Chapter IX: Inoculation Superseded and Suppressed

The illusory character of human testimony is graphically illustrated in the case of inoculation. Suppose an inquirer wished to ascertain the ratio of deaths to inoculations, he would be completely bewildered. We have seen what Dr. Buchan wrote--

In the natural way, one in four or five generally dies of
smallpox; but by inoculation not one of a thousand. Nay, some
can boast of having inoculated ten thousand without the loss of
a single patient.

John Birch, an eminent London surgeon, said--

Not one in three hundred dies of inoculation in the general
irregular mode of proceeding, and not one in a thousand among
observant practitioners; and if the inoculated patient die, he
dies of smallpox and of nothing but smallpox.[69]

In the _Edinburgh Review_, October, 1806, we read--

Of those who have smallpox naturally, one is found to die in
six. Of inoculated patients, only one dies in two hundred and
fifty. This at least is Dr. Willan’s calculation; and we are
persuaded that it is very near the truth. In London, where it
ought to be best ascertained, some eminent practitioners have
stated the proportion to be so high as one in the hundred. The
zealous anti-vaccinists have denied it to be greater, under
judicious treatment, than one in a thousand. It cannot be denied,
however, that besides the risk to life, the disease, even under
the mitigated form, has frequently proved an exciting cause
of scrofula and other dreadful distempers, and has often been
attended with blindness and deformity.

In Reynolds’s _System of Medicine_, it is stated by Marson that--

The Smallpox and Inoculation Hospital was founded in London in
1746, and inoculation was continued there until 1822. Dr. Gregory
went carefully over the records of the Hospital for that period
of seventy-six years, and found that only three in a thousand
died of inoculation. The inoculated disease was usually very
mild, but not invariably so.

Scores of such testimonies might be adduced, twitching the reader from conclusion to conclusion; and in the conflict of authorities what is to be said? It is true that if we select what evidence we like, and call it sound, and reject what we dislike, and call it unsound, we may prove anything; but it is also true, that if we are to be fettered by evidence we shall stand paralysed amid contradictions. When men who are competent, and obviously honest, deliver varying testimony, we are driven to seek some method of reconciliation; and in this matter of Inoculation wherein our resort is to books, and about which we can have no immediate experience, we may derive much light from the corresponding practice of Vaccination. Thus, what is commoner than for vaccinators to assert, that never within their sphere of observation have they witnessed a single case of injury resulting from Vaccination--not one! Subject any dozen ordinary practitioners to judicial examination, and they would thus testify with scarcely a note of variation. On the other hand, take any dozen mothers of families, especially from among the poor, and they would tell of illness, disease, and death following the vaccinators’ lancets. The men are more or less competent and honest, and the women likewise, and how shall we account for their variance? In the first place, the men have been drilled from the outset of their profession into the conviction that Vaccination is absolutely harmless, and if any disaster follows, it is coincidence, not consequence. Occasionally a practitioner of more vigorous intelligence than the average, like Mr. Henry May of Birmingham, sees what the mothers see, but does he report accordingly? Not at all. In Mr. May’s own words--

A death from Vaccination occurred not long ago in my practice,
and although I had not vaccinated the child, yet in my desire to
preserve Vaccination from reproach, I omitted all mention of it
from my certificate of death.[70]

Mr. May recognised the fact and concealed it: a duller man would have ascribed the death mechanically to erysipelas or pyœmia. Indeed, it is a commonplace with medical men, that no child dies of Vaccination; and hence Vaccination is not an admitted cause of death; and when the fact is insisted upon, there is no limit to the hardihood wherewith the truth is crushed down and covered up. Coroners refuse to hold inquests on children slain by Vaccination, and Dr. Lankester, as coroner for Middlesex, did not hesitate to authorise a false certificate of death in order, like Mr. May, “to preserve Vaccination from reproach.”[71] As for mothers, poor creatures, few of them have minds of their own, and if only they were adequately assured that it was for the good of their offspring that their noses should be slit, they would believe, weep, and submit.

But it will be pointed out that inoculators of the more reasonable sort admitted a certain mortality from the practice. It is so; but the admission was unavoidable. Inoculation communicated smallpox, and there was no evasion of the fact that occasionally the malady assumed a severe form, and the patient died. For such mishaps, however, there were always excuses. The patient was not in a suitable condition of body; he had been eating improperly; he had caught cold; and so on. There remained, nevertheless, the sequelæ of Inoculation, which were just as persistently denied as are those of Vaccination, although there were always clear-sighted observers who maintained that it was impossible to infect the blood with a complex organic virus, and that it should exhaust its effects in a single and definite issue. We all remember how we used to be assured with contemptuous emphasis that it was utterly impossible to communicate Syphilis by Vaccination, and that assertions to the contrary were the fables of ignorance and malice; yet, we see that what was fabulous a few years ago, is now accepted as medical matter-of-fact. Nowhere is scepticism so useful as among physicians; for whenever they protest most, suspect most.

With the close of the 18th Century, Inoculation with smallpox to avert smallpox was accepted as sound practice throughout England. Its safety and efficiency were extolled by medical writers in terms curiously identical with those applied to Vaccination. The objectors were few, and for pious rather than physiological reasons; and the question that exercised practical and benevolent minds was how to universalise the remedy, which, on account of its troublesome accompaniments, was chiefly confined to the upper and middle classes. On this point it may be well to cite the words of Dr. Haygarth of Chester, who, in a letter to the Council of Health of Geneva, dated 10th February, 1792, thus sets forth the position of affairs--

In Chester, and, I believe, in most of the large towns of
England, the casual smallpox is almost constantly present. _All
the children of the middle and higher ranks of our citizens
are inoculated in early infancy._ The populace, very generally
regarding the distemper as inevitable, neither fear nor shun
it; but much more frequently by voluntary and intentional
intercourse, endeavour to catch the casual infection. All the
difficulties of our Smallpox Society in Chester proceeded from
this strange delusion and perversity of disposition. With us
the smallpox is seldom or never heard of except in the Bills of
Mortality; but there its devastation appears dreadful indeed.

The strong objection to Inoculation was, that it diffused the disease generally which it was supposed to avert individually. Inoculators tried to minimise and deny the danger, but in vain; and nothing so contributed to the supersession of the practice by Vaccination as the expectation of escape from the artificially propagated disease. How extensive was that propagation, we leave the writer in the _Edinburgh Review_ of 1806 to describe--

The inoculated smallpox is an infectious disease, and those who
take it naturally from an inoculated patient have it as violently
as if they had been infected from a case of spontaneous disease;
it is to all intents and purposes the natural smallpox again in
them. Now, if it be considered that several hundred thousand
persons have been annually inoculated in these Kingdoms for the
last fifty years, it will be easy to calculate the immense
addition that must have been made in that period to the cases of
actual disease, and the increase of natural smallpox that may be
supposed to have arisen from this constant multiplication of the
sources and centres of infection.

Unless this culture and this traffic in smallpox throughout the United Kingdom be realised, the potent cause of the immediate and extravagant success of Vaccination will be left out of reckoning. When we are harassed, anxious and impatient under some course of conduct, our ears are open to any promise of relief; and it was to a generation so afflicted and so receptive that Jenner in 1798 made his revelation of the virtue of cowpox. No more need, said he, to inoculate with smallpox. Substitute cowpox; and whilst it will protect as effectually, it will inflict no injury and diffuse no infection. The revelation was received with acclamation, and within eighteen months of its delivery (without due experience, and without any warrant that could pass muster in the severe realm of science) the leading physicians and surgeons of London subscribed and published the following manifesto in the newspapers of 1800--

We, the undersigned physicians and surgeons, think it our duty to
declare our opinion, that those persons who have had the Cowpox
are perfectly secure from the infection of the Smallpox, provided
this infection has not been previously communicated.

I do not wish to anticipate the wondrous tale of Jenner--my present purpose is to show how Inoculation was set aside; and it suffices to state that cowpox rapidly made an end of inoculation with smallpox. Indeed, I question whether a revolution in practice was ever effected with similar facility. Within eight years of the delivery of Jenner’s revelation, the writer in the _Edinburgh Review_ of 1806, already cited, was able to testify--

The bitterest enemies of Vaccination will not deny, that
more than nine-tenths of the medical world are decidedly and
zealously in favour of it, and that all their demonstrations
of its dangers and terrors have been insufficient to convert a
single one of their brethren from so damnable and dangerous a
heresy. Testimonies, it may be said, should be weighed, and not
numbered; and in this respect the vaccinators, we are afraid,
will have a splendid and indisputable triumph. We give the
anti-vaccinists all the advantage in our power when we assign
to them a few members of the profession in London; for in the
country at large, we believe, they have not one respectable
practitioner on their side in five hundred. In this great city
and school of medicine [Edinburgh] we are assured, they are
without a single public adherent.

The resistance to Vaccination was almost entirely confined to the resistance of inoculators, who were too deeply compromised by their own disloyalty to Nature, to make effective resistance. They were steadily borne down by the vaccinators, many of whom had been energetic inoculators, and displayed the usual ardour of apostates in condemning what they had formerly approved. Indeed, when we consider how Inoculation was commended for its efficiency and harmlessness by the same medical authorities who, within a year or two after Jenner’s appearance, denounced the practice for its difficulties and dangers, their tergiversation appears little short of shameless. Dr. Lettsom had been an inoculator, yet on 2nd July, 1805, he felt warranted in writing--

What have not the abettors of Variolous Inoculation to answer
for? To shoot a dozen or two innocent people in the public
streets of London would not be half so injurious as allowing
the murderers to kill the rising generation, the future hope of
the State. Nothing can show the supineness and ignorance of the
Government more than legalising these Variolous Murders.

How far the conquest of the inoculators by the vaccinators had advanced, appeared in a debate in the House of Commons in 1806, when Wilberforce urged that Inoculation should be suppressed, or at least that those who insisted on Inoculation should be compelled to place their patients in quarantine. Mr. Windham admitted the scandal of wretched and miserable subjects of Inoculation being carried about in the streets, but he hesitated to recommend coercive legislation until persuasion had been fully tried and had failed. Dr. Matthews, M.P. for Hereford, took occasion at the same time to run with the hounds. Inoculation, he said, was a frequent cause of disfigurement and of death in its most awful form; it was a magazine of the most dreadful evils; a magnifier of mortality; and a means of introducing scrofula, a more dangerous and pernicious disorder than smallpox itself--facts which it would have been more creditable to have proclaimed when Inoculation was in fashion. It is so easy to kick when a foe has fallen, and where all are kicking. Human nature is never so despicable as when thus engaged.

The question of restraining Inoculation came again before the House of Commons in 1807, when the practice of inoculating out-patients at the London dispensaries and hospitals was energetically condemned. “I think that the legislature,” said Mr. Sturges Bourne, “would be as much justified in taking a measure to prevent this evil by restraint, as a man would be in snatching a fire-brand out of the hands of a maniac just as he was going to set fire to a city.”

No one was more eager to suppress Inoculation by force than Jenner himself, and in July 1807, he sought an interview with the Premier for the purpose. In a letter to Dr. Lettsom he thus describes his mortification--

You will be sorry to hear the result of my interview with the
Minister, Mr. Perceval. I solicited this honour with the sole
view of inquiring whether it was the intention of Government
to give a check to the licentious manner in which Smallpox
Inoculation is at this time conducted in the metropolis. I
instanced the mortality it occasioned in language as forcible
as I could utter, and showed him clearly that it was the great
source from which the pest of smallpox was disseminated through
the country as well as through the town. But, alas! all I said
availed nothing, and the speckled monster is still to have the
liberty that the Smallpox Hospital, the delusions of Moseley, and
the caprices and prejudices of the misguided poor, can possibly
give him. I cannot express to you the chagrin and disappointment
I felt at this interview.

We are not accustomed to regard politicians of Perceval’s order as favourable to liberty; and yet it is refreshing to remark in even the Tories of the Georgian age a jealous regard for the personal freedom of Englishmen, and a hearty contempt for the plausible quacks who were always contriving to circumscribe it. Perceval was not opposed to Vaccination, but he would not consent to give it an illicit advantage over Inoculation. If it were the good thing it was asserted to be, it might be left to prevail by reason of its own quality.

Under medical and social pressure, the practice of Inoculation at public institutions was gradually abandoned. On 5th May, 1808, the inoculation of out-patients was discontinued at the London Smallpox Hospital, but not until 20th of June, 1822, did the inoculation of in-patients cease. In 1816 the Colleges of Surgeons of London and Dublin pledged themselves against the practice. A formal attempt at coercive legislation, often called for, was at last made by the directors of the National Vaccine Establishment. They framed and promoted a bill, which was introduced to the House of Lords in 1813 by Lord Boringdon, but it was ignominiously withdrawn in 1814--a choice example of grand-motherly legislation. Among its provisions was the enactment that whenever an inoculation took place, the clergyman of the parish should receive notice, and that red flags should be displayed from the house where the patient lay! As Earl Stanhope observed, instead of being a measure of humanity, it would, if passed into law, be one of the most troublesome, inconvenient, and mischievous ever enacted.

In the discussion on this foolish project, Lord Eldon pointed out that the common law was already sufficient to arrest the exposure of sufferers from infectious disease; and acting on the hint the Vaccine Establishment prosecuted a woman, 27th April, 1815, for carrying her inoculated child covered with pustules through the streets of her neighbourhood. Evidence was adduced that she had thus infected eleven persons with smallpox of whom eight had died. The Court of King’s Bench pronounced her conduct illegal and criminal, but as it was the first prosecution for such an offence, she was let off with a sentence of three months’ imprisonment.

A practice thus banned could not long survive in England, and by and by a medical man who would consent to inoculate became a rarity, or was accounted disreputable. Yet there remained old-fashioned folk who would have nothing to do with cowpox, and insisted on having genuine human pox for their children and grandchildren. Hence Dr. Epps writing in 1831 had to say--

There is a class of medical practitioners who inoculate for the
smallpox. Society should utter its voice of moral indignation
against such individuals, who glory in anything by which they can
claim singularity, or by which they can increase their pecuniary
means. Let not society be deceived into any parley with such
practices upon the plea, that parents _will_ have their children
inoculated with the smallpox.[72]

Gradually the inoculating practitioner ceased, and the practice remained in the hands of “ignorant and unqualified persons, old women, and itinerant quacks;”[73] and then the end came. An Act of Parliament was passed in 1840 wherein it was enacted that--

Any person who shall produce or attempt to produce in any person
by inoculation with variolous matter, or by wilful exposure to
variolous matter, or to any matter, article, or thing impregnated
with variolous matter, or wilfully by any other means whatsoever
produce the disease of smallpox in any person in England,
Wales, or Ireland, shall be liable to be proceeded against and
convicted summarily before any two or more justices of the peace
in petty sessions assembled, and for every such offence shall,
upon conviction, be imprisoned in the common gaol or house of
correction for any term not exceeding one month.

The Government did not at first intend to make the prohibition absolute, but Mr. Wakley insisted that the time had arrived to suppress the nuisance summarily, and that not a voice would be raised in opposition. Nor was there any opposition. Mr. Goulburn expressed some hesitation, but the House was practically unanimous.

Outside the House few regrets were expressed. Dr. George Gregory, physician of the Smallpox Hospital at St. Pancras, was, however, a man of philosophic turn, and he did not see the old idol cast down unmoved.

On 23rd July, 1840 [he wrote], the practice of inoculation, the
introduction of which has conferred immortality on the name of
Lady Mary Wortley Montagu, which had been sanctioned by the
College of Physicians, which had saved the lives of many kings,
queens, and princes, and of thousands of their subjects, during
the greater part of the preceding century, was declared illegal
by the English Parliament, and all offenders were to be sent
to prison, with a good chance of the tread-mill. Such are the
reverses of fortune to which all sublunary things are doomed.[74]

Gregory was not blind to the extravagant claims made for Vaccination, and evidently had a lurking conviction that all was not gain in the substitution of the new practice for the old, saying--

Had not the discovery of Jenner interfered to interrupt its
extension and improvement, Inoculation would have continued to
this day increasing yearly in popularity.[75]

Yet was not Inoculation abolished. Sometimes when we get the devil out at the door, he presently re-enters by the window; and thus while Parliament was making an end of Inoculation in one form, it was reviving in another.

It is to be understood that Jenner’s cowpox, whatever it might be, was an uncommon and erratic disease, and its discovery and maintenance difficult. To provide a substitute, cows were from time to time inoculated with smallpox, and the resulting virus was used instead of the Jennerian specific. Lest one should be accused of questionable witness, let us refer to Dr. Seaton’s _Handbook of Vaccination_. There we read--

Mr. Ceely of Aylesbury in February, 1839, succeeded in inducing
vaccine vesicles on two sturks by inoculation with variolous
lymph, and in thus establishing lymph-stocks, which passed at
once into extensive use, so that, in a few months, more than 2000
children had been vaccinated from them. In December, 1840, Mr.
Badcock succeeded in variolating a cow at Brighton, and deriving
therefrom a stock of genuine vaccine lymph. In this manner he
has raised stocks of vaccine lymph for use on no fewer than
thirty-seven separate occasions. The lymph thus obtained by him
is now largely employed; it has been supplied to many hundreds
of practitioners, and very many thousands of children have
been vaccinated with it. Mr. Ceely’s experiments were repeated
in America in 1852 by Dr. Adams of Waltham, and Dr. Putnam of
Boston, who were able, it is said, to furnish the city and
neighbourhood of Boston with all the vaccine matter used there
since that period.

Again, Sir John Cordy Burrows, a surgeon, speaking as a magistrate, at Brighton on 5th February, 1876, observed--

The public seem scarcely to understand what Vaccination means.
The vaccine lymph taken from a child is nothing more than what
has passed from a smallpox patient through a cow. In 1856-58 I
took an active part in inoculating seventeen cows with smallpox,
producing in three cases vaccine lymph, and from these the world
has been supplied.

Thus, as asserted, has Inoculation been revived, and Jenner’s specific set aside. When Dimsdale had Russian nobles to operate upon, he tried to mollify the smallpox by passing it through healthy children. Cows have now taken the place of children, and the virus in its passage from arm to arm may still further be reduced in virulence, when it does not take up fresh malignities such as syphilis; but it is inoculation with smallpox all the same.

FOOTNOTES:

[69] _Serious Reasons for Uniformly Objecting to the Practice of Vaccination._ By John Birch. London, 1806.

[70] _Birmingham Medical Review_, January, 1874.

[71] The facts are set forth in _Vaccination Tracts_, No. 14, p.7.

[72] _Life of John Walker, M.D._ London, 1831, p. 326.

[73] Letter of Poor Law Commissioners, 20th August, 1840.

[74] _Lectures on Eruptive Fevers._ London, 1843, p. 39.

[75] _Ib._, p. 93.