Chapter XV

REPORT OF THE ROYAL COLLEGE OF PHYSICIANS.

The Report of the Physicians appeared on the 10th April, 1807, a verbose document, wherein assertion and conjecture were awkwardly intermingled. As to the extension of the practice, it was said--

During eight years which have elapsed since Dr. Jenner made his
discovery public, the progress of Vaccination has been rapid, not
only in all parts of the United Kingdom, but in every quarter
of the civilised world. In the British Islands some hundred
thousands have been vaccinated; in our possessions in the East
Indies upwards of 800,000, and among the nations of Europe the
practice has become general.

Professional men have submitted it to the fairest trials, and the
public for the most part have received it without prejudice. The
testimony in its favour has been most strong and satisfactory,
and the practice of it, though it has received a check in some
quarters, appears to be upon the increase in most parts of the
United Kingdom.

From the Report it appeared that the opposition to Vaccination proceeded from the Inoculators; and the document may be described as a charge against the old practice as much as a positive defence of the new--

However beneficial the inoculation of the Smallpox may have been
to individuals, it appears to have kept up a constant source of
contagion, which has been the means of increasing the number
of deaths by what is called the natural disease. It cannot be
doubted that this mischief has been extended by the inconsiderate
manner in which great numbers of persons, even since the
introduction of Vaccination, are every year inoculated with
Smallpox, and afterwards required to attend two or three times
a-week at the place of inoculation, through every stage of their
illness.

Some Inoculators asserted that Vaccination produced “new, unheard-of, and monstrous diseases,” and made use of pictures to excite terror and disgust--

Publications with such representations have been widely
circulated, and though they originated either in gross
ignorance, or wilful misrepresentation, yet have they lessened
the confidence of many, particularly of the lower classes, in
Vaccination.

Whatever the character of Vaccination--had the claim made in its favour been a true claim, still the chief resistance to its practice would have consisted in the common apathy--

The lower orders of society can hardly be induced to adopt
precautions against evils which may be at a distance; nor can
it be expected from them, if these precautions be attended with
expense. Unless, therefore, from the immediate dread of epidemic
Smallpox, neither Vaccination or Inoculation appears at any time
to have been general, and when the cause of terror has passed by
the public have relapsed into indifference. It is not easy to
suggest a remedy for an evil so deeply implanted in human nature.

The suggestion was, however, made that Vaccination should be offered gratis, but at the same time it was the opinion of the College that until Variolous Inoculation was superseded or prohibited, “it would be impossible to prevent the constant recurrence of Natural Smallpox.”

The recommendation of Vaccination gratis provoked the wrath of Dr. Moseley--

Gratis! [he exclaimed]: Why, every person knows that for years
past in almost every street of London, signs or boards on the
sides of houses, or on Methodists’ shops, or in apothecaries’
windows, have invited the ignorant multitude to gratuitous
Vaccination. I have seen as many gratis Cowpox hand-bills, gratis
puffs, gratis pathetic sermons and addresses, and gratis station
advertisements as would load an ox. What does the College think
of the mountebank Jennerian placard, dispersed on walls and
alleys, and among all the blackguard public houses in town and
country, and hung up in the shop or parlour of every Cowpoxer in
England with Their Majesties’ Names and those of Their August
Family audaciously emblazoned upon it?[138]

The Report of the College is interesting as a historic confession and a mark of progress. The physicians who drew it up were the same men who in 1800 professed their unlimited confidence in Vaccination, whilst as yet they knew little about it, proclaiming in the newspapers that they considered it their duty to declare--

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

From a profession so unqualified an absolute retractation was not to be expected; but experience had begotten caution, and it is instructive to remark with what qualifications the retreat from the original position was attempted. Thus--

The security derived from Vaccination _if not absolutely
perfect_ is as nearly so as can perhaps be expected from any
human discovery; for among several hundred thousand cases, with
the results of which the College has been made acquainted, _the
number of alleged failures has been surprisingly small_, so much
so as to form no reasonable objection to the general adoption of
Vaccination.

The Report was not the deliverance of men possessed with the confidence of 1800: throughout there was manifest the failing conviction which evades responsibility and seeks for confirmation from sources external to itself. After a reference to the Variolous Test, the Report ran on--

It appears from numerous observations communicated to the
College, that those who have been vaccinated are secure from the
contagion of epidemic Smallpox. Towns and districts of country
in which Vaccination had been general, have afterwards had
Smallpox prevalent on all sides of them without suffering from
the contagion. There are also in the evidence a few examples of
epidemic Smallpox having been subdued by a general Vaccination.

The liability to confound coincidence with cause was not unknown in 1807, and might have been suggested as a possible explanation of the cessation of a variolous epidemic contemporaneously with Vaccination; although at the present day Vaccination, when Smallpox is epidemic, is known to do little else than invite and extend the malady.

How the general (that was to say partial) Vaccination of certain towns and country districts secured universal exemption from Smallpox, the Physicians failed to explain. Extraordinary tales of Vicarious Vaccination were current and piously received. If a fraction of an urban or rural community happened to be vaccinated (usually a fraction least likely to be troubled with Smallpox in any event) and Smallpox did not break out, or did not widely prevail, the salvation of the community was ascribed to the Vicarious Vaccination. The phenomenon has, strange to say, escaped the attention of theologians, although medical men constantly attest its occurrence.

Ruefully was it conceded that Vaccination was not an absolute preservative from Smallpox, but the pain of concession was softened with the plea of mitigation--

In _almost_ every case where Smallpox has succeeded Vaccination,
the disease has varied much from its ordinary course; it has
neither been the same in violence, nor in the duration of its
symptoms, but has, _with very few exceptions_, been remarkably
mild, as if the Smallpox had been deprived, by the previous
vaccine disease, of all its usual malignity.

It goes without saying, that such a statement was quackish romance. How could a physician know that any case of Smallpox had been made milder by Vaccination? for how could he know how severe the disease would have been without Vaccination? Any ground of comparison was wanting. Smallpox is an eruptive fever of wide degrees of intensity--slight as to be a trivial ailment, severe as to be inevitably fatal. “So true,” wrote Dr. Wagstaffe in 1722, “is that common observation, that there is one sort in which a nurse cannot kill, and another which even a physician cannot cure.” Yet every case of mild Smallpox after Cowpox came into fashion was placed to the credit of Vaccination!

Some writers [the Report continues] have greatly undervalued
the security Vaccination affords, while others have considered
it to be of a temporary nature only; but if any reliance is to
be placed on the statements laid before the College, its power
of protecting the human body from Smallpox, _though not perfect
indeed_, is abundantly sufficient to recommend it to the prudent
and dispassionate. The opinion that Vaccination affords but a
temporary security is supported by no analogy in Nature, nor by
the facts which have hitherto occurred.

The analogy of Nature was a treacherous support, whilst the Physicians did not foresee the time when their successors would plead the fact of the temporary security of Vaccination as a reason for systematic Re-Vaccination.

It is not difficult to discern between the lines of the Report a spirit of doubt and hesitation. Those who framed it had gone too far to turn back; there was Jenner on their hands; and a public ready to hoot if there was any open apostasy. The outlook at home was not encouraging, but there was the Continent, yea more, the wide world itself wherein to cover the reproach of failure--

They could not be insensible [said the Physicians] to the
confirmation they receive not only from the introduction of
Vaccination into every part of Europe, _but throughout the vast
Continents of Asia and America_.

The vast Continents of Asia and America! A fine phrase--a very fine phrase, with more comfort in it than scoffers might imagine.

In the Report we detect one good service, namely, the explosion of Jenner’s fiction about Spurious Cowpox. When Vaccination was first brought forward, cases were adduced of Smallpox after Cowpox. Jenner at once asserted that the Cowpox in such instances must have been spurious, for Smallpox after genuine Cowpox was impossible; and Spurious Cowpox was thenceforward freely used to baffle inquirers and to account for failures. Spurious Cowpox served the ends of the Vaccinators magnificently, but by and by it began to have awkward consequences. Genuine Cowpox was said to be harmless--it was the Spurious that was ineffective or worked mischief; and the Inoculators plied the terror of Spurious Pox against Vaccination. It therefore became necessary to clear Spurious Cowpox out of the way, and Jenner, before the College of Physicians, pressed upon the point, “owned up,” as Americans say, and authorised the following explanation--

Some deviations from the usual course have occasionally occurred
in Vaccination, which the Author of the practice has called
Spurious Cowpox, _by which the public have been misled, as if
there were a true and a false Cowpox_; but it appears that
nothing more was meant than to express irregularity or difference
from that common form and progress of the vaccine pustule from
which its efficacy is inferred.

Mark! Here was a third definition of Spurious Cowpox by Jenner.

_First_, in the _Inquiry_ of 1798, he described Spurious Cowpox as eruptions on the cow underived from horsegrease, producing no erysipelas when inoculated on the human subject, and without effect against Smallpox. True Cowpox was generated from horsegrease, and from horsegrease only.

_Second_, in the _Origin of the Vaccine Inoculation_ of 1801 all reference to horsegrease was dropped for commercial reasons, whilst the existence of Spurious Cowpox was reasserted “as some varieties of spontaneous eruptions upon the cow.”

_Third_, before the Physicians in 1807, he removed the spurious disease from the cow altogether, saying, nothing more was meant by Spurious Cowpox than variations in the form and progress of vaccine pustules on the arms of the vaccinated!

In short, to vary the phrase of Betsy Prig, “There never was no Spurious Cowpox.” Slippery, very slippery, was the immortal Jenner.

With the report of the Royal College of Physicians were delivered reports from the London College of Surgeons, and from the Edinburgh and Dublin Colleges of Physicians and of Surgeons.

The report from the London College of Surgeons was considered most unsatisfactory, and could its tenor have been foreseen, the Jennerians might never have asked for it. 1100 circulars were dispatched on 15th December, 1806, to all the members of the College whose addresses were known in the United Kingdom, submitting the following questions--

1st. How many persons have you vaccinated?

2nd. Have any of your patients had Smallpox after Vaccination?

3rd. Have any bad effects occurred in your experience in
consequence of Vaccination? and if so, what are they?

4th. Is the practice of Vaccination increasing or decreasing in
your neighbourhood? if decreasing, to what cause do you impute it?

To the 1100 circulars only 426 replies were received. Why nearly two-thirds of the members kept silent when at the outset they were converted in multitude to Vaccination, was left unexplained. The replies were thus summarised by the Board on 17th March, 1807--

The number of persons stated in such letters to have been
vaccinated, is 164,381.

The number of cases in which Smallpox had followed Vaccination is
56.

The Board think it proper to remark under this head, that, in the
enumeration of cases in which Smallpox has succeeded Vaccination,
they have included none but those in which the subject was
vaccinated by the surgeon reporting the facts.

The bad consequences which have arisen from Vaccination are--

66 cases of eruption of the skin, and
24 of inflammation of the arm, whereof
3 proved fatal.

Vaccination, in the greater number of Counties from which reports have been received, appears to be increasing: in the Metropolis it is on the decrease.

The principal reasons assigned for the decrease are--

Imperfect Vaccination,
Instances of Smallpox after Vaccination,
Supposed bad consequences,
Publications against the practice,
Popular prejudices.

The report of the Edinburgh College of Physicians disowned acquaintance with Vaccination, the practice being entirely in the hands of surgeons and other practitioners--

With a view, however, to publish their conviction of the
immense benefits which have been, and which will in future be
derived to the world, from Inoculation for the Cowpox, they had
spontaneously and unanimously elected Dr. Jenner an honorary
Fellow of their College, a mark of distinction which they very
rarely confer, and which they confine almost exclusively to
Foreign Physicians of the first eminence.

The report of the College of Surgeons, dated 3rd March, 1807, left nothing for the Jennerians to desire. The Edinburgh surgeons were satisfied from their own experience that Vaccination constituted a permanent security from Smallpox, and they had observed no ill consequences from the practice. Vaccination commenced in Edinburgh in 1801, and was now so general in the city--

That for two or three years past, Smallpox has been reckoned
rather a rare occurrence, even among the lower order of the
inhabitants, _unless in some particular quarters about twelve
months ago_. Among the higher ranks of the inhabitants the
disease is unknown.

Rare, unless in some quarters about a year ago! We turn to the report of the Edinburgh Dispensary for 1805, and there we read--

The loathsome disease has unfortunately been very prevalent in
several quarters of the city.

And this coincidently with extensive Vaccination to which apparently there was no active opposition! We have also to remember in this connection the statement of Professor Alexander Monro in 1765, that “the inhabitants of Scotland generally have Smallpox in their infancy or childhood; very few adults being seen in this disease”; and that in Edinburgh, with conditions strongly favourable to Smallpox, the mortality from the disease was on an average little more than a hundred a year. The Edinburgh physicians knew nothing practically of Vaccination, and we see how the Surgeons, who did know, shaped their evidence.

The Dublin College of Physicians echoed the fashionable opinion “that Cowpox Inoculation was safe, and fully answered its purpose.” They were “willing to allow that doubtful cases had occurred of Smallpox after Vaccination, but on minute investigation, these supposed instances originated generally in misrepresentation, or the difficulty of discriminating between Smallpox and other eruptions.” Rather awkwardly, seeing how the opposite opinion was in vogue, they professed their faith in Variolous Inoculation--

The Smallpox is rendered a much less formidable disease in
Ireland by the frequency of Inoculation for it, than in other
parts of His Majesty’s dominions, where prejudices against
Inoculation have prevailed. Hence parents, not unnaturally,
object to the introduction of a new disease, in the shape
of Vaccination, preferring to trust to the practice with the
mildness and safety of which they are well acquainted.

The Dublin College of Surgeons showed themselves more fully abreast of the time. They had nothing to say for Inoculation, but testified their confidence in Vaccination, and how its practice was increasing in Ireland. From 1800 to 1806 a total of 14,335 had been “inoculated with vaccine infection” at the Dublin institutions, and many elsewhere--

Cowpox has been found to be a mild disease, and rarely attended
with danger, or any alarming symptom, and _the few cases
of Smallpox which have occurred in Ireland after supposed
Vaccination_, have been satisfactorily proved _to have arisen
from accidental circumstances_.

Arisen from accidental circumstances! Thus was the divine illumination of experience veiled and denied!

Fortified with this budget of questionable evidence, the Government proceeded to claim from the House of Commons a second endowment for Jenner.

FOOTNOTE:

[138] _Review of Report on Vaccination._ By Benjamin Moseley. London, 1808.