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.