolation, it was a creation of Jenner’s fancy. There was less smallpox in London in 1806 than in 1805; but if there was not more, the bold Jennerian would answer, there ought to have been, and it could only be through the mercy of Providence that there was not.

Throughout the century, the English in India have spared no pains to diffuse and enforce vaccination among the inhabitants, numerous medical men finding place and pay in the futile occupation. Smallpox can only be overcome by systematic sanitation, which is laborious and difficult; and among peoples whose conditions and habits of life freely generate zymotic disease, vaccination is as likely to be effective as any other sort of incantation. Sir Richard Temple states the position at this day in these words--

Smallpox is universally prevalent in India, carrying off tens of thousands of victims, children especially, in almost every province year by year, and impairing or disfiguring others for life. The Government has for many years made persistent efforts to arrest the disease by means of Vaccination, with remarkable success in some districts, like that of Kumaon in the Himalayas, but generally with indifferent success, and often without any perceptible result. The practice of Vaccination not being in vogue, Inoculation used to be largely adopted by the natives in many districts, but has now been prohibited, though not always prevented actually. The State everywhere undertakes or encourages Vaccination. Hundreds of native vaccinators are employed, and returns are rendered of large numbers of persons said to be successfully vaccinated. Nevertheless Smallpox appears again and again with terrible manifestations before the people, and causes them to disbelieve the efficacy of Vaccination.[245]

We now come to Ceylon, in which vaccination was held to have had a perfect triumph. “To Sweden and to Ceylon,” says Baron, “Dr. Jenner was in the habit of pointing when he wished to prove what his discovery might accomplish; or when he lamented that fatal obstinacy of his fellow-creatures which, with such examples before them, could induce them to reject blessings within their reach.”[246] Sweden we shall discuss in another chapter, and of Ceylon I may observe that a portion of the island was taken by the British from the Dutch in 1795, and that in several parts it was extremely unhealthy. Smallpox was a frequent and deadly epidemic, but to what extent there is no evidence save hearsay and estimates from hearsay. The Dutch did not concern themselves with the health of the natives, but when the English took over their settlements in 1800 in the midst of a severe epidemic, they opened hospitals for smallpox and for inoculation with smallpox under the supervision of Dr. Christie.[247] He, hearing the glad tidings of vaccination, resolved to introduce the practice, and having in 1802 received virus from Dr. Scott, of Bombay, he set to work with systematic energy and perseverance. Supported by the authority of successive Governors, he closed the hospitals, forbade variolation, organised a staff of vaccinators, and kept them employed, until the greater part of the population under English influence was vaccinated. In the words of Moore, writing in 1816--

At length the priesthood submitted to Vaccination, the last to adopt this innovation upon their ancient customs; and the remains of the Smallpox were happily extinguished in all that part of the island which belonged to Great Britain.[248]

That smallpox had been exterminated by vaccination in Ceylon was set forth by vaccinators as something indisputable; but there were two observations to make--first, that smallpox was often suppressed in the sense that for a time there was no smallpox in a certain population, and especially subsequent to a severe epidemic; and second, that variolation was suppressed. Granted that smallpox ceased in Ceylon coincidently with the introduction of vaccination, it may be fairly held that the exhaustion induced by the preceding epidemic, and the cessation of variolation, were sufficient to account for the phenomenon. What remains to be said of Ceylon, I shall leave Dr. George Gregory, physician of the London Smallpox and Vaccination Hospital, to say for me. He wrote--

Ceylon was the British colony where the Government earliest interfered and most vigorously encouraged the practice of Vaccination. Salaried vaccinators were scattered over the whole island. So successful were their labours, that up to the beginning of 1819, it had often been said that the experiment of exterminating Smallpox had been made and successfully carried out in Ceylon. In July, 1819, however, a severe epidemic Smallpox broke out there. In 1830 a second epidemic overspread the island--in 1833 a third, and in 1836 a fourth. In these four epidemics, 12,557 persons were attacked, of whom 4,090 died, being at the rate of 33 per cent., or one out of every three.

In each of these epidemics a certain number of vaccinated persons took Smallpox. The proportion of the vaccinated to the unprotected varied. In the third epidemic, out of a total of 460 attacked, 341 represented themselves as vaccinated.[249]

Vaccination was introduced to China from the English factory at Canton, and Sir George Staunton translated into Chinese a tract on Cowpox, and had it printed at Canton in 1805, the translator’s name and the foreign origin of the practice being suppressed. Jenner, writing to Dunning, 10th December, 1806, said--

From Canton I have a most curious production--a pamphlet on Vaccination in the Chinese language. Little did I think, my friend, when our correspondence first began, that Heaven had in store for me such abundant happiness. May I be grateful!

The Chinese had their own system of variolation, namely, the use of pulverised smallpox scabs as snuff; but some of them accepted vaccination, tried it, and dropped it when they found it did not keep off the disease as warranted. Smallpox in China is almost exclusively a disease of childhood, and is little dreaded. Dr. D. F. Rennie, medical officer to the British Embassy at Peking in 1861-62, says of that city--

Since 1820 vaccination (introduced from Canton) has been practised to a limited extent among the population--probably one-fifth may be vaccinated. At one time it was believed to afford protection, Smallpox not having been so common immediately after its introduction. Of recent years, however, confidence in it has considerably diminished, owing to the frequency with which those are attacked who have been vaccinated.[250]

Persia was sometimes referred to in the ravings that went on as to the triumphs of vaccination in the East; but what was known of Persia? The practice was introduced where Europeans were resident, but it never became general. Dr. C. J. Willis has recently described surgery and medicine in Persia as extremely rude and superstitious, and that “vaccination is not in favour, whilst inoculation, or the direct communication of the disorder, by placing the patient in the same bed with one suffering from smallpox of the most virulent type, is the method pursued.”[251]

It was natural enough for Jenner, in presence of failure and contempt in England, to appeal to success in the East, and to try to overwhelm his adversaries with evidence which they could not overtake; but any one of judicial temper must have perceived that if vaccination was to be vindicated, data of a very different order would have to be forthcoming. Where the number of the population in a distant region was unknown, where the ordinary prevalence of smallpox among the people was undefined, where the extent of artificial variolation was unspecified, and the existence and intensity of related forms of zymotic disease were undescribed, what conclusion could be drawn as to the efficacy of vaccination that a man of science was bound to respect? Why should certain knowledge in England be surrendered for assertion from abroad.

FOOTNOTES:

[231] Baron’s Life of Jenner, vol. 1. p. 410.

[232] Baron’s Life of Jenner, vol. i. p. 409.

[233] Ibid. vol. i. p. 419.

[234] Histoire de la Vaccination en Turquie et l’Orient. Par Jean de Carro. Vienne, 1804.

[235] Baron’s Life of Jenner, vol. i. p. 428.

[236] The History and Practice of Vaccination. By James Moore. London, 1817. P. 236.

[237] Baron’s Life of Jenner, vol. i. pp. 556-559.

[238] Baron’s Life of Jenner, vol. ii. p. 359.

[239] Ib., vol. ii. p. 92.

[240] Baron’s Life of Jenner, vol. ii. p. 24.

[241] Letter to Dunning, 23d December, 1804.

[242] Letter to Worthington, 4th May, 1810.

[243] Baron’s Life of Jenner, vol. ii. p. 356.

[244] Baron’s Life of Jenner, vol. ii. p. 89.

[245] India in 1880.

[246] Life of Jenner, vol. i. p. 426.

[247] An Account of the Introduction, Progress, and Success of Vaccination in Ceylon. By Thomas Christie, M.D. London, 1811.

[248] The History and Practice of Vaccination. By James Moore. London, 1817. P. 242.

[249] Lectures on the Eruptive Fevers. London, 1843. P. 210.

[250] Peking and the Pekingese. London: 1865.

[251] British Medical Journal, 26th April, 1879.

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XXX. DIFFUSION OF VACCINATION THROUGHOUT EUROPE

Vaccination was accepted as a revelation, and diffused as a religion, and was almost everywhere received gladly. We have to bear in mind, however, that the way had been made straight for it by the practice of inoculation with smallpox; which practice, after a struggle prolonged over many years, had become an established part of medical art, and was only limited in its application by the inconvenience and risks that attended it. The promise of the primitive vaccinators was, that the security which resulted from inoculation with smallpox was to be had from inoculation with cowpox, with absolute certainty, absolute safety, and absolute permanence. The argument was, that since no one could have smallpox twice (however slight the attack), and as cowpox was a mild form of smallpox, it sufficed to be inoculated with cowpox to be safe from smallpox through life; and if only the infliction of cowpox were made universal, smallpox would be extirpated. Such was the plausible doctrine; so plausible that it had only to be stated to command assent; whilst so great was the elation over the discovery (as much, perhaps, for deliverance from inoculation with smallpox as from smallpox itself) that it was accounted a sacred duty to diffuse its benefits over the whole earth. Greater good on easier terms it was difficult to imagine. With a scratch of a needle one of the worst penalties attached to over-crowding, to filth, and to ill-living, might be avoided and done away with for ever.

How pleasant are such sugared lies, Deceiving by their sweetness!

The first cowpox missionaries were Dr. Marshall and Dr. Walker. £100 was teased out of the Admiralty, and £100 out of the War Office toward their expenses, and placed on board the Endymion, they proceeded, on 1st July, 1800, to the Mediterranean. At Gibraltar, Minorca, and Malta, they vaccinated soldiers and sailors, first operating on orphans and foundlings to give the gallant fellows courage. Then Walker accompanied Sir Ralph Abercrombie to Egypt, from whence, after a variety of adventures, he returned to London to serve as domestic apostle, and vex Jenner for the remainder of his life. Marshall proceeded to Sicily and Naples. In Palermo, in the preceding year, 1799, there had been an epidemic, in which, it was said, 8,000 had perished, and Marshall appeared on the scene as a belated messenger of salvation. At Naples he had a cordial reception from the wretched Ferdinand IV. and his wretched court, who, with general indifference or enmity to what was good, were ready to show themselves gracious toward cowpox. Marshall went through the customary performances of the variolous test and the exposure of the vaccinated to infection; and without further ado an hospital was opened, and all who would be saved from smallpox were entreated to hasten and receive the new inoculation.

It was not unusual [wrote Marshall to Jenner] to see in the morning a procession of men, women, and children, conducted through the streets by a priest carrying a cross, coming to the hospital to be inoculated. By such popular means, the practice met with no opposition; and the common people expressed themselves as certain that it was a blessing sent from Heaven, though discovered by one heretic and practised by another.

When Marshall was at Gibraltar, Lord Keith issued the following memorandum to the fleet--

H.M. Ship Foudroyant, GIBRALTAR BAY, 19th October, 1800.

Any soldiers, seamen, or marines in the Fleet who may not have had the Smallpox, and wish to avoid that dreadful malady, may, by application to Dr. Marshall, on board the flag-ship, be inoculated with the Cowpox, which, without pain or illness, or requiring particular diet or state of body, or leaving any marks, effectually excludes all possibility of the patient ever being affected with the Smallpox.

By command of the Vice-Admiral, PHILIP BEAVER. To the respective Captains of the Fleet.

I may observe, in passing, that there was little delay in introducing vaccination to the British navy. Sir Gilbert Blane was urgent, Earl Spencer, first Lord of the Admiralty, acquiescent, and Dr. Trotter, physician to the fleet, enthusiastic. So early as 9th December, 1800, Trotter was prophesying--

The Jennerian Inoculation will be deservedly recorded as one of the greatest blessings to the navy of Great Britain that ever was extended to it.

Smallpox was one of the pests of the service. Trotter, writing 20th February, 1801, said--

Within the past seven years there have been more than a hundred instances in which the seamen have been infected; twenty having occurred in the last six months in the Channel fleet alone.

These outbreaks were invariably referred to an origin external to the ship; as if anywhere smallpox could have had a more congenial breeding-place than the crew of a man-of-war! As Dr. Johnson observed, “When you look down from the quarter-deck to the space below, you see the utmost extremity of human misery; such crowding, such filth, such stench!”[252] Incited by the enthusiastic Trotter, the medical officers of the Fleet subscribed for a gold medal, and presented it to Jenner. On the obverse, Apollo was represented introducing a young seaman recovered from cowpox to Britannia, who, in return, extended a civic crown, on which was inscribed JENNER; above were the words, Alba nautis stella refulsit, and below the date, 1801. On the reverse was an anchor and over it Georgio Tertio Rege, and under it Spencer Duces. The medal was presented to Jenner in February, 1801.

The dates are worth noting afresh. Jenner’s Inquiry was published in the summer of 1798; and thus we see that within three years his prescription for the prevention and extermination of smallpox was adopted in a branch of the public service where obstinate conservatism was the ruling temper; and an assertion that only time could test was accepted without hesitation as verified and certain. If vaccination had answered to the claim made for it, the haste wherewith it was acknowledged would have been unjustifiable, and wholly unlike the struggle that truth has commonly to pass through in order to obtain supremacy in the intellect and practice of mankind.

The first attempts to inoculate with cowpox in France proving futile, Dr. Woodville went over to Paris in 1800 to show in practice the method of operation. He had a warm reception, and the Quaker was overwhelmed with the exuberant attentions to which he was subjected. In the Moniteur he was described as “a learned man, animated with generous zeal, and worthy of gratitude and praise;” who had inoculated six thousand children with invariable success; and that cowpox as a preventive of smallpox could only be spoken of as something miraculous. A house was opened as a vaccine station, and men, women, and children, flocked thither to receive the benign fluid and life-long protection from a dreadful malady.

When the negotiations for the peace of Amiens were in progress, 1802, an address was presented with much pomp to the Marquis Cornwallis by the Medical Committee of the Somme, claiming brotherhood with the physicians of England, eulogising Jenner, denouncing his detractors, stigmatising variolators as acting neither from the love of truth nor for the glory of their profession, but, from avarice and hatred of improvement; whilst, as the result of numerous experiments, “the discovery made in England had been stamped with the seal of infallibility in France.”

At first, vaccination in France was left to voluntary effort, and made little progress in face of a strenuous resistance developed by alarmed variolators; but a severe smallpox epidemic in 1802 incited the Government to action. A medical commission was appointed to investigate and report, and in 1804 it was determined to spare no effort to extend vaccination over the whole of France. A Central Committee for Vaccination was constituted, and appeals and commands were addressed to the clergy and officials of all orders to have those under their authority and influence inoculated with cowpox. Some préfects were content to recommend and warn, but others adopted more vigorous measures, such as the exclusion of the unvaccinated from schools, from employment, from charities--in short, anticipating much legislation that has come into force, or that fanatics wish to bring into force. Nevertheless, the progress made did not satisfy Napoleon, and seeing that until vaccination was everywhere paid for by the State, its performance must remain irregular and perfunctory, a manifesto was issued to the effect that his Majesty the Emperor and King had learned from the reports of the Central Committee that the preservation and increase of his vast dominions were immediately related to systematic and universal vaccination; wherefore, his Majesty, wishing to give a signal mark of his paternal solicitude for his subjects, had granted to his Excellency the Minister of the Interior, an annual special credit, destined to provide for the expenses necessary for extending the new practice, and for forming centres of issue of vaccine virus in twenty-four of the chief cities of the Empire--these, then, including Brussels, Florence, Parma and Turin. And his Majesty had also, out of his paternal benevolence, provided annual prizes as incentives to emulation in propagating vaccination, so that the scourge of smallpox might be completely banished from his territories.

It would be idle to speculate as to how much serious faith lay within this apparent zeal for vaccination; for, as Professor Seeley observes, “Napoleon seemed to care for no opinion, though he adopted, with studied artificial vehemence, every fashionable opinion in turn.” There might be, I dare say, something piquant to his theatrical genius in opposing his odious contempt for human life to the rigorous enforcement of what was considered a supreme prescription for its preservation. Jenner availed himself of the Emperor’s histrionic instinct in soliciting the release of English travellers detained in France. To one of these occasions we owe the artless anecdote of the arrest of Napoleon’s refusal by the interposition of Josephine, who exclaimed, “Jenner!” The Emperor paused and said, “Jenner! ah, we can deny nothing to that man!” It is sad to relate, the favour was not reciprocated. When Jenner, at the suggestion of Baron Corvisart, appealed to the British Government for similar indulgence to a Frenchman, he had to report that there was no charm in his intervention among his countrymen.

That vaccination should have a welcome in Spain was not surprising, after its reception in Naples. The craze was universal, and diffused through the lowest intelligences. Cowpox was introduced to Madrid with the certificate of France under that of England; and, spite of the distractions of the time, excited much attention. Mr. Allen, secretary to Lord Holland, writing to Jenner from Madrid in 1803, observed--

There is no country likely to receive more benefit from your labours than Spain; for, on the one hand, the mortality among children from the Smallpox has always been very great; and, on the other hand, the inoculation for the Cowpox has been received with the same enthusiasm here as in the rest of Europe; though I am sorry to add that the inoculation of the spurious sort has proved fatal to many children at Seville, who have fallen victims to the Smallpox after they had been pronounced secure from that disease.[253]

There were philosophising doctors in Madrid who did not see why cowpox should possess a singular efficacy, and induced the King, in 1804, to order that all the children in the foundling hospital should be inoculated with goatpox. They did not, perhaps, know that Jenner had inoculated his son with swinepox, and that the child underwent the variolous test on several occasions with impunity.

The great event in connection with Spain was the expedition of Dr. Francis Xavier Balmis, physician to his Catholic Majesty. He obtained a concession to introduce vaccination to the colonies in America and Asia, and to defray expenses by freely trading in merchandise. He sailed from Corunna, 30th November, 1803, with twenty-two children for the propagation of virus. The Canary Islands were first visited, then Porto Rico, and at Caracas the party divided, Don Francis Salvani proceeding to Peru and Chili, whilst Balmis attended to Cuba and Mexico, crossing the Pacific to the Philippines with twenty-six children to maintain the succession of the virus, and proceeding from thence to Macao and Canton. Having circumnavigated the globe as vaccinator and trader, Balmis re-appeared in Madrid with great éclat, and kissed the King’s hand on 7th September, 1806. Philanthropy and business were successfully combined, for as Moore, writing in 1817, observes--

Nearly three years were nobly spent by this excellent man in putting a Vaccine Girdle round the globe; and it is an additional pleasure to learn that by trading during his circumnavigation, he acquired an easy fortune. He now enjoys at Madrid the distinction he has merited, and patronises the diffusion of Vaccination through the Peninsula.[254]

The expedition of Balmis naturally excited much attention, and its progress and results were described in terms of inflated rhetoric. Thus, we read in Baron’s Life of Jenner--

The conductors of the expedition were everywhere welcomed with the utmost enthusiasm. It was to be expected that the representatives of the Spanish Monarch, and all the constituted authorities, would gladly co-operate; but it was scarcely to be anticipated that the unenlightened minds of the Indians would so soon appreciate the value of the mission. It is, nevertheless, most gratifying to know that the numerous hordes which occupy the immense tract of country between the United States and the Spanish colonies all received the precious fluid with the utmost readiness. They acquired the art of vaccinating, and soon performed the operation with great dexterity.

Thus not only the Spanish Americans were brought under the dominion of cowpox, but the Indians, yea, all the Indians; and not reluctantly, but joyfully, and became experts in the practice of the rite! Baron continues--

Fame had preceded the arrival of Salvani at Santa Fé. On approaching the capital, he was met by the Viceroy, the Archbishop, and all the civil and ecclesiastical authorities. The event was celebrated with religious pomp and ceremonies; and in a short time more than fifty thousand persons were vaccinated. Similar honours awaited the expedition throughout its whole course. At Quito they were greeted with boundless joy and festivity. Such expressions well became them. The people of Colombia, the Indians more especially, having been often scourged by the horrid ravages of Smallpox, regarded it as the most terrible affliction which Heaven could send them. On its first appearance in a village, a panic seized every heart; each family prepared an isolated hovel, to which those who were supposed to be infected were banished. There, without succour, without remedy, and with a very insufficient supply of food, they were exposed to the alternations of a very variable climate, and left to their fate. In this way whole generations perished. Under Viceroy Toledo the population of the native Indians had amounted to 7,500,000; but at the time of the Balmis expedition, the number was supposed to be reduced to one-fifth--that is 1,500,000.[255]

Indian and savage statistics in connection with smallpox and vaccination are usually little else than exercises in imaginative desire--less what is true than what is wished to be true, or to be taken for true. We know the difficulty of vaccinating populations dwelling within defined limits and under highly organised governments, and we can therefore estimate the claims made for Balmis and his partners as roving traders and quacks in the territories occupied by Spaniards and Indians. Yet it was with yards of mythical rubbish of this sort that English vaccinators tried to divert the attention of their countrymen from the failures of vaccination within their own experience; and when worried with ever-recurring disasters at home, it was in turning to Mexico and Peru that Jenner professed to find consolation.

Dr. Sacco, of Milan, was described as “the apostle of vaccination in Northern Italy,” and “unquestionably the greatest vaccinator in the world.”[256] His operations received the sanction of the Napoleonic administration, and as early as 1801 he was appointed Director of Vaccination to the Cisalpine Republic. “Strong measures,” writes Moore, “were adopted; proclamations were read from every pulpit; vaccination was practised in every church; and the clergy gave such effectual aid, that the Professor and his associates in three years vaccinated 70,000 persons, and extinguished smallpox in Lombardy.”[257] In other words, the vaccination of 70,000 persons extinguished smallpox in a population of several millions! Baron enlarges the numbers, saying that Dr. Sacco and his assistants in the course of eight years vaccinated 1,300,000 persons; and cites a letter from Sacco, dated from Trieste, 5th January, 1808, with the following extraordinary statement--

During eight years I reckon more than 600,000 vaccinated by my own hand, and more than 700,000 by my deputies in the different departments of the kingdom. I assure you, out of a population of 6,000,000 to have vaccinated 1,300,000 is something to boast of; and I flatter myself that in Italy I have been the means of promoting Vaccination in a degree which no other kingdom of the same population has equalled.[258]

Moore’s 70,000 is a credible number, whatever may be thought of its vicarious operation; but Sacco’s 600,000 by his own hand in eight years! Ah, well! when we are lost in the fabulous, it is unnecessary to waste our strength in the discrimination of the greater from the less in falsehood. Nevertheless, taking Sacco’s figures, we have to observe that the vaccination of 1,300,000 saved 6,000,000 from smallpox. That Italy was freed from smallpox is true, and the exemption of the population, whether vaccinated or unvaccinated, was prolonged over nearly thirty years. The disappearance of the disease had, however, set in before vaccination was heard of, but the subsidence was claimed for Sacco, although it extended to millions of Italians who owed nothing to the new prophylactic. As already observed, from some cause undefined, the area and intensity of smallpox was signally diminishing toward the close of last century, and this in spite of the stimulus applied to the disease by variolous inoculation. It may have been so stimulated as to have been worked out--forced, as it were, to exhaustion, after the habit of much else, good and bad, when developed to the extremity of existence.

As a grand vaccinator Dr. De Carro, of Vienna, was scarcely less distinguished than Sacco. He was a Swiss from Geneva, who had studied and graduated at Edinburgh, and settled in Vienna. He performed the first vaccination on the Continent, in 1799, with virus conveyed on a couple of threads from Dr. Pearson; and in 1802 he succeeded in transmitting the first effective virus to India. De Carro conducted his operations with great energy and tact, and in 1802 he induced the Austrian Government to issue an ordinance conferring on vaccination Imperial sanction and recommendation. Concurrently with this activity, smallpox was abating, and post hoc was converted into propter hoc. De Carro was credited with the extinction of smallpox in Vienna; but as no more than a portion of the citizens had been vaccinated, Vienna thus supplied another instance of the vicarious influence of the Jennerian rite.

Sacco and De Carro corresponded with Jenner, and it is worth noting that both concurred with him in the opinion that cowpox originated in horsegrease; and, further, that horsegrease was as good against smallpox as horsegrease cowpox itself. Indeed, Sacco set up a stock of virus derived from horsegrease, operated with it, and supplied De Carro, who used it so freely in Vienna that, as he said, he could not tell the vaccinated from the equinated. Writing to Jenner, on 21st June, 1803, De Carro observed--

The means of making your discovery were everywhere; yet nobody before you had the least idea of the singular connection between the Horsegrease, the Cowpox, and the Smallpox.[259]

The favour shown for vaccination by the English Court facilitated its adoption throughout Germany; and yet it might be said the craze went of itself, compelling patronage and exacting advocacy. The King of Prussia opened a Royal Inoculation Institute in Berlin, and tracts and medals, speeches and sermons, were brought into requisition to recommend the new rite. From the furore created, many were led to believe that all Prussia was vaccinated, and as smallpox ceased to prevail, cowpox had the credit. To vaccinate a nation, however, is far from easily accomplished, and when we refer to the official accounts, we discover that, notwithstanding great ado, the numbers operated upon constituted less than a tithe of the people. Jenner cites a report of Professor Avelin, of Berlin, in a letter to Moore, 15th February, 1812, as authority for these statistics--

The anniversary of the invention of the Cowpox Inoculation, or the Jennerian Feast, was celebrated very solemnly at Berlin on 14th May. By public accounts, it appears that there were inoculated in all the Prussian States--

In 1801 9,772 1802 17,052 1803 50,054 1804 102,350 1805 43,585

At these times the population was about 9,743,000. From 1806 to 1810 (since the horrible war and the diminution of the population to 4,338,000) the inoculated were 160,329. Dr. Bremer alone at the Royal Institute in Berlin inoculated 14,605. The total, as officially and voluntarily sent to the Government, amounted to 402,720 vaccinated, but certainly one-half was not officially mentioned. It may certainly be at least 600,000, or even 800,000.[260]

Supposing a million had been vaccinated in Prussia in the course of ten years, let me ask once more, how could they have saved the remaining millions from smallpox? Yet, with knowledge of these figures, Moore, the Director of the National Vaccine Establishment in London, did not hesitate to write--

The King of Prussia directed his children to be vaccinated, and also issued orders that Vaccination should be immediately employed in the Army; and the new practice encountered no further difficulties. By which, and by the total abandonment of Variolous Inoculation throughout Germany, the Smallpox rapidly declined; and in a few years was extinguished in some of the largest cities, from whose purlieus infectious diseases are expelled with great difficulty. Thus even in Vienna, where full four hundred persons had annually been destroyed by the Smallpox, this mortality diminished rapidly after the introduction of the Vaccine, and in five years absolutely ceased.[261]

Russia, of course, followed suit in cowpox inoculation. At the coronation of Alexander in Moscow in 1801 a foundling was operated on, christened Vaccinoff, pensioned for life, and dispatched to St. Petersburg to serve as a source of virus for other foundlings. Then followed imperial decrees prescribing vaccination, and Dr. Crichton was directed to organise a medical staff for the performance of the rite in each province of the Empire. In 1811 a ukase was issued commanding all Russians to be vaccinated within three years. As measuring the possibilities of despotism in such a matter, we learn from Dr. Crichton that between 1804 and 1812 there were 1,235,597 vaccinations performed in Russia--a similar number to that which Sacco professed to have accomplished in Northern Italy in the same time. It was estimated in Russia that of every seven children born, one perished of smallpox, and therefore Crichton argued the lives of 176,514 had (up to 1812) been saved by vaccination. The calculation illustrates the facility with which the early vaccinators deceived themselves--first, as to the certainty of their prophylactic; second, as to its vicarious efficacy; and, third, in assuming that a reduction in smallpox represented a reduction in mortality.

From Crichton, too, we learn that there were anti-vaccinists in Russia in those days--

Notwithstanding the supreme order of His Imperial Majesty, that all his subjects he vaccinated within three years, we find that, powerful as his Majesty is, this cannot be executed. There is a power greater than sovereignty, namely, the conscience of religious opinions of men, and in one or two of the distant governments there exists a peculiar religious sect belonging to the Greek Church, who esteem it a damnable crime to encourage the propagation of any disease, or to employ any doctors, or to swallow any medicines under the visitations of God. Reason has been employed in vain with these poor people; they have been threatened with severe punishments in case they remain refractory, but all to no purpose. You may well imagine that no punishment has been resorted to, though threatened, and the Government has come to the wise conclusion of leaving the dispute to time.[262]

To complete this rapid survey of the diffusion of vaccination throughout Europe, there remain Sweden with Finland, and Denmark with Iceland; but as the case of Sweden is specially interesting and instructive from the fulness and precision of its vital statistics, coupled with the claim made by vaccinators that Sweden affords irrefutable evidence of the efficacy of their prescription, I reserve it for a special chapter. There is nothing pleasanter than finding the strongholds of one’s antagonists, capturing, and occupying them.

FOOTNOTES:

[252] Boswell (Croker’s Ed.) vol. vii. p. 102.

[253] Baron’s Life of Jenner, vol. i. p. 604. Allen little suspected that there never was any spurious Cowpox; that it was only “spurious” when it did not prevent Smallpox.

[254] The History of Vaccination. By James Moore. London, 1818. P. 279.

[255] Baron’s Life of Jenner, vol. ii. pp. 80-2.

[256] Baron’s Life of Jenner, vol. ii. p. 234.

[257] Ib. vol. ii. p. 112.

[258] History of Vaccination, London, 1817. P. 263.

[259] Baron’s Life of Jenner, vol. ii. p. 432.

[260] Baron’s Life of Jenner, vol. ii. p. 378.

[261] History of Vaccination, p. 245.

[262] Baron’s Life of Jenner, vol. ii. p. 186.

Spotted a typo or a problem in this chapter? Tell us

XXXI. SWEDEN, DENMARK AND ICELAND

Jenner was in the habit of pointing to Sweden and Ceylon as proofs of what vaccination might accomplish. We have seen how badly Ceylon answered to his reference; and I now proceed to inquire whether Sweden served his purpose any better.

The decline of smallpox in some communities, contemporaneously with the introduction of vaccination, might be ascribed to the cessation of inoculation with smallpox--virtually the culture of that disease; but in Sweden little had to be accounted for in that way. Spite of strong recommendations, variolation was rarely practised, and never became popular. The very year that vaccination was introduced, Dr. Acksell, of Kalmer, stated in an official report, dated 30th March, 1801, “that it is impossible to convince the lower classes of the advantages of inoculation. Dr. Colliander and I have had it announced to the people from the pulpit, that, we were ready to give our services, gratis, in inoculating their children, but not a single person applied.” And such undoubtedly was the state of things throughout the kingdom.

Sweden last century was sorely afflicted with smallpox, and, considering the repute of variolation in other lands, it is surprising how the people refrained from its vaunted protection. It is thought dreadful that in London one death in ten should have been due to this disease, but in Sweden the ratio stood as high as one in seven. To give some idea of the extent of the mischief at its highest and its lowest, let us look at eighteen years in the latter half of the century--

Year. Population. Total Deaths. From Smallpox.

1752 1,799,188 49,467 10,302 1757 1,870,372 55,829 10,241 1763 1,940,011 64,180 11,662 1768 2,006,790 54,751 10,650 1769 2,015,127 54,991 10,215 1773 1,972,407 105,139 12,130 1775 2,020,847 49,949 1,275 1776 2,041,289 45,692 1,503 1777 2,057,147 51,096 2,943 1778 2,073,396 55,028 16,607 1781 2,132,912 54,313 1,485 1784 2,145,213 63,792 12,453 1786 2,156,109 55,951 671 1787 2,163,862 51,998 1,771 1792 2,211,643 52,958 1,939 1797 2,322,814 55,036 1,733 1798 2,344,228 53,862 1,357 1800 2,347,303 73,928 12,032

In these figures we see how wide were the variations in smallpox mortality prior to the introduction of vaccination; and also how indifferent was its influence on the general mortality, much smallpox not raising the death-rate, nor little smallpox lowering it.

Among the factors of mortality in Sweden were scarcity and famine. At this day, when the ends of the earth are drawn together, we are apt to forget the struggle, the misery, and the sickness that prevailed when a deficient harvest in one country, or parts of the same country, could not be made good from the sufficiency of others. Population in Northern Europe did little more than maintain existence through several centuries against the severity of Nature, with food scant and bad, and raiment and shelter inadequate. Of the latter fifty years of last century, at least fifteen were years of dearth in Sweden, and consequently of increased mortality.

The chief sufferers from deficient and unsuitable food are the young, their suffering having form in various ailments, and among them smallpox. I have repeatedly had to point out how smallpox is especially an affection of childhood, and how in Scotland, for instance, it used to be almost exclusively confined to the young, like measles and whooping-cough. The like was true of Sweden; for of the deaths from smallpox from 1774 to 1798--

8·19 per cent. were under one year of age; 21·90 ” between one and three; 31·77 ” ” three and five; 23·74 ” ” five and ten;

a total of 85·60 per cent, being mere children. Or, to put it otherwise--

In 1778, when 16,607 perished, 13,096 were under ten. 1784 ” 12,453 ” 11,789 ” 1786 ” 671 ” 625 ” 1798 ” 1,357 ” 1,207 ”

and so on.

Now, whilst I have no wish to minimise the sadness and culpability of the mortality of the young, I have yet to maintain that its consequences are by no means so serious to the State as when the heads of families and bread-winners are stricken down; and that it is a gross exaggeration to compare the fatality of smallpox with that of men slain in battle. Again, we have to recollect how many of the young die from smallpox, so to say, needlessly, from inattention and malpractice. This was clearly recognised in a Royal Letter issued from Stockholm in 1763, recommending variolation, in which the Medical Board was directed “to instruct the common people how children should be treated when suffering from natural smallpox,” assigning the cogent reason, “because many more children die from want of care than from the disease.” The assertion may be taken as indisputable; and, being true, it stands for the fact that the mortality from smallpox might have been largely reduced if parents had had the knowledge and the means to nurse their offspring through their illness. They died less of smallpox than of ignorant and defective treatment whilst under smallpox.

I have also to observe that smallpox in Sweden was steadily declining toward the close of the century, and that the decline continued into the present century. Taking the years in decades from 1749 to 1868, and casting the average, we have these results--

Annual Annual Deaths Death-rate Deaths from Decade. Population. Annually. per 1,000. Smallpox.

1749-58 1,821,009 50,556 27·76 6,056 1759-68 1,946,258 53,288 27·38 5,309 1769-78 2,028,141 59,262 29·22 4,535 1779-88 2,140,315 56,766 26·52 5,179 1789-98 2,246,744 57,883 25·76 3,810 1799-08 2,394,432 63,365 26·46 3,282 1809-18 2,444,568 67,537 27·63 690 1819-28 2,787,025 63,121 22·60 373 1829-38 2,976,829 70,168 23·57 633 1839-48 3,255,604 68,080 20·91 299 1849-58 3,588,571 78,218 21·80 816 1859-68 4,016,690 79,033 19·68 861

With these details before us, we are in a position to appreciate the claim made for vaccination, that it exterminated Smallpox in Sweden.

Vaccination began to be practised in Sweden in the year 1801. It was at first viewed with distrust by some of the leading medical authorities, but grew so rapidly in favour, that the medical board in 1803 ventured to make proposals for its general introduction. By Royal Letters in 1804 and 1805 measures were decreed for the encouragement of Vaccination; and in the almanacs for 1806, information and advice were inserted concerning “the new and certain means for the prevention and extirpation of Smallpox.” Nevertheless, the practice made way but slowly into the confidence of the common people, and not until 1812 did a committee of the Diet go so far as to recommend its compulsory adoption. The principle of compulsion was affirmed by the Diet in 1815, leading to a Royal Decree of 6th March, 1816, whereby Vaccination was made obligatory under penalty of fine and imprisonment.

Subsequently, the law was modified, but never relaxed. Whilst the rite was obligatory, it was offered gratuitously, and public vaccinators, usually parish clerks and midwives, were appointed throughout the land, and stimulated to exertion by special rewards. Vaccination was made a condition of admission to school, and was placed by the clergy on a level with baptism and confirmation. Wherefore, in course of time, it has come to pass that Sweden is described as “the best vaccinated country in the world.”

To this result the recognised interest of the Swedish clergy in medical practice largely contributed. They were not slow to perceive a fresh line of business in vaccination. Archbishop Lindblom, among others, was extremely zealous in promoting the practice in his diocese, and from a correspondence between the Consistory of Upsala and the Medical Board, it appears that the competition between the physicians and the parsons was severe. The Consistory complained that the rewards for vaccination energy were more liberally bestowed on medical men than on the deserving clergy, and that it was unfair to insist on the clergy taking out a license to vaccinate, ending with the reproach that the mishaps of some medical men had so alarmed the people in certain districts, that very few were willing to avail themselves of the wonderful prophylactic. The Board replied, that they were aware that mistakes had occurred through the use of spurious cowpox, as proved by the outbreak of smallpox afterwards; but, at the same time, what better check could be devised on incompetent practitioners than a medical license? The right of the clergy to vaccinate was not contested, but only that they should possess some recognised qualification. The extent of the ecclesiastical operations in cowpox appears from the return of the Archbishopric of Upsala, which showed that from 1804 to the end of 1810 there were 33,298 persons vaccinated, of whom 7,025 were inoculated by clergy, 20,000 by church officers, and 6,273 by medical men and others. It was by the clergy and the doctors that the project of compulsion was initiated. In a letter from the Medical Board to the King in 1810, complaint was made that “the public in Sweden do not in all places manifest the care and zeal which might be expected from sensible and tender parents in applying for, or allowing to be applied, the precious means of salvation provided for their children’s good looks and future health.” In 1814, the same Board wrote that “several of the Bishops who take the deepest interest in the spread of vaccination, have expressed their conviction that certain well-devised penalties have become as necessary as regards the ignorant masses as encouragements are useful”; and as late as 1815, the Board had to testify against the “sluggishness and indifference prevalent among the less enlightened classes.”

Compulsion was, therefore, enacted in 1816 to overcome the inertia of the lower orders, the mass of the people who at all times yield the largest crop of smallpox.

“Smallpox was exterminated in Sweden by vaccination,” is a common saying. Moore, in his History of Vaccination, published in 1817, after describing the various measures taken, observed--

It is superfluous to add, that by such a concurrence of virtuous exertions, Smallpox was quickly suppressed in Sweden.

Ere proceeding to inquire whether smallpox was thus suppressed, I would call attention to the hands by which vaccination was administered in Sweden. It is the custom at this day to describe vaccination as a delicate operation, and to attribute subsequent smallpox to some irregularity or defect in its performance; and yet here we are asked to contemplate a whole nation delivered from smallpox, the vaccinators being chiefly priests, clerks, and midwives. What does it mean? Is it that any sort of vaccination is good when smallpox does not follow, and that any sort is bad when smallpox does follow? If smallpox had not ceased out of the land, would it then have been said, “What wonder, considering the character of the vaccinators”?

To the assertion that smallpox in Sweden was exterminated by vaccination, the answer is an unqualified contradiction. It is not true; it is demonstrably untrue. Smallpox was declining in Sweden before vaccination was heard of, and the fall continued irrespective of its influence. Look at the figures. Here we have the returns of smallpox mortality in Sweden during the last sixteen years of the past, and the first sixteen years of the current century, up to the time when vaccination was made compulsory--

Deaths Deaths Year. from Year. from Smallpox. Smallpox.

1785 5,077 1801 6,057 1786 671 1802 1,533 1787 1,771 1803 1,464 1788 5,462 1804 1,460 1789 6,764 1805 1,090 1790 5,893 1806 1,482 1791 3,101 1807 2,119 1792 1,939 1808 1,814 1793 2,103 1809 2,404 1794 3,964 1810 824 1795 6,740 1811 698 1796 4,503 1812 404 1797 1,733 1813 547 1798 1,357 1814 308 1799 3,756 1815 472 1800 12,032 1816 690 ------ ------ Total, 66,866 Total 23,376 ====== ======

Thus we see the process of subsidence, with alternations from year to year, with the reduction of two-thirds, from 66,866 in the former to 23,376 in the latter series of years.

It will be said, of course, that vaccination was introduced into Sweden in 1801. True, but the introduction of vaccination was one thing, and its diffusion over the nation another. It was a section of the people least likely to be affected with smallpox who welcomed and practised vaccination; and however energetic and successful they might be in their promotion of the new rite, their efforts were limited to thousands among millions. All the while smallpox was declining, and they took the decline for encouragement, and began to cry out, “See! see what we are doing!” The enactment of compulsory and gratuitous vaccination in 1816 was an open confession that the lower classes remained to be dealt with, that is to say, the very people among whom smallpox had its stronghold. There are tribes whose priests profess to bring rain, and drive away sickness with their enchantments; but if showers had begun to descend, and the sick to recover, ere their assistance was invoked, it would be hard to convince even the credulous that the desired relief was due to their subsequent magic. But it is precisely in the subsequent magic of the vaccinators that we are asked to believe when told that vaccination drove smallpox out of Sweden. It was going out before vaccination was called in, and kept going out all the same when the vaccinators plied their enchantments. Happily, patient Nature holds her way unprovoked by human quackeries. Not even to confute impostors does she reverse for an instant her impartial operations.

But, although deaths from smallpox fell off so rapidly, there was no correspondent improvement in the public health. Smallpox was merely replaced by other forms of disease. Thus, the death-rate of Sweden per 1,000 for seventy years, stands as follows--

Decade. Deaths. | Decade. Deaths. | 1749-1758 27·76 | 1789-1798 25·56 1759-1768 27·38 | 1799-1808 26·46 1769-1778 29·22 | 1809-1818 27·63 1779-1788 26·52 |

Moreover, smallpox mortality, whilst rapidly decreasing before the enactment of compulsory vaccination, has since been slowly increasing. Thus--

Years before Average annual | Years after Average annual Compulsion. smallpox | Compulsion. smallpox mortality. | mortality. 1756-1775 5,480 | 1816-1835 450 1776-1795 4,617 | 1836-1855 577 1796-1815 2,303 | 1856-1875 1,031

We therefore see that while Jenner and his friends were boasting of their achievements in Sweden, they had to account for the fall in smallpox before their intervention, and for its continued decline ere their intervention was operative; and, moreover, to answer the question, What is the profit of salvation from smallpox if death ensue from other causes? It is, however, to be observed that such large considerations were outside the scope of Jenner’s intelligence. There was smallpox, and there was vaccination, his invention, the infallible preventive of smallpox, and he saw nothing beyond. His self-love was implicated in the defence of vaccination, and any story in its favour was accepted as true, and proclaimed abroad, whilst anything to its discredit was resented as a personal affront, or denounced as wilful and diabolic falsehood. As for statistics, he had no capacity. Baron says, “Neither Dr. Jenner’s previous education nor his habits gave him a relish for any of the branches of pure science; and he seemed to have a peculiar horror of arithmetical questions, and was often jocular on this defect in his nature.”[263] This inability to calculate goes far to account for the absurdity of many of his statements concerning the miraculous effects of vaccination among populations where only two or three per cent. had been operated upon; and who, therefore, must have vicariously delivered the remainder from smallpox. To an intellect thus defective, the introduction of vaccination to Sweden was the vaccination of the Swedes; the decline of smallpox was its suppression; and its suppression was the consequence of vaccination. But the excuse that is available for Jenner does not serve those who cannot plead his congenital defect, and are satisfied to repeat his preposterous assertions.

Smallpox kept declining in Sweden until the decade (1841-50) when the annual average of deaths per million fell to 212. The variations in the mortality in single years are remarkable. Here are thirteen years when the deaths were under a hundred--

1821 37 1822 11 1823 39 1829 53 1842 58 1843 9 1844 6 1845 6 1846 2 1847 13 1848 71 1855 41 1856 52

On the other hand, here are eighteen years when the deaths were over a thousand--

1825 1,243 1833 1,145 1834 1,049 1838 1,805 1839 1,934 1850 1,376 1851 2,488 1852 1,534 1858 1,289 1859 1,470 1865 1,336 1866 1,217 1867 1,061 1868 1,429 1869 1,474 1873 1,122 1874 4,063 1875 2,019

The death-rate from smallpox, which fell to 212 per million in 1841-50, rose to 862 per million in 1851-60, to 867 per million in 1861-70, and, owing to the epidemic of 1873-74, the worst in Sweden since 1801, the last decade, 1871-80, will exhibit a higher average.

In presence of these statistics, it is fair to repeat the inquiry, “Why was smallpox declining before vaccination was introduced; and why has smallpox revived and increased in ‘the best vaccinated country in Europe’?”

Again, too, I must call attention afresh to the fact of the irrelevant influence of smallpox upon the national mortality. Mr. P. A. Siljeström has published a diagram of the course of mortality in Sweden from 1774 to 1878, with the part smallpox has played in that mortality, from which it is manifest (to all who choose to use their own eyes) that the action of smallpox as a destroyer of life has been wildly exaggerated.[264] Bad years of smallpox are not years of a high death-rate, nor are years with little smallpox years of a low death-rate. When smallpox is prevalent it appears to replace other forms of disease, and when not prevalent, to be replaced by diseases of greater fatality. Wherefore, argues Mr. Siljeström--

Of what use is it to the public that a smaller number of citizens die annually from Smallpox (supposing that this result is brought about by Vaccination), if an equally large number, nevertheless, die from other diseases? We can see no farther advantage in it than there would be in a battle, if none of the men fell before the fire of the artillery, but all the more died from the fire of the line. To the individual it may possibly be more agreeable to die of any other disease than Smallpox, and it ought, therefore, to be allowed to everyone to save himself, through Vaccination, or any other lawful means, from an eventuality which he fears; but this cannot possibly, in itself, be regarded as the business of the State.

Sweden is a large country, and its diseases must be subject to many local variations; but Stockholm, representing a compact population, exhibits much the same phenomena. In some years of last century the city was severely afflicted with smallpox, as the deaths in these years show--

1778 639 1783 714 1784 411 1787 414 1795 447 1800 703

These years were the worst; there were variations such as these--

1780 14 1782 12 1785 20 1793 22 1797 13 1798 12

As in Sweden at large, so in Stockholm, a fall in smallpox had set in, and was continued into the new century, until years appeared without a single death; for which vaccination had the credit, and the disease was proclaimed “stamped out,” none dreaming of reverse ahead. By and by it began to revive, and deaths were thus registered--

1857 319 1865 273 1866 157 1870 96 1871 113 1873 191

And then came the dreadful epidemic of 1874, when 1,191 perished, and 317 in 1875.

Thus, in two years, 1,382 perished in a population of 150,000--a death-rate of 7,916 per million--against 2,430 per million in London during the memorable epidemic of 1871; the severest outbreak of smallpox in the century in “the best and most vaccinated population in Europe!”

Under examination, the case for vaccination in Sweden altogether disappears. By Mr. P. A. Siljeström the examination has been conducted with a precision, a thoroughness, and a judicial temper that leave nothing to desire. His treatise was translated into English by Miss Frederica Rowan, and published in 1875, under the title of “The Vaccination Question: an Essay towards determining the Boundaries within which a Scientific Theory may rightfully claim to have effect given it by Legislation;” and a skilful abridgment was produced by Prof. F. W. Newman; but the original, which extends to no more than 104 pages, should be studied by whoever is seriously interested in the vaccination question. Sweden, through the possession of a long series of vital statistics, offers special facilities for a comprehensive study of the phenomena of smallpox; and in Mr. Siljeström’s treatise, we have veracity with good sense, and science with philosophy, instead of the inadequate and catchpenny stuff current in this country as “truth about vaccination.”

In Finland, the story of vaccination is much the same as in Sweden, with the difference that there was no natural subsidence of smallpox to be placed to its credit. Wherefore, as concerns Finland, it is the habit of vaccinators to preserve a discreet silence, the facts not tending to edification in the Jennerian faith.

A curious evidence of the simple trust with which the cowpox revelation was received in certain countries, is found in an ordinance issued in Finland constituting smallpox after vaccination a proof of imposture on the part of the vaccinator. The ordinance ran thus--

That the Inoculator or Vaccinator whose patients, within a shorter or longer time after having by him been inoculated or vaccinated, shall prove to have been attacked by natural Smallpox, with deadly result or other serious consequence, shall without pardon be declared unworthy of all further right to reward or confidence, and moreover, be impeached for due punishment on account of dishonest and unprofessional behaviour.

Under such a law (no severer than many which enact punishment where the buyer does not obtain from the seller what he gives his money for) how would it fare with the legion who now practise vaccination? But I am reminded that vaccinators no longer undertake to preserve their patients from smallpox, but only to keep it off until it comes, and then to make it milder.

Vaccination was introduced to Denmark at the same time as Sweden, and was made compulsory in 1810. As in Sweden, smallpox was falling off, and, as in Sweden, the vaccinators were loud in their outcry over their success; but their claim was absurd. The population of Denmark in 1801 was 925,680, and up to 1810 no more than 118,782 persons had been vaccinated, whilst the births during the same period were 283,905. It was, therefore, assumed that the vaccination of less than a tenth of the population in eight years had reduced and extinguished smallpox among the unvaccinated nine-tenths! Where there is a disposition to believe, anything may pass for credible.

Subsequently to 1801 there was little smallpox in Copenhagen, and from 1811 to 1823 not a death from the disease was recorded; but in 1824 smallpox reappeared; and in 1835 there were 434 deaths in the city; when it began to be admitted that vaccination did not prevent smallpox, and that revaccination was necessary for complete protection; but, if requisite, how was the miraculous extinction of the disease by the primary vaccination of less than a tenth of the population in the early years of the century to be accounted for?

Here we have the record of Copenhagen smallpox for seventy-five years, 1801-75--

Years. Deaths. Annual Average. 1801-10 639 64 1811-20 -- -- 1821-30 119 12 1831-40 568 56 1841-50 245 24 1851-60 160 16 1861-70 168 16 1871-75 518 103

Thus the number of deaths in the five years, 1871-75, was nearly equal to the deaths in the preceding thirty years, 1841-70; whilst at the same time the more or less smallpox had no apparent influence in raising or lowering the general mortality.

Iceland, as a dependency of Denmark, is often cited as evidence for the virtue of vaccination. Speaking in the House of Commons recently, Mr. T. W. Evans proclaimed, “Vaccination has extinguished smallpox in Iceland! There has not been a case in the island for thirty years.” Could aught be more conclusive? and the assertion is re-asserted with triumph: yet, under examination, we shall see the statement and the inference vanish like smoke.

First, the absence of smallpox from Iceland for series of years was nothing uncommon. Iceland’s history is singularly copious and accurate; and from Schleisner’s Iceland from the point of view of Medical Science, Copenhagen, 1849, we have the following list of smallpox epidemics during five hundred years--

1347--A great epidemic. 1380--Ditto. 1430--Terrible epidemic--8000 deaths. 1511--A great epidemic. 1555--Ditto. 1574--Ditto. 1580--A kind of variolous disease. 1590--Smallpox epidemic. 1616-17--Ditto by importation. 1632--Smallpox epidemic. 1636--Ditto. 1655--Ditto. 1658--Ditto. 1670-1--Varioloid and Smallpox. 1707-9--A dreadful epidemic by importation--18,000 died. 1742--A small epidemic from case brought in Dutch vessel. 1762-3--A mild epidemic. 1785--A small epidemic--73 deaths. 1786--Epidemic--1237 deaths. 1787--Epidemic--113 deaths. 1839-40--Smallpox again brought to Iceland, but prevented from spreading by strict quarantine.

From this list it will be seen that for centuries Iceland has had long terms of immunity from smallpox. Thus--

Dates. Immunity. 1347 to 1380 33 years. 1380 ” 1430 50 ” 1430 ” 1511 81 ” 1511 ” 1555 44 ” 1671 to 1707 36 years. 1709 ” 1742 33 ” 1787 ” 1839 52 ”

Inasmuch then as vaccination could have nothing to do with the years of immunity in former times, on what ground of reason can vaccination be set forth as the cause of immunity at this day? Schleisner observes--

Since 1306 Smallpox has been epidemic in Iceland nineteen times, and has always been brought in either by French, English, Dutch, or Danish ships. In early times it frequently caused a terrible mortality, as in 1707, when 18,000 out of a population of 50,000 perished; and in 1430, when 8000 are said to have died. In later years its violence has diminished in consequence of the introduction of Vaccination. In 1785-6-7, its last attack in the eighteenth century, only 1425 persons died.

Very good; but in 1785-87, vaccination was unknown; and as the epidemics of 1742 and 1762 are recorded by Schleisner as “small” and “mild” respectively, while so early as 1580 one is described as “a kind of variolous disease,” it is evident that vaccination could have as little to do with making “smallpox milder” as with the long terms of immunity which Iceland has enjoyed.

In an appeal by Mr. William Morris on behalf of the Icelanders, threatened with famine in 1882 he observed--

Lastly, the Measles, which has not been in Iceland for thirty-six years, and which falling on a people not used to it, is a deadly and not a trivial disease, has attacked Reykjavik, where half the people are down with it, and many have died, and it is now spreading over the island.

Measles absent from Iceland for thirty-six years! Supposing there were some dodge against measles corresponding to vaccination against smallpox, would not the exemption in every year up to the thirty-sixth have been ascribed to its efficacy?

Dr. Garth Wilkinson relates that in 1866 when standing on the Lawrock, where the Althing was held, Dr. Hjaltalin, Medical Inspector of Iceland, told him--

When, in 1000 A.D., Christianity was first introduced into Iceland, the heathen party in the Althing credited the wrath of their gods with a volcanic eruption which broke out on a neighbouring farm. Snorri, the great Icelandic historian, being present, asked, “What then was it that made the gods angry when the older lava was on fire?” It clearly was not Christianity then. He carried the day against the gods by this common-sense question, and Christianity became the law of the land.

Somewhat parallel with this history is the claim made for the extirpation of Smallpox by Vaccination in Iceland. It is a case of ante hoc pricking the windbag of post hoc, and, a fortiori, of propter hoc.[265]

Whilst thus the Icelandic Vaccination Bubble is burst, it remains to be observed that if vaccination had saved the Icelanders from smallpox it could only have been vicariously--as in so many instances of similar salvation; for during the first half of the present century no more than 17,072 vaccinations were effected in a population of between fifty and sixty thousand in the flux of birth and death. The vaccinations are thus recorded--

YEARS--1804-15 VACCINATIONS-- 1345 ” 1816-30 ” 10,386 ” 1831-37 ” None. ” 1838-50 ” 5341 ------ Total, 17,072[266]

There is much of the like order of “facts in favour of vaccination” current concerning other European populations, which only pass muster because they are rarely subjected to criticism; because vaccination is considered such a benign invention that to question its credentials is wicked; and because it is held that if even some of the claims made for it are touched with fable, yet their effect on the popular mind is so clearly for good in inspiring confidence and overwhelming occasional mishaps, that it is inexpedient to be over-scrupulous. But, however instructive and wholesome may be the exposure of such sophistications, it is necessary to restrain ourselves, and for the remainder of my Story we shall keep to English ground.

From the preceding details we see how far vaccination in Sweden, Denmark and Iceland fell short of the claims made for it by Jenner and his successors. Jenner, it is true, died in 1823, before the more pronounced refutations of his assertions had been evolved, but, as said, it is questionable whether he ever realised that the names of countries stood for millions of men, women and children whose vaccination could only be overtaken by organised exertion in the process of years. His various boasts, therefore, of vaccinated nations and exterminated smallpox are to be taken as proofs of defective arithmetical capacity and of that scientific imagination which runs with possibility and matter-of-fact.

FOOTNOTES:

[263] Baron’s Life of Jenner, vol. ii. p. 293.

[264] Tables relative to Vaccination in Sweden, 1774-1778. London Society for the Abolition of Compulsory Vaccination.

[265] Vaccination Tracts, Part III. No. 14. London, 1878.

[266] Report on the Vaccination Act (1867) from the Select Committee of the House of Commons, 1871. P. 414.

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XXXII. NEWCASTLE SMALLPOX: A COMMON STORY

To examine the statistics of the larger English towns in order to determine whether vaccination has had any influence on the abatement of smallpox, would involve us in discussion interminable. For our immediate purpose it may suffice to select three examples; 1st, NEWCASTLE-ON-TYNE, as an instance of a common story; 2nd, NORWICH, as an instance of a smallpox epidemic; and 3rd, GLASGOW, as an instance of smallpox displaced and replaced as a factor of mortality.

THE NEWCASTLE DISPENSARY.

We often hear of “the statistics of the Anti-Vaccinators;” to which the summary answer is that Anti-Vaccinators have no statistics. Their statistics are the statistics of the Vaccinators, in which they provide the material for their own condemnation; which is probably the reason why the so-called statistics of the Anti-Vaccinators are so intensely disliked, avoided, and unanswered.

The Newcastle Dispensary in 1877 completed its hundredth year, having been founded in 1777, and Dr. Monteith prepared a concise history of the institution, which was published in 1878 by order of the Committee.[267] The report is especially valuable as a record of the comparative incidence of disease in a large industrial population, where, if anywhere, smallpox might be expected to show itself in severe form. In 1781 the population of Newcastle was estimated at 23,000; in 1821 it had risen to 41,794; in 1851 to 87,784; and in 1871 to 128,443; and through all these years and changes, the Dispensary continued in active operation, the percentage of the patients to the population being maintained with remarkable uniformity. It is needless to add that the majority of the patients have been from the ranks of the poor, among whom smallpox has always its chief seat. As Dr. Monteith observes--

They are the class intermediate between the well-to-do working-man and the pauper. The state of distress in which these people continually live is known to few. The patient, when visited by the doctor, is usually found lying in “poverty, hunger, and dirt,” and the treatment of the cases is undertaken in circumstances very unpropitious to success. Medical advice and medicine are not the only things needed. Good food, warmth, and judicious nursing are imperatively required, and are seldom if ever attainable.

Before turning to the Dispensary’s record of a century of smallpox, it may be well to observe that Variolation was practised in Newcastle with great assiduity, and that the Dispensary took a lead in the business, the surgeons inoculating any one who applied. Dr. Monteith relates--

By the year 1777 the arguments in favour of Variolation had so far triumphed over the habits and prejudices of the profession that there is no instance mentioned in our reports of any medical man in Newcastle opposing it. It is always spoken of as one of the best established facts of medical science. With the general public the case was different. Their prejudices were as strong as ever, and they exhibited a horror of Variolation which would satisfy the most ardent Anti-Vaccinator. To combat these prejudices various means were tried--sermons from the pulpit, pathetic exhortations in the newspapers, etc. The last and most convincing argument consisted of a pecuniary reward to parents who should allow their children to undergo the operation. The sum offered was 5s. for one child, 7s. for two, 9s. for three, and 10s. for four, and upwards. The success of this expedient was remarkable. Parents came flocking in with their children in great numbers. Tempted by the rewards, they subjected their little ones to an operation which, unless their sentiments had greatly altered, they believed to be barbarous and hurtful in the extreme, and a clear temptation of Providence. Variolation on these terms commenced in the spring of 1786; and every year thereafter, until 1801, children were operated on at the Dispensary at the rate of over 200 per annum. In 1801 there had been in all 3,268 operated upon.

As soon as Vaccination came into vogue, Variolation was denounced as the chief cause of the existence of smallpox. It was said that what was done to avert the disease from the individual diffused it among the multitude. Vaccinators long maintained that they could easily exterminate smallpox, if only Variolators would refrain from keeping it alive. Variolation gradually ceased, and was formally prohibited in 1840, and by and by Vaccination was made compulsory. Nevertheless, the confident prophecy of the Vaccinators remains unfulfilled, for smallpox is not exterminated.

The change from Variolation to Vaccination at the Newcastle Dispensary was immediate. Dr. Monteith says--

It is creditable to the good sense and enlightenment of the Dispensary authorities that they at once abolished Inoculation of Smallpox, and substituted Vaccination in its stead. In 1801, the first year, 215 children were vaccinated. The annual number rapidly rose until it reached its maximum in 1813, when 1,874 were vaccinated, after which the numbers as rapidly declined.

For this decline various reasons were assigned, such as the increase of the private practice of vaccination, and the disposition to undervalue every benefit, however great, that is purely eleemosynary. It is forgotten that Vaccination fell off as its illusory character became more and more manifest, and as the promises made on its behalf were, one and all, indisputably belied. When Jenner died in 1823, he passed away amid indifference, if not contempt. His bubble had burst. The furore for vaccination witnessed in the present generation is by no means a continuation of the original furore. That passed away. Our furore is a revival, dating from the popularity of sanitary reform, to the back of which a new generation of medical men contrived to attach vaccination!

In the hundred years, 1777 to 1877, the Dispensary had to deal with 2,616 cases of smallpox, of which 428 terminated fatally, which as to years and mortality may be thus classified--

Years. Cases. Deaths. Mortality per 100. 1777 to 1802 365 90 24·6 1808 ” 1827 273 57 20·8 1828 ” 1852 925 152 16·4 1853 ” 1877 1,053 129 12·25 ----- --- ---- 2,616 428 16·3

The progressive reduction in mortality is, of course, ascribed to vaccination having made the disease milder; though the report informs us that “the mortality from smallpox reached its highest point--33·3 per cent. in the five years from 1802 to 1807,” the very time when enthusiasm in favour of the Jennerian rite was at its acme. We, on the other hand, would attribute the lower mortality, as did Dr. Andrew Combe, to better modes of treatment, even neglect being preferable to much of the old-fashioned regimen for smallpox. Considering the figures, Dr. Monteith observes--

Of Smallpox I desire to speak with circumspection, for in Newcastle Anti-Vaccinators are somewhat rampant. Figures, however, are stubborn things, and their import is not easily explained away. Like the vast majority of medical men, I have always firmly believed in the good results of Vaccination. Without admitting that my faith has been shaken by considering these statistics, I must confess that I have been a good deal disappointed with them. I had expected to find this terrible disease regularly decimating the population every year until the epoch of Jenner’s discovery, and afterwards diminishing, rapidly and steadily, almost to nothing. These figures do not warrant us in taking so sanguine a view of the matter.

Whilst, therefore, we observe considerable improvement in the figures, I am of opinion that they leave us in this dilemma--either that there now exists a grossly exaggerated impression of the prevalence and fatality of Smallpox in former times, or else that they had begun to decrease long before the discovery of Vaccination, the beneficial effects of which must, therefore, have been at least assisted by other causes.

Here we have an honourable confession from out the bonds of professional prejudice, and a reluctant exposure of the legend of a world decimated by smallpox, and ceasing to be decimated after the advent of Jenner. There is nothing singular in the Newcastle evidence that has awakened distrust in the mind of Dr. Monteith. Similar evidence is found wherever facts are available. The legend to the contrary has become established, like many other legends, by dint of repetition, until those who venture to question it are regarded with suspicion and dislike.

The Report of the Newcastle Dispensary illustrates another truth, namely, that the abatement or cessation of smallpox is by no means equivalent to a reduction of death; that evil conditions of life remaining unchanged, a fall in smallpox is compensated for by a rise in some cognate form of zymotic disease. Thus Dr. Monteith remarks:

It is generally said by the opponents of Vaccination that the other exanthemata have increased since its introduction. It must be allowed that our figures (probably unreliable as general data), give some support to this supposition. The proportion of cases of Scarlatina in the five years, 1827-32 was 4·3 per cent. It has never reached that high limit since; but the percentage has never fallen below 2 in the last thirty-five years. Mortality has also increased to an alarming extent. At one time so low as 2·5 per cent., it has amounted to 17 per cent. in the last five years. Scarlatina is now by far the most fatal disease on the list, with the exception of Consumption.

Of Scarlatina, the Dispensary record stands thus--

Years. Cases. Deaths. Mortality per 100. 1777 to 1802 355 33 9·3 1803 ” 1827 795 30 3·7 1828 ” 1852 1,856 155 8·3 1853 ” 1877 3,659 567 15·5 ----- --- ---- 6,665 785 11·7

Of Measles it is said, “the disease has somewhat increased in numbers, whilst the proportion of deaths to cases has not varied much.” Thus the record stands--

Years. Cases. Deaths. Mortality per 100. 1777 to 1802 186 16 8·6 1803 ” 1827 435 22 5·0 1828 ” 1852 1,572 83 5·2 1853 ” 1877 2,537 123 4·8 ----- --- --- 4,730 244 5·1

Of Whooping Cough it is observed--

The death-rate in former years fluctuated widely. At present it appears to remain stationary at a figure somewhat above the average of the century. There is a common impression that Whooping Cough is a disease of little danger and no importance, but the following table shows that of late years it has been more fatal than Smallpox or Measles.

Years. Cases. Deaths. Mortality per 100. 1777 to 1802 245 22 9·0 1803 ” 1827 220 23 10·4 1828 ” 1852 743 112 15·0 1853 ” 1877 1,716 241 14·0 ----- --- ---- 2,924 398 13·6

Smallpox, Scarlatina, Measles, and Whooping Cough may be regarded as convertible forms of infantile zymotic disease. Conditions of existence remaining equal, one may be the substitute of the other, maintaining thereby a common death-rate. Diarrhœa is sometimes placed in the same category; and, like erysipelas, it is to a large extent a consequence of vaccination. It should never be forgotten that vaccination induces a constitutional disturbance or fever, which illness is offered to Nature as a propitiation for smallpox; with which propitiation, say the vaccinators, Nature is satisfied, and withholds the infliction of smallpox. Vaccination, as an illness, however, is frequently attended with diarrhœa, and the increase of that affection, pari passu, with the increase of infant vaccination, is marked. Thus stands the record of Diarrhœa--

Years. Cases. Deaths. Mortality per 100. 1777 to 1802 1,390 67 4·8 1803 ” 1827 1,529 7 ·4 1828 ” 1852 3,995 43 1·0 1853 ” 1877 6,117 362 5·9 ----- --- --- 13,031 479 3·6

Dr. Monteith observes--

The mortality from Diarrhœa is unfortunately steadily increasing, the percentage for the last five years, 1872-77, being the highest on record--viz., 14·4. The majority of the deaths takes place among infants; and the disease is produced in most cases by the ignorance or carelessness of mothers in giving them food which is not fit for them. But why this should be the case now any more than it was twenty or fifty years ago, I cannot understand. An increased consumption of alcoholic stimulants in later times has been suggested to me as an explanation.

Any explanation is welcome that will preserve vaccination from reproach, yet what medical man is ignorant of the fact that diarrhœa is one of the commonest sequences of vaccination? Nature thus endeavouring to throw off the effects of the virus infused into the blood.

Taking, then, these five diseases in the order of their mortality, they range thus--

1777- 1803- 1828- 1853- 1802 1827 1852 1877 Total.

Scarlatina, { Cases, 355 795 1,856 3,659 6,665 { Deaths, 33 30 155 567 785 Diarrhœa, { Cases, 1,390 1,529 3,995 6,117 13,031 { Deaths, 67 7 43 362 497 Smallpox, { Cases, 365 273 925 1,053 2,616 { Deaths, 90 57 152 129 428 Whooping- { Cases, 245 220 743 1,716 2,924 Cough, { Deaths, 22 23 112 241 398 Measles, { Cases, 186 435 1,572 2,537 4,730 { Deaths, 16 22 83 123 244

In the course of a century the Newcastle Dispensary had dealt with a total of 250,637 cases, of which no more than 2,616 were of smallpox, or about 1 in 96. The total deaths during the century were 14,088, of which no more than 428 were due to smallpox, or about 1 in 33; whilst from scarlatina they were 1 in 18, from diarrhœa 1 in 30, and from whooping-cough 1 in 35. It may be said, the record of the Dispensary does not account for the population of Newcastle. True; but it accounts for the lower strata of the population, and, therefore, for an excessive proportion of smallpox. The complete statistics of the city would exhibit smallpox as a still lighter affliction. And, we repeat, there is nothing singular about the record of the Newcastle Dispensary. It is a common story. Whenever we get out of the region of romance, and tread the ground of matter-of-fact, it is to discover that the wilder horrors and ravages of smallpox have been originally evolved from imagination, and are perpetuated in ignorance from hearsay.

FOOTNOTE:

[267] Report of the Newcastle Dispensary, from its Foundation in 1777. Printed by order of the Committee. Newcastle-upon-Tyne, 1878.

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XXXIII. THE NORWICH EPIDEMIC--1819

I have repeatedly cautioned my readers against the common assumption that the London smallpox of last century was the measure of English smallpox. It was not so. Smallpox was endemic in London, whereas it occurred as an occasional epidemic in other English towns, and was almost unknown in many rural districts. Moreover, the disease was not allowed to die out, but was diligently cultivated and diffused by variolation. As vaccination was introduced, the practice of variolation correspondently ceased, and with its cessation there was an abatement of smallpox, which abatement was unwarrantably ascribed to vaccination. How much of the smallpox of last century was due to variolation it is impossible to determine; nor would it be safe to accept the assertions of the early advocates of vaccination on the point. I apprehend that if smallpox were something desirable which everyone was intent on catching, it would be discovered that it could not be universally caught, and that its propagation had definite limits; and it is not improbable that among Londoners the limit of propagation was closely approached, so that nearly all who were susceptible contracted the disease. What, however, I wish to enforce is, that the decline in the prevalence of smallpox in some places coincidently with the introduction of vaccination was largely due to the discontinuance of smallpox culture, and that the suppression of that culture would have given the same result. Nor let it be forgotten that an almost world-wide fall in smallpox had set in toward the close of last century, which the vaccinators attributed to their prophylaxy in the nineteenth. Miraculous effects are frequently asserted where miraculous causes would be disowned.

The vital statistics of last century are, to a great extent, the products of inference and conjecture, and more or less affected by the purpose and bias of their collectors; but if even we had the correct mortalities of smallpox in the chief centres of population,--such as York, Hull, Norwich, Chester, Coventry, Bath, Bristol, Exeter, and Plymouth--we should still be puzzled to separate what was due to insanitary conditions of life from what was due to the artificial induction of the disease by variolation. It has been said that the 18th Century did not terminate in England until 1830; and accepting that liberal allowance, we may resort to an interesting record of a virulent epidemic in Norwich in 1819 for some light on the character and incidence of urban smallpox prior to the rise of such great communities as Liverpool, Manchester, Leeds, Sheffield, and Birmingham. The account of the epidemic was written by John Cross, a surgeon practising in Norwich.[268]

In those days Norwich contained a population of about 40,000. The city was accounted salubrious, and smallpox was little known. Cross writes that “in 1805, after being for a time almost extinct, smallpox prevailed so much in Norwich as to excite some attention.” The attention excited led to an attempt to introduce vaccination. A meeting was held in the Guildhall, 16th July, 1805, “to concert measures for the extermination of the disease,” and resolutions were passed to discourage inoculation with smallpox, and “to substitute immediate and universal vaccination of the inhabitants of the city and its hamlets.” This outbreak of smallpox and vaccination appears to have subsided together, for Cross continues--

After being absent for a year or two, Smallpox was again introduced to Norwich by an individual from London, and spread so extensively among those whose obstinacy or whose prejudices made them resist Vaccination, that 203 deaths from Smallpox were recorded in the Bills of Mortality between 1807 and the end of 1809. Smallpox again appeared in 1813, in which year 65 deaths took place; the mortality being confined to so small a number by the early and extensive adoption of Vaccination before the danger was actually at hand. From the year of 1813, it may be said, there was no Smallpox in Norwich until the rise of the epidemic which I propose to describe. Not a death from the disease was noticed for four years. Indeed, the only case that came to my knowledge, during the time specified, was the servant of a celebrated public character, who, being seized with Smallpox, was detained in Norwich, but from whom, so far as I could learn, the contagion did not extend.

I shall presently refer to the number of vaccinations effected in Norwich, and to their influence in arresting smallpox. What I would now draw attention to is, the comparative rarity of smallpox in Norwich in those times. Years two, three, and four elapsed without a single death from the disease! How does such a fact accord with the common-place of vaccinators, that before the advent of Jenner the people of England were decimated with smallpox, and that 40,000 perished annually? When we press for evidence for these extraordinary statements, we either get no answer, or we discover that the mortality of a bad year of London smallpox has been multiplied by the population of the United Kingdom, thus yielding the astounding total of 40,000 victims. Our reply is, that there is no warrant whatever for this conversion of London mortality into national mortality; that London was unique in its circumstances; and that, setting the immense rural majority aside, even in the largest cities, such as Norwich, years passed without any deaths from smallpox.

Vaccination had the prestige of fashion, and the leading citizens of Norwich were philanthropic and scientific after the newest lights, and whatever was accounted “proper,” they were intent to effect. To have the vulgar vaccinated was, however, no easy matter. Many declined because they had no fear of smallpox. What, indeed, had they to be alarmed about? Moreover, as experience advanced, the futility and danger of the new inoculation became more and more apparent. It began to be known that it not only failed to avert smallpox, but it frequently induced serious illness, permanent injury, and sometimes death. It is to be remembered that the symptoms of vaccination were watched at the outset of the practice with keen attention, and that the general verdict, especially of mothers, was distinctly adverse to its harmlessness. That such was the common judgment was manifest from the rapid decline of the early furore in its favour, and its contemptuous neglect by the mass of the people until revived and enforced by legislation. As the citizens of Norwich would not be vaccinated, it was determined to try the effect of bribery, and surgeon Rigby in 1812 induced the court of guardians to offer a reward of 2s. 6d. to every person “who should bring a certificate from a surgeon of having gone satisfactorily through the cowpox.” The results of this bribery are set forth as follows by Cross--

511 received the award in 1813 47 ” ” 1814 11 ” ” 1815 348 ” ” 1816 49 ” ” 1817 64 ” ” 1818 1402 ” ” 1819

The larger numbers in 1813, ’16, and ’19 were due to panic and pressure; but the figures maybe taken for a graphic representation of the distrust with which vaccination was regarded after ample experience. Of course many were vaccinated who did not claim the parish half-crown; and at the end of 1819 it was calculated that 10,000 in Norwich had submitted to the Jennerian rite from the date of its introduction at the beginning of the century. Thus considerably less than a fourth of the inhabitants were what is called “protected.”

We now come to the narrative of that great outbreak of smallpox, which, says Cross, destroyed more lives in less time in Norwich than any epidemic since the Plague. It is almost superfluous to state that the disease did not originate in Norwich: it never appears to originate anywhere: it was imported. A girl travelling with her parents from York caught the infection in transit at a market-town, and as soon as she arrived in Norwich was laid up with the disease.

This happened [says Cross] in the latter end of June, 1818; and the earliest cases of Smallpox that were seen by any medical man were traced to this origin. I have been able to ascertain the different families by which the disease was kept up during the remainder of that year, but it extended to very few, and proved fatal in only two instances. A druggist inoculated three children in January, 1819, thus helping in a small degree to spread the contagion, which the season of the year was calculated to keep within narrow bounds. Still no alarm was excited; a single medical man only was acquainted with the disease; and the cases of Smallpox were so few until the latter end of February as to be scarcely noticed. At this time, however, the disease extended from one of our greatest charity schools to all quarters of the city.... Comparatively dormant during the winter, as the season became milder it burst upon us suddenly and unexpectedly, continuing its work of devastation for three or four months with undiminishing fury. The following list of burials taken from the Bills of Mortality will give a sufficiently accurate idea of the advance and decline of the disease--

1819. Deaths from Deaths from Total of Smallpox. other diseases. deaths. January, 3 61 64 February, 0 71 71 March, 2 68 70 April, 15 61 76 May, 73 63 136 June, 156 70 226 July, 142 61 203 August, 84 63 147 September, 42 96 138 October, 10 63 73 November, 2 62 64 December, 1 83 84 --- --- ---- 530 822 1352

The greatest mortality occurred in June when 43 were buried from Smallpox in one week. The rapid declension of the disease from that period is obvious from the above table; and it was so nearly extinct at the end of the year, that I could not find a variolous patient from whom ichor could be procured for an important experiment. As probably one in six of all who were affected by the epidemic died of it, I am convinced it is not far from the truth to assert that considerably over 3000 individuals, or a thirteenth part of the whole population of Norwich, had Smallpox in the year 1819.

It is always sound policy to take what is considered the case against us at its worst; and as this dreadful Norwich epidemic is cited as evidence of what is possible in the absence of vaccination, and as something that opponents of vaccination should regard as conclusive against them, there is cause to give it special attention; and the more so as the leading facts are well ascertained. First, however, I would remark that I have no desire to minimise the horrors of smallpox: it is a loathsome, and, because preventible, a discreditable disease: but neither let us maximise its horrors, but try, at least, to recognise facts in their true dimensions.

Five hundred and thirty died in Norwich of smallpox in 1819 of 3000 supposed to have had the disease, the deaths being, as commonly estimated, one in five or one in six of those affected. The deaths from all diseases in Norwich in 1819 were 1352--a mortality of 30 per 1000; a high rate, but by no means uncommon in urban populations free from smallpox. I have next to observe that if 3000 had smallpox, there were 37,000 who escaped, and to ask, How did they escape? By what means were they protected? It may be replied that a fourth of them were vaccinated; but how does that account for the immunity of 30,000 unvaccinated? The 10,000 vaccinations reputed to have been effected in Norwich from the beginning of the century were the work of nearly twenty years, and the major part of them in 1819 must have been represented by adults practically out of the range of infection, protected not by vaccination, but by their years.

“Protected by their years! What do you mean?” exclaims a reader.

Precisely what I say--that in the Norwich epidemic, as in variolous epidemics generally, adults are comparatively secure, and the young, and especially infants, are the victims. In Norwich, in 1819, scarcely a bread-winner, or a father or mother was laid in the grave slain by smallpox.

“It is incredible!”

It is incredible simply because the facts of smallpox are persistently overlooked. Here is proof of the incredible in a statement carefully prepared by Cross of the ages of the 530 who died in the Norwich epidemic--

Under two years of age, 260 Aged from two to four years, 132 ” four to six years, 85 ” six to eight years, 26 ” eight to ten years, 17 ” ten to fifteen years, 5 ” fifteen to twenty years, 2 ” twenty to thirty years, 2 ” thirty to forty years, 1 --- 530

It will be said, as a matter of course, that if these children had been vaccinated they would not have perished; but the answer is that at this day the chief mortality of smallpox is among the vaccinated young, in whom the whole virtue of the rite may be supposed to abide fresh and efficient. Cross was an enthusiastic vaccinator, but he allows, with due excuses, that the vaccinated minority contributed a certain quota to the sick and the dead, and that the ill repute of vaccination caused many in their terror to resort to variolation, and thus to incur and diffuse the mischief of which they stood in dread. Some old women and a druggist were, he says, responsible for four or five hundred of these creations of smallpox during the epidemic, “each of which became a centre of contagion.”

Age, I said, constituted the chief protection from smallpox, but good houses and good fare formed another line of defence. “The effects of the Norwich epidemic were confined almost exclusively,” says Cross, “to the very lowest orders of the people.” Moreover, he observes--

The disease was often aggravated, and made to assume its worst characters, by the most injudicious treatment. The prejudiced and most ignorant being the principal sufferers, the prescriptions of old women were more listened to than the advice of medical men. A practice kept up by tradition among the poor of the city for above a century was revived, in spite of all remonstrance, as follows--

“At the commencement, to set the object before a large fire and supply it plentifully with saffron and brandy to bring out the eruption; during the whole of the next stage to keep it in bed covered with flannel, and even the bed-curtains pinned together to prevent a breath of air. To allow no change of linen for ten or more days, until the eruption had turned; and to regard the best symptom to be a costive state of the bowels during the whole course of the disease.”

Such were the means by which the horrors of the epidemic were aggravated. The old nurses triumphed not a little in having an opportunity of showing their skill after it had been so long unexercised; nor was it often easy, among the deluded persons in whose families this affliction occurred, to persuade or compel them to adopt a different plan of treatment.

Cross described several cases in which unquestionable vaccination had been followed by unquestionable smallpox. In one instance, a girl of eleven years of age, correctly vaccinated in both arms, perished of malignant smallpox, whilst her unvaccinated brother, six years of age, recovered from a severe attack. Such cases in 1819 were treated as exceptional, but they have long passed into the category of matter-of-course, and ceased to excite observation or surprise.

Such was the memorable Norwich epidemic. However dreadful, it was in no wise extraordinarily dreadful. If the death-rate was raised for a single year, it would be reduced in subsequent years, and the average rate recovered that accorded with the common obedience of the community to the laws of health. In Nature consequences are equal, and any temporary aberration is in the long run compensated for. If vaccination could have kept smallpox from Norwich, the citizens would have had in some other form the measure of disease that pertained to their way of life.

We might, moreover, inquire, whether to escape an epidemic, severe as that of 1819, it would have been economical to put 40,000 people through the pains and perils of vaccine fever. Why should a universal affliction be incurred to avert a partial one?--an affliction confined to the young of the lower orders. The vaccination of Norwich from 1801 to 1819 would have cost far more sickness and death than did the smallpox of the same years. In short, if vaccination had conferred the immunity claimed for it, the price of the salvation would have been in prodigious excess of its value.

FOOTNOTE:

[268] A History of the Variolous Epidemic which occurred in Norwich in the year 1819, and destroyed 530 Individuals; and an Estimate of the Protection afforded by Vaccination, and a Review of Past and Present Opinions upon Chickenpox and Modified Smallpox. By John Cross, Member of the Royal College of Surgeons in London. London, 1820. Pp. 296

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XXXIV. SMALLPOX DISPLACED AND REPLACED

DR. WATT’S DISCOVERY--GLASGOW, 1813.

Addressing the House of Commons in 1878, Sir Thomas Chambers said, “You cannot show that Vaccination has reduced deaths, or saved a single life. There may be no Smallpox, but the disappearance of Smallpox is by no means equivalent to a reduction of mortality.” M.P.’s were astonished and incredulous; but ignorantly. The fact is incontestable; and Dr. Robert Watt of Glasgow had the signal distinction of detecting and setting it forth in the year 1813.[269]

Watt was writing a treatise on Chincough, otherwise Whooping Cough, and in the course of his work made a careful examination of the registers of death in Glasgow to ascertain how far it was true “that the disease was more fatal some years than others; that it was more dangerous at a particular age; and that the female sex suffered more from it than the male;” and, from the outset of his investigation, “was struck with the immense numbers carried off yearly by the Smallpox.” He might well be struck; for Glasgow was a rare place for Smallpox, as appears from the following statement compiled from Watt’s Tables--

DEATHS IN GLASGOW FOR TEN YEARS, 1783-1792.

Year. From Measles. Whooping | Children Children Total, Smallpox. Cough. | under under all | Two. Ten. Ages. 1783 155 66 153 | 479 719 1413 1784 425 1 13 | 671 877 1623 1785 218 -- 34 | 576 744 1552 1786 348 2 173 | 706 941 1622 1787 410 23 57 | 746 1016 1802 1788 399 1 17 | 770 1059 1982 1789 366 23 45 | 794 1058 1753 1790 336 33 177 | 903 1236 1866 1791 607 4 117 | 984 1367 2146 1792 202 58 68 | 664 902 1848 ---- --- --- | ---- ---- ------ Total, 3466 211 854 | 7293 9919 17,607

The succeeding ten years, 1793-1802, repeat much the same tale, with, however, a diminution of mortality in an increasing population, and a decrease in smallpox with an increase in measles and whooping-cough: thus--

DEATHS IN GLASGOW FOR TEN YEARS, 1793-1802.

Year. From Measles. Whooping | Children Children Total, Smallpox. Cough. | under under all | Two. Ten. Ages. 1793 389 5 112 | 807 1126 2045 1794 235 7 51 | 553 759 1445 1795 402 46 180 | 761 1048 1901 1796 177 92 60 | 562 797 1369 1797 354 5 76 | 586 884 1662 1798 309 3 98 | 642 864 1603 1799 370 43 95 | 783 1105 1906 1800 257 21 27 | 545 716 1550 1801 245 8 125 | 494 766 1434 1802 156 168 90 | 544 985 1770 ---- --- --- | ---- ---- ---- Total, 2894 398 914 | 6277 9050 16,685

Considering these figures said Watt--

I remarked that the deaths by Smallpox were chiefly in infancy; hence the deaths under two or three years of age bore a very great proportion to the whole deaths in the city. Taking an average of several years, I found that more than half the human species died before they were ten years of age, and that of this half more than a third died of the Smallpox; so that nearly a fifth part of all that were born alive perished by this dreadful malady.

Watt meant of course the human species as exhibited in Glasgow, of whom more than half died before the age of ten, and a fifth of smallpox. What was true for a time of Glasgow smallpox was not even true of Edinburgh, much less of the whole earth.

Variolation was practised in Glasgow, but to what extent appears to be unknown. Certain, however, it is that smallpox was as little dreaded as are other calamities accounted common and unavoidable. Indeed many were not unwilling to subject their offspring to the disease at seasons supposed to be favourable on the principle of “getting a bad job over.” Then, too, the mass of the population was disposed as if by design for the generation of febrile ailments. Tall buildings forming narrow lanes, wynds, or closes issued like so many rents or fissures from the leading thoroughfares. These buildings were divided into flats packed with humanity from basement to attic. Air and light were treated as superfluities. Water there was none, save what was brought from wells; and middens received the slops and refuse often shot from the windows. Life in a Glasgow wynd in former days is indescribable, yea almost inconceivable; yet in such wynds multitudes passed their existence, conscious of no hardship, recognising nothing better, and withal characterised by many virtues. Bearing such conditions in mind, the vital statistics of Glasgow excite no surprise: the wonder is that the death-rate did not draw nearer to extermination. As for smallpox, how could a family resident in a flat in a noisome Glasgow close at the end of last century escape smallpox, if smallpox were prevalent? To them smallpox lay in fate, and was accepted on the same terms as wind and weather, summer and winter.

Novelties have always had a ready welcome in Glasgow, and when cheap and easy salvation from smallpox was proclaimed, there was a rush for it. Smallpox abated: vaccination had the credit: and faith was justified. Considering the devastation smallpox had wrought among the young, Watt says--

I began to reflect how different the case must be now; and to calculate the great saving of human life that must have arisen from the Vaccine Inoculation. At this time [1813] above 15,000 had been inoculated publicly at the Faculty Hall, and perhaps twice or thrice that number in private practice. In eight years [1805-12] little more than 600 had died in Glasgow of Smallpox; whereas in 1784 the deaths by that disease alone amounted to 425, and in 1791 to 607; which, on both occasions, exceeded the fourth of the whole deaths in the city for the year.

It seemed reasonable to infer that since the mortality from smallpox had so largely declined, fewer children must have died; but to Watt’s astonishment the facts did not answer to the logic. He writes--

To ascertain the real amount of this saving of infantile life, I turned up one of the later years, and by accident that of 1808, when to my utter astonishment, I found that still a half, or more than a half, perished before the tenth year of their age! I could hardly believe the testimony of my senses, and therefore began to turn up other years, when I found that in all of them the proportion was less than in 1808; but still on taking an average of several years, it amounted to nearly the same thing as at any former period during the last thirty years. This was a discovery I by no means expected, and how it could have come to pass appeared to me inexplicable.

We shall better understand Watt’s perplexity over smallpox reduced and death unaffected, if we set before us the table of mortality for the decade during which vaccination was brought into practice in Glasgow.

DEATHS IN GLASGOW FOR TEN YEARS, 1803-1812.

Year. From Measles. Whooping | Children Children Total, Smallpox. Cough. | under under all | Two. Ten. Ages. 1803 194 45 60 | 610 940 1860 1804 213 27 52 | 583 863 1670 1805 56 90 129 | 616 884 1671 1806 28 56 162 | 517 786 1620 1807 97 16 85 | 595 899 1806 1808 51 787 92 | 1079 1775 2623 1809 159 44 259 | 782 1187 2124 1810 28 19 147 | 765 1027 2111 1811 109 267 62 | 769 1274 2342 1812 78 304 103 | 804 1278 2348 ---- ---- ---- | ---- ------ ------ Total, 1013 1655 1151 | 7120 10,913 20,175

To make the facts clear let us bring the results of the three decades together--

Decade. From Measles. Whooping | Children Children Total Smallpox. Cough. | under under Deaths, | Two. Ten. All Ages. 1783-1792 3466 211 854 | 7293 9,919 17,607 1793-1802 2894 398 914 | 6277 9,050 16,685 1803-1812 1013 1655 1151 | 7120 10,913 20,175

Before making any commentary on these remarkable figures, it may be well to attend to what Watt had to say concerning them. He was satisfied that vaccination arrested smallpox, but it was plain that it did not arrest death, and he felt bound to find some explanation--

From every circumstance that has come under my observation, the efficacy of Vaccine Inoculation appeared certain. The experience of pretty extensive practice had confirmed me fully in this opinion. But still the question recurred, how are we to account for the same, or nearly the same, number of deaths under ten years of age? As no new disease has appeared, the deficiency occasioned by the want of Smallpox must have been made up by a greater mortality among the other diseases of children. Has it been equally divided among them, or has a greater share fallen to some than to others? To solve this question is the chief object of my inquiry.

To ascertain the fact, he divided the thirty years, 1783-1812, into five periods of six years each, and thus set forth the average proportionate mortalities--

Years. From Measles. Whooping | Children Children Total Smallpox. Cough. | under under Deaths, | Two. Ten. All Ages. 1783-1788 19·55 ·93 4·51 | 39·40 53·48 9,994 1789-1794 18·22 1·17 5·13 | 42·38 58·07 11,103 1795-1800 18·70 2·10 5·36 | 38·82 54·48 9,991 1801-1806 8·90 3·92 6·12 | 33·50 52·03 10,034 1807-1812 3·90 10·76 5·57 | 35·89 55·69 13,354

The first three of these periods, 1783-1800, had passed before the Vaccine Inoculation could have had any influence [observes Watt]; in the fourth, 1801-1806, it had nearly reached its maximum; and in the last, 1807-1812, it may be said to have been pretty fully established, perhaps as much so as in any other city in the empire.

Vaccination having been introduced to Glasgow to save life, Where was the salvation? Smallpox had fallen off, but if its victims were merely assigned to other modes of death, where was the advantage? Watt continues--

The first thing which strikes the mind on surveying the preceding Table, is the vast diminution in the proportion of deaths by the Smallpox--a reduction from 19·55 to 3·90 per cent.; but the increase in the Measles column is still more remarkable--an increase from ·93 to 10·76 per cent. In Smallpox we have the deaths reduced to nearly a fifth of what they were twenty-five years ago, whilst in the same period, the deaths by Measles have increased more than eleven times. This is a fact so striking, that I am astonished it has not attracted the notice of older practitioners.

The greatest number of deaths from Smallpox in any one month during the last thirty years was 114 in October, 1791. In the following December they were 113. These are the only two instances in thirty years when the deaths by Smallpox amounted to 100 in a month. But these were slight visitations when compared with the ravages which have been committed in an equally short time by Measles. In May, 1803, the deaths by Measles alone amounted to 259, in June to 260, and in July to 118. In December, 1811, they amounted to 161, and in the January following to 130. What an amazing difference when we compare these numbers with 433, the sum of all the deaths by Measles in eighteen years preceding 1801! In the last five years 1430 have died of Measles in Glasgow.

This prodigious increase in the mortality from Measles was naturally referred by some observers to the practice of Vaccination, and Watt held there was ground for the assumption inasmuch as when Smallpox preceded Measles it made Measles milder--

When Measles was so prevalent and fatal in 1808, I was often told that it was owing to the Vaccine Inoculation; but this I considered an idle tale, the invention of those who were hostile to Cowpox. I could readily admit that more must die of Measles than formerly; for some of the weak and unhealthy, who would have died of Smallpox (saved from Smallpox) would fall a sacrifice to Measles; but I could not then go farther.

But however novel and strange the opinion may appear, it must be admitted that while Smallpox was in full force, it had the power of modifying and rendering Measles mild; and now that Smallpox is in great measure expelled, Measles is gradually coming to occupy the same ground. I am sorry to make this statement, but the facts, at least with regard to Glasgow, are too strong to admit of doubt....

That Measles should have been modified by Smallpox is rendered highly probable by the manner in which the Vaccine Disease prevents Smallpox or renders it so mild as to be without the smallest danger. May not Smallpox have a similar effect in relation to Measles?

When Smallpox was in full force, few children escaped, and most of those who had Smallpox and Measles had Smallpox first. This, I believe, will have been the case with more than nine-tenths of the community. Still, however, as Measles came round, it occasionally had precedence of Smallpox, and it was perhaps chiefly among such patients that it proved fatal. In looking over the registers of former years, I find the deaths by Measles were generally among very young children.

He was even disposed to believe that Smallpox, on the whole, exercised a beneficial influence in the eradication of latent disease--

An opinion has prevailed with some, that Vaccination does positive harm by infusing peccant or vicious humour into the constitution. I do not see the smallest ground for this hypothesis; but that Smallpox does good to those who survive the disease by rendering the system insusceptible of other infections, or by rendering them milder when incurred, must, I think, be admitted.... I do not presume that the constitution is improved by Smallpox, but perhaps by eradicating certain unobserved deviations from health, which, if not early removed by the accession of some acute disease, would have proved the seeds of early mortality by gaining a deeper hold of the constitution before Measles and other epidemics of later appearance came round.

In this point of view, we are not to consider Smallpox as peculiarly fatal, but fatal merely as having the start of some other diseases. Measles, Chincough, Croup, and Scarlet Fever would have proved equally fatal had any of them occurred first.... It is only on this principle that we can explain how it happened that thirty years ago not one in a hundred died of Measles, whereas now one in ten dies. Thirty years ago as few escaped Measles as now, but before they were affected they had generally passed through Smallpox, by which the secondary disease was so modified as to be almost completely divested of danger.

Watt, it will be observed, treats smallpox throughout as a malady of childhood; thus confirming Monro’s observation in 1765, that “the inhabitants of Scotland generally have smallpox in their infancy or childhood, very few adults being seen in the disease.”

From the preceding excerpts, it is not difficult to comprehend Watt’s position. He was persuaded of the prophylaxy of vaccination; he was satisfied that it had reduced smallpox in Glasgow; but, to his astonishment, he discovered that it had not reduced the general death-rate; and that in so far as smallpox had been displaced, other ailments, and specially measles, had maintained the tale of fatality.

The discovery that the fall in smallpox was compensated for by a rise in deaths from other diseases was a remarkable discovery, the importance of which is as yet far from appreciated. Watt was however at fault in attributing the decline of smallpox in Glasgow to vaccination; and in failing to inquire whether the phenomenon had any relation to vaccination whatever. He is the best scientific demonstrater who most completely exhausts the possibilities to the contrary of what he seeks to establish. Supposing vaccination to be as powerful against smallpox as its promoters averred, the causes in Glasgow was not commensurate with the effect. Nowhere was vaccination more practised. 15,000 were vaccinated at the Faculty Hall, says Watt, “and perhaps twice or thrice that number in private practice”--a loose and questionable statement. The 15,000 operated on at the Faculty Hall in the course of ten years were the poor, the vast majority in Glasgow and elsewhere, and the chief sufferers from smallpox. The assumed “twice or thrice that number” were those who employed their own medical men--a luxury less common then than now. The population of Glasgow approached 100,000, and it is obvious that the larger part must have lived outside the fortification of the Jennerian rite.

But admitting that all, or nearly all, in Glasgow were vaccinated who had not had smallpox, still that would afford no proof for what was claimed. Watt was cautious, and held closely by his Glasgow evidence, content to have it taken for what it was worth; but had he ranged wider, he would have discovered that the fall in smallpox extended over Europe, and was as well marked in Vienna as in Glasgow, in Stockholm as in London, in Italy as in Denmark. As in Glasgow the credit for the fall was claimed for vaccination, but the fall had set in before vaccination was heard of, and extended over populations to which vaccination had no application. Indeed Watt allows that the fatality of smallpox had begun to decline and that of measles to increase prior to the conveyance of the Jennerian salvation to Glasgow; but he failed to discern the significance of the fact. So too in other cities where smallpox fell off: the death-rate did not fall off; but, as in Glasgow, was kept up by cognate varieties of fever.

As concerns Watt, we have the advantage of some notes upon his “remarkable treatise” by Dr. William Farr in the Thirtieth Annual Report of the Registrar-General, 1869. Having given an abstract of Watt’s results, Dr. Farr observes of his discovery of displaced and replaced mortality--

This is an important point in pathology; and it must be admitted that although there were defects in his data, Dr. Watt succeeds in showing (1) that Smallpox was one of the greatest causes of death in Glasgow down to the year 1800, (2) that the deaths by Smallpox were reduced to a fifth of their original number by Vaccination,[270] and (3) that the children died in nearly the same numbers as before, but of other forms of disease.

Glasgow has always been famous for statistics, and these unfortunately show an increase of the mortality of children. Thus in the five years 1821-25 the mortality of boys under five years of age was 8·08; in 1831-35 it was 9·78. In the year 1865 the mortality of boys in Glasgow was 11·48, of girls, 10·36. These recent returns confirm the principle. Smallpox is no longer so fatal as it was before Vaccination was introduced; in Glasgow it caused in the year 1864 no longer 20 but 2 in 100 deaths--only 180 in 6054 deaths, that is 3 per cent. of the deaths under five years of age; yet the mortality of children is certainly as high, probably higher, than it was in the last 10 years of the last century.

Compulsory Vaccination in England has reduced further the fatality of Smallpox, but since 1853 other diseases have so prevailed as to counter-balance the gain under this head. The mortality of children has not declined in a corresponding degree.

With confirmation under such authority, it is needless to enforce the validity and importance of Watt’s discovery. Dr. Farr is pleased to ascribe the subsidence of smallpox alike in England and Glasgow to vaccination, but he makes no effort to prove his case: indeed the effort might have led him to recognise his mistake. Referring to scarlet-fever, he shows how from a mild it has become a severe affliction--

Sydenham (d. 1689) describes simple Scarlatina distinctly: he does not refer to the throat affections, and says the patient can only die by the doctor’s default. Joseph Frank describes the disease as now the most dreadful scourge in Europe.

If then scarlet fever has of itself acquired this terrible intensity and predominance, why should it be thought incredible that smallpox of itself should undergo correspondent mitigation and diminution? Or, is it to be argued that vaccination has extinguished smallpox to revive as scarlet fever?

Dr. Farr proceeds to observe--

It is singular that Dr. Watt, evidently a practitioner of great sagacity, does not at all advert to the wretched sanitary condition in which the increasing population of Glasgow lived at the time he was writing.

It is the observation of Dr. Farr that is singular. At the time when Watt wrote there was no clear conception of the relation of condition to disease. Jenner was always writing about smallpox, yet there is not a hint in any of his papers as to its development in filth and stench. His own residence was a pesthouse, but it never entered into his head to ask, Why? Let us avoid anachronism. Those whose memory or reading extends to the cholera epidemic of 1831-32 will know, that it was regarded as an inscrutable visitation toward which humble submission was the proper attitude. A letter of Collins, the artist, to the Rev. R. A. Thorpe, 26th November, 1831, correctly expresses the common feeling. Referring to the Cholera and the Reform Bill, he says--

Of the two scourges now afflicting us, I know not which is the worse, but I do know that we have fallen into the hands of God in both cases, and not before we deserved it.[271]

I myself recollect the dismay the Combes excited in Scotland when they began to teach that we were largely responsible for our ailments, and that sickness and sanctity were an unwholesome alliance; and how a pious physician remarked, when the prevalence of typhus in Glasgow had been denounced as disgraceful to the authorities, “We have learnt the truth in another school, and would shudder to impeach the Divine prerogative in life or in death.” What Watt really thought of smallpox is to be found in a passage of his treatise which Dr. Farr must have overlooked. He says--

We may it seems, by the permission of Divine Providence, deprive death of some of its apparently most efficient means, but deprived of these, new means are discovered, or the old improved.

I cannot help quoting the following passage from Dr. Woolcombe as somewhat prophetic of this general result. Says he--

“May not the discovery of the Cowpox, if it should ultimately effect the extermination of the Smallpox, which it may do when the prejudices of mankind shall permit, be welcomed rather on account of its influence in diminishing human suffering, than on account of its effect in diminishing human mortality? Since disease is one of the appointed checks to excessive population, and the plan of Providence in the creation of human life requires the termination of the existence of one-third of its creatures before they have attained the age of two years, it may be doubted whether the annihilation of so efficient an instrument as Smallpox can be admitted without the substitution of some other equally destructive malady. The substituted malady may indeed be productive of less collateral affliction than the loathsome distemper whose place it supplies. But granting that no direct substitute should arise, it will not follow that disease in general will be deprived of its accustomed share in checking population; and if it be not, the only difference will be in the proportion of victims submitted to other disorders. The infant rescued from Smallpox, may be rescued only to perish in childhood by Measles or Scarlatina, or be preserved to swell the list of youthful victims to the insatiate maw of Consumption.”[272]

Such was the manner in which Watt dealt with the problem of mortality. Sanitation had no place in his consideration. It was, he thought, the design of Providence to limit population, and if children were saved from smallpox, they would be cut off otherwise; and the statistics of Glasgow confirmed the opinion. Smallpox had abated, but funerals were numerous as ever. The uniformity of the mortality we admit, but no longer ascribe it to Providence intent on the limitation of population. If children die, it is not of fate, but from the ignorance, or indifference, or wickedness of those who are responsible for them.

Still some may object, “If by vaccination or any other means smallpox is got rid of, Should we not to that extent save life?” The answer is, No. Life is only extensible in so far as improvement is effected in the conditions of life. Forms of disease are subject to modification; they are probably convertible and interchangeable; one form comes as another goes; but conditions remaining the same, the crop of death is equal. Hence Mr. Edwin Chadwick’s advice--

Keep your eye on the death-rate. Let nothing short of its reduction satisfy you. There may be no startling outbreak of this fever or of that fever; but if the death-rate is unabated, there can be no improvement that ought to satisfy you. The death-rate is the test of sanitary progress. Keep therefore your eye on the death-rate.

Thus it was that though smallpox subsided in Glasgow no lives were saved; for no change for the better having taken place in the condition of the inhabitants, the means of death were merely transferred to other agencies. As Dr. Farr observes--

The Glasgow victims were gathered together from all quarters, from the Highlands, from Ireland, and from elsewhere; they were lodged in conditions unsuitable to human life.... To render them unassailable by the matter of Smallpox was not enough, for it left them exposed to the other forms of disease. Thus in a garden where the flowers are neglected, to keep off thistle-down merely leaves the ground open to the world of surrounding weeds.

To operate on mortality, protection against every one of the fatal zymotic diseases is required; otherwise the suppression of one disease-element opens the way to another.

Dr. Farr thus exactly expresses what I wish to enforce. Whether smallpox prevail or disappear is of little importance. What is of importance is the prevalence of disease and death, and not the presence or absence of any of their special factors when the total result is constant and the measure of violated physiological laws. It is true that Dr. Farr recognises a virtue in vaccination, but on much the same terms that obeisance is rendered to a fetish. Vaccination might be struck out of his arguments without affecting his conclusions. How, for example, could the facts with their rationale be better stated than in these his words?--

Out of 1000 born in Liverpool, 518 children were destroyed in the first ten years of their life; some by Smallpox, many by Measles, Scarlatina, Whooping Cough, many by Typhus and Enteric Fever; one disease prevailing in one year, another disease prevailing in another; but still yielding the like fatal results. This represents what Dr. Watt found in Glasgow long ago. Out of 1000 children born in London, 351 died under ten years of age by zymotic diseases and other causes; the deaths are less by 167 than the deaths in Liverpool. How much less is the loss of life by these diseases in the healthy districts of England! There, out of 1000, only 205 children die in the first ten years of life. The enormous difference cannot be ascribed to Vaccination, as common in town as in country; the protection of life against Smallpox alone leaves it still at the mercy of the dangerous diseases of the insalubrious city.

Death from disease in insalubrious circumstances is but part of the mischief. Those who survive find their energies enfeebled and depressed in the struggle for survival. The time must surely come when smallpox and all allied forms of disease will be accounted discreditable and intolerable, and when their occurrence will be taken for notes of warning and command to search for and root out their causes. Then, too, magical preventives and palliatives and medical cures will have a very different place in the popular imagination.

* * * * *

Jenner read Watt’s pamphlet, and, more suo, the wretched creature failed to discern its scope and significance, seeing in it a malevolent aggression upon his interest in vaccination. He wrote to Moore from Cheltenham, 6th December, 1813--

You probably may not have seen a pamphlet lately published by Dr. Watt, as there is nothing in its title that develops its purport or evil tendency. Measles, it seems, has been extremely fatal in Glasgow for the last four or five years among children, and during this period Vaccination has been practised almost universally. Previously to this, Measles was considered a mild disease. Hence Dr. Watt infers that Smallpox is a kind of preparative for Measles, rendering the disease more mild. In short, he says, or seems to say, that we have gained nothing by the introduction of Cowpox; for that Measles and Smallpox have now changed places with regard to their fatal tendency. Is not this very shocking? Here is a new and unexpected twig shot forth for the sinking Anti-Vaccinist to cling to.[273]

Observe, the truth of Dr. Watt’s evidence was passed over! Inasmuch as it did not tend to the glory of vaccination, it was “evil,” and it was “shocking.” At a later date Baron assumed the same line, saying--

Notwithstanding the proofs of the power of Vaccination in diminishing the mortality from Smallpox, it has been a question whether infantile mortality has been diminished; it having been supposed that the beneficial effects of Vaccination were countervailed by a greater mortality in the other diseases of children. This very discouraging statement was published by Dr. Watt, of Glasgow; and the opinion, which was hastily adopted and unwisely promulgated, has unquestionably had a great effect in retarding the progress of Vaccination. It, unfortunately, gave countenance to some of the worst prejudices of those who were opposed to the practice.[274]

Here again we see no attempt made to disprove Watt’s statement, whilst its mischievousness was assumed because it was “discouraging,” and lent “countenance to some of the worst prejudices of those who were opposed to vaccination!” Truth is the best of all things--except when it spoils business. Then it becomes “evil,” and “shocking,” and “gives countenance to the worst prejudices.”

FOOTNOTES:

[269] An Inquiry into the Relative Mortality of the Principal Diseases of Children, and the numbers who have died under Ten Years of Age in Glasgow during the last Thirty Years. By Robert Watt, M.D., Lecturer on the Theory and on the Practice of Medicine in Glasgow. Glasgow, 1813. Pp. 64.

[270] An inference disputed for reasons given.

[271] Memoirs of William Collins, R.A. By his Son. Vol. ii. p. 3.

[272] _Remarks on the Frequency and Fatality of Different Diseases._ 1808.

[273] Baron’s Life of Jenner, vol. ii. p. 392.

[274] Ibid., vol. ii. p. 248.

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