XXXV. THE NATIONAL VACCINE ESTABLISHMENT--1808-40
We shall now return to the current of our Story, nor turn aside until it is brought to a conclusion in the enactment of Compulsory Vaccination.
With £3000 a-year the National Vaccine Establishment was constituted by the House of Commons, on 9th June, 1808; sixty members voting for the project, and five against.
The reasons for the institution were somewhat complicated. The Royal Jennerian Society had been wrecked by Jenner’s jealousy and intrigue. The working and subscribing members seceded with Dr. Walker, and set up the London Vaccine Institution; and a variety of ornamental and influential folk, who paid little and did less, found themselves with Jenner on their hands, exigent, impecunious, and helpless, and they publicly committed to the patronage and diffusion of vaccination.
It was an awkward situation, and two operations for relief became necessary: first, to dispose of Jenner; and second, to escape from the maintenance of vaccination.
The first was effected by inducing the House of Commons to vote Jenner £20,000, and the second by the institution of the National Vaccine Establishment. Thus dexterously, fashionable and medical London contrived to get rid of Jenner and vaccination on terms satisfactory to all concerned.
The early furore for vaccination had spent itself. Scepticism had thriven by experience. Many of the vaccinated had taken smallpox, and explanations and excuses were becoming exhausted. It was easy to claim the benefit of mistakes when the operators were amateurs; but when the failures were the work of Jenner and his certified associates, it was hard for faith to hold out. Spurious cowpox served to account for many disasters; but when Jenner, pressed to define spurious cowpox, was driven to confess its non-existence, and that, when he had spoken of it, he had only meant any irregular action of cowpox on the persons of the vaccinated, it is easy to imagine how people who had respect for themselves were pleased to drop out of the connection. They might not care to express all they suspected, nor to proclaim their credulity, but it was a welcome deliverance to be no longer responsible for a practice and a character grown so questionable. On John Bull’s broad back was laid the burden.
In the project of the National Vaccine Establishment there was an explicit concession to the scepticism of the time. One of its purposes was alleged to be Investigation. Lord Henry Petty, in recommending the measure in the House of Commons, observed--“The evidence as to the infallible efficacy of vaccination is confessedly incomplete; and it is highly desirable that the truth should be ascertained by public inquiry, rather than by societies whose conductors are liable to the imputation of mercenary motives.” Jenner bitterly resented the indignity implied in placing vaccination under investigation. He held, and in a sense justly, that it was too late to speak of investigation when the reality of his discovery had been attested in the public honours and rewards conferred upon him. “Alas!” he exclaimed, “poor Vaccinia, how art thou degraded!” He was still further outraged by his exclusion from the Board of the Establishment, on the ground that the public might have assurance of impartiality. How much sincerity there was in the profession, I do not pretend to divine; it is sufficient to point out that matters had come to such a pass with vaccination that it was considered expedient to conciliate the taxpayers with the promise of inquiry for their money. Plainly the enthusiastic certainty of 1802 had given place to a widely different sentiment in 1808.
There were, however, wheels within wheels. “You may take it for granted,” said a Radical of those days, “that every vote of public money has an object in excess of the ostensible one, and covers jobs big or jobs little.” And so it was in the case before us. The discomfited residue of the Royal Jennerian Society had influence with the Government to take over their smashed-up enterprise; but their solicitation might have been ineffectual, had not the Government seen a way of providing for a certain claimant in the course of the operation. Sir John Moore was serving his country in the Peninsula; he had friends at the sources of power; and he had a brother named James, surgeon to the Life Guards, for whom a comfortable berth was wanted. Let us make Moore, they said, Director of this new Establishment, with a salary of £200 a-year; and the thing was done. Investigation was promised, Cowpox was endowed, and Moore was provided for.
Jenner had actively promoted the formation of the Establishment, under the conviction that he should be its governor; but when the organisation was revealed, he was profoundly disgusted. The management was assigned to a Board of eight members, consisting of the president and four censors of the College of Physicians, and the master and two governors of the College of Surgeons, with salaries of £100 a-year apiece. From this Board, as stated, Jenner was deliberately excluded, “so as to ensure impartial investigation.” It was at first proposed to hold Jenner subordinate to the Board, giving him the title of Director, with Moore as his working deputy; for it was clearly recognised by those who had had experience of him during his London career, that for regular duty he was good for nothing; and that with his sickly family resident in Gloucestershire, he was never to be reckoned upon for a day. When, however, the Board disregarded his nominations, especially that of his bully, John Ring, as “Principal Vaccinator and Inspector of Stations,” he at once severed his connection with the Establishment; “since,” in his own words, “he found that he was to have nothing to do, and that his office was only a name.” “My not being a member of the British Vaccine Establishment will,” he wrote, “astonish the world; and no one in it can be more astonished than myself”; but so far as can be discerned, the astonishment was chiefly limited to himself. Evanescent and futile is the astonishment of the world under most circumstances, and had the public opinion of the time been consulted, there is little doubt that it would have gone with the Board against Jenner.
Moore was, therefore, promoted to Jenner’s place as Director of the National Vaccine Establishment, in subordination to the Board of Physicians and Surgeons. Seven stations, with seven superintendent surgeons, were opened in London for vaccinating all who should apply, and for collecting and distributing virus.
At first [writes Moore] the applicants for Vaccination at the various stations were not numerous, not amounting to 3,000 a year; but, by continued exertions, and the declension of prejudice, the numbers regularly increased, and 7,771 persons were vaccinated in London in the year 1816.[275]
These numbers are significant, as indicating the extent of the collapse of vaccination, and how little the continuous decline of smallpox in London was due to its extension.
Moore was a shrewd tactician. He had the sense to recognise that if there was anything in vaccination, it was folly to stand at variance with Jenner; and by persuading him that he exaggerated the offence implied in the policy of the Board, he gradually soothed his feelings and led him into a long and confidential correspondence. Jenner, on his side, finding that nothing resulted from his sulks, relaxed, and from time to time favoured the Board with the light of his countenance and counsels.
The national endowment of vaccination affected prejudicially all other enterprises in the same line. What remained of the Royal Jennerian Society withered up, and the conductors of the London Vaccine Institution found the collection of subscriptions almost impossible. It was naturally objected by those solicited, “Why should we be asked to subscribe for what Government has already provided?” But with Dr. John Walker, the director of the London Institution, vaccination was a fanaticism, and he was ready to live on bread and water rather than withdraw from the promotion of what he was persuaded was a work of salvation. He therefore struggled on, in spite of discouragement and petty means, and as the inability of the Government Establishment to meet demands became manifest, whether from excess of dignity or apathy, the Quaker Institution, as it was called, began to thrive, to acquire the confidence alike of the medical profession and the public, and to rival in business the Establishment itself.
As for the investigation promised in the House of Commons, it was never even attempted. Jenner’s anxiety was superfluous. When a case of smallpox, or injury, or death after vaccination was reported, it was the recognised formula to assert either some defect in the operation, or the virus, or some cause, or any cause ab extra rather than allow the Jennerian principle to suffer. As an illustration of the procedure of the Board in this respect, we have the instance of Mr. Thomas Brown, surgeon, Musselburgh, as served up in Moore’s insolence--
The Vaccine was in two years spread over Scotland. After a time, however, one croaking voice was raised to disturb the general concord. Mr. Brown, who was fretting in obscurity at Musselburgh, published a book in 1809 to maintain that the Vaccine only possessed the property of preventing Smallpox temporarily; that in three years its influence declined; and in five or six, hardly any security against Smallpox remained.
Brown submitted his cases to the Board, but they met with no attention.
In this extremity [continues Moore] he wrote a scurrilous accusation of the National Vaccine Establishment to the Secretary of State, which was referred to the Board. When they met, the Registrar read it, and then tied it up with red tape among that mass of papers which are consigned to rest.[276]
Could more be expressed in less? Thus was Brown, the representative of true science and enlightened and honest inquiry, set at naught and traduced by a Board endowed for investigation! Nor, in saying so, do I speak simply as an antagonist of vaccination. Brown was no anti-vaccinist. What he contended for is now everywhere admitted by vaccinists. They allow that the protection afforded by vaccination is temporary, and that it is necessary to renew its prophylaxy from time to time. The practice of revaccination is based on the verity of Brown’s contention, and yet, according to Moore, he was a vain-glorious and scurrilous fellow, and by Jenner was pronounced “an object of commiseration rather than resentment.”
As purveyors of virus, too, the Establishment fell behind Walker’s Institution, and the Quakers’ pox had the preference among connoisseurs in the article. Jenner wrote to Moore, 5th March, 1816--
The Matter sent out by the National Vaccine Establishment is much complained of. I was applied to a few weeks since by the surgeons of the hospital at Gloucester for some Vaccine Matter, and their request was accompanied by the observation, “That after using thirty points sent from town, not a single pustule was produced.”
To account for such failures, it began to be reported that the virus was gradually losing its virtue in transit through many arms; but, continued Jenner--
Medical men are more expert than others in discovering causes without the fatigue of much thinking, and in the present instance they have all hit upon the wrong one--no great wonder. They attribute the lessened activity of the Matter, and its disposition to produce imperfect vesicles, to the great length of time which has elapsed since it was taken from the cow, and to the immense number of human subjects through whom it has passed. This is a conjecture, and I can destroy it by facts. The Matter may undergo a change that may render it unfit for further use by passing even from one individual to another; and this was as likely to happen in the first year of Vaccination as the twentieth. There are medical men who will take anything they can catch under the mere name of Vaccine Matter, or from pustules incorrect in character. It is from the spread of such Matter that the dissatisfaction of which I speak has arisen.[277]
When we refer to the record of the National Vaccine Establishment, there is little reason for surprise over its inefficiency. The House of Commons, having voted the endowment of £3,000 a-year, the Government committed the organisation of the Establishment and the administration of its funds to the heads of the Royal College of Physicians. How the £3,000 a-year was disposed of, came to light in 1822, when the accounts were published. The statement stood thus for 1821, representing what had gone on during the past twelve years--
£ £
PHYSICIANS.--Sir Henry Halford, Bart. 100 Dr. Frampton 100 Dr. Thomas Hume 100 Dr. Charles Badham 100 Dr. R. Lloyd 100 ---- 500
SURGEONS.--Sir Everard Home 100 Sir W. Blizard 100 Henry Cline 100 ---- 300
REGISTRAR.--James Hervey, M.D. 300 DIRECTOR.-- James Moore 200 SECRETARY.--C. Murray 50 ---- 550
VACCINATORS.--One at £150 150 Five ” 100 500 One ” 75 75 Six ” 50 300 ---- 1,025
HOUSEKEEPER 40 MESSENGER 52 Rent of furnished House, 18 Percy Street 260 ---- 352
Printing, stationery, coal, candle, &c. 183 ------ Total £2,910 ------
The accounts, though they revealed what was suspected, were widely denounced as scandalous. Parliament voted £3,000 a-year to extend vaccination among the poor, and here were a set of physicians and surgeons pocketing £800 of it, and muddling away the greater part of the remainder. They affected to regard vaccination as the deliverance of mankind from the scourge of smallpox, and yet they had not hesitated to appropriate the means provided for its diffusion! There was scarcely the pretence of work for wages. The Board met once a week, but the attendance was irregular, and at each member’s discretion. The eight hundred-a-yearers dropped in when convenient for gossip, and to ask what was doing. When set upon their defence, the argument was that the public were distrustful of vaccination, and that to inspire confidence it was necessary that the Establishment should have the benefit of the ostensible support of the College of Physicians and the College of Surgeons, for which the honorarium of £100 annually to each of their representatives was by no means excessive. In reply, it was pointed out that Dr. Walker, supported by voluntary contributions, collected with difficulty, and with less than the pay of many an artizan, had done more for vaccination in London and the country, and was more respected and trusted, than the Establishment with all the prestige of corporate authority.
As the result of many protests, the waste of public money was brought before the House of Commons by Joseph Hume. It was Mr. Hume’s distinction that, with strong good sense and invincible patience, he upheld the standard of honesty in public finance, holding that it was as wrong to defraud the nation as to defraud an individual; and that it was as foolish (not to say more wicked) to pay away the people’s money for nothing, as to throw away one’s own. The principle, so obviously indisputable, and yet so shamelessly violated in every department of the State, was enforced in detail by Mr. Hume with a persistency and success that has never been surpassed, and, I fear, never appreciated as deserved. He showed that patriotism is a practical virtue, instead of a sentimental pretext for public plunder, and taught honour to placemen to whom honour was unknown. Appropriately, therefore, Mr. Hume led the charge against the National Vaccine Establishment, and in 1827 the annual vote was reduced from £3,000 to £2,500, £300 of the £500 being saved by knocking off two useless physicians and one useless surgeon. Even then the extravagance that remained continued to excite indignation, the consequences of which are recorded in a “Report from the Select Committee on the Vaccine Board, with the Minutes of Evidence, ordered by the House of Commons to be printed, 28th August, 1833.” If space allowed, it would be easy to linger over the disclosures of this Committee. Suffice it to say, that Dr. George Gregory, of the Smallpox Hospital, held that the whole work of the Board might be done handsomely on £1,200 a-year. The Committee, however, shrank from such a severe exercise of economy, and recommended the provision of the following staff and expenses--
Vaccinators at Stations in London (a sum which will probably admit of reduction) £900 Inspector } { 200 Registrar } Qualified on occasion to exchange duties { 200 Messenger 55 Offices, rent of 100 Incidental expenses 150 ------ Total £1,605
The Committee observed that the Board might consist of two physicians and one surgeon, whose duties, not being onerous, might be discharged gratuitously. As the Committee was more loose-handed than Dr. Gregory, so the Commons were laxer than the Committee. The President and a Censor of the College of Physicians, and the President of the College of Surgeons, were suffered to continue their £100 a-year each, and the annual subsidy for the Establishment stood fixed at £2,200, until vaccination, under the disguise of sanitation, developed into the monstrous proportions with which we are at this day afflicted.
There is much talk prevalent in favour of “the endowment of research;” but what may come of such endowment, when not sharply looked after, is manifest in the example of the National Vaccine Establishment. The investigation, assumed to start with, was never pursued; and the guardianship of the public interest undertaken by the Colleges of Physicians and Surgeons was never anything but make-believe. Annual Reports were presented to Parliament, signed by the heads of the Establishment, but of research they bore no trace, and many of them might have been dashed off by the Registrar in the course of an hour. Destitute of any scientific merit, these reports yet afford some curious glimpses of what was going on from year to year, with indications of the chief points of resistance encountered by the practice of vaccination; and, in turning over the series from 1810 to 1840, I have made the following notes, which may be read, perhaps, with interest.
VARIOLATION.
The chief resistance proceeded from the inoculators with smallpox; indeed, with the exception of apathy, there might be said to be no other resistance. Hence we read under the several dates--
1810.--During 1809, the surgeons vaccinated 1,493 persons. We are sorry to have to relate a decline of Vaccination in the Metropolis, and an apparent indisposition to the practice of it; and to express regret that there should be evil-disposed persons, who are endeavouring to frustrate His Majesty’s intentions by alarming the misinformed with stories which they know to be false.
1812.--We have reason to ascribe the increase of Smallpox in London during last year to the rash and inconsiderate manner in which great numbers are still inoculated for the Smallpox, and afterwards required to attend two or three times a week at the place of inoculation in every stage of their illness. The practice of Inoculation is the great means whereby Smallpox is kept in existence, and its infection propagated to persons and places where it would not otherwise be seen.
1814.--The Board has with great regret to observe that, although the punishment of three months’ imprisonment was awarded against Sophia Vantandillo, for carrying her child, whilst under the influence of Smallpox, through the streets, (which infected many others, eight of whom died) the unwary are still enticed by the hand-bills of shameless empirics to submit their children to Variolous Inoculation. It is, however, to be hoped that the above sentence passed by the Court of King’s Bench, which the Board has taken every method of promulgating, may produce considerable benefit. The Board selected Sophia Vantandillo as a proper example on account of the extent of the mischief occasioned by her misconduct; and that this prosecution, followed by a lenient punishment, may prevent any further wilful exposure of inoculated persons, is its fervent wish. The Board at the same time prosecuted Mr. Burnet, who inoculated the child, and who has long circulated most mischievous and offensive hand-bills, offering to inoculate persons with Smallpox gratis, and stigmatising Vaccination as productive of the most loathsome disease. This practitioner having suffered judgment to go by default, has been sentenced by the Court of King’s Bench to six months’ imprisonment.
The whole of the expenses incident to this Establishment for 1814 have been defrayed by the vote of last year, but the Board regrets that in consequence of the recent prosecutions and convictions, and the measures adopted for the more effectual extension of the practice of vaccination throughout the Empire, an addition of £500 to the annual grant will be necessary.
1815.--In Edinburgh, Glasgow, and Norwich, Inoculation is disused, and, in consequence, the Smallpox is scarcely known. In the country about Aberystwith in Wales, and Bawtry in Yorkshire, it has entirely disappeared. The reverse is, unhappily, the case in Portsmouth, Bristol, and London. In the Metropolis alone the mortality may be estimated at 1,000 annually; perhaps throughout the United Kingdom it is not less than ten times that number. It appears to us that this waste of human life can be prevented only by such legislative enactments as will entirely put a stop to Inoculation with Smallpox.
That smallpox was increased by variolation we have no reason to doubt, notwithstanding the fact that toward the close of the last century, when variolation was most practised, smallpox was steadily falling-off; but to ascribe the existence and persistence of smallpox to variolation was absurd. Smallpox was a widely-diffused disease before variolation was introduced to anticipate and minimise it.
1817.--The pernicious practice of Smallpox Inoculation, now very generally relinquished by the medical profession, is only persisted in by a very few of the least creditable class of practitioners, and is usually carried on clandestinely; yet the Board are concerned to state that this destructive operation is now performed for gain by itinerant Empirics, Farriers, Publicans, Nurses, low, cunning people of both sexes, and of various descriptions. And such is the infatuation of the poor and ignorant, that many of them carry their infants to be inoculated by those who only know how to inflict, but not how to assuage, the violence of Smallpox. The consequence has been that many have perished under their management; and the disease in particular districts has been widely disseminated. As this iniquitous conduct has prevailed much in London, an epidemic of Smallpox was last year excited among those who were not secured by Vaccination, and 1,051 persons died of the disease.
1836.--Only 300 died of Smallpox in London in the course of last year; and it is probable that this mortality, however comparatively small, is owing to the continued partial practice of Inoculation, which is liable to disseminate far and wide its contagious influence, to the imminent danger of all who have not been protected by previous Vaccination, or by having had Smallpox already.
Variolation was made a penal offence in 1840, and became less available as an excuse for the persistence of smallpox in defiance of vaccination.
FAILURE OF VACCINATION.
Accepting Jenner’s revelation, the heads of the medical profession in London assured the public, in a manifesto in 1800, that “those persons who have had Cowpox are perfectly secure from the future infection of Smallpox.” It was a rash assertion. Proofs of its untruth were not slow to appear. At first they were denied, then explained away, and then admitted under qualifications more or less adroit. When, in 1808, the National Vaccine Establishment was constituted, the fact of the failure of Vaccination to answer to its original promise was generally recognised. Nevertheless, the reports of the Establishment exhibit much ingenious wriggling and attempts to out-lie Nature. For example--
1811.--That in some instances Smallpox has affected persons who have been most carefully vaccinated, is sufficiently established; nor ought we to be surprised at this, when we consider that Inoculation for Smallpox sometimes fails, and that several cases may be produced in which persons have been affected with the natural disease more than once in the course of life. The Board have infinite satisfaction in stating the two following important and decisive facts in proof of the efficacy and safety of Vaccination, namely, that in the cases which have come to their knowledge, Smallpox after Vaccination, with a very few exceptions, has been a mild disease, and that out of the many hundred thousand persons Vaccinated, not a single authenticated instance has been communicated to them of the occurrence of fatal Smallpox after Vaccination.
The Board have great pleasure in stating that the money granted by Parliament during the last session has been sufficient to defray the expenses of the year 1811, and they are of opinion that the same sum will be adequate to the expenditure of the current year.
There were 3,148 vaccinations effected under the Board in 1811, which was at the rate of about £1 a-head.
Moore, after reporting some cases of smallpox after vaccination, at St. Osyth, in Essex, went on to say--
1816.--Some very rare instances of failures in Vaccination, as exceptions to a general law, may be expected as long as Smallpox is prevalent; since it has been fully ascertained that when the air is strongly impregnated with the infectious vapour of Smallpox, some of those who have had the disease are attacked a second time.
1818.--From the foundation of this Establishment in 1808 to the present year there have been vaccinated 52,253 persons at the stations in London. Only four of these are yet known to have had Smallpox afterwards, and these were never very seriously ill.
1819.--The testimonies of some of our correspondents concur in showing that great numbers of persons who had been vaccinated have been subsequently seized with a disease presenting all the essential characters of Smallpox; but that in the great majority of such cases, the disease has been of comparatively short duration, unattended by symptoms of danger. In several of these cases, however, the malady has been prolonged to its ordinary period, and in eight reported cases it has proved fatal. It appears to us to be fairly established that the disposition in the vaccinated to be thus affected by the contagion of Smallpox does not depend upon the time that has elapsed after Vaccination, since some persons have been so affected who had recently been vaccinated, whilst others who had been vaccinated eighteen and twenty years have been variolated, and exposed to contagion with impunity.
1820.--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 are assignable (and not altogether unreasonably, perhaps) to this cause. These cases the Board have industriously investigated, and though it appears that many of them rest only on hearsay evidence, and that others seem to have undergone the Vaccine Process imperfectly, 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 at first admitted too unreservedly.
1825.--That a considerable number of persons have had Smallpox after having been vaccinated, we are ready to admit; although of cases of this kind, a large majority are found on examination to be without that test of the operation being performed successfully and effectually, which all agree to be necessary to perfect security. Vaccination, therefore, it will be said, does not afford an absolute and perfect security. We do not present it to the world with that pretension, but we declare it to be the least imperfect of the resources we possess for encountering the disease.
1827.--It is true, cases are reported to us very often of the occurrence of Smallpox after Vaccination; but we have reason to believe that the number of those who fall into this safe, though sometimes severe disease, after Vaccination, is not greater than that of those who formerly died by Inoculation whilst that practice prevailed.
1833.--Of an equal number of persons vaccinated and variolated, only so many of the former will be capable of taking the Smallpox afterwards, and that in a safe degree of the disease, as are found to die by the latter.
1836.--If 300 children be vaccinated, one will be susceptible of Smallpox afterwards, but only in a mild and perfectly safe form, whereas if 300 be variolated, one will surely die.
As evolutions from inner consciousness, the statistics of Variolation and Vaccination under 1827, 1833, and 1836 are noteworthy. They illustrate the facility of the Board at the discovery of what was thought ought to be true.
DEVELOPMENT OF A FABULOUS SALVATION.
1811.--Previous to the discovery of Vaccination, the average number of deaths by Smallpox within the London bills of mortality was 2,000 annually; whereas during 1811, only 751 died of the disease, notwithstanding the increase of population.
1818.--During the year, 6,289 have been vaccinated in London and the vicinity; and the Board have much satisfaction in adducing unequivocal evidence of the increasing advantages of the Jennerian discovery; for it appears from the bills of mortality of London that, instead of 2,000 deaths by Smallpox, which was the annual average previous to the practice of Vaccination, there died in 1818 only 421.
That, previous to the introduction of vaccination, 2,000 was the average annual death-rate from smallpox in London is a statement that requires definition. At an early date the number is under the mark, and at a later it is over the mark. Dr. Farr delivers the truth in these words--
Smallpox attained its maximum mortality after Inoculation was introduced. The annual deaths from Smallpox in London, from 1760 to 1779, were on an average 2,323. In the next twenty years, 1780 to 1799, they declined to 1,740. The disease, therefore, began to grow less fatal before Vaccination was discovered, indicating, together with the diminution of fevers, the general improvement of health then taking place.
Bearing Dr. Farr’s figures in mind (and not forgetting the 2,000 adduced by the Board in the reports for 1811 and 1818), what does the reader think of the following audacious attempts on public credulity?--
1826.--From the quantity of vaccine lymph distributed, we are led to presume the practice of Vaccination is becoming daily more general; and the inference is still further confirmed by the fact that in 1826, only 503 deaths have occurred from Smallpox within the bills of mortality; whereas in the preceding year, 1,299 persons are recorded as having fallen victims to the loathsome disease. The whole of this difference ought not, perhaps, in candour to be attributed to the influence of Vaccination; for Smallpox during 1825 assumed a peculiarly malignant character; and there were more instances of the distemper occurring twice in the same individual than had ever been reported to us before. But when we reflect that before the introduction of Vaccination the average number of deaths from Smallpox in London was annually about 4,000, no stronger argument can reasonably be demanded in favour of the value of this important discovery. Nor can any more striking proof be given of the paternal care of the Government to protect the people at home and abroad from this destructive disease than the establishment and maintenance of this Board.
The bouncing falsehood, having passed muster, was repeated with enlargement at a suitable interval--
1834.--Only 334 deaths by Smallpox have been reported, a number considerably less than have died in any year since the introduction of Vaccination, and falling short by at least 4,000 of the average of deaths annually by Smallpox in London before the protecting influence of Cowpox was discovered and promulgated.
And again it appeared with a fresh touch of exaggeration--
1836.--The annual loss of life by Smallpox in the Metropolis before Vaccination was established exceeded 5,000, whereas, in the course of last year, only 300 died of the distemper.
Impunity being apparently assured, the fable came to be delivered as matter-of-course, thus--
1839.--Formerly 5,000 died annually of Smallpox within the London bills of mortality; but since Vaccination superseded Variolation, the number has gradually decreased, until it amounted to only 200 in the year 1837. In the course of the year that has terminated (during which Smallpox prevailed epidemically), there died 800; not one more, after all, than one-sixth of the number who died annually [that is to say, 4,800] during the prevalence of Variolation, notwithstanding the increased population of London and its environs. By a careful retrospect, we are, therefore, justified in stating that 4,000 lives are saved every year in London, since Vaccination so largely superseded Variolation.
The fall in smallpox that set in toward the close of last century was not confined to London, but extended to many European populations. It began before vaccination was heard of, and continued independently of it, though the vaccinators eagerly claimed the phenomenon as the result of their superfluous efforts. The claim was absurd as concerned London, for it plainly appears that vaccination during the years in question never overtook, or even approached, the metropolitan birth-rate. Here is the record of the vaccinations effected by the Establishment in five years--
1818 1819 1820 1821 1822 Total. ----- ----- ----- ----- ----- ------ 5,490 7,874 6,054 6,627 8,230 = 34,275
The entire vaccinations in five years not equalling the London births in any one year! There were, we dare say, as many more vaccinated by voluntary effort; but the figures, however extended, cannot be got to cover the immense mass of lower-class Londoners, who then, as now, were the chief factors of smallpox. What I say emphatically is, the National Vaccine Establishment had as much influence on London smallpox as the Holy Alliance.
POCK-MARKED FACES.
One of the arguments for vaccination at this day runs thus--“How do you account for the absence of pock-marked faces? When I was young, forty years ago, nothing was commoner than countenances disfigured by smallpox.” Occasionally the reminiscence is transferred to a mother or grandmother, who is reported to have said that she remembered when every third or fourth person was pitted.
We need not take seriously the motherly or grand-motherly reminiscences, so apt to be touched with the glamour of years. Confining ourselves to living memories, the owners thereof may, perhaps, be surprised to learn that the transformation for which they personally avouch was effected before they were born, or were qualified observers; and before vaccination was sufficiently practised to have wrought the change; and here is the evidence, as set forth in the reports of the National Vaccine Establishment, and printed by order of the House of Commons. Under the following dates we read--
1822.--As a proof of the protecting influence of Vaccination, we appeal confidently to all who frequent theatres and crowded assemblies to admit that they do not discover in the rising generation any longer that disfigurement of the human face which was obvious everywhere some years since.
1825.--The deaths by Smallpox amounted to 1,299 in 1825, a much greater number than has been reported for some years past. From this melancholy statement it is impossible to avoid the conclusion that the lower orders of society continue to be prejudiced against Vaccination, and allow Smallpox to take its course.
And yet what argument more powerful can be urged in favour of Vaccination than the daily remark which the least observant must make, that in our churches, our theatres, and in every large assemblage of the people, to see a young person bearing the marks of Smallpox is now of extremely rare occurrence.
To what can the freedom from the vestiges of so loathsome a disease be attributed, but to the protecting influence of Vaccination? for Variolation has now been disused by all respectable practitioners for some time past.
1837.--The rarity of an example of disfigurement by Smallpox now to be found in the theatres, in churches, or in any large assemblage of the people, affords proof that Vaccination has lost none of its efficacy.
Pock-marked faces are by no means uncommon at this day in London, though their number has diminished through more careful nursing and the use of well-known means for preventing disfigurement; and whoever cares to pursue the inquiry will discover that the majority of the marked have been vaccinated and many re-vaccinated--a proof that it is not the rite which prevents the scars.
The general impression we derive from the reports of the Establishment, 1808-40, is that they proceeded from men who were committed to vaccination, but had no profound faith in its efficacy; who were averse from the admission of its impotence, and ultimately held by it as possibly the best available defence against smallpox. With ample means and opportunities for investigation, they made no discovery, nor achieved any advance in practice, nor apparently conceived that there was either discovery or advance to be made. They accepted smallpox as a mysterious ordinance of Nature, with cowpox for a probable antidote, and there stuck fast, thoughtless and helpless. They did not even observe that smallpox was specially a disease of the young and the poor, nor deduce conclusions therefrom. They had their money, and went through an appropriate routine, and there their action ended.
FOOTNOTES:
[275] History and Practice of Vaccination, p. 223.
[276] History and Practice of Vaccination, p. 226.
[277] Baron’s Life of Jenner, vol. ii., p. 398.
XXXVI. THE NATIONAL VACCINE ESTABLISHMENT--1841-50
Along with the prohibition of Variolous Inoculation in 1840, Parliament passed an Act for the provision of Vaccination out of the poor-rate. A scheme had been formulated and petitioned for by the Provincial Medical and Surgical Association in 1838, with the expectation that the Government might be induced to create a multitude of places for “regularly educated vaccinators, with suitable salaries, in districts sufficiently numerous to embrace the whole of the poor population of the country.” The House of Commons being of a thrifty turn in those days, did not however favour such a magnificent development of place and pay under the National Vaccine Establishment, and disposed of the project by referring the provision of vaccination to the parochial authorities, who might be trusted to do what was needful with due regard to economy. In every union, and in every parish that was not in union, it was provided that there should be one or more medical practitioners appointed by the Guardians for the gratuitous vaccination of the inhabitants, with remuneration from the rates according to the number operated upon.[278] This accession to their burdens met with anything but welcome from the ratepayers in general. Contracts for vaccination at so much per head were submitted for competition, and those who accepted the rite at the public expense were spoken of as paupers, and in some places had their names published to “shame them.” To remove the stigma of pauperism from the parish prophylaxy, an Act was passed in 1841 in which it was declared that public vaccination was not of the nature of “parochial relief, alms, or charitable allowance,” and did not therefore deprive the recipient of any “right or privilege,” or subject him “to any disability or disqualification whatsoever.”[279]
The reports of the National Vaccine Establishment from 1841 to 1850 continued to be of the same perfunctory character. They usually started with a profession of confidence in vaccination, after the fashion of Mrs. Micawber’s resolution never to desert Micawber; the signature to which declaration by the President and Senior Censor of the Royal College of Physicians, and the President of the Royal College of Surgeons being accompanied with a douceur of £100 to each. For example, we read--
1841.--Smallpox has prevailed epidemically with considerable severity since our last Report; but we do not abate an iota of our confidence in Vaccination as the best protective against its malignant influence.
1845.--The unabated confidence with which we continue to regard Vaccination, etc., etc.
1847.--Nothing has occurred to diminish our confidence in the protective influence of Vaccination. It is true that Smallpox has now and then reappeared; and lately to an extent which has called for additional efforts on the part of all the officers of the Establishment; but we regard such recurrence as due to the ordinary operations of those periodical influences which give to the disease its epidemic character; and in some localities, as in Ireland, to that distress with which contagious diseases are so invariably associated.
The reporters apparently forgot that according to the doctrine of which they were the representatives, vaccination excluded the possibility of smallpox under whatever circumstances of atmosphere, filth, or privation. If only effective in the absence of the ordinary conditions of smallpox, wherein consisted the benefit of the rite?
Ceely of Aylesbury in 1839, and Badcock of Brighton in 1840, succeeded in inoculating cows with smallpox, and the resulting virus was described as cowpox, and used for vaccination far and wide. Apparently the procedure was not approved by the Vaccine Establishment, for we read in the report--
1841.--The matter we employ is obtained by succession from the original virus communicated by Dr. Jenner himself, and that we find is as effectual as ever. We may be excused therefore, we hope, if we discourage an incautious dissemination of matter obtained from new sources, which has not stood the test of ample experience.
The original virus communicated by Jenner himself! What was it? When the National Vaccine Establishment was instituted in 1808, the virus in circulation in London was accepted as stock, and it certainly had several origins. It was cowpox as discovered by Pearson; it was horsegrease cowpox and horsepox as derived from Jenner; and there is reason to believe it was smallpox from Woodville and others. The claim, therefore, to the possession of a specific variety of matter communicated by Jenner was fictitious.
Again, through the recurrent failure of vaccination to avert smallpox, the Board had to discountenance the assertion that their virus had lost its virtue through prolonged transmission--a reason which led some to prefer the fresh variolous stocks of Ceely and Badcock--
1840.--The experience of another year has afforded proofs of the propriety, in the present state of our knowledge, of preferring Vaccine Matter, the produce of the original virus furnished by Dr. Jenner, which has now passed happily through successive generations of subjects in the course of 43 years, and which forms the principal source of our supply, to any which may have been recently taken from the cow.
Here we have “the original virus furnished by Dr. Jenner” set forth as no more than “the principal source of supply.” The reports are characterised by many similar inconsistencies--
1845.--We regard as erroneous the belief that Vaccine Virus undergoes deterioration by being kept; in proof of which we are prepared to establish, by unquestionable documents, the striking fact, that Lymph which had been conveyed to and from India has retained its protective properties wholly unimpaired after a lapse of 20 years.
Another vexation of the Board was due to the assertion that the protective virtues of vaccination gradually wore out, and that the repetition of the rite was necessary for the maintenance of salvation. In the London Medical Gazette, 2nd August, 1844, it was proclaimed--
We are sorry to announce the extensive prevalence of Smallpox at this time among us. REVACCINATE, REVACCINATE, say we.
Such advice was essentially heretical and damnable; for Jenner affirmed and maintained--
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 Smallpox.
If revaccination were possible, smallpox after vaccination was possible; and if so much were conceded, on what ground was vaccination to be defended? Whatever the facts, the members of the Board resolved to stand loyally by the primitive Jennerian doctrine, and in their Report for 1851 thus testified--
It may be expedient to remind the public of the established fact which the Board upon former occasions anxiously insisted upon, that the restriction of the protective power of Vaccination to any age, or to any term of years, is an hypothesis contradicted by experience, and wholly unsupported by analogy.
Notwithstanding the prohibition of Variolous Inoculation, the Board had repeatedly to deplore its continuance especially in Ireland. Thus we read--
1850.--The Board again entreat the attention of the Government to the fact that Inoculation for the Smallpox still continues; and that the disease is communicated by vagrants to those unprotected by Vaccination in town and country. The contagion is carried throughout the land by wandering Irish, and no care, however great, can be successful in eradicating Smallpox, whilst the neglect of Vaccination and the practice of Variolous Inoculation are permitted in Ireland.
It was Jenner’s practice to attribute to wilful blindness and innate depravity any scepticism as to the efficacy of vaccination; and throughout the Reports of the Establishment this habit of imputation was maintained. Vaccination was treated as a sort of divine revelation, plenary and manifest, which could only be disputed or resisted from deliberate perversity, or, more charitably, from abject dulness or ignorance; and it would be easy to construct a catena of piquant deliverances under this semi-theological persuasion. Such observations as the following were of the order of matter-of-course--
1850.--We regret to learn that in our own country the spread of Vaccination is still materially impeded by influences emanating from ignorance and prejudice in the lower orders, and from prejudices in many who cannot plead the excuse of ignorance.
1851.--It is lamentable to observe not only the indifference, but the active hostility displayed by the community to Vaccination. Deeply-rooted prejudices and absurd superstitions are ever opposing its adoption.
The Reports of the Establishment year after year displayed in full measure the familiar complacency of official routine--where pay is constant and wheels propelled from office desks revolve smoothly in space--so many Londoners vaccinated, so many charges of virus distributed, and confidence in the sacred prophylactic unabated. A revolution was, however, impending. The attitude of the public mind toward disease had become transformed. Faith in sanitation as a preventive of fevers had been created, and a popular demand for sanitary improvement had set in. Under cover of this new enthusiasm some of the shrewder advocates of vaccination conjectured that it would be possible to effect its endowment and establishment on a scale hitherto unattempted in England. It was true that vaccination had no relation to sanitation; but the reforming and philanthropic mob were madly in favour of whatever bore the promise of health, and were not likely to show themselves hypercritical or obstructive.
The first movement toward a new advance is discernible in the Report of the Establishment for 1850 wherein we read--
The Board have had to solicit the attention of Her Majesty’s Government on several occasions to the deplorable fact that a very large proportion of the children of the poorer classes in the Metropolis, and in England and Wales generally, but above all in Ireland, remain year by year without the benefit of Vaccination. Their testimony on this important part of the sanitary condition of the population has been derived from the reports of numerous competent medical witnesses in all parts of the United Kingdom, and from the frequent recurrence of rapid and fatal invasions of Smallpox, to which their attention has been repeatedly called by urgent applications for Vaccine Lymph. It is satisfactory to find that the representations which the Board have made are most unequivocally confirmed by the report of Mr. Grainger, from which it appears that the number of persons under one year who were vaccinated during the year ended 29th September, 1848, in 627 Unions of parishes in England and Wales (exclusive of those vaccinated at the cost of their parents) amounted to no more than 33 per cent., compared with the total number of births registered in the same period.
These figures are worth noting. Dating from 1840, an effort was made to overtake the vaccination of the people by the agency of the poor law; and yet so late as 1848, not more than one-third of the children born were accounted for as Jennerised. Adding to this third the offspring of the upper and middle classes, we may safely conclude that up to 1850 not half the inhabitants of England and Wales were vaccinated; and the unvaccinated half included the lower classes most subject to smallpox--victims of that “distress with which contagious diseases are so invariably associated,” to cite the words of the Report for 1847. The point is especially worth noting because the decline of smallpox, which set in last century, is continually ascribed to vaccination. A true cause however must be commensurate with the effect; and yet here we see the asserted cause of the fall in smallpox did not apply in 1848 to half the English people; in which half, moreover, lay nine-tenths of the field in which smallpox was possible. The Report for 1850 continues--
The Board lament that they have no means of adopting or enforcing such measures as are obviously necessary for the prevention of Smallpox. They have no power of instituting domiciliary visits, or house to house visitation; and indeed hitherto such have been deemed too much of an encroachment on the liberty of the subject. They have no power to punish officially the practice of illegal Inoculation, or the exposure of infected persons; and they have only had the means granted to them of prosecuting such offenders in two cases, in order to establish the fact of the illegality of Variolous Inoculation. They can only recommend and aid, but they cannot enforce Vaccination.
The progress of Vaccination is more rapid in Foreign Countries where municipal measures or legislative enactments are adopted to promote its dissemination; and they beg to express their conviction that if England is to be free from Smallpox, the interposition of the Legislature alone, by wise and comprehensive measures, can disarm the Pestilence of its terrors, and realise the fond hopes and prayers of the Friends of Humanity for its extinction.
In these observations is revealed the movement of a new spirit--of a revived resolution to obtain for vaccination the force of law. Similar projects had from time to time been advanced by enthusiasts, and swept aside by statesmen. Canning, for instance, had declared that he could not imagine any circumstances whatever that would induce him to consent to the compulsory infliction of vaccination; and, at a later date, Sir Robert Peel expressed himself to like effect, saying, “To make vaccination compulsory, as in some despotic countries, would be so opposite to the mental habits of the British people, and the freedom of opinion wherein they rightly glory, that I never could be a party to such compulsion.”[280] But Peel died in 1850, and a strong public opinion in favour of sanitary reform had come into existence without much scruple as to methods. Diseases, hitherto regarded as supernatural inflictions, were traced to conditions of life, remediable or avertible; so that the submission and terror which sickness formerly inspired gave place to widely different sentiments--a temper of intolerance with illness, and a determination to extirpate its infectious forms with those who in ignorance or wilfulness should persist in their generation and diffusion.
FOOTNOTES:
[278] 3 & 4 Vict., cap. 59.
[279] 4 & 5 Vict., cap. 32.
[280] Report of Royal Jennerian and London Vaccine Institution, 1853.
XXXVII. VACCINATION ENFORCED--1853
Vaccination, it will be objected, had no connection with sanitary reform. True: it had none; but the dull public when possessed with a new enthusiasm is not apt to discriminate; and those who had an interest in pushing vaccination found their operations facilitated by the rising faith in the preventibility of disease; their promise of saving the country from smallpox seeming of a piece with much else that had become credible.
Yet, strange to say, the credit of vaccination had never fallen lower than prior to its enforcement. The proof is written at large in the reports of the National Vaccine Establishment from 1831 to 1850, which it is difficult to peruse without perceiving them to be the testimonies of half-hearted officials to a generation grown sceptical and indifferent. The medical literature of the time reflects the same uncertainty and doubt. Vaccination was admitted to be no sure defence against smallpox: it might, it probably did, mitigate the disease when it occurred; and, in the absence of anything better, its practice was advisable; but on such terms, what scope was there for its advocacy! In the writings of Dr. George Gregory, this scepticism is so pronounced, that he scarcely hesitates to recommend a reversion to inoculation with smallpox. A like scepticism as to the virtue of vaccination with a like disposition to return to variolous inoculation, is exhibited by Dr. Copland in his Dictionary of Practical Medicine, 1844-58--a work of high repute, and the standard of medical opinion for the time. In short, vaccination was subject to general distrust; every claim made for it had been belied; and except for its endowment by the State, and the determination of sundry adventurers to have that endowment enlarged, the practice would gradually have fallen into disuse.
The same absence of confidence in vaccination was conspicuous in the school of sanitary reformers. It was of the essence of their revelation that smallpox was as preventible as other fevers, and by the same methods. I might, indeed, challenge any one to produce aught from the utterances of the early apostles of sanitation in deliberate or explicit praise of vaccination. The prescription might not be formally condemned; it might even be cursorily approved; but it was foreign to the tenor of their doctrine, and its recommendation must have died in their throats. Dr. Southwood Smith delivered two lectures in Edinburgh in 1855 on the Prevention of Epidemics, but of smallpox as preventible by vaccination he said not a word. On the contrary, this was his testimony, his all inclusive testimony--
Overcrowding we can prevent; the accumulation of filth in towns and houses we can prevent; the supply of light, air, and water, together with the several other appliances included in the all-comprehensive word CLEANLINESS, we can secure. To the extent to which it is in our power to do this, it is in our power to prevent epidemics.
The human family have now lived in communities more than six thousand years, yet they have not learnt to make their habitations clean. At last we are beginning to learn the lesson. When we shall have mastered it, we shall have conquered epidemics.
Among the upper and middle classes distrust in vaccination was general. How, indeed, could it be otherwise? All were vaccinated, yet whenever smallpox was epidemic, recipients of the rite enjoyed no immunity. In one of Miss Mitford’s letters we find an experience and a judgment which were far from uncommon. Writing, 1st February, 1850, she observed--
About two months ago, my man, a very steady and respectable servant, was seized with Smallpox after Vaccination. He was very, very ill, delirious nearly a fortnight, and not a nurse could be had for love or money. I have lost all faith in Vaccination, either as preventing or mitigating Smallpox. I know of thirty severe cases this winter, five of them fatal, in my own immediate neighbourhood, and in Reading it has been a pestilence.[281]
Vaccination among the poor was (as it is) detested. Coaxed or forced into its reception without consideration or preparation, like sheep or cattle, they realised its mischiefs and misery in full measure; and naturally, whenever pressure was relaxed, avoided its acquaintance.
How then did vaccination come to be imposed upon a community thus affected? The answer is the usual one, illustrated continually in English politics: an organised interest, possessed with a definite intention, can always prevail over the public--careless, uninstructed, and without positive conviction. Under such circumstances, it is a mere question of management what may be achieved in Parliament at variance with the common welfare. Those there get, who know how to take.
All trades and professions fulfil the law of their being in striving after advantage and extension. The clergy and the clerically-minded laity are persuaded that to multiply churches and provide stipends, is to prepare for the millennium, and nothing save hopelessness prevents demands upon the national exchequer for the purpose. The sacrifices the army and navy would exact on their own behalf for security from foreign aggression are only limited by the public incredulity. The commercial classes are free-traders in principle; but if a protective bounty could be had for any manufacture, it would be instantly grasped at by those concerned, and most ingenious reasons invented to justify that particular departure from the rule of justice. This tendency of interests to aggrandise themselves, per fas et nefas, at the public expense, is recognised by all statesmen, and is only kept in check by perpetual vigilance.
What is true of all, is true of the medical profession, crowded with competitors eager for employment. Vaccination as a branch of business, capable of development and endowment at the public cost, was certain of vigorous promotion whenever there was opportunity; but not until 1853 did the way open for the compulsory infliction of the Jennerian rite. The undertaking was hazardous. The opposition to which Canning and Peel had given expression, had to be circumspectly encountered. It was a job that might easily be wrecked; and therefore it was considered inexpedient that the medical corporations should appear too openly in the transaction. Instead, a committee was formed in 1850 under the title of “The Epidemiological Society for the Investigation of Epidemic Diseases,” with a number of suitable decoys, and ostensible occupation; but chiefly designed as an instrument wherewith to operate on Parliament for the better establishment and more liberal endowment of vaccination.
It was resolved to proceed tentatively--to secure if possible the affirmation of compulsion, allowing the shock of innovation to subside before going on to provide the effective means of espionage and persecution. As it turned out, the caution exercised was superfluous. Much more might have been demanded and conceded of the ignorance and indifference of the legislature. Lord Lyttelton was selected to introduce what was called the Vaccination Extension Bill, and in moving the second reading in the House of Lords on 12th April, he ingenuously disowned any qualification for the task, saying--
I have no scientific knowledge of the subject myself, and for my information I am indebted to some able and learned persons belonging to the Epidemiological Society--
Adding in proof of the manner in which he had been crammed by the said “able and learned persons”--
It is unnecessary for me to speak of the certainty of Vaccination as a preventive of Smallpox, that being a point on which the whole medical profession have arrived at complete unanimity!
The statistics with which Lord Lyttelton supported the necessity for compulsion are interesting as indicating the extent and irregularity of vaccination among the English people. He said--
We are told that the number of births registered in England and Wales in the year ending 29th September, 1852, was 601,839, and the number vaccinated under the Act of 1840 was 397,128; so that, in round numbers, 400,000 were vaccinated by the machinery in force, leaving only 200,000, or one-third of the whole number, to be treated by private vaccination. There are several fallacies in that statement. The general result is by no means the consequence of anything like a uniform system throughout the country. I have before me a detailed statement of the extent of Vaccination in various parts of England in 1851, which shows there is great want of uniformity in certain districts. In towns where people have a shorter distance to go to get their children vaccinated, the result is more favourable than in the rural districts. For example, in Birmingham, on the total number of births in 1851, the vaccinations were 91 per cent.; in Leicester they were only 41 per cent.; and in Loughborough only 18 per cent. The contrast between the manufacturing and the rural districts is favourable on the side of the former. In Bideford, the vaccinations were only 11 per cent. upon the births; in West Ashford in Kent, they were only 22 per cent.; and in Winchcomb only 6 per cent. While the general average is lower in the agricultural than in the manufacturing districts, some contrary instances are found. Thus in Derby the vaccinations are only 42 per cent.; while at Watford, which is a rural district, the vaccinations were 126 per cent. upon the births in 1851--which included, of course, the vaccination of children born in previous years. But in London, and in no less a parish than that of St. James, Westminster, it is reported that in 1851 on 973 births only 44 vaccinations took place; while in Wellingborough Union, where there were 800 births in 1851, no vaccination at all is reported!
Strange to say, Lord Lyttelton made no attempt to complete his argument. He ought to have shown that in the places where vaccination was least practised there was most smallpox, and where most practised there was least smallpox. Had he made the attempt, his eyes might have been opened to the untrustworthy character of “the able and learned person” by whom he had been mendaciously primed.
Lord Shaftesbury, in supporting the measure, adduced similar instances of neglected vaccination as follows--
Births 1851. Vaccinations. Paddington 1458 386 Hampstead 286 93 Huntingdon 805 68 St. Neots 671 17 Carnarvon 929 125 Bangor and Beaumaris 1025 420 Newton Abbott 1563 150
He, too, forgot to show that these places were “decimated” (that’s the word) with smallpox, whilst other places where vaccination was generally practised enjoyed exemption. On the contrary, with curious inconsequence, he went on to recommend a sure prescription of his own, namely, improved dwellings for the poor. These were his words--
It is perfectly true that Smallpox is chiefly confined to the lowest classes of the population; and I believe that with improved lodging-houses, the disease might be all but exterminated.
Not a doubt of it; but if improved lodging-houses would “all but exterminate smallpox,” why resort to such a superfluity as vaccination?
There was no adverse discussion--indeed, no discussion whatever. Lord Ellenborough observed of the Epidemiological Society, under whose direction they were legislating, that he “would not adventure upon the extraordinary name by which the members are designated.” The bill was read for the third time, nem. diss., on 18th April, and was introduced to the House of Commons on 5th May, where its course was as uninterrupted as in the Lords. Sir John Pakington, in moving the second reading on 20th July, pleaded like Lord Lyttelton his own ignorance, and the evidence and authority of the Society with “the extraordinary name,” thus stating the case--
An Act was passed in 1840, by which Boards of Guardians were authorised to defray the expenses of Vaccination in their respective unions. The Poor Law Board have done all in their power to carry out the provisions of the Act; but still the grave fact remains, that the system is voluntary: that in many places the people are prejudiced; that a large proportion of the population is not vaccinated; and that mortality from Smallpox exists to a very great extent. In the year ending March, 1843 out of 527,325 born in England and Wales, only 183,000 or 34 per cent. were vaccinated. In the succeeding years the vaccinated stood to the unvaccinated in the following ratio:--
1844-45, 100 to 156 1845-46, 100 to 134
In 1846-47 the births were 552,000 of which only 267,000 were vaccinated, or about 50 per cent. of the whole. In consequence, however, of stimulus applied by the Poor Law Board, two-thirds of the births in 1847-48 were accounted for as vaccinated; but still in many parts there prevails excessive neglect. For example, so late as 1851 in 32 unions in and around Birmingham, the births were 17,700 while the vaccinations were only 6,174--two-thirds being unvaccinated.
Here, too, we note the omission of proof, that where vaccination was neglected smallpox was prevalent, and where practised smallpox was absent. Lord Palmerston supported the second reading without hesitation. Sir George Strickland was the only dissentient, saying--
Sir John Pakington has himself supplied the strongest reason why the bill should not pass. He has shown that Vaccination as at present conducted is working well; but because some mothers object to the practice, we are to be saddled with a compulsory law. We are too prone to resort to force to overcome resistance, which would yield to reason with the exercise of patience. What need is there that we should imitate the legislation of Saxony, or Austria, or Prussia in such a matter? In this country we cannot have one law for the poor and another for the rich, and yet here we are asked to apply a measure to the former which we could not think of for the latter. How can we expect to abate prejudice against Vaccination by compulsion? If we acted more on the old English principle of leaving people to secure their welfare by their own good sense, we should in the end achieve our purpose much more successfully.
The bill was read, for the third time in the House of Commons without debate on the 13th, and received the royal assent on 20th August, 1853. In short, it passed through Parliament without opposition. What, it will be asked, were its provisions?
By the Act (16 and 17 Vict. cap. 100) it was required--
1. That every child, whose health permits, shall be vaccinated within three, or in case of orphanage within four months of birth, by the public vaccinator of the district, or by some other medical practitioner.
2. That notice of this requirement, and information as to the local arrangements for public vaccination, shall, whenever a birth is registered, be given by the registrar of births to the parents or guardians of the child.
3. That every medical practitioner who, whether in public or private practice, successfully vaccinates a child shall send to the local registrar of births a certificate that he has done so; and the registrar shall keep a minute of all the notices given, and an account of all the certificates thus received.
4. That parents or guardians who, without sufficient reason, after having duly received the registrar’s notice of the requirement of Vaccination, either omit to have a child duly vaccinated, or, this being done, omit to have it inspected as to the results of Vaccination, shall be liable to a penalty of £1; and all penalties shall be recoverable under Jervis’s Act, and shall be paid toward the local poor-rate.
Thus from 1853 every English parent became liable to a fine of twenty shillings and costs who refused or neglected to have his child vaccinated within three months of birth. It may seem surprising that an Act so arbitrary, enforcing an indefinite medical prescription (for Vaccination was not defined, and Vaccination is a rite of several varieties) should have been passed so lightly; but we have to recollect the circumstances. The House of Commons in those days was the house of the upper and middle classes, and was as little affected as the House of Lords itself by the proposed legislation. It was an Act for application to the vulgar--to the prejudiced, whose prejudices were to be encountered, not with arguments, but with fines; an illustration of the levity with which the unconcerned can dispose of the opinions and feelings of those to whom they owe no allegiance. Since that time the working-classes have plainly discovered that they only obtain consideration in Parliament in so far as they can make their power felt in the constitution of Parliament. No rights are secure that cannot be enforced, nor any justice certain that cannot be vindicated. Those who hold their ground by any other tenure than their own intelligence and vigour are liable to continual imposition and depredation.
The good old rule, the simple plan, That they should take who have the power, And they should keep who can--
is the abiding social law, however veiled or elevated in application.
Again we have to recollect, that in 1853 there was no developed or scientific resistance to vaccination. As to the nature and value of the practice there was wide diversity of opinion, notwithstanding Lord Lyttelton’s affirmation of the complete unanimity of the medical profession; but although such scepticism was general, the rite constituted an established poll-tax among the respectable classes, which sort of thing is never readily surrendered. Hence it seemed less unreasonable to enforce the like observance on “the ignorant and prejudiced” at the cost of the poor-rate. When Canning refused to consent to compulsion in 1808, cowpox had a competitor in smallpox inoculation; and Peel in his later protest expressed the preference of an expiring generation for living English liberty over cut-and-dry subservience. Despotic philanthropy was coming into vogue, and it was no longer thought impracticable or inexpedient to do good to people in spite of themselves. There was therefore little to be said against the Act of 1853 beyond what Sir George Strickland expressed. The right of the prejudiced and ignorant to the enjoyment of their prejudice and ignorance had become obsolete and indefensible.
The report of the Epidemiological Society was taken as the warrant for the Act of 1853 alike by the Lords and Commons. Turning to that report,[282] it is difficult in a few words to convey an adequate idea of its untruthful character. Whoever, it is said, wills the end wills the means; and certain medical men having resolved to make vaccination compulsory whatever was requisite had to be accomplished; and Dr. Seaton undertook the operation, the Epidemiological Society, of which he was “the ruling spirit”,[283] playing the part of guarantee. For the persuasion of the Lords and Commons, an advocacy of vaccination without hesitation or qualification was deemed advisable, and the line was thus followed up--
Smallpox is a disease to which every person is liable who is not protected by a previous attack or by Vaccination. In its unmodified form it is fatal to about one in four or one in five of all whom it invades; and, when it does not destroy life, it in many cases disfigures and deteriorates the general health. Every case of it is a centre of contagion, and every unvaccinated or imperfectly vaccinated population is a nidus for the disease to settle in and propagate itself. It is on the two latter propositions, which do not admit of being controverted, that we conceive any enactment for rendering Vaccination compulsory must be based. If it admit of doubt how far it is justifiable in this free country to compel a person to take care of his own life and that of his offspring, it can scarcely be disputed that no one has a right to put in jeopardy the lives of his fellow-subjects.
All will recognise the authoritative air of the foregoing, so impressive where nothing better is known; but the indisputable proposition, “that no one has a right to put in jeopardy the lives of his fellow-subjects,” was curiously inconsistent with faith in the asserted prophylactic; for if the vaccinated were secure from smallpox, how could the unvaccinated place their lives in jeopardy? The style assumed was thus maintained--
We are ourselves satisfied, and it is the concurrent and unanimous testimony of nearly 2,000 medical men with whom we have been in correspondence, that Vaccination is a perfectly safe and efficient prophylactic against this disease.
This proposition we hold to be proved--
1. By the general immunity with which it is found that those who have been vaccinated can mingle with Smallpox patients, a fact so familiar that we do not feel that we need adduce any illustration of it.
2. By the gradual decrease which has taken place in the mortality from Smallpox, as compared with the mortality from all causes, since Vaccination has been introduced and been generally received.
As to the immunity of the vaccinated, it was disproved in every smallpox epidemic, and in every smallpox hospital, and by the precautions and terrors of those accounted secure. To sustain the proposition that smallpox had decreased in consequence of the introduction of vaccination, a variety of statistical tables were adduced, English and Continental; but had the Lords or Commons subjected them to scrutiny they would have discovered that the details were either irrelevant or adverse to the conclusion asserted. Many of the statistics, especially of last century, were not certainties, but conjectures and estimates, vitiated, too, with the bias of their compilers. When it is said that smallpox decreased in consequence of the introduction of vaccination, the answer is that smallpox was decreasing prior to its introduction in almost every country of Europe; and that the decrease continued irrespective of its influence, save in so far as it might have discouraged the culture of smallpox by inoculation. To illustrate this contention it may suffice to take the table of London Smallpox set forth by Dr. Seaton, in which the average of deaths from Smallpox in every 1000 deaths from all causes was contrasted in decennial periods for fifty years, prior and subsequent to the introduction of vaccination.
PRIOR TO VACCINATION.
Deaths from Ten Years ending-- Smallpox. 1760 100 1770 108 1780 98 1790 87 1800 88
SUBSEQUENT TO VACCINATION.
Deaths from Ten Years ending-- Smallpox 1810 64 1820 42 1830 32 1840 23 1850 16
The figures are far from trustworthy, but taking them as they stand, and admitting the decline, where was the proof that it was due to vaccination? The introduction of that practice was one thing: its application quite another. There was no reason to believe that more Londoners were vaccinated in 1820 than in 1810, or in 1840 than in 1830; indeed, the available evidence went to the contrary, vaccination having fallen in repute after the furore of 1801-5, and the demonstration of its impotence and its injuriousness. Probably not ten per cent. of the births in London up to 1840 were accounted for as vaccinated; and notwithstanding the provision of vaccination at the cost of the poor-rate by the Act of 1840, not fifty per cent. in 1850. Yet to a cause so utterly inadequate, the steady decline in London Smallpox was ascribed! The same fallacy pervaded the statistics of other countries and cities, yet so strong was the prepossession in favour of the conclusion determined upon, that it was apparently neither seen nor suspected, obvious though it was.
Nor was it surprising that with a disposition so fixed and obtuse, no enlarged or philosophic views should have been entertained. “Smallpox,” said Dr. Seaton, “had decreased compared with mortality from other causes.” True; but what if mortality from other causes had compensated for the decrease of smallpox? and if such compensation had taken place, as, for example, in Glasgow, in what consisted the advantage? Again, no reference was made to illness and death resulting from vaccination, as if the rite were harmless as baptism. Allowing that the practice did in some occult fashion tend to the abatement of smallpox, it was still open to question whether the infliction of an acute specific disease on all sorts and conditions of infancy was not likely to be far more injurious to life than the smallpox it was supposed to avert. Such considerations, however, were foreign to Dr. Seaton and his Epidemiological Society with whom vaccination stood for little else than an extension of medical business at the public cost.
It is not to be forgotten that the Act of 1853 brought to fruition what was long hankered after by the trade spirit of the medical profession. The Act of 1840 endowed vaccination out of the poor-rate; but to make the rite compulsory and to ensure good pay for its performance was the consummation desired. The terms and conditions that ensued on the Act of 1840 are thus described by Dr. Seaton--
The fee paid in England and Wales varies from 1s. to 2s. 6d., never falling below or rising above those sums. In 1842 and 1843, the Commissioners estimated the average fee at 1s. 9d. From our inquiries, it appears that in the large manufacturing towns the fee varies from 1s. to 1s. 6d.; the larger sums of 2s. and 2s. 6d. being paid for the most part in country towns. In London, the more ordinary fee is 1s. 6d.; in several parishes 2s. 6d. is paid; and in one, 1s. In some few unions a bad principle obtains of paying a larger sum for a certain number of cases, as 50, and a smaller sum for all above. The average payment per case for the whole of England and Wales from 1841 to 1851 inclusive, was 1s. 5½d.
In Ireland, the payment appears to be very low. The more general sum is 1s., often 6d.; in three or four instances, 3d. and 4d. The vicious principle just noticed, of paying a higher fee for a limited number of cases, seems to be almost universal. Thus, where 1s. is the fee, this is paid for the first 200 cases, and 6d. for all above. In one case, Nenagh, 1s. is paid up to 200, and 1d. for all above. In other cases, 3d. and 4d. are paid for all above a certain number. Whilst this pitiful remuneration exists, it is not surprising to find that in many districts the medical practitioners decline the appointment, leaving the people unvaccinated.
According to the information we have received, it is found, as might be anticipated, that on the whole Vaccination is more efficiently carried out in the districts where the higher fee of 2s. 6d. is paid; or where, as in large towns, the number and proximity of children compensate the vaccinator in some degree for lower payment.
The better pay, the better vaccination! The object of the Epidemiological Society, as the stalking-horse of the medical trades-unions, lay in those fees. Vaccination was a pretext for a universal poll-tax, set at as high a figure as practicable, to be succeeded when possible by compulsory revaccination, with a correspondent tariff annexed. Recalling the early days of vaccination when the operation was described as simplicity itself, and when women, parsons, and busybodies inoculated and propagated “the benign fluid” under Jenner’s authority, it was remarkable to have the rite thus formalised and converted into the peculium of a priesthood. Nor can it be objected that when vaccination was thus practised, it was ineffective against smallpox; for whenever its virtue is brought into dispute, we are referred to those primitive times and that primitive practice for the most successful and unquestionable exhibitions of its power.
Caveat emptor is a well-recognised caution, which to avoid was the purpose of the Epidemiological Society. A mercantile transaction was carried out under the cloak of impartial science. No reader of Seaton’s report could suppose otherwise than that vaccination was universally regarded as an infallible preventive of smallpox, and that if by any means the English people could be subjected to its observance, they would obtain immunity from the disease. Evidence to the contrary was kept out of sight; and yet evidence to the contrary lay within the knowledge of every medical man; and proof might be adduced to weariness from contemporary medical literature to show that in this respect the Epidemiological report was contrived to blind and mislead Parliament. As a witness, none will impugn Sir Henry Holland, and writing in 1839 he observed--
Not only in Great Britain, but throughout every part of the globe, we find that Smallpox has been gradually increasing in frequency as an epidemic; affecting a larger proportion of the vaccinated; and inflicting greater mortality in its results.
The early enthusiasm for the great discovery of Jenner swept doubts away; and they returned only tardily, and under the compulsion of facts.... Any explanation from the ignorant or imperfect performance of Vaccination was found insufficient to meet the number and variety of the proofs. And, though more palpable at one time than another, according to the greater or less prevalence of epidemic causes, yet every succeeding year has multiplied them, and every statement from other countries attested their truth.
It is no longer expedient, in any sense, to argue for the present practice of Vaccination as a certain or permanent preventive of Smallpox. The truth must be told, as it is, that the earlier anticipations on this point have not been realised.... Whether Smallpox may ever be wholly eradicated is a very doubtful question, and the probability is on the negative side.[284]
In statements like these, Dr. Holland did no more than express the contemporary conviction of the medical profession. Vaccination was not surrendered: whilst it was allowed that it could not be trusted to prevent smallpox, it was held that it made the disease milder, and that whilst its prophylaxy wore out, it was renewable by revaccination. Obvious it was that vaccination thus qualified could never obtain legislative sanction; but such sanction being imperatively demanded, the Epidemiological Society provided what was thought requisite for Parliamentary conviction.
It is said that Vaccination was a medical question; but all questions are transformed when they ascend to politics. The origin, character, and action of varieties of animal virus are mysteries, and may remain mysteries with general indifference; but when it is claimed that the inoculation of such virus prevents smallpox, and that whoever refuses to submit his child to the said inoculation shall be fined 20s., then the matter is brought within the personal jurisdiction of every citizen, and he becomes entitled to information, to the exercise of his judgment, and the expression of his opinion. As a mystery, vaccination belongs to experts; but as a Parliamentary preventive of smallpox it is within the discrimination of all who can observe and appreciate the evidence of numbers. For a legislator like Lord Lyttelton to confess his ignorance, and that he moved under the dictation of certain “able and learned persons,” was to abandon his proper function, and surrender himself to imposture.
FOOTNOTES:
[281] Memoirs. By C. Boner. Vol. i. p. 176.
[282] Letter from Dr. Edward Seaton to Viscount Palmerston with Report on Smallpox and Vaccination in England and Wales and other Countries, and on Compulsory Vaccination, with Tables and Appendixes presented to the Epidemiological Society. Ordered by the House of Commons to be printed, 3rd May, 1853.
[283] British Medical Journal, 3rd July, 1880.
[284] Medical Notes and Reflections. By Henry Holland, M.D., F.R.S. London: 1839. Pp. 401, 415, 416.
XXXVIII. UNIVERSAL COMPULSION DEMANDED--1855
Under the terror of the 20s. fine, proclaimed everywhere by vaccinators voracious for fees, a prodigious extension of practice was effected in 1854. The vaccinations under one year of age were more than doubled; and nearly 300,000 children above one year old, to whom the law did not apply, were driven into the net, and “cut for the pox” at the public expense. Thus the public vaccinations of 1854 exceeded the births of that year by 75,000. Subsequently the rate fell off and fluctuated as appears from the following table for England and Wales--
Public Years. Births. Vaccinations. 1853 601,223 376,218 1854 623,699 698,935 1855 623,181 464,099 1856 640,840 435,012 1857 649,963 423,421 1858 654,914 468,008 1859 669,834 455,349 1860 689,060 494,942
Yet this extension of practice did not satisfy the medical adventurers of the Epidemiological Society. They pointed out that universal vaccination was the desideratum, and these results fell short of universality--
The Act of 1853 was intended to apply not to 65 per cent. of the births, but to every child born. A certain deduction, it is true, must be made for those privately vaccinated; and whilst there are no data for exactly estimating the proportion of these (which probably varies considerably in different parts of the Kingdom); yet taking the country throughout, there is reason to believe that not more than from 10 to 15 per cent. of the children born are so vaccinated; for it is found that in unions where particular care is bestowed upon public vaccination, the number publicly operated on is from 85 to 90 per cent. of the births. If we estimate 80 per cent. only, as the number requiring to be provided for by public vaccination, the results of last year [1854] fall short of those which should be attained by nearly 100,000.
This estimate is worth attention as sustaining a conclusion I have repeatedly tried to enforce. Prior to 1840, vaccination was a matter almost exclusively of private concern, extending to no more than 10 or 15 per cent. of the population--or, let us allow, 20 per cent.--and those chiefly the well fed, well clad, and well housed. Yet the diminution of smallpox, dating from a period in last century when variolous inoculation was in full practice and cowpox was unknown, is persistently ascribed to the introduction of vaccination which up to 1840 did not apply to more than one-fifth of the people; the four-fifths exempt from the prophylaxy being notoriously the chief factors of the disease!
Parliament having so readily consented to the Compulsory Act of 1853, it gave cause for acute chagrin that more had not been asked, when more might so easily have been had; and the operators behind the Epidemiological Society set to work to try whether the lost opportunity might not be retrieved. In a Memorial addressed to the President of the Board of Health in the name of the Society, in 1855,[285] we find a project developed which lacked nothing of audacity and comprehensiveness. First, the virtue of vaccination was asserted in unqualified terms--
Smallpox is the most preventive of diseases, differing from all other epidemic diseases in this remarkable respect, that while these latter can only be prevented by discovering and remedying the various conditions (as of crowding, want of drainage, filth, and the like) which give rise to or assist in the dissemination of the specific poison of each disease, the former may be guarded against and prevented by a direct prophylactic measure. To Smallpox, in short, there is an antidote. The same cannot be affirmed, in the present state of knowledge, of any other epidemic disease.
That antidote is Vaccination. In exact proportion as this has been efficiently practised, have the extent and severity of Smallpox been diminished over the surface of the world. To the neglect of it, or to its inefficient performance, is due the large existing mortality from the disease in this country.
Evidently the advice, Pecca fortiter, had been laid to heart by the framer of the preceding declaration. Certainly the scheme for which it stood as preamble required violent justification. It was no less than the institution of a Vaccination Office with despotic powers as a department of State. The appointment of public vaccinators subordinate to the Board of Guardians, subject to contract, and paid out of the poor-rate, was held to be a degrading form of service: it prejudiced vaccination as a form of alms, and reduced medical men to the rank of parochial officers. Worst of all, the pay was bad--
The provisions for the remuneration of public vaccinators have not been such as to secure their hearty and zealous co-operation. The most injurious consequences have undoubtedly resulted from this, both in limiting the numbers vaccinated, and in discouraging the vaccinators from giving that pains and attention to watch the progress of the Vaccine Disease which are imperatively necessary.
They must, therefore, be emancipated. An independent organisation, with a medical chief, was essential alike to the mystery and dignity of the craft, and the universal and efficient exercise of its functions. To save the country from smallpox, two conditions were requisite--
First, that it be made a matter of legal obligation on all persons resident within England and Wales, whether born within that portion of the Kingdom or not, to give evidence of being vaccinated.
Second, that to achieve this end, there be provided administrative science, zeal, and activity.
The union of these conditions is indispensable; either without the other will fail.
It was pointed out that the Act of 1853 only applied to children born in England and Wales after a certain date--
It does not extend to the whole existing population, nor to immigrants. It is well known that Smallpox is largely imported into this country, and kept up from Ireland. These Irish not only form a nidus for the disease in towns where they collect in large numbers, but they disseminate it throughout the country at harvest time, and in the season of hopping.
To fight and overcome smallpox, to meet and arrest epidemics, the law must be administered by qualified, zealous, and “adequately remunerated” officers; but “the keystone to any effective system” must be a commander-in-chief--
No compulsory enactment, however comprehensive and stringent; no alteration in the mode of appointing public vaccinators, however desirable; no additional remuneration and encouragement to them, however necessary, will be sufficient to secure the grand object to be had in view, the Universal diffusion of Vaccination and the Extinction of Smallpox, unless there be some competent and energetic Medical Officer to harmonise the whole system and keep it in constant activity; to examine continually its working, that what is defective may be immediately supplied; and, in cases in which it is required, to enforce the law, whether against those who refuse to submit themselves to Vaccination, or against those who, by travelling about, diffuse Smallpox throughout the Kingdom.
It was further said, “The changes thus proposed have long been looked forward to by the president and council of the Epidemiological Society as essential to a proper system of public vaccination”--of which, indeed, there was no doubt; for to effect the said changes was the chief end of the Society and of its ruling spirit, Dr. Edward C. Seaton. Though it may seem incredible, it will not surprise any who have studied the habit of the thorough-bred quack, that the designated commander-in-chief, “the keystone of the system,” the miraculous combination of scientific and administrative ability, was none other than the projector, Dr. Seaton himself! He it was who in fancy saw himself the elected head of the New Vaccination Office, with place and pay at his disposal, and power to examine and vaccinate every resident upon English soil.
The Memorial concluded with the opinion that in view of “the continued high rate of mortality from smallpox,” some measure should be concerted “for carrying out the alterations suggested during the present (1855) session of Parliament.”
It goes without saying that the project developed in the Memorial was an impracticability; and that it should have been “long looked forward to by the president and council of the Epidemiological Society” proves what manner of dreamers they were. The mortality from smallpox in England and Wales constituted, they said, 2 per cent. of the national mortality; but not even the reduction of the 2 per cent. could have reconciled the people to the New Vaccination Office with its ruling spirit, its expenditure, and its inquisitors. Bad as smallpox may be, there is worse than smallpox; and much worse would have been Dr. Seaton with his pernicious quackery and his intrusive myrmidons. The recrudescence of similar projects from time to time attests the existence of visionaries who not only misunderstand the temper and traditions of their countrymen, but the constitution of human nature itself.
The year 1855 was one of war and excitement, but a bill drawn on the lines of the Memorial was introduced to the House of Commons providing that from the 1st of January, 1856, the vaccination of the people should be committed to a medical superintendent with a medical staff, drawing their salaries from the Treasury, who would take over the existing local administration from the Poor Law authorities, and organise and develop it afresh. Further, it was provided--
That every adult person resident in England and Wales on 1st January, 1856, who had not already been successfully vaccinated, nor had Smallpox, be vaccinated by a duly qualified practitioner, or by a public vaccinator, within three months of that date, and submit to an inspection by the medical man, or public vaccinator, eight days after vaccination, under a penalty of £1.
That adults not born in England and Wales, and coming to reside therein, be vaccinated (if not already vaccinated) within three months of their arrival, under a penalty of £1.
That children be taken by their parents to be vaccinated within three months after 1st January, 1856, and be inspected eight days after vaccination, under a penalty of £1.
That children brought to England and Wales from other parts be vaccinated in like manner within three months of their arrival.
That children and adults be revaccinated until the operation is declared successful. If after repeated vaccinations, a patient prove insusceptible, a certificate to that effect shall protect him from the penalty otherwise rigidly inflicted.
That Public Vaccinators be entitled to a fee of 2s. 6d. for every child or adult successfully vaccinated within two miles of the Vaccinator’s residence, and 3s. 6d. if beyond that limit. That Medical Practitioners, not public vaccinators, be entitled to 1s. for every person entered by them on the register as vaccinated.
That a certificate of successful vaccination be granted for the trifling fee of 6d.
That the Superintendent be empowered to institute rigid inquiry and to prosecute for penalties wherever he suspects the regulations of the Act have been neglected or violated.
Here, indeed, was a dose of despotism for Englishmen! Nothing being done in 1855, there was time for reconsideration. It was felt that the withdrawal of vaccination from local administration was too revolutionary; and another bill was introduced in 1856, under the direction of Mr. W. F. Cowper, President of the Board of Health (dropping the New Vaccination Office), with provisions for the inspection and vaccination of children in public schools, and of emigrants; for revaccination in the event of epidemics; and for coroners’ inquests on unvaccinated children dying of smallpox. There was no popular demand for such legislation. It was promoted by a group of medical place-hunters operating under the mask of the Epidemiological Society. The solitary petition in its favour was presented, 26th May, 1856, by Mr. James Furness Marson, a comrade of Dr. Seaton in the direction of the Society. Marson was resident surgeon of the Smallpox Hospital at Highgate, and as evidence of his unscrupulous advocacy, we may take the following assertions--
Your Petitioner has, in the course of twenty years, vaccinated upwards of 40,000 persons, and has never seen any evil results traceable to Vaccination, with the exception of a single instance in which measles occurred at the same time, and four or five examples of rather severely sore arms arising from lymph recently taken from the cow. He has never seen other diseases communicated from the Vaccine Disease, nor does he believe in the popular reports that they are ever so communicated.
The mortality from Smallpox in the Unvaccinated, of cases taken generally, is 35 per cent.; and among the Vaccinated attacked by Smallpox it is 7 per cent.
Among children under fourteen years of age who have been vaccinated, Smallpox hardly ever proves fatal.
As an example of what can be done by efficient Vaccination, your Petitioner begs to state that not one of the servants or nurses of the Smallpox Hospital has had Smallpox for the last twenty years. They have all been either vaccinated or revaccinated on coming to live at the Hospital.
The Petitioner omitted to mention how many of the said servants and nurses had entered the Hospital as patients, and were pleased to remain as officials. Prevarication throughout was the note of Marson’s petition: he might argue that what he stated was true--true under conditions and reserves unstated.
It is often observed that the crafty never operate so successfully as when they have the earnest and ingenuous for instruments; and in Mr. Cowper, President of the Board of Health, the wire-pullers of the Epidemiological Society had just such a tool. He believed what he was told, and delivered it with his own sincerity. In moving the second reading of the Bill on 31st March, he represented its object as “nothing more than the consolidation and amendment of preceding Acts;” and went on to say--
It is admitted by every medical man whose opinion is worth a moment’s consideration, that Vaccination is a specific against Smallpox; of course I mean where the operation is properly performed. In fact, it is a point decided in the medical world that Vaccination, when properly performed, is a guarantee against Smallpox, except in extremely rare cases; and no evidence has been produced to justify the idea that it is attended with injurious consequences. Statistics show that in proportion as Vaccination is extended, the mortality from Smallpox is diminished.
And so on; the lesson being recited with all the docility of a good child. Mr. Henley struck a different note--
There is considerable dissatisfaction throughout the country with the mode in which Vaccination is performed. In my own neighbourhood, for example, the poor people complain that all sorts of eruptions appear on their children after the Vaccination they are compelled to undergo; and though they may be quite wrong, you cannot persuade them to the contrary. Then, too, I cannot approve of the transfer of Vaccination from the Guardians to a Central Medical Board. That change must be removed from the bill.
The second reading having passed unopposed on 31st March, and nothing more being heard of the bill, Mr. T. Duncombe, who knew the ropes of the parliamentary ship, grew suspicious, and on 7th July asked Mr. Cowper if he could fix a time when the bill would be brought on. Suspicion was amply justified by Mr. Cowper’s answer. He said--
The bill is not one in which Members take any great interest. It is one of that class of bills which are usually taken at a late period of the evening; and I hope the Hon. Member will not object to its being taken at the same time as other bills of similar character.
To which Mr. Duncombe replied--
If Hon. Members do not care for the bill, they do great injustice to the people, because it is a compulsory bill. Two hundred petitions have been presented against it, and only one in its favour. A more arrant job than this bill I never knew, and I hope an opportunity may be given me to oppose it.
Mr. Cowper’s simplicity was apparent in his answer. He said--
I do not mean that the bill is of no importance, for it is intended to check the ravages of a disease which kills thousands every year. What I intended was, that the opposition which my Hon. Friend offers is not shared by other Members. My Hon. Friend says the bill will make Vaccination compulsory; but Vaccination is compulsory already. The purpose of the bill is to consolidate and improve existing legislation. It would be much fairer if my Hon. Friend brought in a bill to repeal compulsion. I will not bring in the bill after 12 o’clock at night.
The pledge not to bring on the bill after midnight settled its fate. Its promoters, aware that its provisions would not hear discussion, had reckoned on its unopposed passage at an hour when members were few, weary, and indifferent. Mr. Duncombe’s vigilance defeated the scheme, which Mr. Cowper incontinently revealed. The bill was brought into Committee on 10th July, and the order for its reading discharged amid general satisfaction. Mr. Henley observed--
I am very glad this bill is withdrawn. The endeavour to make Vaccination compulsory has been most mischievous. Vaccination was quietly making its way. People were adopting it more and more; but from the moment it was made compulsory, they began to think every evil which happened to their children afterwards ensued from it. I have no objection to refer the question to a Select Committee as suggested, but whatever their report, nothing will satisfy me that it is advisable to make Vaccination compulsory.
Mr. Duncombe agreed that the course proposed was judicious--
The question is delicate and difficult, and investigation should precede legislation. In 1853, at a later period of the session than that at which we have arrived, the Compulsory Vaccination Act was smuggled through the House. Fortunately it became inoperative through its own defects, which it is now proposed to remove, and to make the law more stringent; but while I believe that great good has resulted from Vaccination, I do not think we should try to encourage it by penal enactment.
Mr. Cowper, in protesting against surrender, observed--
Some argue as if people should never be forced to do what they do not like; but the force of this objection is greatly weakened when we recollect that in compelling Vaccination we are not obliging parents to do anything disadvantageous to themselves, but merely to take precautions against a loathsome and terrible disease.
The most intolerable tyrannies vindicate themselves by the advantages they enforce on their perverse subjects. The claim made for vaccination, that it protects the vaccinated from smallpox, deprived the vaccinated of any right to complain of risk of injury from the unvaccinated. Moreover, that those who were persuaded that vaccination neither prevented nor mitigated smallpox should be required to undergo an operation, that was to them a cruel and dangerous imposture, was surely a wrong of the most excruciating character. It was well that neither the bill of 1855 or 1856 was allowed to pass; but if either had passed, it might have brought the question of compulsion to an earlier issue.
FOOTNOTE:
[285] Memorial presented to the President of the Board of Health, by the President and Council of the Epidemiological Society, on a proper State Provision for the Prevention of Smallpox and the Extension of Vaccination. Ordered to be printed by the House of Commons, 1st March, 1855.
XXXIX. JOHN GIBBS’S LETTER--1855
As we have said, there was little living confidence in vaccination. Jenner’s undertaking, “that the person inoculated with cowpox is rendered perfectly secure from the infection of smallpox,” had been everywhere conspicuously belied. But latterly a new faith had come into existence as to the preventibility of disease and the possibility of its suppression; and, thus persuaded, the public were less disposed to be sceptical toward new or revived prophylactic impostures. Favoured by this disposition of the public mind, a clique of vaccinators, operating under cover of the Epidemiological Society, were able to obtain concessions from Parliament which, prior to the sanitary evangel, were unattainable. It was only when too audacious, they proposed to set up a Vaccination Office, endowed from the Exchequer, with inquisitorial and punitive functions, that they suffered check.
To resist doctrine it is necessary to possess doctrine. People might distrust or dislike vaccination, but they were at a great disadvantage against aggressors until prepared to justify their distrust and dislike in definite and scientific form, setting evidence against assertion, and veracious against factitious statistics. Unfortunately the mischief of coercive legislation was consummated ere opposition was organised. The first to frame a comprehensive indictment against vaccination was John Gibbs, an Irish gentleman. It took the form of a letter addressed to Sir Benjamin Hall, dated from Maze Hill Cottage, St. Leonards-on-Sea, 30th June, 1855. On the motion of Joseph Brotherton, M.P. for Salford, the letter was ordered to be printed by the House of Commons, 31st March, 1856.[286]
Mr. Gibbs opened his letter with drawing attention to the fact that whilst the Compulsory Act of 1853 was the first direct attack upon personal liberty in medical matters, there was “no subject upon which so many otherwise well-informed persons betrayed such ignorance and credulity as upon vaccination.” Indeed, upon nothing were the legislators who enacted compulsion so frank as in their confession of ignorance and submission to medical instruction. What was there to justify legislation on terms thus abject against their fellow-countrymen?--
Why is Vaccination held in abhorrence by so many? Have those who reject it no weighty reasons to justify their rejection? They do not believe that it affords an efficient and assured protection against the invasion of Smallpox; they have a natural disgust to the transfer of a loathsome virus from a diseased brute, through they know not how many unhealthy human mediums, to the veins of their children; they have a dread, a conviction, that other filthy diseases, tending to embitter and shorten life, are frequently transmitted through the vaccine virus; they cannot bring themselves to believe that the true way to health can be to corrupt the blood and lower the vital energies by the infusion of a poison and its consequent train of morbid influences; and further, they have a conscientious conviction that voluntarily to propagate disease is to set at naught the Divine Providence and violate the Divine Will.
Are such scruples and objections entitled to no respect? Should they be permitted to have no force? Are they capable of no justification? Should the sole answer to them be a Coercion Act? Such is not the best way to disarm hostility, and to ensure conviction. Who would put faith in the professions of a philanthropist who should threaten the objects of his beneficence with fine or imprisonment if they did not accept his proffered boon? Or who could receive with cordiality and respect the doctor of physic who should thunder at the door, armed with scab and lancet, threatening to assault the inmates if they did not accept his services? If Vaccination be indeed a blessing which must needs be showered upon the land, would it not be more becoming in a wise Government and a free people to trust to the dissemination of information rather than attempt to make unconverted converts by force?
Had smallpox been preventible by vaccination, such contention would have been useless. The virtue of the rite, manifest in its efficacy, would have secured its observance. The bitterness of compulsion lay in the attempt to enforce imposture, and to suppress the convictions of those whose perceptions were sharper, and whose loyalty to right was more determined than in the mass of the nation. Mr. Gibbs had no difficulty in adducing evidence in proof that vaccination did not prevent smallpox. The reports of the Registrar-General and the hospitals furnished testimony in such profusion, that his difficulty lay in the selection of examples likely to be most convincing. From the Lancet, of 21st May, 1853, he took the following confession--
In the public mind extensively, and to a more limited extent in the medical profession itself, doubts are known to exist as to the efficacy and eligibility of Vaccination. The failures of the operation have been numerous and discouraging.
Nor did the failure to prevent smallpox exhaust the condemnation of vaccination. Ineffective, it was far from harmless. Itself a disease, it was a conductor and excitant of other diseases, and, inoculated, occasionally bore with it other company. Erysipelas, as Jenner taught, was the note of successful vaccination; but erysipelas, not being a limitable affection, was frequently a mortal one; and deaths from erysipelas as a sequence of vaccination were of constant occurrence. Then there were skin eruptions, carbuncular and glandular swellings, tuberculosis, scrofula, syphilis, etc., either provoked or inseminated with the vaccine disease. Such results were so distinctly recognised that, in the Lancet, of the 11th November, 1854, it was stated--
So widely extended is the dread that along with the prophylaxy something else may be inoculated, that few medical practitioners would care to vaccinate their own children from a source of the purity of which they are not well assured.
But the care vaccinators exercised over their own offspring was impracticable for the multitude. Again, citing the Lancet, 23rd October, 1854, it was said--
The poor are told that they must carry their children to be vaccinated by medical men who may be strangers to them. They apprehend--and the apprehension is not altogether unfounded, or unshared by the educated classes, that the vaccine matter employed may carry with it the seeds of other diseases not less loathsome than the one it is intended to prevent.
Useless against smallpox, and injurious in itself, it remained to test the influence of vaccination on the health of the community--
What is the per centage of deaths from all epidemics among the Vaccinated as compared with the Unvaccinated? What is the per centage respectively of cases of disease of the respiratory organs, of skin diseases, of scrofula, and of convulsions? What is the average duration of life among the Vaccinated and among the Unvaccinated? Of a thousand children vaccinated within a given time after birth, and of a thousand unvaccinated, the whole two thousand being placed as nearly as possible in like circumstances, what per centage in each thousand attain the age of puberty?
These are statistics with which the advocates of Vaccination have never grappled. Is it not, then, rather premature to decide that Vaccination is an unmixed good, a boon which we ought not only gratefully to accept, but which we should even combine to force upon the acceptance of others?
If it should appear that before a given age the rate of mortality from all causes be the same among a thousand vaccinated and a thousand unvaccinated children, of what avail is Vaccination? Of what import is it, as a public question, in what shape death claims his allotted number of victims, whether by Smallpox, Scarlet Fever, or Hooping Cough? If, however, the rate of mortality should prove to be greater among the Vaccinated than among the Unvaccinated, how shall we avoid the conclusion that Vaccination is a curse and not a blessing?
The interdependence of the forms of zymotic disease, so luminously displayed by Dr. Watt in the statistics of Glasgow, was apparently a conception in excess of the capacity of the average medical mind. It was the custom of vaccinators to treat smallpox as a solitary existence, any diminution of which was ascribed to the observance of their rite, and any increase to its neglect, although the observance of the rite was neither less in the waxing, nor more in the waning of the disease. With many illustrations from medical literature, Mr. Gibbs enforced the lesson that diseases were not irregular and detached disasters, but varied manifestations of a common disorder: that when one form prevailed, other forms abated or disappeared; that health, and the defect of health, were referable to habits and conditions of life; and that the consequent rate of mortality was unaffected whether smallpox happened to be one of its factors--indeed, in numerous instances, a reduced rate of mortality signalised the prevalence of smallpox. In short, to suppose that the creation and culture of an ailment like vaccination could by any means tend to the invigoration of life was to reverse the canon--that health always and everywhere was the best defence of health.
Among the supporters of his thesis, none had greater weight than Dr. George Gregory. Adducing “the experience which twenty years of official connection with the Smallpox and Vaccination Hospital had given him,” he asserted--
The great principle that there are no diseases strictly isolated from others. They are links in a chain--
“All are but parts of one stupendous whole.”
They must be viewed in conjunction, if we would hope to form just, enlarged, and legitimate views of the character and pathological affinities of each.
Long surmised, but never proved, until the statistical inquiries of recent times showed its correctness, Dr. Gregory continues--
We may, for want of a better name, call this curious doctrine the Law of Vicarious Mortality; by which is understood that whenever one epidemic diminishes, another increases, so that the sum total of epidemic mortality remains, on an average of years, nearly the same.
EPIDEMIC MORTALITY IN ENGLAND AND WALES DURING 1838, 1839, AND 1840.
+------------------------------+----------+----------+----------+ | |Year 1838.|Year 1839.|Year 1840.| +------------------------------+----------+----------+----------+ |Smallpox | 16,268 | 9,131 | 10,434 | |Measles | 6,514 | 10,937 | 9,326 | |Scarlet Fever | 5,802 | 10,325 | 19,816 | | +----------+----------+----------| | Total Mortality by the | 28,584 | 30,393 | 39,576 | | Exanthemata, | | | | |Hooping Cough | 9,107 | 8,165 | 6,132 | | +----------+----------+----------+ | Total Epidemic Mortality | 37,691 | 38,558 | 45,708 | | +----------+----------+----------+ | Total Mortality throughout | | | | | Englandand Wales | 342,529 | 338,979 | 359,561 | +------------------------------+----------+----------+----------+
We learn from this table, that every year is distinguished by some master epidemic. In 1838, Smallpox was the ruling epidemic throughout England. In 1839, Measles and Scarlet Fever struggled for the mastery. In 1840, Scarlet Fever was so general and so fatal, that the mortality by it exceeded by one-fifth the ravages of Smallpox during the epidemic season of 1838, and more than doubled the mortality by that disease in 1839....
Everything teaches us that when one avenue to death is closed another opens--
“Noctes atque dies patet atri janua Ditis.”
Vaccination, great as its merits are [What are they?--J. G.], and no one more fully appreciates them than I do, does not, and cannot do, all that its too sanguine admirers promised. The blessings of Vaccination are met and balanced by the Law of Vicarious Mortality. How and why is this? The explanation is easy. The weak plants of a nursery must be weeded out. If weakly children do not fall victims to Smallpox, they live to fall into the jaws of tyrants scarcely less inexorable. Scarlet Fever and Measles are both advancing in respect of mortality; and the increase of deaths by Hooping Cough since this century set in [that is, since the introduction of Vaccination.--J. G.] is quite extraordinary.[287]
The concession of so much was the concession of all. If smallpox was merely displaced to be replaced, and the tale of death maintained by cognate diseases, what was there to claim for vaccination, even if it were allowed to have an influence adverse to smallpox? Where were the lives saved? and where the glory of the immortal Jenner?
The advocates of compulsory vaccination were accustomed to cite countries like Austria, where the practice was enforced, for English imitation. Let us then compare, said Mr. Gibbs, the death-rate of the chief centres of English population with the death-rate of the chief divisions of Austria, and note which had the advantage in the years 1850-51--
Death-rate per 1000.
England and Wales 22·0 London 23·3 Liverpool 29·0 Manchester 29·0 Birmingham 23·3 Leeds 24·6 Dublin 26·8 Cork 23·3 Lower Austria 35·7 Upper Austria 27·7 Styria 30·3 Bohemia 38·6 Moravia 30·9 Galicia 30·8 Lombardy 33·9 Venetia 33·3
These figures required no commentary. If vaccination had stopped smallpox in Austria, it evidently had not reduced mortality even to the level of the most insanitary English towns.
Assuming, said Mr. Gibbs, that vaccination is entitled to all the credit claimed for it, let us endeavour to estimate the gain, if it should be enforced. The yearly average of deaths from all causes, in England and Wales, is 370,000, of which about 7,000 are from smallpox--
This 7,000, then, is the limit of gain which enforced Vaccination could confer; but from the 7,000 should be deducted about one-third for deaths from Smallpox among the Vaccinated; and from the remainder should be deducted an equivalent for the deaths caused immediately and remotely by Vaccination; and another equivalent for the deaths resulting from the Law of Vicarious Mortality. This done, it would require no little ingenuity to discover a balance in favour of Vaccination.
Having thus argued the matter out, was not Mr. Gibbs justified in asking--
What would be thought of the tinker who would knock a hole in the bottom of his saucepan lest one should be burned there in the ordinary way?
Yet it is just what the vaccinator does; and when he finds--as he might have foreseen, had he been governed by common sense--that his saucepan does not wear a bit the better, but rather the worse, he gravely endeavours to excuse the failure, by asserting that unfortunately he made the hole too big, or too little, too much on this side, or too much on that, or by offering some other equally wise excuse.
Lastly, there were the political and moral considerations involved in compulsory vaccination--the first attempt in England to confer on a medical prescription the force of law--
Surely, a wise Government may perceive that there are greater evils than the occasional outbreak of an epidemic. The systematic violation of human rights and natural affections, the uprooting from the human breast of feelings of self-reliance, a state religion in physic, coercion which may well be regarded as odious persecution, the belief of the poor that what they hold dearest is sacrificed to the selfish prejudices of the rich--any one of these is far worse than a pestilence.
Cannot they who believe in Vaccination protect themselves? Nobody seeks to hinder them; nobody presumes to dispute their right to adopt any medical practice, however questionable it may be. Why cannot they act with like forbearance to others? Surely, if freedom be more than a name, it implies the right of the freeman to reject not only that which other men may choose to regard as evil, but even that which they may combine to urge upon him as good....
How absurd that an attempt should be made to visit with punishment the want of belief in a scientific, or rather unscientific, dogma! How absurd to pretend to the possession of a prophylactic of such unquestionable potency that its acceptance requires the threat of force! In their anxiety to coerce others, compulsory vaccinators demonstrate their own defect of faith in the prescription which they assert affords complete security from Smallpox.
As observed, the service of Mr. Gibbs is entitled to special commemoration, because it was the first attempt to put the arguments against vaccination into systematic shape. He demonstrated the quackery of the practice, and the fallacies wherewith it was defended; and denounced the tyranny of the legislation that would compel those who recognised the imposture to submit to it. The service thus rendered by Mr. Gibbs constituted a ground of vantage for further operations: those who had to contend against the delusion had their hands strengthened, and their power of assault magnified, by what he was favoured to accomplish.
* * * * *
JOHN GIBBS was born at Enniscorthy, County Wexford, on 25th May, 1811. Owing to the unsettled life of his father as Captain of the Royal Cork Volunteers, his education was desultory--at various schools, and under various masters. Sagacious, bright, earnest, and independent, he early manifested a passion for such things as made for human welfare, and improvement. Abstinence from alcohol, in connection with Father Mathew’s mission, had in him an enthusiastic advocate. A book by Captain Claridge on the water cure excited his interest, and led to the formation of the Enniscorthy Hydropathic Society. Anxious to master the mysteries of this new treatment of disease, he set out for Silesia in 1843, and placed himself under the instruction of Priessnitz, remaining with him as a chosen disciple until 1847, when he left with a certificate of competency.
Whilst acquiring his art with Priessnitz, he communicated his experiences to his Enniscorthy friends, who published them in the Wexford newspapers, a selection from which was reproduced as Letters from Grœfenberg, in 1847. A passage in one of these letters, dated 27th November, 1844, indicates the manner in which his attention was drawn to smallpox--
Another case of Smallpox has just been treated by Priessnitz. The patient is the daughter of a peasant in the neighbourhood, and is about twenty years old. She was confined for eight days, and was most profusely covered with the eruption. An Italian physician said that he never saw the symptoms come out better. She had at first the usual treatment--wet sheets, wet rubbings, and tepid baths; and, after the eruption appeared, three wet sheets and three tepid baths daily. She will not have the slightest mark. Under the water cure Smallpox appears to be deprived of half its terrors; as far as my observation extends, it neither robs man of life, nor women of beauty.
On his return, he assisted Dr. Lovell in opening a hydropathic establishment at Barking, Essex; and, in 1848, he undertook the medical superintendence of the Grande Chartreuse in Piedmont. There he met Miss Anna Skelton, to whom he was married, at Nice, in 1849. Ultimately he made his home at St. Leonards, Sussex. The passage of the Compulsory Vaccination Act, in 1853, led him to publish a pamphlet, Our Medical Liberties, 1854, which excited the attention and won the approval of many thoughtful people. At the suggestion of Mr. Thomas Baker, he constructed a letter from the substance of the pamphlet, and addressed it to the President of the Board of Health, which, as we have seen, was issued as a parliamentary paper. The more vehement controversy which sprang up in recent years when the Vaccination Act was tightened, found Mr. Gibbs in health too feeble for active exertion. After his wife’s death, he retired to Jersey to be near his sister, Mrs. General Lane, in whose house he died in the winter of 1875.
FOOTNOTES:
[286] COMPULSORY VACCINATION.--Copy of a Letter, dated 30th June, 1855, addressed to the President of the Board of Health by JOHN GIBBS, Esquire, entitled, Compulsory Vaccination briefly considered in its Scientific, Religious, and Political Aspects. Ordered by the House of Commons to be printed, 31st March, 1856.--Folio, pp. 31.
[287] Eruptive Fevers, pp. 5-8. London, 1843.
XL. SIMON’S DEFENCE AND HAMERNIK’S JUDGMENT
An attack on Vaccination like that delivered by John Gibbs had to be met, and Mr. John Simon, Medical Officer to the Board of Health, was selected for the purpose. The answer appeared in 1857 in a quarto blue-book entitled Papers relating to the History and Practice of Vaccination,[288] 83 pages consisting of a defence of Vaccination, and 188 pages of illustrative and corroborative documents. Oddly enough the treatise of Mr. Gibb is never once mentioned, whilst the order of defence is obviously marshalled in front of his positions. The reason for this reserve was double: first, it was considered unadvisable to magnify or advertise so dangerous an antagonist; and second, it is considered unprofessional to discuss a medical question with one who is not in medical orders.
In reviewing Mr. Simon’s defence we are constantly reminded of Mill’s observation, that a doctrine is never truly judged until it is judged in its best form; and of Coleridge’s caution, that an adversary’s bad arguments are no evidence of the goodness of our own. It lay in the nature of things that many absurd and trumpery objections should be advanced against vaccination, but to cite and sneer at them was neither to appreciate nor to refute the objections that were valid. Had Simon been less scornful and less loftily disposed, condescending to deal with his antagonist verbatim, he might have proved no more successful, but he would have had at least the praise of judicial intention.
After the custom of the eulogists of vaccination, Mr. Simon opened with a chapter on “Smallpox before the Discovery of Vaccination,” consisting of terrible tales of the ravages of the disease among Mexicans, Indians, Greenlanders, Icelanders, Siberians, Hottentots, etc., as if disbelievers in vaccination were under any obligation to dispute them. It is not denied that smallpox may be a deadly epidemic: the contention is that vaccination would not abate its deadliness. At the same time, when terrible tales are told of the devastations of smallpox, it is but fair to press for proofs of their authenticity. Travellers and historians occasionally prefer the excitement of wonder to adherence to matter-of-fact. When, for instance, Mr. Simon gravely relates that “in Mexico 3½ millions were suddenly smitten down, leaving none to bury them,” it is permissible to inquire who was responsible for the Mexican census in the days of Cortez, and who counted the unburied dead? Further, it is idle to attach importance to isolated statements about smallpox, as if smallpox were an independent destroyer of mankind. It is a member of a group of destroyers, and its activity is usually coincident with a correspondent dormancy among its associates. Until the complete vital statistics of a community are in evidence, it is vain to assert whom smallpox present has slain, or absent has saved. It is the prevalence of death, and not the mode of death, that is the critical question.
Again, when the familiar list of great folk who died of smallpox in Europe in the 17th and 18th centuries is run over, the remark occurs, that considering the habits and habitations of the said great folk, their fate was in nowise surprising. Those who believe that smallpox is generated in unwholesome conditions of life are not to be confounded by facts that illustrate their contention. And the like is to be said of the equally familiar tale of London smallpox. It was to be expected that citizens housed and fed as Londoners were housed and fed should have been plagued with smallpox and its congeners. What is denied is that vaccination could have saved them from smallpox, or reduced their death-rate, their conditions of life remaining the same.
The extravagant exhibition of the horrors of smallpox is the customary preliminary to the presentation of Jenner as the saviour from them; and the part of showman in this respect was fulfilled with more than ordinary abandon by Simon, who thus depicted the situation and the rescue--
Medicine baffled and helpless! For millions of our race in after times the continued raging of that pitiless plague! A drearier picture could scarcely have saddened mankind.
That this despair was not lasting is due to the genius of an English surgeon; and the close of the 18th Century, which had much to darken it, will be remembered till the end of human history for the greatest physical good ever yet given by science to the world.
Then followed the Jennerian legend, related in highly fabulous form with sundry extensions from Simon’s private fancy. It is sufficient to reassert that Jenner did not introduce cowpox. On the contrary, he rejected cowpox for horsegrease cowpox; and such was his prescription because he knew from the evidence of his neighbourhood that cowpox afforded no protection from smallpox. It is true that when Pearson discredited horsegrease cowpox, and recommended cowpox, Jenner dropped his prescription, and put himself forward as the discoverer of cowpox; but it is also true that in subsequent years he resumed his original position, and indeed dispensed with the cow altogether, and, like Sacco of Milan and De Carro of Vienna, used and diffused horsegrease or horsepox neat, describing the equine virus as “the true and genuine life-preserving fluid.” Of all this, however, Simon was either ignorant, or preferred to say nothing. He, too, dropped cowpox as a disease of the cow. Referring to a conjecture by Jenner that cowpox was “smallpox in a milder form,” he maintained that the conjecture had been verified by Gassner in 1801; by Thiele in 1836; by Ceely in 1839; and commercially by Badcock of Brighton in 1840. Again and again Badcock derived fresh stocks of vaccine virus from cows artificially infected with smallpox; having vaccinated with such virus more than 14,000 persons, and having furnished supplies of it to more than 400 medical practitioners--
It has been made matter of almost familiar experiment that the infection of Smallpox may, by inoculation, be communicated from Man to Cow; that its result is an eruption of vesicles presenting the physical characters of Cowpox; that the lymph from these vesicles, if implanted in the skin of the human subject, produces the ordinary local phenomena of Vaccination; that the person so vaccinated diffuses no atmospheric infection; that the lymph generated by him may be transferred, with reproductive powers, to other unprotected persons; and that, on the conclusion of this artificial disorder, neither renewed Vaccination, nor inoculation with Smallpox, nor the closest contact and cohabitation with smallpox patients, will occasion him to betray any remnant of susceptibility to infection. (P. xiv.)
Thus were the discredited claims of Jenner revived and reasserted for a new variety of virus--for smallpox inoculated on the cow! Even revaccination was pronounced impossible, and logically; for revaccination implies susceptibility to infection. It was idle, however, to shelter this new development under Jenner’s authority. When Jenner said that cowpox was smallpox in milder form, he meant in process the reverse of Simon’s interpretation. He meant that smallpox came to man from the horse through the cow; and not that the cow contracted smallpox from man. Showing his nephew a horse with greasy heels, he said, “There is the source of smallpox.”[289] When the stock of cowpox for vaccination ran low, Jenner feared it might be difficult to enlarge the supply. Why? Because farmers exercised such precaution, since they learnt that cowpox was derived from horsegrease, that the disease among cows had become well nigh extinct. Possibly Jenner was mistaken: possibly cowpox originated in smallpox: but what Simon described as “settled” in 1857 exists to this day in vehement dispute. Simon’s prescription was practically a fresh discovery--a new departure in vaccination. It recalls the practice of the variolators who took virus for timid patients from healthy subjects inoculated with mild smallpox; the supposition being that the virulence of the mild pox was meliorated in them, they playing the part that Ceely and Badcock assigned to the cow. Thus when Dimsdale variolated the Empress Catharine, it was with smallpox mitigated in the person of a strong young man. Had Dimsdale substituted a cow for a man, he would not only have anticipated Jenner, but the later revelation and practice of Ceely and Badcock--“the greatest physical good ever given by science to the world.”
Simon next went on to describe “Smallpox since the Use of Vaccination,” concerning which these observations may suffice--
1st--Smallpox was abating over Europe prior to the introduction of vaccination, notwithstanding the stimulation of the disease by variolation.
2nd--The discredit cast upon variolation by vaccination threw smallpox out of culture, and to that extent abated smallpox.
3rd--It was absurd to ascribe the decline of smallpox to vaccination in countries where only a part of the people were vaccinated; and usually, as in England, a part least liable to smallpox.
These considerations, sufficiently developed in preceding chapters, nullify the conclusion, supported by elaborate statistical tables, that vaccination was the cause of the decline in smallpox. The asserted cause was incommensurate with the effect.
Another remark remains, namely, that all vaccination was taken by Simon for effective vaccination, except where smallpox followed, and then suspicion was thrown on the virus or the time and mode of its administration. But under his own definition of virus, namely, smallpox inoculated on the cow, the greater part, if not the whole, of the vaccinations accomplished were with virus altogether diverse--with cowpox that owed nothing to smallpox, with equine cowpox, with horsepox, and much else known only to omniscience. Yet it was to these heterogeneous inoculations, modified inscrutably in transit from patient to patient, that the subsidence of smallpox was attributed! In a word, whatever was anywhere or by anybody called vaccination, served, according to Simon, to exterminate smallpox. Where shall we find an epithet for such crass assurance, with neither science or common-sense to lend it the gloss of probability!
The succeeding chapter, “Alleged Drawbacks from the Advantages of Vaccination, and alleged Dangers of its Practice,” was as abusive as unfair. It is admitted that much nonsense has been written against vaccination, and, if the pot may call the kettle black, much more nonsense has been circulated in its favour. Vaccination was recommended for the improvement of health and the complexion, for the cure of skin diseases, for the Plague, for whooping-cough, for rot in sheep, and for distemper in dogs--Jenner himself vaccinating the King’s staghounds. But to what purpose such recrimination? The prime charge against vaccination is, that it is a disease which neither averts or mitigates smallpox; and the second is, that it frequently excites and sometimes conveys other diseases.
Simon waxed eloquent on the absurdity of referring the origin of certain scrofulous affections to vaccination, whilst describing such affections as notorious sequences of smallpox; but where was the absurdity if vaccination was (as he held) a mild form of smallpox?--the mild disease serving equally as a ferment or excitant of evil humours. In his furious contempt he forgot his science and logic, and implicitly conceded all for which rational adversaries of vaccination contended.
In the same reckless vein he asked, “Is properly performed vaccination an absolutely inoffensive proceeding?” and answered--
Not at all, nor does it pretend to be so. The very meaning of the thing is, that it shall artificially and designedly produce a transient and trifling indisposition; that for some days the infant shall be uncomfortable with a sore arm and a slight irritation of the adjacent axillary glands, and a perceptible amount of general feverishness. (P. lx.)
Here we agree, and here disagree--agree as to the disease, disagree as to the determination of its limits. First, the virus is in quality indefinite; and second, the recipient of the virus is a complex of qualities indefinite; so that, as Dr. Mead observed, when smallpox was used for inoculation, “it is more material into what kind of body it be infused, than out of what it is taken.” As pathologists freely allow, it is impossible to predicate the transformations of organic poisons in the animal frame. A vigorous infant may throw off the virus, designated vaccine, and suffer no apparent harm, but the same virus may operate very differently in contact with debility and disease; so that, in the words of James, we have to say, “Behold how great a matter a little fire kindleth!” The conditions of vaccination are essentially those of hazard; the issues are those of a game of chance; the result at the best being a risk for naught.
Simon, too, was positive as to the impossibility of the invaccination of syphilis--a fact no longer in question, save as to the degree of frequency. And here, also, in his recklessness he forgot consistency, saying--
When a child is born with the heritage of syphilis (a very frequent incident, if its parents have been suffering from that infection) the characteristic symptoms do not appear till some weeks after birth; and then the scandal discloses itself. (P. lxvi.)
Just so; and before disclosure the child is vaccinated, and serving as vaccinifer, the latent syphilis is inoculated and diffused.
Vaccination, according to Simon, was easy--“The mere manual trick is learnt from a minute’s teaching and an hour’s practice.” Difficulty begins in the selection of proper subjects for the rite, for which none are qualified, save the healthy; and for the recognition of health a trained eye is wanted--
If sickly children are vaccinated, children breeding other disorders, children having skin disease, children teething and the like, the results must be at least unsatisfactory, and possibly dangerous. (P. lxii.)
If such children are exempted from vaccination, how can vaccination ever approach universality? And when universal vaccination is effected, as it is frequently effected, how can it fail to be attended with “results, at least unsatisfactory, and possibly dangerous”?
More difficult than the selection of subjects is the selection of virus for the rite; and the manifold dangers and the requisite precautions were thus specified--
Especially as regards the quality of vaccine lymph, the careless or uneducated vaccinator is using a dangerous weapon. It is only during part of the course of a vaccine vesicle that its lymph is suitable for further vaccinations: for after a given moment, at which the contents of the vesicle possess their maximum of simple contagiousness, they tend more and more toward the quality of common inflammatory products; and matter now taken from the vesicle is no longer the simple agent of a specific infection, but has less efficiency for its real purpose, and is specially able to produce other undesired results.
A danger of somewhat similar kind is that of taking lymph from vesicles which already have been accidentally ruptured, or where from any other cause, local or constitutional, their specific fluid is likely to have been modified by common irritative processes.
The danger of taking matter from irritated vesicles, and from vesicles at too advanced a period of their course, is one which circumstances render frequent; and there is reason to believe that, in at least a very large proportion of those cases where abnormal effects have resulted from so-called vaccination, it has been the employment of this ambiguous irritative matter which has occasioned the mischief and scandal.
Still more critical changes occur in lymph when removed from the body, unless appropriate means be taken to preserve it; for, under the influence of air and moisture, it tends, like other dead organic matter, to putrid decomposition; and inoculation with it, when thus changing, can hardly be more useful or less dangerous than a casual scratch inflicted in the dissecting room. (P. lxii.)
No one who considers this limitation of vaccination to the healthy, and these prescriptions as to the collection and exhibition of “lymph,” can fail to see that the charges of injury and death brought against the common practice were allowed and accounted for--were, indeed, the unavoidable associates of that practice. Vaccination, as described by Simon, was an ideal operation--impracticable on any ordinary terms. His contention and his approbation were reserved for “properly-performed vaccination” on a healthy child, with innocuous virus, the proof of each condition being discovered in the result. If unsatisfactory or injurious, or deadly, then the vaccination could not have been “properly performed”--either the child was unhealthy, or the virus was at fault.
Nor can we wonder that the people, having experience of the uselessness and misery of the virulent practice should, undismayed by the terror of smallpox, decline its observance; nor that those who made gain thereby should, distrusting their power to prevail by reason, invoke legislation to enforce the imposture, calling in the policeman to support the doctor, as of old the soldier supported the priest.
Still further to sustain his case, Simon addressed the following Circular of Questions to upwards of 500 medical men--
I.--Have you any doubt that successful Vaccination confers on persons subject to its influence a very large exemption from attacks of Smallpox, and almost absolute security against death by that disease?
II.--Have you any reason to believe or suspect that vaccinated persons, in being rendered less susceptible of Smallpox, become more susceptible of any other infective disease, or of phthisis; or that their health is in any other way disadvantageously affected?
III.--Have you any reason to believe or suspect that lymph, from a true Jennerian vesicle, has ever been a vehicle of syphilitic, scrofulous, or other constitutional infection to the vaccinated person; or that unintentional inoculation with some other disease, instead of the proposed Vaccination, has occurred in the hands of a duly educated medical practitioner?
IV.--Do you (assuming due provisions to exist for a skilful performance of the operation) recommend that, except for special reasons in individual cases, Vaccination should be universally performed at early periods of life?
Whilst these questions were framed to draw the answers required, yet, however modified, the tenor of the returns would have been much the same. We might confidently predict uniform replies, if a circular were addressed to 500 clergymen soliciting their judgment as to the disendowment of the Church, to 500 Nonconformist divines as to the benefit of hearing sermons, to 500 military men as to the expediency of an imminent war, to 500 naval officers as to an enlargement of the navy, or to 500 publicans as to the justice of local option. Nor is there sense in attributing value to testimony to be had on demand by the yard. It is brought forth as of course, and to expect otherwise is to expect what is contrary to nature.
It will be said, “Do you really mean that medical men defend vaccination because it pays?” In no other sense, I reply, than as clergymen or publicans defend their vested interests. Medical men among themselves make no secret of their pecuniary interest in vaccination, as any one may see who reads their journals; and Simon’s advocacy culminated in a demand for more liberal pay, as the only guarantee for “properly-performed vaccination.”
We may view the matter in another light. Suppose a circular had been addressed to 500 medical men fifty years ago, as to the utility of bleeding, or blistering, or salivation, would not the tenor of the answers have been equally uniform with Simon’s in favour of vaccination? Where are these practices now? But suppose any one of them had obtained legislative sanction and endowment, can we doubt that it would have survived to this day, certified as salutary and harmless by the gross of the medical profession? Let us clear our minds of cant. The assumption that men’s convictions (I except the moral aristocracy) are not controlled by their selfish interests (often enough the reverse of their true ones) is cant.
Among those interrogated was Dr. Joseph Hamernik of Prague, whose developed answers form a paper which, by reason of the independence, acumen and philosophy displayed, constitutes the distinction of Simon’s collection of documents.
First, Hamernik inquired whether cowpox and smallpox had any relation to each other, deciding that they were diverse and independent diseases. Vaccinated persons may be attacked with smallpox during the development of the cowpox vesicle, or a few days after the drying-up of the same. When inoculation is made with a mixture of cowpox and smallpox, there ensue a vaccine vesicle on the site of the puncture and a variolous eruption over the body. In fact, it is not uncommon to find cowpox and smallpox flourishing simultaneously on the same individual. Under some conditions, the one disease appears to stifle the other. Thus a powerful epidemic of smallpox will prevent the development of cowpox, illustrating the Hippocratic aphorism, Duobus doloribus simul obortis--vehementior obscurat alterum, exactly as happens when other diseases simultaneously invade the human organism. Again, in well-marked epidemics, cowpox does not protect from smallpox, even after repeated vaccinations. Under stress of such experience, the confidence in such vaccination was much shaken in England during the epidemics of 1825 and 1838. Vaccination was likewise found useless in the epidemics of Paris in 1825 and Marseilles in 1828. “Nor can revaccination achieve what vaccination cannot,” said Dr. Brown of Musselburgh. The revaccinated die of smallpox like other people, as is proved by the official returns of the armies of Wurtemburg and Prussia--
Revaccinations among civilians in Bohemia are extremely rare, and hence I am unable to cite many cases. I only saw two persons who had been revaccinated die at the Prague Hospital--a Russian officer in the guards, and a physician from Bremen.
There is no validity in the statement that epidemics of Smallpox are arrested and made milder by rapid Vaccination and Revaccination; unless medical men could test the accuracy of their verdict, as lawyers do, by a new trial. Until they can do so, we must admit that there are cases and epidemics of Smallpox light and severe. It was so before Vaccination was heard of, and is likely so to continue longer than Vaccination will endure.
Second, turning to the examination of the characters of smallpox before and after vaccination, he observed--
If Vaccination really possessed the properties ascribed to it, a change must long ere this have taken place in the character of Smallpox, both of the sporadic and epidemic kind. Smallpox has been minutely described by pathologists before Vaccination was introduced, and in such a manner that one would think they had seen the disease in the wards of our hospitals. Indeed the best pathologists of our time, who have paid special attention to Smallpox, agree that they could add nothing to the descriptions of Rhazes (who died at Bagdad A.D. 930), of Sydenham, 1675, of Richard Mead, 1754, and of John Huxham, 1764. Mead admits a light and severe Smallpox, and Huxham observed such slight epidemics that no fever appeared in the whole course of the disease. At present, pathologists would hardly class such cases with Variola Vera; they would, perhaps, call them Variola Modificata; or let them figure in their tables as Varioloid and proofs of the good results of Vaccination.
It may be that in former centuries Smallpox assumed more frequently the malignant or hæmorrhagic type; but this circumstance can in nowise be explained by the intervention of Vaccination. Even as many individuals of the animal and vegetable kingdoms have disappeared, so also have great changes taken place in the number and severity of diseases. When scurvy, putrid fevers, dysentery, etc., were commoner, Smallpox was likely to be more malignant: so much was due to the prevalent poverty and scarcity throughout Europe. Pauperism, want and hunger, are always characterised by a proportionate frequency, gravity and diffusion of various diseases.
Then, too, much of the mortality of smallpox in former times was attributable to maltreatment; and Hamernik illustrated what was possible under good treatment, by adducing his own experience when the smallpox wards in Prague were under his care. “The recoveries were, very speedy, and the deaths less than five per cent.”
Third, he held that the doctrine of Jenner was opposed to recognised pathological principles. Observation has taught us that two severe diseases cannot affect an individual at the same time. Thus typhus cannot go on with scarlet fever or smallpox, nor tuberculous with cancerous disease. The rule, however, only holds good with diseases that affect the whole organism. It does not apply to trifling or local affections, to which latter category cowpox belongs. The best marked diseases pursue their course contemporaneously with cowpox; and the scars of the punctures through which it has been inoculated have no more influence in averting smallpox than any similar scars resulting from analogous cutaneous lesion--
I consider it as a general pathological law that morbid actions which have entirely run their course can have absolutely no influence whatever upon the subsequent pathological reactions of the individual. Hence it is possible to suffer repeatedly from smallpox, scarlet fever, typhus, pneumonia, tubercular disease, etc. Nay, Smallpox has been observed five different times upon the same patient. Keeping these incontestable facts in view, it becomes a matter of indifference what was Jenner’s doctrine relative to Cowpox, whether identical with Smallpox, or whether antagonistic to Smallpox or anything else. Nor can Variolation be advocated, if we pay attention to the same pathological law. A variolous attack, when once passed away, has no more influence, as regards future events, than any other disease. The reason why many escape Smallpox altogether, why some have it twice, why the inoculation of the disease has sometimes no effect, or why some can inhale its effluvia with impunity, is entirely concealed from us. As Cowpox is a disease foreign to man, it is particularly for graziers that further investigations can be interesting.
In answer to the Second Question, whether vaccinated persons, being less susceptible to smallpox, become more susceptible of any other infective disease, or of phthisis, Hamernik answered that the interrogation implied what, for reasons given, he disputed, namely, that the vaccinated were less liable to smallpox--
The assumption is perfectly gratuitous. Epidemics of Smallpox occur at widely varying periods, with different degrees of intensity, prevalence, and duration. The Vaccinated and the Unvaccinated suffer in every epidemic; and the influence of Vaccination cannot be determined from the character and progress of the disease in individual cases.
I am aware that the beneficial influence of Vaccination is inferred from the registers of public vaccinators; but I freely confess I consider these books as perfectly valueless; and I may add that the most intelligent of the gentlemen who keep them fully concur in my opinion. In this country we know full well how vaccinators are situated; and that little confidence can be placed in them is generally acknowledged.
To the Third Question, whether syphilitic, scrofulous, and other constitutional affections are communicable in vaccination, Hamernik answered with regret in the affirmative. It was true that the contrary opinion was written at large. Taupin testified that he had taken virus from children suffering from typhus, scarlet fever, measles, smallpox, itch, inflammation of the brain, the lungs and the intestines; from chorea, epilepsy, scrofula, tuberculosis, and ring-worm, and no harm had resulted to the vaccinated; and Launauzy agrees with Taupin, that it is mere prejudice and groundless to suppose that cowpox taken, from unhealthy children can inflict any hurt--
On this head, it will be sufficient for me to remark that to arrive at a knowledge of the amount of mischief such doctrine has brought upon mankind, it would be necessary to learn how much the promulgators gained by their unlimited favour for Vaccination.
Professor Waller, of Prague, has proved that syphilis may be inoculated by means of a patient’s blood; and as blood is often drawn with the virus of vaccination, no doubt can exist as to the possibility of doing in this manner a vast amount of mischief. Monteggio taught at Milan in 1814, that when a syphilitic child is vaccinated, the result is a vesicle containing both kinds of virus; and Carioli expressed the same opinion in 1821. Marcolini relates that, on 16th June, 1814, ten children were vaccinated from a syphilitic infant, who died at the end of a few months, and five of the ten children syphilised from her.
In answer to the Fourth Question, whether vaccination should be universally performed at early periods of life? Hamernik replied, that he obviously could not recommend a practice which put health, and even life itself, in jeopardy for no certain advantage. Any efficient examination of virus was impracticable. Vaccinators may set to work with zeal and care, but their energy soon cools, and they settle into perfunctory routine. Government should assume a passive attitude toward vaccination; or if people will be vaccinated, something might be done to minimise the danger. If the practice is assigned to salaried functionaries, they are sure to create evidence to justify and perpetuate their official existence. Left to common option--
Vaccinations would every year become fewer, until at last we should read with astonishment in old newspapers how much attention was once paid to the practice.
Whilst the majority of Simon’s correspondents conjured up arguments for vaccination, their facts, apart from their rhetoric, conveyed much that was instructive. For instance, a register was produced of the deaths in Christ’s Hospital, London, for the century, 1751-1850. The boys in that charity boarding-school numbered about 550; and in twenty-five years, 1751-75, there died of smallpox 22, and in twenty-five years, 1776-1800, there died 9. In the fifty succeeding years, 1801-50, there died 1, and he in 1820. Thereon we are asked to recognise the efficacy of vaccination! But what reduced the mortality from 22 in 1751-75 to 9 in 1776-1800? And if 550 boys in the centre of London, in the flux of constant coming and going, escaped with so few fatalities from smallpox, what comes of the asserted omnipresence and havoc of the disease in London before the introduction of vaccination? Across the street from Christ’s Hospital stands Newgate, which, during the same years, was haunted with jail fever; which fever was gradually suppressed, and by what charm? Certainly by no rite analogous to vaccination. Why, then, should we be required to admit an agency in the reduction of smallpox which played no part in the reduction of a cognate disease? In times when smallpox was frequent in Christ’s Hospital, about as little regard was paid to stench and ventilation as in the prison over the way. In later years a more wholesome atmosphere prevailed, and concurrently the diet of the scholars was altered and improved--changes in themselves as sufficient to account for the disappearance of smallpox from the school as for typhus from the jail.
The like indifference to variations of circumstance vitiated throughout the generalisations of Simon and his correspondents. Assuming that the conditions of life and the characters of disease remained unaltered, smallpox was treated as uninfluenced by aught but vaccination. It needs no words to condemn such procedure as radically unsound; and men, otherwise sane, only persist in it as they persist in similar hallucinations. Even the matter of vaccination they left undefined, or differently defined. Whatever was called vaccination was taken for vaccination, and the reduction of smallpox ascribed to it. In Jenner’s hands it was first horsegrease cowpox, then cowpox, and lastly horsepox. According to Simon true vaccination was effected with smallpox inoculated on the cow. Which, we demand, was the virus that wrought the numerous miracles we are summoned to believe? Is it indeed true that there is nothing certain about vaccination save the vaccinator’s fee? Is it that, as in other thaumaturgical performances, virtue resides in the performer, described by Simon as “the duly educated medical practitioner?” Is it argued that vaccination is a species of incantation, and that it matters little what is the vehicle of the rite, its efficacy being dependent on the credentials of the administrator? Or that what is believed to be good against smallpox is good against smallpox, the charm consisting in the faith wherewith it is received?
The belief in vaccination and its proofs is much akin to the belief in witchcraft and its proofs. To argue about witchcraft, and to answer its proofs, was to become a sort of partner in the delusion. Deliverance lay in the unqualified denial of the imposture; and from that firm ground difficulty was solved and the inexplicable disappeared. As soon as the position of absolute disbelief is taken up, the plausibilities in favour of vaccination resolve themselves into the element of phantasy, so powerful and yet so evanescent. The arts of its advocates then become manifest with all the dodges, conscious and unconscious, whereby the light of truth is shut out, and the gloom requisite for visions provided. The story of vaccination is the story of many other impostures which have bewildered and afflicted mankind, and the study of one is the revelation of others.
FOOTNOTES:
[288] Papers relating to the History and Practice of Vaccination. Addressed to the President of the General Board of Health, and presented to both Houses of Parliament by command of Her Majesty. London, 1857. Pp. lxxxiii. and 188.
[289] Baron’s Life of Jenner, vol. i., p. 135.
XLI. COMPULSION INTENSIFIED--1861 AND 1867
The Vaccination Act of 1853 imposed a forfeit not exceeding 20s. on any parent or guardian who failed to have a child vaccinated within three months of birth; but experience revealed a grave defect in the law. There was no provision for the prosecution of defaulters; and those who had no faith in vaccination, or accounted it a nuisance, enjoyed immunity without serious annoyance. To meet this defect a bill was introduced to Parliament in 1861, providing that “the guardians or overseers of any parish may appoint some person to institute and conduct proceedings for enforcing obedience.” The bill was passed through the House of Commons under the care of Mr. Robert Lowe, meeting with little resistance, and with less in the Lords. In vindicating the measure, 10th July, 1861, Mr. Lowe observed--
Parliament in 1853 passed an Act for Compulsory Vaccination, but owing to a defect in the provision of expenses for prosecution, it has fallen into desuetude. When the present Government was formed in 1859, a clause was introduced to the Public Health Act correcting the defect; but under pressure of the Member for Finsbury [Mr. Thomas Duncombe] I surrendered it. It has been to me a bitter reflection that I did so; for I am convinced that the sacrifice of that clause has occasioned the loss of thousands of lives in this country.
The question is sometimes asked, Why is it that association with horses is so prejudicial to morality? This interrogation might be accompanied with another, namely, Why is it that the advocacy of vaccination is so frequently associated with romance and rant? That public vaccination had fallen into desuetude was untrue. There were fluctuations from year to year, but the rate was maintained without practical abatement. That in 1861 it could be said that thousands of lives had been lost because prosecuting officers were not provided in 1859, was romance and rant without mitigation. In England and Wales there died of smallpox--
In 1858 6460 1859 3848 1860 2749 1861 1320 1862 1628 1863 5964 1864 7684 1865 6411
Where then were the thousands of lives lost from the formation of the Government in 1859 to 1861? and where were the lives saved after the enactment of the vital clause? But who that knew Mr. Robert Lowe could believe that he was convinced that the surrender of the clause occasioned the loss of thousands of lives, and that the loss was to him a bitter reflection? Would not the vulgar version of the invocation, O mihi beate Martine! have been appropriate to the situation?
Further, continued Mr. Lowe--
From 1837 to 1840 the deaths from Smallpox amounted to 12,000 a-year. From 1840 to 1863, during which period Vaccination was provided by the Poor Law Boards, the annual average of deaths was only 5,200. Thus by the diffusion of Vaccination, the mortality of Smallpox was reduced by more than one-half. Then in 1853 the Compulsory Law came into operation, and its first effect was remarkable. The number of vaccinations enormously increased and the deaths diminished. In 1854 they sank to 2,808, and in 1855 to 2,525. Afterwards they gradually increased up to the present time [When in fact they never were lower!], the Act having, as I already explained, fallen into desuetude. Thus is the efficiency of Vaccination established!
Into such stuff may a clever man descend! The statement was rotten with untruth. It was gross misrepresentation to set forth the average mortality of 12,000 for the years 1837-40 as permanent mortality which the Act of 1840 reduced to 5,200. The years 1837-40 embraced a severe epidemic, following years of quiescence during which vaccinators had been singing pæans over their imaginary victory. Holding as we do that smallpox comes and goes with indifference to vaccination (unless in so far as it keeps the disease alive) the figures cited by Mr. Lowe as completely illustrate our contention as they nullified his. By no contrivance can the fluctuations of smallpox be associated with more or less vaccination.
Probably Mr. Lowe was inspired by his medical staff, but, if so, he made the inspiration his own, evolving as from personal certainty, such fancy-work as this--
Out of 1000 who take Smallpox without being vaccinated 350 die; while out of 1000 badly vaccinated only 150 die; but out of 1000 well vaccinated only 5 die.
To which the conclusive answer would have been, that a mortality of 7 in 20 of the unvaccinated was about double that of smallpox in the time when all were unvaccinated; and that disregarding the factitious classification, the mortality over all cases continued as it was in the pre-vaccination era. What smallpox was, smallpox has remained--discrete, confluent, malignant; each type being qualified as slight, dangerous, and deadly; the relation of vaccination to the type being wholly irrelevant.
Further, he proclaimed without reserve, that smallpox was transmuted to cowpox in the cow--
There was a theory started that the efficacy of Vaccination was wearing out; but the valuable discovery of Mr. Ceely has set any apprehension on that score at rest for ever. Mr. Ceely has proved that Smallpox, when taken from the human body and introduced to that of the cow, produces Cowpox. It is thus evident that we have the means of obtaining Cowpox of the requisite strength to any extent. The beautiful discovery has also been made that the security of Vaccination may be almost indefinitely increased by multiplying the number of punctures.
Thus was mystery dispelled! Cowpox was smallpox diversified in the cow, and the lost security of Jenner’s single puncture was recovered in tattoo!
Appealing to the sentiment of medical men in favour of vaccination as exhibited in the replies to Simon’s queries in 1857--a fallacy for conviction which Mr. Lowe would have been quick to detect if advanced for any clerical, scholastic, or other trading interest, he observed--
The terrible malady falls heavily upon young children: in Vaccination is their defence. Consider, then, what a painful responsibility will rest upon us, if, in the face of almost unanimous medical testimony, we leave them to perish, and communicate a dreadful contagion throughout the country. These children have no discretion of their own; and it is a profanation of liberty and self-government to say that any man has a right to set up his own sordid and brutal prejudices against such medical opinion, and expose his child to disease and death.
Words, ferocious words; but how do they bear examination? Why should disbelief in vaccination be stigmatised as sordid and brutal prejudice? Why should parliamentary affection for children surpass parental affection? The argument, if valid, would equally apply to any matter in which the conviction of a minority was at variance with that of a majority; and if in such circumstances the minority is bound to submission, where is the substance answering to civil and religious liberty? If the clear scientific persuasion of the smallest minority concerning such a matter as vaccination is to be subjected to vulgar medical dictation by the brute force of the majority, what form of tyranny may not be justified?
The Bill [continued Mr. Lowe] which I wish to pass into law is very simple. All that it enacts is that Poor Law Boards may appoint persons to prosecute those whom the medical officers report ought to be prosecuted.
And the bill was passed without division. Mr. Duncombe and Mr. Coningham protested, but neither had mastered the question so as to offer effective opposition. Mr. Coningham observed that figures might be made to prove anything; and as concerned the unanimous opinion of medical men, they had to bear in mind the saying, “There is nothing like leather.” If smallpox had fallen off, there were extensive sanitary improvements to account for the fall; and, for his part, he placed his trust much more in better conditions of life for the people than in a prescription like vaccination.
The Act obtained did not fulfil the expectations of its promoters. Mr. Lowe’s bitter regret for thousands of lives lost in consequence of his concession to Mr. Duncombe proved to be wasted emotion. Guardians did not exercise their powers as inquisitors and persecutors with adequate energy. Sir Morton Peto, in the House of Commons, on 14th March, 1864, asked--
Whether the registration of Vaccination is not a total failure, alike for statistical purposes and for the prosecution of offenders under the Compulsory Act; and whether it is the intention of the Government to amend the law this session.
To which Mr. Lowe made answer--
It is quite true that the system of registration under the Act is very bad, but it would cost a great deal of money to improve it. Moreover, even when improved, it would not make the measures for compulsion effectual to any extent. The great difficulty of working compulsion is not so much due to defective legislation as to the reluctance to prosecute poor people for disobedience to the law, the neglect of which is countenanced by too many who ought to know better. I am sorry, therefore, I cannot hold out any hope of improving the system.
The medical officers of the Poor Law Board were, however, intent upon coercive legislation; and Mr. H. A. Bruce, more pliant than Mr. Lowe, introduced a bill of their contriving in 1866, which he assured the House of Commons “involved no new principle, and merely consolidated provisions dispersed over six Acts of Parliament, with a few amendments.” On going into committee on the bill, 11th April, 1866, he delivered an elaborate defence of vaccination, prepared for him by the astute promoters of the measure, starting in this fashion--
At the close of last century Dr. Jenner achieved his immortal discovery by which, perhaps, more misery has been prevented through the alleviation of pain and the preservation of life than by any other discovery that has ever been made.
Spoken from whatever elevation, nothing divides talk like this from that of a quack at a country fair. Having struck the note, Mr. Bruce ran through the familiar gamut of assertion wherewith the rite of vaccination is supposed to be justified. The following is a sample of the advocacy imposed upon him--
A statement has been widely circulated that Syphilis has been communicated by Vaccination. Millions of children have been vaccinated in the last sixty years, but not a single case has occurred in which it has been proved that Syphilis has been communicated. A case is alleged to have occurred in France in which a child had been vaccinated from another which inherited Syphilis, but the surgeon in that case, in taking lymph from a child covered with syphilitic blotches, acted in monstrous disregard of common prudence and medical knowledge. No such case, so far as the most careful medical research can discover, has happened in this country.
Whilst this statement would now incur general discredit, yet even in 1866 the official prompters of Mr. Bruce presumed over much on public credulity. It was not probable that what vaccinators did not wish they would discover; or, if discovered, proclaim. Nevertheless, the denunciation of the “alleged” French instance was entirely inconsistent with the contention that syphilis could not be communicated from a syphilitic vaccinifer, blotched or unblotched. So much it was imperative to maintain, for it was obvious that the complete vaccination of any population must involve infants with latent syphilis whose virus might transfer the disease to the untainted. This peril, opponents of vaccination, from Cobbett onwards, had recognised; and as its recognition was prejudicial to vaccination, its possibility was stoutly outsworn until manifold and indisputable evidence compelled its admission, and shifted the question to the extent of its frequency.
Mr. Henley, following Mr. Bruce, spoke some homely sense--
We all know that when we want anything of the kind done, the medical man entertains us with a fine cock-and-bull story about waiting until he can get lymph from a healthy child. This caution implies risk; and though it is said that not a single case of injury has occurred in sixty years, yet nobody will persuade me that medical men take all these pains (where they are well paid and watched) if there are not grounds for the exercise of care. Undoubtedly it was an abomination to take vaccine from a diseased child, but how is a public vaccinator to know that any child is diseased? If he inquires too particularly, he will run the risk of a slapped face from the mother for his trouble.
Mr. Henley also drew attention to the claims made for vaccination, coupled with the admission that the greater part of it was good for little--
One remarkable statement has been made--that there has been an examination of 500,000 children belonging to the humbler classes chiefly affected by Compulsory Vaccination. Of the number so examined only one in eight was found to have been perfectly vaccinated, which fact involves the further fact that seven out of the eight were imperfectly vaccinated, or not vaccinated at all. If only one in eight has been perfectly vaccinated, great doubt will come upon many people’s minds as to the matter with which the others have been inoculated.
Much in the bill was crude and impracticable, and Mr. Ayrton expressed the sense of many in the House when he observed--
The bill before us is badly drawn, and bears too much the marks of its official origin. Great powers have been taken for the vaccinating department, but nothing is provided for the protection of the public. It seems to me that if Vaccination is to be enforced by penalties, public vaccinators should be subject to penalties for inefficient and injudicious work. I have been entrusted with a great many petitions against the bill, and I have been much impressed with the admission that the existing system of Vaccination has entirely failed in effecting its object. The bill will have to be referred to a Committee, and as many believe that Vaccination does as much harm as good, I trust the members will not be fettered in their inquiries.
It is needless to say the asserted failure of vaccination was an artifice to induce Parliament to pass the bill. The public vaccinations for 1863, 1864, and 1865, were as numerous as ever, and accompanied with a marked increase of smallpox. No doubt vaccination was a failure, but in a different sense from that in which the word was used to acquire increase of power and pay for the application of the rite. The bill was referred to a select committee, who reported; but the Conservatives having displaced the Liberals, it was withdrawn. Mr. Corry, in announcing the fact to the House of Commons, 23rd July, 1866, said--
I have ascertained that the measure is likely to meet with great opposition on both sides of the House; and it is, therefore, very doubtful whether it could be carried at this late period of the session. Moreover, some of its provisions require further and careful consideration.
The bill was framed and promoted by the Poor Law Board, independently of Liberals and Conservatives, the problem of the medical officials being, “How far is it possible to obtain the assent of Parliament to what we consider desirable.” There were limits to parliamentary complaisance, however wide, and, informed by the experience of 1866, a revised bill was introduced to the House of Commons by Lord Robert Montagu in 1867, who, like his predecessors, reproduced the instructions of his advisers with sufficient flavour to pass them off as his own. A portion of his business was to obtain recognition for the payment of extra fees for successful vaccination--
When an Inspector reports that certain Vaccinations are of the 1st class, the Public Vaccinator will receive 1s. over and above the sum paid by the Guardians for each Vaccination he has performed. If the Vaccinations are reported of the 2nd class, he will receive 8d. For 3rd class Vaccinations nothing in excess of the Guardians’ contract fee will be paid.
This graduation of vaccination excited no comment though why aught save first-class should have been accounted tolerable, or paid for, was far from obvious. The possible amount chargeable for these awards was thus estimated--
The ratio of children born to the population is about 3½ per cent., which gives 700,000 a year for the population of 20 millions. Reckoning that four-fifths of these children, or 560,000, are vaccinated gratuitously during the year, the expenditure will be £28,000 if all the Vaccinations are 1st class, and £18,500 if 2nd class. Shall we, then, think it too much if, for a sum between £18,500 and £28,000 we ensure that there shall never occur a case of smallpox, and that we save 7,000 lives a year?
Such was the argument put into the mouth of Lord Robert Montagu for the persuasion of Parliament! Only pay an extra price for first and second class vaccination, and not a case of smallpox shall occur in England, and 7,000 lives a year shall be saved! When we inquire where the 7,000 lives a year were lost, we discover how boldly the credulity of Parliament was imposed upon. There died of smallpox in England and Wales--
In 1861 1,320 1862 1,628 1863 5,964 1864 7,684 1865 6,411 1866 2,977
Where, then, were the 7,000 lives to save? In 1864 the mortality exceeded 7,000; but to select an extreme year and represent it as ordinary would have incurred a sharp epithet if practised in finance instead of smallpox.
A similar fable of salvation from smallpox was related by Lord Robert Montagu concerning Scotland. He said--
It is wiser to save people’s lives than to consult their prejudices. The example of Scotland shows the value of a thorough-going Vaccination Act. The measure for that country has reduced the smallpox death-rate from 2,000 to 120 per annum.
The Act to extend and make Vaccination compulsory in Scotland was passed in 1863--an Act little else than superfluous, for the people were vaccinated without it. There died of smallpox in Scotland--
In 1859 682 1860 1,495 1861 766 1862 426 ----- 3,369
In 1863 1,648 1864 1,741 1865 383 1866 200 ----- 3,972
The average of these eight years was 907 deaths annually; and one inquires with some amaze, Where were the 2,000 which compulsory vaccination reduced to 120? It is difficult to repress some indignation over such measureless misrepresentation; nor to point out that we are not dealing with theologians, who are often assumed to hold a license for prevarication, but with medical officials with M.P.’s for spokesmen. The following years, of which Lord Robert Montagu, speaking in 1867, was necessarily ignorant, gave these deaths from smallpox in Scotland--
In 1867 100 1868 15 1869 64 1870 114 1871 1,442 1872 2,488
Smallpox was proclaimed “stamped-out” of Scotland in 1870, but the epidemic of 1871-72 proved how vain was the boast. Smallpox, in common with typhus, may be exterminated, but by no such irrelevance as vaccination.
One object of the bill was the reconstruction of vaccination districts, so as to secure sufficient numbers for arm-to-arm practice.
It is necessary [said Lord R. Montagu] to successful Vaccination that the two classes of patients, those who have been vaccinated eight days before should meet those who are to be vaccinated, so that the doctor may take vaccine from the arms of one set and transfer it to those of the other.
Mr. Henley, in opposition, maintained that careful vaccination on such terms was impracticable, saying--
It seems a large proportion of the Vaccination provided by the public is imperfect; but the bill before us is wholly inadequate to secure Vaccination that is trustworthy. If a vaccinator never sees a child until it is brought to him, and knows nothing of its parentage, how can he judge whether it is fit to be vaccinated, or fit to serve for the vaccination of others? No torture will induce a mother to confess before company that anything ails her baby. Every one who knows anything of women is aware that they will conceal in public what they may reveal in the privacy of home. The shame of making known her own infirmities, or those of her family, will keep a woman silent in a crowd, and if she does reply to awkward questions, it will be to mislead. Medical men will consequently be perplexed and outwitted; and, therefore, on the terms prescribed a safe and efficient system of Vaccination cannot be secured.
Further, said Mr. Henley, the bill was defective because no attempt was made to conciliate the prejudices or consult the convenience of the people who were compelled to have their children vaccinated.
The bill is one of pure coercion, making no allowance for those who are brought under its scope. It must not be forgotten that the poor mother is not able to do much within the month after her confinement. The period of three months specified within which Vaccination must be effected will press very severely upon the lower orders. We are told that no district of less than 5,000 inhabitants will work successfully, and that 10,000 is a better number. If country districts are to comprise 5,000, how many miles will poor folk have to travel to reach a vaccination station? Consider the inconvenience it will be to a woman to drag her child two or three miles for vaccination, and be obliged to go a second time for inspection! The medical authorities insist that four punctures at least ought to be made on the unfortunate children. Not only are those four wounds to be inflicted, but the children are to be brought in all weathers to have their wounds opened and matter extracted for the benefit of others, thus prolonging their sufferings and the cares of their mothers. If we are to act upon the principle of doing as we should be done by, I would ask how you would like to be compelled to carry your children to a vaccination station and have them mixed up with all and sundry, and inoculated at a hazard with you know not what? For myself I see no difficulty in having the children of the poor vaccinated at their own homes. It would be far better to pay more and work discriminately than let the people think there is one law for the rich and another for the poor. If you simply try to drive you will find the people apt to kick, and still more ready to evade the restrictions you put upon them.
Mr. Kendall confirmed Mr. Henley, saying--
As Chairman of a large Union, I have seen great inconvenience from the crowding of children at vaccination stations. They are taken to those stations whether wet or dry, and cold and shivering are kept huddled together in a manner most likely to breed illness and diffuse infection.
Mr. Lowe sneered at Mr. Henley’s concern for the poor, reminding him that the wounds he deplored would save them from a loathsome disease. Mr. Henley did not dispute the salvation, as he might have done, but pleaded for its more considerate performance. Spite, too, of his assumption, there is one law for the rich and another for the poor. Compulsory vaccination as applied to the majority would never be tolerated by the upper and middle class minority; nor would a plutocratic Parliament have entertained so profane a project. Nor (it must be said) would working men show themselves much more enduring in their own persons. The victims of the law are their wives and children; and it is surprising how much indignity and cruelty they will endure in these helpless dependents. Mr. Henley was more chivalrous for them than they are for themselves.
An argument for fresh legislation was the failure of the Act of 1853. Mr. Brady said--
As a medical man I can testify that medical men are almost unanimous in favour of Compulsory Vaccination; but in order to give the public the full benefit of the system it must be fairly paid for. We shall be penny wise and pound foolish unless the persons employed to carry out this measure are liberally remunerated. When the bill of 1853 was before the House, I said the remuneration was inadequate, and that the Act would be a failure, and that prediction has proved true.
That the Act of 1853 was a failure, in the sense of not securing the vaccination of the people, was untrue--though necessarily true as concerned the prevention of smallpox. The assertion of failure in 1867 was an artifice to overcome the apathy of Parliament. It was assumed that there was a population to be vaccinated, and vaccinated in a new and superior fashion, if only better pay were provided. More money was wanted to work the Vaccination Mill. In the words of Lord Robert Montagu--
On the birth of a child being registered, the Registrar is bound to give notice to the parent, and to supply him with proper forms, whether for public or private Vaccination. He will enter in a book the name of the child, with the means of identification. After Vaccination, the Public Vaccinator will send the certificate of successful Vaccination to the Registrar, who will enter it in his book. Thus the Registrar will know which children have been registered in his district and which have not; which children are liable to Smallpox and which are not liable. [O Credulitas!] Then it is made the interest of all concerned to work the system and enforce its checks. It is the interest of every Local Registrar to hunt up every birth, because for every entry he has 1s. It is his interest to obtain the certificate of successful Vaccination, for entering which he has 3d. It is the interest of the Public Vaccinator to operate on as many children as possible, because for each successful operation he has at least 1s. 6d., and for first class work an extra 1s. It is the interest of the parent to have his child vaccinated, for he is otherwise subject to legal proceedings and a penalty of 20s.
Colonel Barttelot objected, saying--
There are about 750,000 births annually in this country, and the parents of the majority surely deserve some consideration. 250,000 of them can neither read or write, yet they are liable to a fine of 20s. if they do not comply with the printed forms of this Act. It would be much better to send doctors to the homes of the children than collect mothers and infants in crowds at vaccination stations.
Mr. Bruce replied that it was proposed to do nothing new--
Compulsory Vaccination on the same terms has been the law of the land since 1853. The present bill lays down no new principle. It merely collects the scattered provisions of the law, and supplies machinery found necessary after much experience.
The observation was, no doubt, ingenuous on the part of the speaker; but, misled himself, he assisted to mislead the House. The bill, Section 31, ran as follows--
If any Registrar, or any Officer appointed by the Guardians to enforce the provisions of this Act, shall give information in writing to a Justice of the Peace, that he has reason to believe that any child under the age of 14 years, being within the Union or Parish for which the informant acts, has not been successfully vaccinated, and that he has given notice to the parent or person having the custody of such child to procure its being vaccinated, and that this notice has been disregarded, the Justice may summon such parent or person to appear with the child before him at a certain time and place, and upon the appearance, if the Justice shall find, after such examination as he shall deem necessary, that the child has not been vaccinated, nor has already had the Smallpox, he may, if he see fit, make an order under his hand and seal directing such child to be vaccinated within a certain time; and if, at the expiration of such time, the child shall not have been so vaccinated, or shall not be shown to be then unfit to be vaccinated, or to be insusceptible of Vaccination, the person upon whom such an order shall have been made shall be proceeded against summarily, and, unless he can show some reasonable ground for his omission to carry the order into effect, shall be liable to a penalty not exceeding 20s.
Yet, said Mr. Bruce, it was proposed to do nothing new! Here was a development of compulsion subjecting a parent to prosecution during fourteen years of the life of his child, and it was nothing new! What resulted from this aggravation of the law, devised with craft and enacted with indifference, remains to be seen.
The bill was opposed by Sir J. Clarke Jervoise, Mr. Thomas Chambers, and Mr. Barrow. Mr. Chambers prophesied--
I am persuaded that when the bill is passed an agitation will commence which will never cease until the Act is repealed.
The carelessness and indifference of the House were, however, insuperable. It was legislation for “the lower orders,” and concerned “respectable folk” not at all. The bill was read a third time without opposition, slipped through the Lords unopposed, and received the Royal assent, 12th August, 1867, as 30 and 31 VICTORIÆ, Cap. 84--An Act to consolidate and amend the Laws relating to Vaccination.
As another example of the advocacy with which this bill was commended to the House of Commons, I take the following from the close of the speech of Lord Robert Montagu, when introducing it to committee, 14th June, 1867. He said--
Smallpox differs from other epidemics in this, that it is one of the worst, but is absolutely preventible. In other diseases all that can be done by the removal of predisposing conditions is to mitigate their virulence; but Smallpox may be altogether prevented. If, then, one who raises his hand against another and kills him is guilty of murder, of what shall he be guilty who, by voice or vote in this House, endeavours to prevent the passing of a measure which will make it absolutely certain that Smallpox shall no longer kill 7,000 a-year in this country!
This absurd adjuration was too much for Mr. Henley, who observed--
The somewhat formidable close of the noble Lord’s speech made it difficult to know whether I ought not to walk out of the House and leave the responsibility of the measure to others. He said those who objected to the bill would be guilty of the deaths of those who died of Smallpox.
Lord ROBERT MONTAGU--I said that Smallpox was so far preventible that those who stopped the adoption of Vaccination would be guilty of the deaths of 7,000 children a-year.
Mr. HENLEY--I understood the noble Lord to say that they would incur that guilt if they objected to the machinery of the bill.
Lord ROBERT MONTAGU--No; not to its machinery.
Mr. HENLEY--Then I do not know precisely what the noble Lord does mean.
In short, the bill was neither honestly advocated or seriously considered. On the one hand, members of Parliament were prejudiced, ignorant and credulous, and careless as to legislation that did not affect their families or those of their influential constituents. On the other hand there was a knot of medical officials eager for power and the aggrandisement of their profession, who did not disdain to practise upon the prejudice, the ignorance, and the credulity of Parliament. The result was an insufferable outrage upon the rights of every nonconformist--an outrage which, if perpetrated on the theological instead of the scientific conscience, would have roused Englishmen to fever heat.
XLII. THE GATHERING MOVEMENT--1867-70
Section 31 of the Act of 1867 implied the doom of Vaccination. It was bad enough to fine a parent for refusing to vaccinate his child; it was, however, a circumscribed annoyance; but to make of refusal a continuous offence until a child attained the age of fourteen was to set up a cause of quarrel that had to be fought out. Slavery in the United States is abolished, but slavery might have endured to this day had the Southerners been more forbearing; but, in the arrogance of their power, they imposed on the Union the Fugitive Slave Law, compelling the people of the North to surrender runaway negroes. This triumph of the slaveholders determined the fate of slavery. In like manner the arrogance of the vaccinators overcame their prudence. Resolved to subdue resistance to their rite, they drove resistance to extremity, and set up an irreducible insurrection. As a medical prescription accepted at discretion, vaccination might have survived unquestioned and paid for; but its transition into an aggressive statute removed it from the safe realm of professional mystery into the jurisdiction of common sense, common observation, and every man’s business.
Sec. 31, Act ’67, was quickly turned to account by the medical officials who had devised and imposed it upon the indifference of Parliament. They had, of course, to operate through local poor-law authorities--a painful necessity; but guardians were occasionally as fanatical as themselves, and exasperated, too, that their petty authority should be set at naught, and especially by parents in humble life. Consequently, here and there over the country continued prosecutions for refusing to vaccinate were initiated, stirring up strife, begetting sympathy with the prosecuted, and gradually converting vaccination into a living political question. Whatever may be thought of Sec. 31, Act ’67, all will allow that it drew a line and established irritation and conflict. Opposition to vaccination had hitherto to contend with nothing so deadly as apathy, but from that drawback it was now delivered. On the other hand, in many parishes, Sec. 31, Act ’67 was allowed to make no difference. Those who disliked vaccination were warned, or prosecuted once, and then let alone; but this leniency served to accentuate the severity practised elsewhere, and to render the law still more odious by reason of the flagrant inequality of its administration.
The scientific opposition to vaccination, initiated by Mr. John Gibbs in 1855, had for some years few accessions, and it required faith in truth in full measure to persist in its advocacy. The Jennerian tradition was so rooted in the public mind that to question it savoured of paradox or profanity. There were occasional manifestations of scepticism when smallpox attacked the vaccinated, but doubt was crushed down as impious and dangerous to established confidence. Mr. Herbert Spencer, for example, in Social Statics, published in 1851, observed--
The measures enjoined by the Vaccination Act of 1840 were to have exterminated Smallpox; yet the reports of the Registrar-General show that deaths from Smallpox have been increasing.
To such matter-of-fact criticism, any answer must have taken form in the style of the bewildered divine, who exclaimed, “Dear brethren, what theology can we enjoy if such objections be entertained!”
Dr. Charles T. Pearce was one of the first to unite with Mr. Gibbs in his labours. As editor of a medical journal, he happened to receive an article from Mr. Gibbs which set him thinking, and as the result of his inquiries, he came out an enthusiastic anti-vaccinator. He made the question of vaccination completely his own, and lectured on the subject throughout the country, eager and ready for combat. In Northampton, in 1860, he held his first public debate, and under his influence the town became a centre of resistance to the compulsory law, so that Mr. Charles Gilpin, M.P. for the borough, addressing his constituents in 1870, thus expressed himself--
I have always thought that when we try to enforce one of the ever-changing opinions of medical men, we touch upon the liberty of the subject and the rights of human nature. I find that a number of parents are fined because they are convinced that Vaccination is useless and injurious. I ask, What is the character of those parents? Are they idle? Are they dissolute? Are they drunken? Are they careless of the welfare of their children? The answer is emphatically, No! They are thoughtful, they are industrious, they are sober. They are men who look into the reasons of things, and who decline to be driven into any course of conduct which they do not rationally approve. When I was in business in the City of London I had my goods seized almost every year for Church rates. I objected to the law, and with a free heart and a firm voice, I said I will endure the penalty. I would not obey a law which I knew to be wrong. Therefore it is that I sympathise with those who are persuaded that Vaccination is wrong; and for their encouragement and consolation let me say, that as compulsory Church rates were abolished because of the stedfast testimony borne against them by Nonconformists, so will compulsion as applied to Vaccination, if resistance is consistently and seriously maintained. As the Society of Friends has demonstrated, no law can survive under the persistent protest of conscience.
Tenacity was the distinction of Dr. Pearce. Undismayed by whatever odds, he maintained his position with deliberation and patience, and by neither historical, statistical, or physiological data was it possible to circumvent him. When he entered into the controversy in 1856, fool and fanatic was the summary designation of whoever ventured to dispute the salvation wrought by vaccination; but, living until 1883, he witnessed such epithets received with amusement as denoting the ill-humour and impotence of those who employed them.
An energetic advocate of the good cause appeared in Dr. W. J. Collins, who, after twenty years of service in London as public vaccinator, felt compelled to renounce the practice as useless and injurious. He stated his conviction frankly and forcibly before the St. Pancras Sanitary Committee in 1863,[290] and in an essay, vigorous with mother-wit, published in 1867,[291] he communicated much useful and unpleasant information to the credulous and deceived public. To contend with a judgment thus instructed and qualified was useless; and those who were affected by the exposure took care to avoid it. Nor considering the danger to the craft from discussion, was the policy injudicious. Truth has many adversaries, but none so hard to overcome as the non-resistant silence of timorous self-interest.
A leader and organiser of the opposition was wanted, and he appeared in Richard Butler Gibbs, cousin of John Gibbs, who, as we have seen, framed the first systematic indictment of vaccination in 1855. Mr. Gibbs, of Irish parentage, was born in London in 1822, and in the course of a commercial career became agent at Pease’s West Collieries for Joseph Pease of Darlington, the first Quaker M.P. It was in 1863, when a member of the Bishop Auckland board of guardians, that he first moved publicly against vaccination, and then less against the practice itself than against its prescription by the authority at that time vested in the Privy Council. He cautioned his colleagues that they were likely to become (as they since have) the tools of a central medical clique. Subsequently finding himself comparatively free from business, he devoted himself to the cause with which his name has been identified. Gathering together the scattered elements of resistance, he formed in 1866 the Anti-Compulsory Vaccination League, and travelled over the country, lecturing and holding public meetings. The enactment of repeated penalties for non-vaccination, strenuously resisted by Mr. Gibbs, established “a raw,” and conferred on the League a grievance and purpose everywhere recognised as indisputable by the people. Sec. 31, Act ’67 was in a popular sense the making of the agitation against vaccination; and it has been maintained (in a sense fortunately) until even the withdrawal of the aggravation cannot save vaccination itself from ultimate rejection. What at the moment we like least, often in the end serves us best.
Mr. Henry Pitman of Manchester entered actively into the movement. He had observed the ill effects of vaccination upon one of his own children, and in connection with Mr. R. B. Gibbs organised public meetings in Manchester and other places. In 1869 he tried how far a penny journal would succeed, and started The Anti-Vaccinator which ran for eighteen weeks. As editor of The Co-operator, which he conducted for ten years, he gave prominence to vaccination news, and in 1870 adjoined Anti-Vaccinator to the title, which was continued until The Co-operative News was established in 1871, when he maintained the publication as The Anti-Vaccinator until the close of the year. In 1876 Mr. Pitman bore testimony to his convictions by going to the Knutsford House of Correction rather than pay the fine and costs imposed upon him for refusing to have his daughter, Violet, vaccinated, and in Prison Thoughts conveyed to others the lesson of his experience. Mr. Pitman has been remarkably successful in impressing public men with his opinions. Courteous and persistent, he has won consideration where rougher speech might not have prevailed.
Professor F. W. Newman was led to a knowledge of the dangers of vaccination by Mr. Henry Pitman; and those who have been observant of his career in later years know with what courage and consistency he has asserted his convictions. Having asked the Professor how he became concerned in the opposition to vaccination, he favoured me thus--
“The outline of my mental history in this direction is as follows. Circumstances had led me to respect Mr. Henry Pitman as a competent and truthful witness of fact. On a certain occasion he spoke publicly on the miserable state to which he had seen a poor lad, Ira Connell of Southport, reduced by vaccination. Ira’s parents, and his brothers and sisters, were all hale: his mother attested that previous to vaccination so was Ira. But after vaccination, Ira had never recovered its dreadful effects, three of his four limbs being crippled.
“Some years later, I myself saw Ira Connell at Southport. I think his age was then 25, but am not sure. He had only one leg sound, and hardly one arm. I will not undertake to describe his state exactly, but it was very pitiable. I am happy to add that in nine or ten years more he has gradually recovered, so as at least not to be visibly crippled.
“Previously I had refused to read anti-vaccination tracts, having too much already to read. I had never known or heard in my own circles of mischief from vaccination, and when some German ladies spoke of its ‘horrors’ I thought them absurd and fanatical; but now that Henry Pitman publicly attested a fact, this woke me up to the duty of further inquiry.
“I at once remembered that in my early youth or boyhood I had been staggered by reading in a medical journal that experience made it impossible to sustain Jenner’s doctrine that vaccination was a certain preventive of smallpox; but the writer nevertheless urged that it was valuable for making smallpox milder if it did follow. This struck me as an ugly shifting of the basis, and far from plausible. One school-and-college fellow of mine, after vaccination, had smallpox that marked him; but nothing further led me to pursue the argument.
“I now at once saw that compulsory vaccination was an infamy, since Parliament could not secure any one from Ira Connell’s fate: and I was indignant on learning that doctors pooh-poohed such miseries, as endured ‘for the general good,’ a theory which justifies any amount of tyranny under the influence of superstition; and I presently remembered that in Roman pestilences sacrifices were believed efficacious, and the arguments of the priests and senators were quite as good as those of our physicians.
“I find that in 1869 I had a sharp debate with a clever young student of Medicine, who poured out the doctrines of the Faculty, which he had been getting up. My respect for the whole Faculty has rapidly got less and less; it had long been declining. I need not obtrude on you the depth to which it has now sunk, excepting always a noble few, who are what Heretics were to the Mediæval Church.
“Next I saw that no Parliament or King has, or can have, any right (on medical theory) to stick a poisoned lancet into a healthy person; and that to fancy that Human Health can be improved by altering the natural blood of Health is an imbecile contemptible fancy. Moreover, that unless Vaccination is believed to remove the causes of smallpox, those causes would entail disease in other ways, and perhaps worse, by suppressing the natural eruption, which eruption alone is called ‘Smallpox.’ My mind was thus decided.
“I did not learn till some years later (what alone concerns Parliament) that the more active is smallpox, the less is the Total Mortality of any year; and conversely, the less active the smallpox, the greater is the Total Mortality. This is the only form of statistics worth attending to. All the rest is dust thrown in our eyes.
“Statistics not founded on a scientific principle are the commonest nidus of fallacy; but if any statistics are to be listened to, those of Total Mortality are the least open to suspicion. The primâ facie evidence is, that instead of Vaccination saving yearly 80,000 lives (Sir Lyon Playfair’s monstrous assertion) Vaccination does only harm; but that Smallpox saves every year many lives (some hundreds or thousands) by a natural eruption, under the morbid circumstances desirable.”
The Countess de Noailles contributed most efficient assistance toward opening the public mind and letting in light. In a communication her ladyship says--
“You ask me how it was that my name came to be connected with the present anti-vaccination movement.
“It was in this way. On my return to England in 1865, Mrs. Cowper-Temple, now Lady Mount Temple, asked me to visit the office of the Ladies’ Sanitary Association, which I had joined her in starting four years before. I had wished the Association to be called the Ladies’ Association for the Protection of the Health of the Children of the Poor; but that was thought too long a name, and was changed; and I mention it only to explain what my idea was in helping to form the Society. Well, on visiting the office of the Association, I saw among the sanitary tracts one with the title, When were you vaccinated? On reading the words, it struck me suddenly that vaccination was all wrong, but as I knew nothing whatever about it, and had heard naught but praise of the practice, I told the excellent secretary of the Association my misgivings on the subject, and she set to work to find out all that was known or thought on the question. Miss Griffiths soon learnt that three relatives--John, Richard, and George Gibbs--had for twenty years been writing and working against vaccination, besides Dr. Collins and others. Seeing that I was not alone in my conviction, I resolved to elicit more opinion on the subject by giving a prize for the best essay on the same, setting forth the supposed benefits, dangers, etc. Miss Griffiths went heart and soul into the question, and with the help of Dr. Druitt, I think, she had judges named and the prize of £100 offered. The judges were Mr. Marson, Dr. Richardson, and Dr. Francis Webb--all in favour of vaccination. The great length of the essay by Dr. Ballard gave it a claim for the prize, and the tremendous because unavoidable admissions as to the dreadful dangers of vaccination contained in this Prize Essay, have caused the doctors to try to suppress it--so at least I have heard.
“Miss Griffiths sent me in November, 1866, the Lancet, containing a horrible account of the poisoning of thirty-six children in Morbihan, Brittany, by public vaccination.
“My forebodings being thus so terribly confirmed, I tried to interest all the doctors who advised the Ladies’ Sanitary Association in the new difficulties in the way of this dreadful practice; but the only one who lent an ear to the sad tale was Dr. Garth Wilkinson, who began mildly, but afterwards waxed valiant in fight. May he and the little band which his genius has helped to bring into the field ‘soon put to flight the armies of the aliens.’
“In 1867 a letter from the Rev. W. Hume-Rothery against compulsory vaccination struck me, and he set to work at the question in the co-operative newspapers; and latterly in the Reporter, in which he has been ably helped by Mrs. Hume-Rothery, the daughter of the late Mr. Joseph Hume, M.P. The strength given to the bad law by Lord Robert Montagu’s Act in 1867 roused its enemies at the same time; and, feeling that my task was done, I left the contest to abler hands.
“I thus found that the Association I had inaugurated in order ‘to protect the health of poor children,’ was being made into an instrument to bind them through their mothers’ ignorance to the most wholesale plan for their degeneration, if not destruction, ever invented by the mind of man. It was in vain that I tried to get the ladies of the Sanitary Association to think over the matter. I was always met by the remark that it was a medical question and one which doctors alone could decide; and all I could obtain of them was to allow me to buy up the offending tract and to remain neutral in the question. When I left the Association a few years after, the tract was circulated again.
“The compulsory law seems to me well described in these words of Carlyle:--‘To decree injustice by a law--inspired prophets have long since seen, what every clear soul may still see, that of all Anarchies and Devil-worships there is none like this; that this is the “throne of iniquity” set up in the name of the Highest, the human apotheosis of Anarchy itself.’”
Dr. Ballard’s essay was of itself a notable achievement. Written in defence of vaccination, the difficulties, dangers and futility of the practice were so largely revealed, that any thoughtful reader was compelled to inquire, Where shall we find compensation for all this trouble, these risks, these sufferings? Dr. Ballard’s essay soon ran out of print, and the author was judiciously enlisted in the medical service of the Local Government Board.
In Dr. Garth Wilkinson the movement obtained the assistance not only of an able physician, but of one whom Emerson has described as “a philosophic critic, with a coequal vigour of understanding and imagination comparable only to Lord Bacon’s;” and “with a rhetoric like the armoury of the invincible knights of old.” Having asked Dr. Wilkinson how he came over to the side we identify with sound science and sound sense, he answered--
“The early History of my Opposition to Vaccination is, briefly, this--I had not considered Vaccination a question; but practised it when required. About 1865 the Countess de Noailles assailed my conscience on the subject, and her earnestness forced me to study it. She was backed by the late Mrs. Gibbs, then Miss Griffiths. Through Miss Griffiths I sent the following message to Madame de Noailles--‘Tell her Ladyship that the question is comparatively unimportant. Vaccination is an infinitesimal affair; its reform will come in with greater reforms.’ I also wrote to Madame that the only short way of getting rid of the Medical vested interest was by paying half a million or a million of money down to the Profession, and buying the slaves, the people, out, as the West Indian Blacks were bought out.
“After-studies extending over eighteen years have convinced me that I was wrong in my estimate of the smallness of the Vaccination question compared with other Evils. As forced upon every British Cradle, I see it as a Monster instead of a Poisonous Midge; a Devourer of Nations. As a Destroyer of the Honesty and Humanity of Medicine, which is through it a deeply-degraded Profession. As a Tyrant which is the Parent of a brood of Tyrants, and through Pasteur and his like a Universal Pollution Master. As a Ghoul which sits upon Parliament, and enforces Contamination by Law, and prepares the way for endless violations of personal liberty and sound sense at the bidding of cruel experts. Not denying other forms of Social Wickedness, I now, after careful study, regard Vaccination as one of the greatest and deepest forms, abolishing the last hope and resort of races, the new-born soundness of the Human Body.”
The agitation against compulsory vaccination prospered under the leadership of Mr. Gibbs. He sought help on all sides, and harmonised its various elements to the common purpose of the League. In his various labours he derived efficient assistance from his brother, Mr. G. S. Gibbs of Darlington, who displayed remarkable ability in the interpretation of vital statistics and in the exposure of their misapplications. Mr. Gibbs established branches of the League wherever there were adversaries of the practice, and was especially successful in the north of England. The relentless application of Sec. 31, Act ’67, in certain parts of the country did much to rouse public attention and sympathy. Parents were repeatedly fined for persistent refusal to have children vaccinated, and in default of payment had their property seized, or were committed to prison, sometimes with hard labour. Occasionally sentences were accompanied with gross insolence from the bench. For example, Mr. Bowman having pleaded at Newcastle his conscientious conviction that vaccination might prove injurious to his child, whilst it could never save him from smallpox, was compared to a thief by the magistrate, who said, “I once knew a man who had conscientious scruples against working so long as he could live by stealing; and I do not think conscience of that sort is entitled to respect.” Law on such terms naturally invites execration, and many who might hold by vaccination are thereby turned against it.
By some it was thought questionable whether Sec. 31, Act ’67, did afford warrant for repeated prosecutions. Mr. John Candlish, M.P. for Sunderland, who sat on the Committee of 1866 which dealt with the Bill which became law in 1867, maintained “that it was not intended that penalties should be repeated, but that one penalty should be a discharge from any obligation to submit a child to vaccination.” It is needless to say, an Act of Parliament is not to be interpreted by the intentions of its framers, but by its words. Moreover, if intentions are brought into question, it would be fair to set intentions against intentions. Several who were concerned in promoting the Act of ’67 had intentions more arbitrary than were conveyed in Sec. 31.
The question, was raised by the Rev. H. J. Allen, Primitive Methodist. He had been repeatedly before the bench at St. Neots, and was committed to prison for fourteen days, but, having paid the fine, £5, was liberated. In less than a month, he was summoned again, and fined £1 for each of his children, including costs. An appeal was made to the Court of Queen’s Bench in 1870, and judgment confirmed the severer interpretation of Sec. 31, Act ’67. Lord Chief Justice Cockburn held that a parent having been fined under the Act for disobeying an order to have his child vaccinated, may be proceeded against from time to time as long as the child remains unvaccinated. He declined to discuss whether vaccination was good or bad; the Legislature had treated it as a matter of great importance, and had passed Acts to ensure attention to it; that being so, he could not doubt that the intention of the Legislature was not merely to impose a penalty upon a person, once and for all, for having omitted to do that which the public health and safety required; but to enforce obedience to the requisitions of the law. He thought, therefore, the order to vaccinate might be renewed, and the penalties might be repeated until the order was obeyed. Mr. Justice Mellor and Mr. Justice Hannen concurred. The judgment in this case, known as Allen v. Worthy, has been repeatedly questioned and always reaffirmed.
Immediately after Mr. Candlish introduced a Bill to the House of Commons to amend the law, repeating his conviction that the construction put upon the Act of ’67 was never intended by Parliament, and that it was by mere verbal accident that penalties were made continuous. The Bill was introduced too late in the session (6th July, 1870) to be carried, but it led to discussion and a promise from Government that the question would be remitted to a Committee next year, 1871.
FOOTNOTES:
[290] Twenty Years’ Experience of a Public Vaccinator. Read before the Sanitary Committee of St. Pancras, 9th June, 1863. Third edition. London, 1866.
[291] Have you been Vaccinated? and What Protection is Vaccination against Smallpox? By William J. Collins, M.D. Fourth edition. London, 1868.