Chapter 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.