THE MEDICAL POSITION IN 1823.
When Jenner died in 1823, the judgment of the majority of the
people was pronounced against cowpox inoculation; but medical men,
who are expected to _know_ something, and _do_ something, against
every ailment, rarely surrender a prescription until it can be
replaced by another. The doctors therefore held by vaccination, but
on modified terms; and the position to which they had been reduced
is set forth in an article in the _Edinburgh Review_, for November,
1822, concerning which Jenner wrote to Gardner, 13th January, 1823,
a week before his death--
I have an attack from a quarter I did not expect, the _Edinburgh
Review_. These people understand literature better than physic.
It will do incalculable mischief. I put it down at 100,000 deaths
at least. Never was I involved in so many perplexities.
What an extraordinary article! working mischief incalculable,
and bad for at least one hundred thousand deaths! A criticism in
the _Quarterly_ is said to have killed Keats, upon which Byron
remarked--
’Twas strange the mind, that very fiery particle,
Should let itself be snuffed out by an article.
If, however, Jenner was right, it will be allowed, I think, that
the murder of a poet was exceeded in atrocity by the slaughter
of at least one hundred thousand ordinary mortals. Wherefore,
to discover the manner of the great iniquity, I looked up the
_Edinburgh Review_ and discovered the diabolical article. It is
entitled “Vaccination and Smallpox”; is obviously written by the
editor, Jeffrey; and the rock of offence was at once apparent.
Doubt is thrown on the efficacy of vaccination to prevent smallpox;
_ergo_, vaccination thus discredited will be neglected; _ergo_,
vaccination thus neglected will enlarge the domain of smallpox;
_ergo_, at least one hundred thousand persons will perish. Q.E.D.
But it will be asked, “What did Jeffrey say?” The article thus
opens--
Vaccination, we are perfectly persuaded, is a very great blessing
to mankind; but not quite so great a blessing, nor so complete
a protection, as its early defenders conceived it to be. The
proof of this has been admitted with great reluctance; but it
has unfortunately become too strong for denial or resistance.
The first answers given to the instances of failure, with which
the friends of Vaccination were pressed, were, either that the
disease which had occurred after Vaccination was Chickenpox,
and not Smallpox; or that the process of Vaccination had been
unskilfully or imperfectly conducted; or that it was one of those
very rare cases which occurred in the times of Inoculation, and
from which Vaccination itself did not pretend to be wholly exempt.
The Report of the Vaccine Pock Institution for 1803 is cited, as
follows, to show how absolute was the confidence in vaccination in
the days of inexperience--
We have been alarmed two or three times with intelligence of
Smallpox occurring several weeks or months after our patients
had undergone the Cowpox. We thought it our duty to visit and
examine these patients, and also to inquire into their history
among their attendants, and by these means we obtained the
completest satisfaction that the pretended Smallpox was generally
the Chickenpox.
As time went on, cases of smallpox after vaccination kept
multiplying, and the various excuses to account for their
occurrence, though obstinately asserted, utterly broke down. There
remained no doubt whatever that to be vaccinated in the most
approved fashion afforded no guarantee against smallpox. In 1820,
said Jeffrey, the Board of the National Vaccine Establishment was
compelled to make the following melancholy admission--
It is true that we have received accounts from different parts
of the country of numerous cases of Smallpox having occurred
after Vaccination; and we cannot doubt that the prejudices of
the people against this preventive expedient are assignable (and
not altogether unreasonably perhaps) to this cause. These cases
the Board has been industriously employed in investigating;
and though it appears that many of them rest only on hearsay
evidence, and that others seem to have undergone the Vaccine
Process imperfectly some years since when it was less well
understood, and practised less skilfully than it ought to be;
yet, after every reasonable deduction, we are compelled to allow
that too many still remain on undeniable proof, to leave any
doubt that the pretensions of Vaccination to the merit of a
perfect and exclusive security in all cases against Smallpox,
were admitted at first too unreservedly.
The significance of a confession like the foregoing is not to be
estimated literally. It was exacted under irresistible pressure of
facts, numerous, definite and undeniable, after every method of
excuse and prevarication had been exhausted. In short, it was an
authoritative retractation of the flaming medical testimony with
which vaccination had been commended to the public in 1800, when
the heads of the profession thought it their duty to declare in the
newspapers--
That those persons who have had the Cowpox are perfectly secure
from the future infection of the Smallpox.
And of Jenner’s emphatic assurance--
That the human frame, when once it has felt the influence of
the genuine Cowpox is never afterwards, at any period of its
existence, assailable by the Smallpox.
The occasion of Jeffrey’s article was the publication by Dr. John
Thomson of a treatise on a violent epidemic in Edinburgh, and other
parts of Scotland, in 1818-19.[224] The disease differed from
ordinary smallpox in respect of the smallness of the pustules,
which contained a milky fluid, and began to dry up on the fourth or
fifth day. In Thomson’s words--
The epidemic appeared to exhibit all the varieties of Smallpox
from the mildest to the most malignant; and it was curious to
observe that the mildest forms, as well as the most malignant,
were strictly vesicular eruptions, in which scarcely a trace of
purulent matter was to be seen from their commencement to their
termination.
Whether this epidemic was smallpox or chickenpox, was the question.
It was chickenpox said some. It was modified smallpox said others.
It probably was chickenpox said Thomson; and if so, he argued,
chickenpox should be accounted a variety of smallpox. The chief
cause of uncertainty was, that the vaccinated constituted the
majority of sufferers--
Had the unvaccinated alone been attacked [wrote Thomson],
nothing, it appears to me, but the most unreasonable scepticism
could ever have suggested a doubt of the disease being genuine
Smallpox.
Thomson reported 556 cases in Edinburgh of which--
310 had been Vaccinated;
41 had had Smallpox; and
205 had neither been Vaccinated nor had Smallpox.
And William Gibson, surgeon at Robert Owen’s mills, New Lanark, had
322 cases, of which--
251 had been Vaccinated.
11 had had Smallpox, spontaneous or inoculated.
57 had neither been Vaccinated nor had Smallpox.
3 had had Smallpox and Cowpox simultaneously.
As is usual in epidemics of smallpox, it was the young who were the
majority of sufferers; Thomson saying--
The epidemic has been observed to attack those chiefly who were
under ten years of age; _increasing years appearing in general to
lessen the susceptibility to Smallpox contagion_.
Thomson supported his opinion that chickenpox and smallpox were
interchangeable varieties of variola with much cogent evidence
and argument. He cited instances in which they occurred together,
one constitution bringing forth chickenpox where another brought
forth smallpox, whilst the infection of one appeared at times in
the manifestation of the other. The controversy is not one on
which it is necessary to pronounce judgment beyond saying that the
whole drift of philosophic pathology is now in Thomson’s favour;
and indeed at the time he wrote, his position would not have been
seriously contested, save for the discredit it accumulated upon
vaccination. One of Thomson’s correspondents, P. Mudie, M.D., of
St. Andrews, stated the difficulty with artless force. He wrote,
18th October, 1818--
Of late years I have remarked, that the disease called Chickenpox
has been much more severe than formerly; and many of the cases
occurring after Vaccination, so much resembled Smallpox, that _if
my mind had not been prejudiced against the possibility of such
an occurrence_, I should have pronounced the eruption to have
been of a variolous nature.
Notwithstanding his experience, Thomson held firmly by vaccination.
Whilst compelled to admit that it did not avert either form of
variola, he maintained with curious fervour that it made the
disease milder, as if to excuse his partial surrender of faith. We
all see more or less according to our prepossessions, and we need
not blame Thomson if with his perspicacity he was unequal to the
entire truth. The vaccinated belonged to classes who were better
housed, better fed, and better cared for than the unvaccinated;
and if their ailment had been measles or pneumonia in place of
chickenpox, they would have all the same made better recoveries.
Precisely the same error is made at this day: what is due to
kindlier conditions of life is ascribed to vaccination.
Some tried to account for the manifest failure of vaccination on
the supposition that the original virus had lost its force in
transmission from arm to arm, but Thomson would not allow that it
had deteriorated. He said--
The Vaccine Virus used in Edinburgh for a series of eighteen
years produces exactly the same appearances as are delineated
by Dr. Jenner as characteristic of Cowpox. I know, also, that
the appearances of the vaccine vesicle produced by this matter,
which must have passed through a succession of at least 900
individuals, agree exactly with those exhibited by vesicles
produced by inoculation, _with the more recent equine matter with
which I have been, lately favoured by Dr. Jenner_.
The latter words are noteworthy. When Jenner’s ascription of
the origin of Cowpox in Horsegrease is referred to, the answer
frequently is, that Jenner was mistaken, and that he did not
persist in his opinion. It is true that he did preserve a judicious
silence about horsegrease when he saw that it would mar rather than
make his fortune. But when he obtained all he was likely to get,
he resumed the expression of his original opinion, and used and
diffused what he described as horsegrease; and the vesicles raised
by the virus, and the cicatrices which remained were identical with
those induced by so-called Cowpox.
Another point developed in Thomson’s evidence was the mistake made
crediting vaccination with the prevention of smallpox where there
was no smallpox to prevent. The victories ascribed to vaccination
were victories either over an imaginary or a retreating enemy.
We cannot too firmly insist upon this point in presence of the
claim continually advanced for the subjugation of smallpox by
vaccination. For some cause undefined, and, probably in its full
extent, undiscoverable, a subsidence of smallpox over the whole
of Europe set in toward the close of last century, and continued
during the early years of the present; and to this subsidence the
favour that vaccination met with was largely due. The decline in
the disease concurrently with the introduction of vaccination,
was ascribed to vaccination, although the decline prevailed among
an overwhelming majority who had never received vaccination. To
make good the claim for vaccination it would have been necessary
to maintain that the vaccine rite, as applied to 2 or 3 per cent.
of Europeans, effected the salvation of 98 or 97 per cent. For
example, a great point was made by Jenner and his friends of the
extinction of smallpox in Vienna, according to the following table--
TOTAL FROM
YEARS. DEATHS. SMALLPOX.
1791-1800 average 14,600 835 or one in 17½
1801 15,181 164 93
1802 14,522 61 238
1803 14,383 27 582
1804 14,035 2 7,017
Yet it was never pretended that in these years more than a fraction
of the Viennese were vaccinated, or that the death-rate of the city
was reduced by the disappearance of smallpox. The like fatuity
characterised the whole of the vaccinators’ statistics. Smallpox
had declined, _therefore_, they argued, vaccination is the cause of
the decline, and multitudes were convinced by the illicit logic.
When vaccination was, however, brought to the test of epidemic
smallpox, its inefficacy became manifest, and thus Thomson had to
avow, as the result of his experience in the Edinburgh epidemic of
1818-19--
It is to the severity of this epidemic, I am convinced, that we
ought to attribute the greatness of the number of the vaccinated
who have been attacked by it, and not to any deterioration in the
qualities of the Cowpox Virus, or to any defects in the manner in
which it has been employed. _Had a variolous constitution of the
atmosphere_, similar to that which we have lately experienced,
_existed at the time Dr. Jenner brought forward his discovery, it
may be doubted whether it ever could have obtained the confidence
of the public_.
Such was the article which Jenner “put down for 100,000 deaths at
least.” Yet neither Jeffrey nor Thomson renounced vaccination.
They agreed that whilst it could no longer be trusted to prevent
smallpox, it made the disease milder in those it attacked. When a
cherished belief is surrendered, it is rarely unconditionally: it
is only by degrees that full concession is made unto truth.
FOOTNOTE:
[224] _An Account of the Varioloid Epidemic which has lately
prevailed in Edinburgh and other Parts of Scotland; with
Observations on the Identity of Chickenpox with Modified Smallpox._
By John Thomson, M.D. London, 1820. Pp. 400.