Chapter XII: Observations on the Position in 1802

One of my medical readers observes--

The House of Commons in 1802 was committed to a variety of
extravagances, but, allowing for these, you have to account for
certain evidence that Cowpox had _some_ influence over Smallpox;
for you surely do not mean to contend that it had _no_ influence
over that disease, and that the evidence before the Committee was
a uniform tissue of illusion and delusion.

Put thus, it is as difficult to deal with the objection as it is to prove a negative. It is not for me to define the influence of cowpox over smallpox, but for those who believe in its prophylaxy. I should argue that as ill-health leads to ill-health, and as corruption breeds corruption, that inoculated cowpox would generate a habit of body favourable to smallpox, and at the same time tend to excite and intensify other forms of disease. I would also ask, What are the extravagances to be allowed for? When these are determined we may then proceed to discuss what are not extravagant. It is a common form of evasion to make a general confession of guilt in order to avoid the pain of specific and explicit condemnation. It is conceded that the House of Commons in 1802 “committed a variety of extravagances,” and under this appearance of candour the chief extravagance is implicitly re-asserted and carried forward, namely, that inoculated cowpox had an influence adverse to smallpox.

In the “variety of extravagances,” few, I suppose, would hesitate to include the asserted annual smallpox mortality of the United Kingdom. Sir Gilbert Blane pronounced it 45,000, while Dr. Lettsom gave it as 36,000--a wide difference in the play of fancy! Dr. Lettsom, who claimed to have paid much attention to figures connected with smallpox, was pleased to convert an extreme London mortality, namely, 3000, into the ordinary mortality, although in some years it fell under 1000. Then estimating the population of London at one million, and the population of the United Kingdom as twelve millions, he multiplied 3000 by 12, and evoked the astounding national death-rate of 36,000 annually from smallpox, all of whom were to be saved by Jenner’s prescription! But whether he had taken the average or even the lowest metropolitan mortality, the computation would have remained grossly fallacious. London overcrowded and pestiferous, was no standard for the general population, urban or rural; and the assumption was monstrous that smallpox, a notoriously sporadic disease, was constant and equally diffused over the land. We are without comprehensive vital statistics for the time in question, but arguing from the London of to-day in continual connection with the provinces, to the London of 1802 in comparative isolation, what do we find? Why, smallpox prevalent in London with little or no smallpox in the country! In the _Pall Mall Gazette_ of 31st May, 1878, we read--

The degree in which the Smallpox epidemic of the last seven years
has been localised in London is very remarkable. The _Lancet_
points out that during the week ending 25th May, 51 fatal cases
were registered in London and its suburban districts, whereas not
one was recorded in any of the nineteen large provincial towns
having an aggregate population about equal to that of London.
Since the beginning of the year the fatal cases of Smallpox
within fifteen miles of Charing Cross have been 1,134, while but
8 have occurred in the nineteen other large towns.

We find similar illustrations of the sporadic character of smallpox wherever we can get at the facts. In 1874 there died in London 735 of smallpox, but not one in Birmingham; 386 in Liverpool, but not one in Plymouth; 347 in Salford, but not one in Nottingham; 190 in Manchester, and but 1 in Sheffield; 24 in Bristol and 4 in Leeds; and so on. What reason is there to believe that what is true of smallpox within our own experience was otherwise in the experience of our forefathers?

I said that few would hesitate to include Dr. Lettsom’s 36,000 and Sir Gilbert Blane’s 45,000 among the extravagances of 1802, but I forgot myself. We have a National Health Society with the Duke of Westminster for President and all manner of notables, aristocratic, philanthropic, scientific, and literary, among its committee and members. Now this Society issues a hand-bill of advices and warnings relating to smallpox, approved too by the Local Government Board, and there we find set forth as unquestionable matter of fact--

“_Before the introduction of Vaccination Smallpox killed 40,000
persons yearly in this country._”

We thus see how hard it is for a convenient fable to die, even when known to be false, and how respectable people will keep repeating it as long as they fancy it is for good.

Absurd as was the extension of the ratio of London smallpox to the populations of the United Kingdom, of Europe, and of the world, the London disease itself afforded little warrant for the extreme terms of horror and dismay with which it was described. Smallpox did not increase the death-rate of London: when smallpox was most prevalent and least prevalent, the total mortality was but slightly affected. As long as the sanitary conditions of the great city remained unchanged, fevers replaced smallpox and smallpox replaced fevers, and whether deaths were from one form of disease or another, so that the people died the same, what did it matter? Smallpox when most prevalent was never accountable for much more than 10 per cent. of the total London mortality, and in some years for less than 3 per cent.; and it is to be remembered that the larger portion of that mortality was infantile mortality--smallpox being in the great majority of cases a disease of the young; none the less objectionable on that account, but less chargeable than some other forms of zymotic disease with striking down the adult bread-winner and enlarging misery and pauperism.

Again, in much of the talk about smallpox, it was assumed that the disease had no limits--that it was something like fire, and might spread to any extent if unchecked. But what was there to justify such an assumption? Assuredly nothing in London experience. Smallpox was always present in London, waxing and waning under some unknown law; the deaths rising as high as 3992 in 1772 and falling as low as 522 in 1797--the extremes of the century. Why did 4000 never die in any year, or 7000, or 10,000? When a fire is extinguished, we know it has met with a check; and if smallpox caused 3992 deaths in 1772 and 522 in 1797, and smallpox be like fire, there was, we see, a check; and I ask, What was that check? There may be answers, but none for unreserved acceptance. What is certain is, that in London smallpox was never an illimitable affliction. It had limits, and it was only in the rhetoric of alarmists that it had none.

And the check to the disease (whatever it was) lay in the bodies of the citizens, and not in their therapeutics. Isolation was rarely attempted, and in their crowded habitations was impracticable. Moreover they had not only the smallpox appropriate to their evil conditions to contend with, but the disease as propagated and diffused by the inoculators. What we have to say is, that whilst in the London of last century we behold smallpox endemic and cultivated, yet in no year did the mortality therefrom exceed 4,000; and further, that with so much to favour and stimulate the disease it was a diminishing quantity. In the words of Dr. Farr--

London Smallpox attained its maximum mortality after inoculation
was introduced, and the disease began to grow less fatal before
vaccination was discovered.

We shall see as we proceed how the natural check to smallpox (whatever it was), the immunity of the majority from infection, and the decline of the disease were all claimed as the blessed results of Jenner’s prescription; and now-a-days it has passed into common-place, for which evidence is thought superfluous, that without that prescription smallpox might have illimitable extension. If anywhere a variolous epidemic is slight, it is said that but for vaccination it would have been severe; and if severe, that its intensity would have been doubled or trebled save for the action of the same prophylactic. We have a remarkable illustration of this style of prophecy in the Report of the Select Committee of the House of Commons upon the Vaccination Act of 1867, dated 23rd May, 1871, where we read--

Smallpox unchecked by Vaccination, is one of the most terrible
and destructive of all diseases as regards the danger of
infection, the proportion of deaths among those attacked, and the
permanent injury to the survivors.

Your Committee believe that if Vaccination had not been general,
_the epidemic_ [then prevalent] _would have become a pestilence,
raging with the destructive force of the Plague of the middle
ages_.

What is beyond evidence is beyond refutation; and the imaginations of M.P.’s, dull though they be, not unfrequently prevail over their intelligence.

To set aside the mass of testimony adduced by Jenner’s friends before the Commons’ Committee in 1802 is sometimes described as a hopeless undertaking; but the answer to such a boast is, that experience has nullified the essential part of that testimony, and that there is little left to account for. No well-informed medical practitioner now believes what the Committee was led to believe, that to be inoculated with cowpox was to be secure from smallpox for life. The security, where still credited, is subject to so many qualifications that the primitive inoculators with cowpox would have thought such protection not worth paying for, still less of exulting over as the greatest discovery ever made in medicine. Nor would many now admit the validity of the Variolous Test which then carried conviction with irresistible force. Inoculation with smallpox was in itself an uncertain operation, and that it should fail after inoculation with cowpox, ere the poisoning of the blood had been worked off, was in nowise surprising. The exposure of vaccinated subjects to smallpox infection was in like manner deceptive; and it was conveniently forgotten that all manner of people were exposed to contagion with impunity in the usual circumstances of life. Taking a year of exceptional smallpox in London, such as Dr. Lettsom set forth as ordinary, when 18,000 were affected and 3000 died (that is one in six), there were in the million of inhabitants 982,000 who escaped. How did they escape? A multitude must have come into immediate contact with the sick: How did they remain unscathed? The question is simple, but it is crucial. If smallpox were like fire, and men, women, and children like fuel, why did not all burn? Under what prophylaxy did they abide secure? Again in this connection, we must not lose sight of the magic of faith. Things being equal, two persons exposed to smallpox, one confident that he was invulnerable through vaccination, and the other apprehensive of danger, the chances are, that the fearful would be attacked whilst the fearless would have his faith justified in immunity.

In considerations thus obvious it is not difficult to understand how the testimony delivered to the Committee had a semblance as of veracious Nature. Any one who has studied the history of remedies, or the various quackeries within his own observation, will know how easy it is to conjure up testimony, with asseverations presumptuous to question, which by-and-by are gradually discredited and ultimately disappear in forgetfulness. I have, therefore, no disposition to be hard on the men of 1802. From our vantage of experience we see how they were led astray, and recognise the pressure of the influences under which they acted. Moreover a remedy that bore the promise of relief from the pest of smallpox inoculation came with strong seduction. What a pest that inoculation was, how it was loathed, and how it was submitted to under the persuasion of duty are written at large in the domestic memoirs of last century. Every mother among the upper and middle classes was persuaded that it was necessary for her children to undergo the variolous ordeal--an ordeal that involved the deliberate introduction of smallpox into her household. It was hateful, it was intolerable, and yet it had to be endured! The doctors minimised the risks to the uttermost, but what they really believed plainly appeared when vaccination presented itself as an alternative. Then smallpox inoculation was denounced by its former practitioners with a fervour that contrasted painfully with their antecedent professions; whilst parents heard with indescribable satisfaction that absolute life-long security from smallpox was henceforward insured at the price of a trifling operation attended by no peril whatever, and with distinct benefit to health. To make the contrast clear I subjoin copy of a hand-bill that was posted on walls and circulated by thousands in London and the country at the time of which I write, 1801-2.

A TABLE SHEWING THE ADVANTAGES OF VACCINE INOCULATION.

_The Natural _The Inoculated _The Inoculated
Smallpox._ Smallpox._ Cowpock._

I. The natural Small- I. The inoculated I. The inoculated
pox is a loathsome, Smallpox also is Cowpock scarcely
infectious, painful, loathsome, infectious, deserves the name of
and fatal disease. It painful, and sometimes a disease. It is not
is confined to no fatal; and, when infectious; and, in
climate, but rages in partially adopted, the opinion of the
every quarter of the spreads the contagion, most experienced
world, and destroys a and increases the practitioners has
tenth part of mankind. mortality of the never proved fatal.
disease.

II. Those who survive II. It sometimes II. It occasions no
the ravages of that occasions the same other disease. On the
dreadful distemper, maladies as the contrary, it has often
often survive only to natural Smallpox. been known to improve
be the victims of other health, and to remedy
maladies, or to drag those diseases under
out a miserable which the patient
existence worse than before laboured.
death.

III. This cruel and III. It frequently III. It leaves behind
lamentable disorder leaves behind it the no blemish, but _a
leaves behind it pits, same blemishes and Blessing_--one of
scars, and other deformities as the the greatest ever
blemishes and bodily natural Smallpox, bestowed on man--_a
deformities which which are the more perfect security
embitter life. deplorable as they against the future
are brought on by a infection of the
voluntary act. Smallpox_.

From this faithful statement of the advantages attending VACCINE
INOCULATION, it must appear evident to every unprejudiced person,
that it is the duty as well as the interest of every parent, of
every individual, and of every nation, to adopt the practice, and
to hasten

THE EXTERMINATION OF THE SMALLPOX.

It was thus that Vaccination was introduced to the English people, not by men accounted quacks, but by leaders of the medical profession; and whatever the illusions and mischiefs of the new practice, we must allow it the credit of discouraging and ultimately superseding the grosser practice of inoculation with smallpox. As for the various items in the bill, we have had, and shall have them before us, and I would only now recall attention to the initial statement that “Smallpox destroys a tenth part of mankind.” The summary answer to the statement is that the number of mankind was unknown, likewise their diseases, and the proportion in which they were fatal. It was a repetition of Dr. Lettsom’s unwarrantable extension of a bad year of London smallpox to the whole earth. Even in an occasional year when upwards of 3000 died in London of smallpox, the total average mortality was not seriously affected thereby. The deaths, as we have observed, were merely taken out in smallpox instead of in some other form of fever. That nothing can permanently reduce the death-rate of any community save improved sanitary conditions and personal habits was unrevealed in 1802.

Notwithstanding the exultation over Jenner, “the saviour of the world from smallpox,” and over “the greatest discovery since the creation of man,” the suspicion is unavoidable that it was largely factitious--“from the teeth outwards,” as Carlyle would have said. The vote of £10,000 to the miraculous benefactor of the human race was carried by a majority of three in a Parliament to which no more than 115 members could be whipped up, and neither Pitt or Fox thought it worth while to be present. Nor was Jenner treated as if his asserted services to mankind were soberly credited. “Yes,” it may be said, “the world never recognises its true benefactors;” but the observation does not apply, for Jenner was profusely recognised, and received praise from his contemporaries which posterity hesitates to repeat. Nevertheless the praise, though profuse, was little more than verbal. Some expressed indignation at the paltry award of £10,000, and proposed to start a national subscription, but no one took the initiative, and the national gratitude was not put to the test. Even the £10,000 was paid tardily. Writing to a friend on 3rd June, 1804, Jenner had to relate that--

The Treasury still withholds the payment of what was voted to me
two years ago; and now there are new officers, and it may yet be
very long before a guinea reaches me from that quarter.

When at last the money was paid, nearly £1000 was deducted for fees, etc.; and, having the repute of the money, he was considered public property. As Dr. Baron records--

The people of England seemed to think that the fee-simple of his
body and mind had been purchased by the TEN THOUSAND POUNDS; and
many an unjust and ungenerous intimation of this feeling was
conveyed to him. To a mind like his, this was no small annoyance.
He was called upon for explanations and opinions by every person
who thought a direct communication with the Author of Vaccination
an honour worth seeking, while they might have obtained all the
information they wanted in his published writings.

So much was matter of course, but Jenner had worse to encounter. He took the fine talk of his medical and political friends _au sérieux_, bade farewell to Berkeley, and set up as London physician in Hertford Street, May Fair. The result we have in his own words--

Elated and allured by the speech of the Chancellor of the
Exchequer, I took a house in London for ten years, at a high
rent, and furnished it; but my first year’s practice convinced
me of my own temerity and imprudence, and the falsity of the
Minister’s prediction. My fees fell off both in number and value;
for, extraordinary to tell, some of those families in which I had
been before employed, now sent to their own domestic surgeons
or apothecaries to inoculate their children, alleging that they
could not think of troubling Dr. Jenner about a thing executed so
easily as vaccine inoculation. Others, who gave me such fees as I
thought myself entitled to at the first inoculation, reduced them
at the second, and sank them still lower at the third.

His fees did not amount to £350 a year, and he presently found himself nothing the better for the parliamentary grant, and involved in grave financial difficulties. He wrote to a friend, 2nd November, 1804--

The London smoke is apt to cloud our best faculties. I do
not intend to risk the injury of mine in this way, unless
occasionally for the transaction of business. The public has not
the smallest right to require such a sacrifice of me. I have
received no reward for showing them how to remove one of the
greatest obstacles to human happiness; but, on the contrary, am
loaded with a tax of more than £400 a year!

And to another correspondent--

I have now completely made up my mind respecting London. I have
done with it, and have again commenced as village doctor. I found
my purse not equal to the sinking of a £1000 annually (which has
actually been the case for several successive years) nor the
gratitude of the public deserving such a sacrifice. How hard
after what I have done, the toils I have gone through, and the
anxieties I have endured _in obtaining for the world a greater
gift than man ever bestowed on the world before_ (excuse this
burst of egotism), to be thrown by with a bare remuneration of my
expenses.

It was hard! People who attributed to Jenner the greatest discovery ever made, the preservation of from 36,000 to 45,000 lives annually in the United Kingdom, and the salvation of the human race from smallpox, were indeed entitled to have dealt with him more handsomely. He had sympathisers and candid friends. “Your liberality and disinterestedness every one must admire,” wrote Mr. Benjamin Travers, “but you are sadly deficient in worldly wisdom. If you had undertaken the extinction of the smallpox yourself, with coadjutors of your own appointment, I am confident, you might have put £100,000 in your pocket; and the glory would have been as great and the benefit to the community the same.” How that £100,000 was used to tantalise him! and yet, as Dr. Pearson pointed out, never any one showed on what practicable terms the immense sum could have been earned by means of cowpox.