Chapter XLII: Introduction: Of Vaccination to the United States

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

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

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

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

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

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

BOSTON in 1752. Population 15,684.

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

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

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

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

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

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

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

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

I do not believe there is at present a single person infected by
Smallpox in all the four New England Governments, that is, not
one in a million of people.

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

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

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

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

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

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

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

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

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

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

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

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

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

Waterhouse then appealed to the pride of his countrymen--

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

Following this prophecy came a frank request for business--

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

After an English pattern he published the following table--

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

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

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

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

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

EDWARD JENNER to BENJAMIN WATERHOUSE.

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

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

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

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

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

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

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

And this after less than twelve months’ experience!

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

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

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

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

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

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

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

MONTICELLO, VIRGINIA, _14th May, 1806_.

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

TH. JEFFERSON.

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

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

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

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

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

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

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

FOOTNOTES:

[225] Baron’s _Life of Jenner_, vol. i. p. 442.

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

[227] Baron’s _Life of Jenner_, vol. i. p. 440.

[228] Pettigrew’s _Life of Lettsom_, vol. iii. p. 405.

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

[230] Baron’s _Life of Jenner_, vol. i. p. 387.