JENNER’S _INQUIRY_, 1798.
The curious tradition among the dairy folk of Gloucestershire,
that persons who had suffered from Cowpox were thereby rendered
insusceptible of Smallpox, was made known to Edward Jenner when
a doctor’s apprentice, _and was never afterwards absent from
his mind_. Thirty years elapsed before the fruit was borne
to the public; _but incessantly he thought, and watched, and
experimented on the subject_, and the work in which at length he
recorded the incomparable results of his labour may well have
commanded the confidence of reflecting persons.
Little would ever be heard of objections to Vaccination, if all
who undertake the responsibility of its performance, and all who
feel disposed to resist its adoption, _would but thoroughly study
that masterpiece of medical induction_, and imitate the patience
and caution and modesty with which Jenner laid the foundations of
every statement he advanced.
In the first _Inquiry into the Causes and Effects of the Variolæ
Vaccinæ_, Jenner set on a scientific basis the popular belief to
which I have referred; and the close of the 18th Century, which
had much to darken it, will be remembered till the end of human
history for the greatest physical good ever yet given by science
to the world.--_Papers relating to the History and Practice of
Vaccination._ Pp. xi. and xii. London, 1857.
These are the words of Mr. John Simon, and in them we have the
Jennerian legend with the morsel of fact to the mass of fable
which characterises legendary matter, ancient and modern. The
recommendation to “study thoroughly that master-piece of medical
induction,” Jenner’s _Inquiry_, is a mere flourish of panegyric;
for, as Mr. Simon was well aware, the book had been out of print
for half a century, and was practically inaccessible; whilst
its reproduction has usually been considered undesirable in the
interests of Vaccination, inasmuch as it reveals more than is
expedient for common knowledge. An idol that is good to swear by is
always fortified by a convenient obscurity.
The _Inquiry_ is a quarto of less than seventy pages in large
type, set in broad margins in the grand style of the period,
and illustrated with four coloured plates. There are eight pages
of Introductory Matter, followed by thirty-four pages of Cases,
concluding with twenty-six pages of General Observations.
It is to the Cases as the ground of the argument, that I would
first direct attention. They are twenty-three, and may be thus
assorted--
13 of Cowpox communicated by accident.
4 of Horsegrease communicated by accident and inoculated by design.
6 of Cowpox inoculated by design or transferred from arm-to-arm.
It may be tedious, but I should like to go with the reader over
these Cases, for they are highly instructive. Let us take the first
twelve of Cowpox communicated by accident.
I.--JOSEPH MERRET, Gardener.
In 1770 attended to Horses, milked Cows, and caught Cowpox.
Afterwards his family had Smallpox, but he escaped. In 1795 Jenner
repeatedly inoculated him with Smallpox without effect.
II.--SARAH PORTLOCK, Farm Servant.
In 1771 had Cowpox. In 1792 nursed her child in Smallpox
“conceiving herself secure,” and was at the same time inoculated
with Smallpox in both arms without effect.
III.--JOHN PHILLIPS, Tradesman.
Had Cowpox when nine years old. Was inoculated with Smallpox by
Jenner at the age of 62 without effect.
IV.--MARY BARGE, Farm Servant.
In 1767 had Cowpox. In 1791 was inoculated with Smallpox without
effect. Had also acted as nurse to Smallpox patients without
catching the disease.
V.--MRS. H----, Gentlewoman.
Had Cowpox when very young, contracted by handling dairy utensils.
Was subsequently exposed to Smallpox, “where it was scarcely
possible for her to have escaped;” and in 1778 was inoculated with
Smallpox by Jenner without effect.
* * * * *
At this point, I would draw attention to the ages of the persons
set forth in these Cases: they were past middle life when the
susceptibility to Smallpox was either low or extinct. The reason
given by Jenner for their production was that he “wished to show
that the change produced in the constitution by Cowpox is not
affected by time”--a claim which vaccinators at this day surrender,
insisting on the necessity of re-vaccination to maintain “the
benign influence;” but apart from that consideration, there was
nothing extraordinary in resistance to inoculated Smallpox. Without
the intervention of Cowpox, inoculators were constantly meeting
patients who would not “take,” even with repeated attempts, and
especially among elderly people; and some who obstinately resisted
inoculated Smallpox, subsequently contracted the disease in the
ordinary way. So much Jenner himself allowed, saying--
There are many who from some peculiarity in habit resist the
common effects of variolous matter inserted into the skin, and in
consequence are haunted through life with the distressing idea of
being insecure from subsequent infection. (P. 60.)
Yet he was pleased to refer this well recognised resistance to
variolation in those who had had Cowpox to Cowpox, allowing nothing
for habit of body!
VI.--SARAH WYNNE, Dairymaid.
In 1796 had Cowpox in May, and “in so violent a degree, that she
was confined to her bed, and rendered incapable for several days
of pursuing her ordinary vocation.” On 28th March, 1797, she was
inoculated with Smallpox by Jenner without effect.
Under this Case Jenner observes, that “among our dairy farmers
those who have had Smallpox either escape Cowpox, or are disposed
to have it slightly; and as soon as the complaint shows itself
among cattle, assistants are procured, if possible, who are thus
rendered less susceptible of it, otherwise the business of the
farm could scarcely go forward.” At the farm where Sarah Wynne was
employed, all had had Smallpox except Sarah, and all save Sarah,
escaped.
VII.--WILLIAM RODWAY, Dairyman.
In 1796 had Cowpox. In 1797 was inoculated with Smallpox by Jenner
without effect.
Under Rodway’s Case Jenner showed that the farmers were at fault in
supposing that Smallpox kept off Cowpox. In the dairy where Rodway
was employed, all the milkers had passed through Smallpox, except
Rodway, and all contracted Cowpox; “but there was no comparison
in the severity of the disease as it was felt by them and by
Rodway. While he was confined to bed, they were able, without much
inconvenience, to follow their ordinary business.” Thus Jenner
argued that though Smallpox might not keep off Cowpox, it made
Cowpox milder.
VIII.--ELIZABETH WYNNE, Dairymaid.
In 1759 had Cowpox slightly when 19 years of age. “As the malady
had shown itself in so slight a manner,” observed Jenner, “and as
it had taken place at so distant a period of her life, I was happy
with the opportunity of trying the effects of variolous matter upon
her constitution, and on the 28th of March, 1797, I inoculated her”
without effect. Nevertheless in the following year, 1798, she again
caught Cowpox, having a “large pustulous sore” accompanied with
“general lassitude, shiverings, alternating with heat, coldness of
extremities, and a quick and irregular pulse.”
IX.--WILLIAM SMITH, Farm Servant.
Although [wrote Jenner as preface to this Case] the Cowpox
shields the constitution from the Smallpox, and the Smallpox
proves a protection against its own poison, yet it appears that
the human body is again and again susceptible of the infectious
matter of the Cowpox.
In 1780, when attending to Horses with sore heels, Smith
conveyed the equine infection to Cows, “and from the Cows it was
communicated to Smith. In 1791, the Cowpox broke out at another
farm where he then lived as a servant, and he became affected with
it a second time; and in 1794 he was so unfortunate as to catch it
again. The disease was equally as severe the second and third time
as it was on the first.” He was twice inoculated with Smallpox in
1795, and exposed to Smallpox without effect.
X.--SIMON NICHOLS, Farm Servant.
In 1782 was employed in dressing the sore heels of Horses, and at
the same time assisted in milking Cows, thereby infecting them and
generating Smallpox. Changing his situation, he communicated the
disease to other Cows, and was himself severely affected. Some
years afterwards, he was inoculated with Smallpox by Jenner without
effect.
XI.--WILLIAM STINCHCOMB, Farm Servant.
In 1782 had Cowpox severely on the same farm with Nichols. In 1792
he was inoculated with Smallpox along with a large party, but in
his case without result. “During the sickening of some of his
companions, their symptoms so strongly recalled to his mind his
own state when sickening with the Cowpox, that he very pertinently
remarked their striking similarity.”
XII.--HESTER WALKLEY, Farm Servant.
In 1782 had Cowpox when she was attended by Jenner. In 1795 she,
and seven other pauper women of Tortsworth, who also had had
Cowpox, were inoculated with Smallpox by Henry Jenner without
effect. “This state of security proved a fortunate circumstance,”
observed Jenner, “as many of the poor women were at the same time
in a state of pregnancy.” Why then, it might have been asked, did
Henry Jenner try to variolate them?
* * * * *
These Twelve Cases illustrate Jenner’s procedure; and those
familiar with scientific methods, and the scrutiny and caution
requisite to arrive at trustworthy physiological data, will
view with some astonishment his free and easy induction. In the
majority of the Cases he was without proof that his subjects had
suffered Cowpox; and the absence of this certainty was the more
remarkable as he knew that the dairy-folk described as Cowpox
several varieties of eruption. The same rural observers who held
that Cowpox averted Smallpox, also held that Smallpox averted
Cowpox; and yet Jenner had to show in Rodway’s Case No. vii., that
they were mistaken; although, granting the thesis that Smallpox
and Cowpox were equivalents and mutually preventive, the rural
faith ought to have stood justified, and Smallpox shown to be good
against Cowpox. Again Jenner allowed that an attack of Cowpox did
not prevent a subsequent attack of Cowpox, saying--
It is singular to observe that the Cowpox virus, although it
renders the constitution insusceptible of the variolous, should
nevertheless leave it unchanged with respect to its own action.
Singular indeed! The observation in presence of the principle
to be established was nothing short of imbecile. If Smallpox
prevented Smallpox, and Cowpox was one with Smallpox, and Cowpox
did not avert Cowpox, how was Cowpox to avert Smallpox? The
insusceptibility of Jenner’s subjects to variolous inoculation was,
as observed, of little account. Resistance to inoculated Smallpox
was of common occurrence, and inoculators practised various dodges
to overcome it. To have made such experiments approximately
conclusive would have required the inoculation with Smallpox of
subjects of corresponding ages and temperaments who had not passed
through Cowpox; and the probability is that the results would not
have been dissimilar.
We must not, however, proceed farther until Cowpox is described;
and for that purpose I cannot do better than cite Jenner verbatim.
JENNER’S DESCRIPTION OF COWPOX.
Cowpox appears on the nipples of the Cows in the form of
irregular pustules. At their first appearance they are commonly
a palish blue, or rather of a colour somewhat approaching to
livid, and are surrounded by an inflammation. These pustules,
unless a timely remedy be applied,[98] frequently degenerate into
phagedenic [spreading] ulcers, which prove extremely troublesome.
The animals become indisposed, and the secretion of milk is much
lessened.
Inflamed spots now begin to appear on different parts of the
hands of the domestics employed in milking, and sometimes on
the wrists, which run on to suppuration, first assuming the
appearance of the small vesications produced by a burn. Most
commonly they appear about the joints of the fingers, and at
their extremities; but whatever parts are affected, if the
situation will admit, these superficial suppurations put on a
circular form, with their edges more elevated than their centres,
and of a colour distantly approaching to blue. Absorption takes
place, and tumours appear in each axilla [arm-pit].
The system becomes affected, the pulse is quickened; shiverings,
succeeded by heat, general lassitude and pains about the loins
and limbs, with vomiting, come on. The head is painful, and the
patient is now and then even affected with delirium. (P. 3.)
And Jenner might have added, with convulsions.
Having drawn this alarming picture of the effects of Cowpox, he
interposes--
These symptoms arise principally from the irritation of the
sores, and not from the primary action of the vaccine virus upon
the constitution. (P. 5.)
If Cowpox meant all this, some might prefer, at least, the risk
of Smallpox; hence the judicious explanation--the irritation of
the sores, and not the poison in the blood, was the cause of the
distressing symptoms. Jenner went on--
These symptoms, varying in their degrees of violence, generally
continue from one day to three or four, leaving ulcerated sores
about the hands, which, from the sensibility of the parts, are
very troublesome, and commonly heal slowly, frequently becoming
phagedenic, like those from whence they sprang. During the
progress of the disease, the lips, nostrils, eyelids, and other
parts of the body, are sometimes affected with sores; but these
evidently arise [How evidently?] from their being heedlessly
rubbed or scratched with the patient’s infected fingers. (P. 5.)
It was this serious disease, this communicated Cowpox, which
the subjects of the foregoing Cases were assumed to have passed
through; and Jenner, in conformity with the opinion of the dairies,
held that they were thereby rendered proof against Smallpox. Whilst
his Twelve Cases make a show of inquiry, they bear no trace of
extensive or critical research. In the general inoculations then
prevalent, those who had undergone Cowpox were not treated as
protected (as were those who had had Smallpox) but were “cut” with
their neighbours--as, in Case xii., were the eight cowpoxed paupers
of Tortworth. Yet Jenner was at no pains to collect and set forth
the evidence of other Gloucestershire practitioners, who, in the
course of duty, must have known as much of Cowpox as himself, and
might have set scores of Cases alongside his perfunctory dozen.
Having perused Jenner’s description of Cowpox, let us now turn to
his account of its origin.
GENERATION OF COWPOX IN HORSEGREASE.
There is a disease to which the Horse, from his state of
domestication, is frequently subject. The Farriers have termed
it THE GREASE. It is an inflammation and swelling in the heel,
accompanied in its commencement with small cracks or fissures,
from which issues a limpid fluid, possessing properties of a
peculiar kind. This fluid seems capable of generating a disease
in the human body (after it has undergone the modification I
shall presently speak of) which bears so strong a resemblance
to the Smallpox, that I think it highly probable it may be the
source of that disease.
In this Dairy Country a great number of Cows are kept, and the
office of milking is performed indiscriminately by Men and Maid
Servants. One of the former having been appointed to apply
dressings to the heels of a Horse affected with the malady I
have mentioned, and not paying due attention to cleanliness,
incautiously bears his part in milking the Cows, with some
particles of the infectious matter adhering to his fingers.
When this is the case, it frequently happens that a disease is
communicated to the Cows, and from the Cows to the Dairy-maids,
which spreads through the farm until most of the cattle and
domestics feel its unpleasant consequences. This disease has
obtained the name of THE COWPOX.
Thus the disease makes its progress from the Horse (as I
conceive) to the nipples of the Cow, and from the Cow to the
Human Subject. (Pp. 2 and 6.)
This conception of the origin and progress of the disease was not
Jenner’s specially: he shared it with the farmers to whom it was a
novelty--
The rise of Cowpox in this country may not have been of very
remote date, as the practice of milking Cows might formerly have
been in the hands of women only; which I believe is the case now
in some other dairy countries; and consequently that the Cows
might not in former times have been exposed to the contagious
matter brought by the men servants from the heels of Horses.
_Indeed a knowledge of the source of infection is new in the
minds of most of the farmers in this neighbourhood_, but has at
length produced good consequences; and it seems probable from
the precautions they are disposed to adopt, that the appearance
of the Cowpox here may either be entirely extinguished or become
extremely rare. (P. 56.)
Thus Cowpox was to be extinguished by forbidding milkers to handle
Horses’ greasy heels. Jenner himself tried to produce Cowpox in the
manner described, but without success--
It is very easy [he wrote] to procure pus from old sores on the
heels of Horses. This I have often inserted into scratches made
with a lancet on the sound nipples of Cows, and have seen no
other effects from it than simple inflammation. (P. 45.)
What was requisite for success, he concluded, was the limpid fluid
from the Horse’s heel at an early stage of the disease, and that it
should be applied to the Cow’s nipples at a certain season--
The virus from the Horses’ heels is most active at the
commencement of the disease, even before it has acquired a
pus-like appearance; indeed I am not confident whether this
property in the matter does not entirely cease as soon as it is
secreted in the form of pus. I am induced to think it does cease,
and that it is the thin darkish-looking fluid only, oozing from
the newly formed cracks in the heels, similar to what sometimes
appears from erysipelatous blisters, which gives the disease. Nor
am I certain that the nipples of the Cows are at all times in a
state to receive the infection. The appearance of the disease
in the spring and the early part of the summer, when they are
disposed to be affected with spontaneous eruptions so much more
frequently than at other seasons, induces me to think, that the
virus from the Horse must be received upon them when they are in
this state in order to produce effects. Experiments, however,
must determine these points. (P. 45.)
Whilst thus explicit as to what was requisite for the infection of
the Cow by the Horse, Jenner did not succeed in producing Cowpox
from Horsegrease. He had to write--
The spring of the year 1797, which I intended particularly to
have devoted to the completion of this investigation, proved from
its dryness remarkably adverse to my wishes. No Cowpox appeared
in the neighbourhood; for it most frequently happens that while
the farmers’ Horses are exposed to the cold rains of spring their
heels become diseased. (P. 44.)
Yet without proof, he argued as if he had proof, saying--
With respect to the opinion adduced, that the source of the
infection is a peculiar morbid matter arising in the Horse,
although I have not been able to prove it from actual experiments
conducted immediately under my own eye, yet the evidence I have
adduced appears sufficient to establish it. (P. 43.)
Evidence adduced! Of evidence there was none. The farmers might
be right in their opinion that Cowpox sprang from Horsegrease,
but opinion was not evidence, nor even such assurance as this of
Jenner’s--
I feel no room for hesitation respecting the common origin of the
disease, being well convinced that it never appears among the
Cows unless they have been milked by some who at the same time
has the care of a Horse affected with diseased heels. (P. 44.)
But not even to this conviction did he adhere. “It was highly
probable,” he thought, “that not only the heels of the Horse, but
other parts of the body of that animal, are capable of generating
the virus which produces the Cowpox”--
An extensive inflammation of the erysipelatous kind appeared
without any apparent cause upon the upper part of the thigh
of a sucking Colt, the property of Mr. Millet, a farmer at
Rockhampton, the inflammation continued several weeks, and at
length terminated in the formation of three or four small
abscesses. The inflamed parts were fomented, and dressings were
applied by some of the same persons who were employed in milking
the Cows. The number of Cows milked was 24, and the whole of them
had the Cowpox. The milkers, consisting of the farmer’s wife,
a man and a maid-servant, were infected by the Cows. The man
servant had previously gone through the Smallpox, and felt but
little of the Cowpox. The servant maid had some years before been
infected with the Cowpox; and she also felt it now in a slight
degree. But the farmer’s wife, who had never gone through either
Smallpox or Cowpox felt its effects very severely.
That the disease produced upon the Cows by the Colt, and from
thence conveyed to those who milked them, was the _True_ and
not the _Spurious_ Cowpox, there can be scarcely any room for
suspicion; yet it would have been more completely satisfactory
had the effects of variolous matter [Inoculation with Smallpox]
been ascertained on the farmer’s wife; but there was a
peculiarity in her situation which prevented my making the
experiment. (P. 62.)
Spurious Cowpox! What was Spurious Cowpox? Here is Jenner’s answer--
Pustulous sores frequently appear spontaneously on the nipples
of the Cows, and instances have occurred, though very rarely, of
the hands of the servants employed in milking being affected with
sores in consequence, and even of their feeling an indisposition
from absorption. These pustules are of a much milder nature than
those which arise from that contagion which constitutes the
True Cowpox. They are always free from the bluish or livid tint
so conspicuous in the pustules of that disease. _No erysipelas
attends them_, nor do they show any phagedenic disposition, as in
the other case, but quickly terminate in a scab without creating
any apparent disorder in the Cow. This complaint appears at
various seasons of the year, but most commonly in the spring,
when the Cows are first taken from their winter food and fed with
grass. It is very apt to appear also when they are suckling their
young. But _this disease is not to be considered as similar in
any respect to that of which I am treating_, as it is incapable
of producing any specific effects upon the Human Constitution.
However, it is of the greatest consequence to point it out here,
lest the want of discrimination should occasion an idea of
security from the infection of the Smallpox, which might prove
delusive. (Pp. 7 and 8.)
Nothing could be more explicit. COWPOX was of two kinds--True and
Spurious. The Spurious consisted of pustular sores which appeared
spontaneously on the nipples of Cows, and was of no avail against
Smallpox: the True Cowpox, on the other hand, was not a disease of
the Cow, but of the Horse transmitted to the Cow.
It is of prime importance to bear this distinction in mind; for
if it is not borne in mind, much that remains to be told must
appear confused or unintelligible. As we have seen, it was the
belief of the dairymaids that if they caught Cowpox they would
never afterwards catch Smallpox. Medical men in practice in
Gloucestershire ridiculed the dairymaids’ belief. They said--
“We know that such is the dairymaids’ faith, but it is mistaken;
for we know dairymaids who have had Cowpox and afterwards had
Smallpox in spite of their Cowpox.”
At this point Jenner intervened, saying--
“Let us distinguish. Eruptions contracted in milking are
indiscriminately described as Cowpox by dairy-folk; but there
is an eruption attended with erysipelas and fever which has all
the virtue they claim for it. This variety of eruption does not
originate on the Cow, but is communicated to the Cow from the
Horse. Thus the dairymaids are right and they are wrong. They are
right when the pox they catch is derived from the Horse through
the Cow: they are wrong when the pox they catch originates on
the Cow without the Horse. In short Cowpox proper is of no avail
against Smallpox. It is Horsegrease Cowpox that is of sovereign
and infallible virtue. Any maid who receives HORSEGREASE COWPOX
into her veins is, as she believes, for ever after secure from the
infection of Smallpox.”
Let us therefore bear in mind that Jenner’s prescription was not
Cowpox but HORSEGREASE COWPOX. It is a point to be insisted upon;
for, as we shall see, it was lost from sight, and kept out of
sight, to the utter confusion of the question.
* * * * *
We now come to Jenner’s Cases of Horsegrease--for not only were
farm-folk reputed secure from Smallpox by reason of Cowpox, but
farriers likewise in consequence of infection with Horsegrease.
XIII.--THOMAS PEARCE, son of a Farrier.
In consequence of dressing Horses with sore heels at his father’s
when a lad, had sores on his fingers which suppurated, and
occasioned pretty severe indisposition. Six years afterwards,
Jenner inoculated him repeatedly with Smallpox, but only produced
slight inflammation, and exposed him to the contagion of Smallpox
without effect.
On this Case Jenner observed--
It is a remarkable fact, and well-known to many, that we are
frequently foiled in our endeavours to communicate Smallpox by
inoculation to blacksmiths, who in the country are farriers. They
often, as in the above instance, either resist the contagion
entirely, or have the disease anomalously. Shall we not be able
now to account for this on a rational principle?
XIV.--JAMES COLE, Farmer.
Was infected with Horsegrease in the same way as Pearce. Some years
afterwards was inoculated with Smallpox, but only a few eruptions
appeared on his forehead, which passed away without maturation.
XV.--ABRAHAM RIDDIFORD, Farmer.
Was affected with very painful sores in both hands, tumours in each
arm-pit, and severe and general indisposition, in consequence of
dressing a Mare that had sore heels. He was attended by a surgeon,
who recognising a similarity of the sores upon his hands with
those of Cowpox, and knowing the effect of Cowpox on the human
constitution, assured him that he never need fear Smallpox; but,
twenty years afterwards, he caught the disease, which ran its
regular course.
From these Cases Jenner drew this conclusion--
Although the absorption of matter from sores on the heels of
Horses, secures, or nearly secures, the system from variolous
infection, yet it is possible that this cannot be entirely relied
upon, until a disease has been generated by morbid matter from
the Horse on the nipple of the Cow, and passed through that
medium to the human subject.
Which conclusion he repeated thus--
The active quality of the virus from the Horse’s heels is greatly
increased after it has acted on the nipples of the Cow; as it
rarely happens that the Horse affects his dresser with sores;
and as rarely that a milkmaid escapes infection when she milks
infected Cows. (P. 45.)
From this conclusion, Jenner at a subsequent period withdrew.
The virus from the Horse was employed for inoculation without
transmission through the Cow, and with results equally
satisfactory. As we shall find, Jenner used and distributed
Equine Virus neat, which he certified as “the true and genuine
life-preserving fluid.”
So far the Cases set forth described no more than ordinary
Gloucestershire experience; but we now come upon ground regarded as
peculiarly Jennerian.
XVI.--SARAH NELMES, Dairymaid.
In 1796 was infected with Cowpox, receiving the virus on a part of
her hand scratched by a thorn. From the large pustulous sore on
Sarah’s hand Jenner, on the 14th May, inoculated--
XVII.--JAMES PHIPPS, eight years old.
Said Jenner, “The more accurately to observe the progress of the
infection, I selected a healthy boy, about eight years old, for the
purpose of INOCULATION FOR THE COWPOX.” The matter was inserted
into his arm by two incisions, barely penetrating the cutis, each
about half an inch long. The inoculation “took,” and was followed
by a chill, loss of appetite, headache, and restless sleep. On the
1st of July, the poor lad was inoculated with Smallpox, and again
several months afterwards, it is said, without effect.
Here [wrote Jenner] my researches were interrupted till the
spring of the year 1798, when, from the wetness of the early
part of the season, many of the farmers’ Horses were affected
with sore heels, in consequence of which Cowpox broke out among
several of our dairies, which afforded me an opportunity of
making further observations upon the curious disease.
About the latter end of February, 1798, William Haynes and Thomas
Virgoe, having to wash a Mare with sore heels, were infected with
Grease, and described their sensations as much the same as when
they were inoculated with Smallpox. Their infection proved that if
Grease was good against Smallpox, Smallpox was not good against
Grease. Haynes was employed as a milker, and Pox broke out among
his master’s Cows about ten days after he had first assisted in
washing the Mare’s heels.
XVIII.--JOHN BAKER, five years old.
Inoculated, 16th March, 1798, with matter taken from a pustule on
the hand of the aforesaid Thomas Virgoe poisoned with Grease from
the Mare’s heels. “He became ill on the sixth day with symptoms
similar to those excited by Cowpox, and on the eighth was free from
indisposition.”
On this case of Horsegrease inoculation, Jenner observed--
We have seen that the virus from the Horse is not to be relied
upon as rendering the system secure from variolous infection,
but that the matter produced by it on the nipple of the Cow
is perfectly so. Whether the virus passing from the Horse
through the human constitution, as in the present instance,
will produce a similar effect remains to be decided. This would
have been effected, but the boy was rendered unfit for Smallpox
Inoculation from having felt the effects of a contagious fever in
a work-house soon after this experiment was made.
Mark the assumption, “_The virus from the Horse is not to be relied
upon as rendering the system secure from variolous infection, but
the matter produced by it on the nipples of the Cow is perfectly
so!_” Such was Jenner’s method of induction! How could he leave
the question undecided? Why not have waited until little Baker
recovered from his fever? or why not have inoculated another
work-house child with Horsegrease? The true sons of science do not
rush into print in such shameless deshabille.
XIX.--WILLIAM SUMMERS, aged five and a half.
Inoculated 16th March, 1798, from the nipple of one of the Cows
infected with Horsegrease by Haynes. Subsequently inoculated with
Smallpox without effect.
XX.--WILLIAM PEAD, aged eight.
Inoculated, 28th March, from Summers. Subsequently inoculated with
Smallpox without effect.
XXI.--HANNAH EXCELL, aged seven.
And several children and adults were inoculated from the arm of
Pead on 5th April. “The greater part of them sickened on the sixth
day, and were well on the seventh; but in three of the number
a secondary indisposition arose in consequence of an extensive
erysipelatous inflammation which appeared on the inoculated arms.
By the application of mercurial ointment to the inflamed parts (a
treatment recommended under similar circumstances in the inoculated
Smallpox) the complaint subsided without giving much trouble.”
Excell was inoculated in three places on her arm. “This,” said
Jenner, “was not done intentionally, but from the accidental
touch of the lancet, _one puncture being always sufficient_.” The
resulting pustules so much resembled those arising from inoculation
with Smallpox, “that an experienced inoculator would scarcely have
discovered a shade of difference.”
XXII.--FOUR CHILDREN.
On 12th April virus was taken from Hannah Excell and inserted in
the arms of--
Robert F. Jenner, aged 11 months,
John Marklove, ” 18 ”
Mary Pead, ” 5 years,
Mary James, ” 6 ”
R. F. Jenner did not “take.” The arms of the others inflamed, and
Jenner fearing erysipelas, as in the preceding cases, applied a
caustic of soap and quick-lime to Marklove and James, “which,” he
says, “effectually answered my intention in preventing erysipelas.”
The disease was suffered to take its course in Pead, and no
erysipelas appeared.
XXIII.--JOHN BARGE, aged seven.
Inoculated from Mary Pead, and successfully. Was subsequently
inoculated with Smallpox without effect.
“These experiments,” said Jenner, “afforded me much satisfaction;
they proved that the matter in passing from one human subject
to another, through five gradations, lost none of its original
properties, John Barge being the fifth who received the infection
successively from Wm. Summers, the boy to whom it was communicated
from the Cow.”
* * * * *
These are Jenner’s Cases. In them we have his “Masterpiece of
Medical Induction”--the fruit of thirty years of incessant thought,
of watching, and of experiment! Let us carefully observe the
dates. Until 1796, when he operated on Phipps, he never made an
experiment in Horsegrease Cowpox Inoculation; and not until the
middle of March, 1798, a few weeks before going to press with the
_Inquiry_, did he repeat the experiment; and though his later
cases were complicated with erysipelas, he did not stay to dispose
of the difficulty and alarm thereby excited. He got together his
scratch lot of Cases, as if under some over-mastering compulsion,
and consigned the concern, crude and incomplete, to the public.
By-and-by the hasty performance came to be spoken of as the result
of thirty years of incessant thought, of patient research, and of
unwearied labour. It is unnecessary to argue the matter. Whilst
there is nothing too great for the credulity of those who are in
the disposition of belief, yet facts are facts, and there is the
stone-wall of the _Inquiry_ with its authentic details whereon to
crack the skulls of romancers. In Jenner’s story as recited to the
vulgar, we have the advantage of witnessing the development of
myth in the light of our own age under our own eyes.
Taking Jenner’s _Inquiry_ at the utmost, What was it? A suggestion
to substitute Horsegrease Cowpox for Smallpox in inoculation.
That was all. Beyond this there was no point of novelty. Some
have credited Jenner with originating the transfer of virus from
arm to arm; but in this respect he followed the example of many
variolators. There was a mild form of Smallpox occasionally
prevalent in London called “pearly pox,” and Dr. Adams and others
kept it going from patient to patient; and the virus from the body
of a healthy variolated child was in constant request by timid
folk, who fancied the virulence of the original infection might
thereby be abated in transmission.
So much for Jenner’s data. Now for a word or two as to the
speculation that invested his prescription.
He considered that some of the diseases which afflict men are
derived from their domestication of animals, and that thus several
diseases might have a common origin. “For example,” he asked, “Is
it difficult to imagine that measles, scarlet fever, and ulcerous
sore throat with a spotted skin, have all sprung from the same
source?”
About the imagination, there might be little difficulty: the
difficulty lay in the production of proof that any disease in man
was derived from disease in animals, and that disease so derived
was variously manifested. Jenner wished to have it believed that
a variety of Cowpox was generated from Horsegrease, which Cowpox
was the source of Smallpox. He adduced no evidence, however, to
connect outbreaks of Smallpox with Cowpox; nor did he ever suggest
that dairymaids caught Smallpox from Cows, or farriers from
Horses. His identification of Horsegrease Cowpox with Smallpox
was the resemblance of their pustules, and on the ground of this
resemblance he affirmed the equivalence of the diseases. Thus in
describing his first inoculation of Cowpox, that of Phipps from the
hand of Sarah Nelmes on the 14th of May, 1796, he wrote--
The appearance of the incisions in their progress to a state of
maturation was much the same as when produced in a similar manner
by variolous matter. This appearance was in a great measure
new to me, and I ever shall recollect the pleasing sensations
it excited; as, from its similarity to the pustule produced by
variolous inoculation, it incontestably pointed out the close
connection between the two diseases, and almost anticipated the
result of my future experiments. (P. 30.)
The similarity of the Cowpox and Smallpox pustules _incontestably
pointed out_ the close connection between the two diseases!
The observation and the conclusion are worth notice, being
characteristic of Jenner’s loose and illogical mind. He was
familiar with Tartar Emetic, and he might have observed that it
produced pustules on the skin exactly like those of Cowpox and
Smallpox; wherefore would it have been fair to argue that the
pustules being alike, their causes were incontestably identical?
Dr. Hamernik of Prague observes--
Some years ago the theory was brought forward, under the auspices
of the great alchemistical artist, Hufeland, that Vaccination
from Tartar Emetic pustules was a perfect substitute for
Vaccination with Cowpox, and had the same beneficent effect.
With this I fully agree; and I remark further, that if Tartar
Emetic pustulation is produced in Cows and Calves, and vaccine
matter is then taken from them, such Vaccination is also
perfectly harmless. The most convincing proof of the beneficent
and identical action of such Vaccination with that of Cowpox, is
furnished by the fact that it presents pustules similar in size
and form, therefore, necessarily of identical value.[99]
Having identified Horsegrease Cowpox with Smallpox, by reason of
similarity of pustules, he went on to assert that such Horsegrease
Cowpox was equivalent to Smallpox for inoculation, and was attended
with the like prophylaxy, saying--
What renders the Cowpox virus so extremely singular is, that
the person affected with it is forever after secure from the
infection of the Smallpox; neither exposure to the variolous
effluvia, nor the insertion of the matter into the skin producing
this distemper. (P. 7.)
It is curious also to observe, that the virus, which, with
respect to its effects, is undetermined and uncertain previously
to its passing from the Horse through the medium of the Cow,
should then not only become more active, but should invariably
and completely possess those specific properties which induce in
the human constitution symptoms similar to those of the variolous
fever, and effect in it that peculiar change _which for ever_
renders it insusceptible of the variolous contagion. (P. 48.)
And so on. The assurance was absolute, and the warrant for the
assurance was the Cases adduced, and the similarity of Horsegrease
Cowpox pustules and Cowpox pustules! But if the pustules were
similar, the effects were not similar. Inoculation with Smallpox
produced Smallpox, mild or otherwise, with pustules few or many;
but inoculation with Horsegrease Cowpox was attended with no
eruption beyond the points of incision--
It is an excess in the number of pustules which we chiefly dread
in the Smallpox; but in the Cowpox no pustules appear, nor does
it seem possible for the contagious matter to produce the disease
from effluvia; so that a single individual in a family might at
any time receive it without the risk of infecting the rest, or of
spreading a distemper that fills a country with terror. (P. 58.)
Very good; but where are we? If similarity of pustule proved the
identity of Smallpox and Horsegrease Cowpox, what did those graver
dissimilarities between the diseases prove? That an objection so
obvious should never have occurred to Jenner indicates the extent
of his logical capacity.
Jenner’s expectation from the issue of the _Inquiry_ had nothing of
the prophetic character described by his enthusiastic biographers.
It is only necessary to peruse its pages and note the dates in
order to perceive the impossibility of the vision of 1780 described
by Baron when Jenner exhibited to Gardner his future glory, and how
he was destined to stand like Aaron between the living and the dead
until the plague was stayed. Alas! how many similar fables may we
entertain because the means of detection are not, as in Jenner’s
case, available.
When Jenner was writing, the English people were committed to
Smallpox Inoculation, or more accurately Smallpox culture, and it
was in competition with Smallpox that he advanced Cowpox. “If
asked,” he said, “whether his investigation be matter of mere
curiosity, or whether it tend to any beneficial purpose,” he
replied by setting forth the draw-backs to the existing practice,
and contrasting them with the advantages of his own.
Notwithstanding [he wrote] the happy effects of Inoculation, with
all the improvements the practice has received since its first
introduction into this country, it not very unfrequently produces
deformity of the skin, and sometimes, under the best management,
proves fatal. (P. 57.)
On the contrary, he said--
I have never known fatal effects arise from the Cowpox, even when
impressed in the most unfavourable manner, producing extensive
inflammations and suppurations on the hands; and as it clearly
appears that this disease leaves the constitution in a state of
perfect security from the infection of the Smallpox, may we not
infer that a mode of Inoculation may be introduced preferable to
that at present adopted, especially among those families, which,
from previous circumstances, we may judge to be predisposed to
have the disease unfavourably?
Inoculation was freely charged with exciting scrofula; thus Jenner
observed--
In constitutions predisposed to scrofula, how frequently we see
the inoculated Smallpox rouse into activity that distressful
malady; and the issue does not seem to depend on the manner of
the inoculation, for it as often occurs in those who receive it
mildly as in those who receive it severely. (P. 60.)
Happily he had the grace to refrain from the explicit assertion
that Cowpox was exempt from similar hazard; yet with characteristic
inconsistency, was disposed to advance a claim for it as an
expulsive irritant--
As we have seen [though he never showed] that the constitution
may at any time be made to feel the febrile attack of Cowpox,
might it not, in many chronic diseases, be introduced into the
system, with the probability of affording relief, upon well-known
physiological principles? (P. 60.)
A reader of the _Inquiry_ in 1798 could never have supposed that it
was an attempt to displace the existing practice of Inoculation.
Nor is there any sign that Jenner at the time contemplated such
an issue. He referred to Variolous Inoculation with respect, and
was satisfied to suggest that in certain cases inoculation with
Horsegrease Cowpox might be substituted with advantage. As to the
permanent existence of Horsegrease Cowpox he was doubtful. Since,
he said, the farmers had traced the infection to the Horse, “the
appearance of the Cowpox may either be entirely extinguished or
become extremely rare.” It may be replied that this behaviour on
the part of Jenner was due to reserve and tact, but the reserve and
tact are invisible. The _Inquiry_ was simply what it appears--a
hasty performance, which, in other hands, developed to more,
far more, than its author contemplated. Subsequently he, and
his friends for him, laid claim to years of research under the
influence of supernatural foresight; but, with the _Inquiry_ before
us, I ask where is the evidence? I take the date, 14th May, 1796,
when Jenner inoculated Phipps from the hand of Sarah Nelmes, as the
time when the project of inoculation with Horsegrease Cowpox began
to assume form, and I maintain that the character, order and dates
of the Cases set forth in the _Inquiry_ plainly show that they were
got together to sustain the conclusion then arrived at. When Mr.
John Simon descants on Jenner’s thirty years of incessant thought,
watching and experimenting which resulted in the production of
that Masterpiece of Medical Induction--_The Inquiry_, the answer
is, Peruse the _Inquiry_, and then say where the fruit of thirty
years of labour is to be found. The assertion is too absurd for
discussion, whatever it may be as an article of faith.
The single point of originality in the _Inquiry_ was the definition
of the disease for which prophylactic efficacy was asserted. The
dairymaids said Cowpox: the farriers said Horsegrease. Jenner
said neither Cowpox nor Horsegrease, but their combination in
Horsegrease Cowpox, which variety of Pox alone ensured life-long
security from Smallpox. We shall see as we proceed how this
position was surrendered and resumed, modified and confused beyond
recognition. Let it suffice at present to say that the note of
Jenner’s _Inquiry_ was HORSEGREASE COWPOX and nothing else. Strike
out HORSEGREASE COWPOX, and the affair is reduced to nonentity.
THE VARIOLOUS TEST.
What was called the Variolous Test worked wonderfully for Jenner;
and as we shall have to refer to it repeatedly, it may be well to
describe and dispose of it at once.
We have seen how the Test was practised in the Cases in the
_Inquiry_. Those who had undergone Cowpox were inoculated with
Smallpox, and as the Smallpox did not “take,” they were assumed
to be proof against that disease. Hence the absolute conclusion
proclaimed _Urbi et Orbi_, that none inoculated with Cowpox could
ever afterwards contract Smallpox.
It was replied, that some who _had_ suffered from Cowpox _had_
contracted Smallpox, and that others _had_ received the disease by
inoculation; to which Jenner’s summary answer was, “There must have
been some mistake about the Cowpox; for no one _can_ have genuine
Cowpox and subsequently incur Smallpox, either by infection or
inoculation.”
Cowpox was inoculated and propagated from arm to arm; and, in proof
that the constitution was fortified against Smallpox, it was common
to inoculate with Smallpox, which usually did not “take”; whereon
the operator exclaimed, “Behold! the patient is insusceptible of
Smallpox _for ever_!”
Such was the Variolous Test. It was to multitudes absolutely
conclusive; and to question its validity was to exhibit a
contentious and unphilosophic disposition.
What shall we now say concerning it?
First, that failures were numerous in Variolous Inoculation apart
from Vaccination, and that it was not supposed that when a patient
did not “take,” he was therefore insusceptible of Smallpox; nor
even when he did “take,” that he was thereby rendered proof against
Smallpox. So many of the successfully inoculated did subsequently
fall victims to Smallpox, that Variolators at the end of last
century were compelled to argue (like Vaccinators at the end of
this) that Variolation was a guard, but not an absolute guard;
and that when it did not altogether avert Smallpox, it modified
and mitigated an attack. The excuse for failure was as artful as
the motive was urgent: Variolation was too good a trade to be
imperilled for lack of a little ingenuity.
Nevertheless, if we make full allowance on the score of frequent
incapacity to receive Variolation, we have yet to explain, on a
candid view of the whole evidence, how it was that in numerous
cases Inoculation with Smallpox was ineffective after Inoculation
with Cowpox.
“What can you urge against the Variolous Test?” was a frequent and
imperious demand.
The explanation in general lay in the fact, that Variolation was
attempted before the complete subsidence of the vaccine fever.
The inoculation with Cowpox had set up a serious constitutional
disturbance, and during that disturbance the Smallpox virus could
not develop its malign energy. Let me show what I mean from the
testimony of Jenner himself.
On 15th March, 1800, the Duke of York requested Jenner to proceed
to Colchester to the 85th Regiment. Jenner was unable to go, and
sent his nephew, George, instead, who had to report a complete
failure. The reason of the failure was, that the entire Regiment,
with women and children, had the itch! Jenner was then driven
to the conclusion which, says Baron, “he adopted and invariably
maintained to the last hour of his life, namely, that any cutaneous
disease, however slight in appearance, was capable of interfering
with the regular course of the Cowpox and of preventing it from
exercising its full protecting influence.”[100]
Just so: and mark how the same logic applies to the Variolous Test,
which “nobody could get over.” If any cutaneous disorder, however
slight, could nullify Cowpox, was it not equally probable that
the cutaneous disorder induced by inoculated Cowpox would nullify
inoculated Smallpox _until the effects of the Cowpox had time to
subside_? When the itch at Colchester was cured, then inoculation
with Cowpox was found to be practicable. Thus worthless was the
Variolous Test on Jenner’s own principle; yet with such evidence
under his eyes and among his fingers, he failed to discern its
significance. Nor apparently did he inquire whether the influence
of Cowpox was perpetuated over specified periods of six months,
nine months, one year, two years, and so on. As trader and
adventurer, it suited him better to be not over inquisitive, and
to avow boldly that his specific conferred life-long immunity from
Smallpox.
Vaccinators at this day rarely refer to the once famous Variolous
Test: to do so would be absurd. The fact of Re-Vaccination, of
Vaccination after Vaccination at short intervals, proves, that
whatever the influence of the operation, it is transient and not
permanent; and the cases of Smallpox after Vaccination, and of
Smallpox in its most malignant forms after Re-Vaccination, as
if induced thereby, leave the Variolous Test, which so widely
impressed and imposed upon our forefathers, an exploded piece of
jugglery.
FOOTNOTES:
[98] Such timely remedies were solutions of sulphate of zinc or
sulphate of copper--a hint for those in quest of antidotes for
Vaccination.
[99] _Remarks on Certain Medical Principles._ London, 1882.
[100] Baron’s _Life of Jenner_, vol. i. p. 380.