DIFFUSION OF VACCINATION THROUGHOUT EUROPE.
Vaccination was accepted as a revelation, and diffused as a
religion, and was almost everywhere received gladly. We have to
bear in mind, however, that the way had been made straight for it
by the practice of inoculation with smallpox; which practice, after
a struggle prolonged over many years, had become an established
part of medical art, and was only limited in its application by
the inconvenience and risks that attended it. The promise of the
primitive vaccinators was, that the security which resulted from
inoculation with smallpox was to be had from inoculation with
cowpox, with absolute certainty, absolute safety, and absolute
permanence. The argument was, that since no one could have smallpox
twice (however slight the attack), and as cowpox was a mild form
of smallpox, it sufficed to be inoculated with cowpox to be safe
from smallpox through life; and if only the infliction of cowpox
were made universal, smallpox would be extirpated. Such was the
plausible doctrine; so plausible that it had only to be stated to
command assent; whilst so great was the elation over the discovery
(as much, perhaps, for deliverance from inoculation with smallpox
as from smallpox itself) that it was accounted a sacred duty to
diffuse its benefits over the whole earth. Greater good on easier
terms it was difficult to imagine. With a scratch of a needle one
of the worst penalties attached to over-crowding, to filth, and to
ill-living, might be avoided and done away with for ever.
How pleasant are such sugared lies,
Deceiving by their sweetness!
The first cowpox missionaries were Dr. Marshall and Dr. Walker.
£100 was teased out of the Admiralty, and £100 out of the War
Office toward their expenses, and placed on board the _Endymion_,
they proceeded, on 1st July, 1800, to the Mediterranean. At
Gibraltar, Minorca, and Malta, they vaccinated soldiers and
sailors, first operating on orphans and foundlings to give the
gallant fellows courage. Then Walker accompanied Sir Ralph
Abercrombie to Egypt, from whence, after a variety of adventures,
he returned to London to serve as domestic apostle, and vex Jenner
for the remainder of his life. Marshall proceeded to Sicily and
Naples. In Palermo, in the preceding year, 1799, there had been an
epidemic, in which, it was said, 8,000 had perished, and Marshall
appeared on the scene as a belated messenger of salvation. At
Naples he had a cordial reception from the wretched Ferdinand IV.
and his wretched court, who, with general indifference or enmity
to what was good, were ready to show themselves gracious toward
cowpox. Marshall went through the customary performances of the
variolous test and the exposure of the vaccinated to infection; and
without further ado an hospital was opened, and all who would be
saved from smallpox were entreated to hasten and receive the new
inoculation.
It was not unusual [wrote Marshall to Jenner] to see in the
morning a procession of men, women, and children, conducted
through the streets by a priest carrying a cross, coming to
the hospital to be inoculated. By such popular means, the
practice met with no opposition; and the common people expressed
themselves as certain that it was a blessing sent from Heaven,
though discovered by one heretic and practised by another.
When Marshall was at Gibraltar, Lord Keith issued the following
memorandum to the fleet--
H.M. Ship _Foudroyant_,
GIBRALTAR BAY, _19th October, 1800_.
Any soldiers, seamen, or marines in the Fleet who may not have
had the Smallpox, and wish to avoid that dreadful malady, may,
by application to Dr. Marshall, on board the flag-ship, be
inoculated with the Cowpox, which, without pain or illness, or
requiring particular diet or state of body, or leaving any marks,
effectually excludes all possibility of the patient ever being
affected with the Smallpox.
By command of the Vice-Admiral, PHILIP BEAVER.
To the respective Captains of the Fleet.
I may observe, in passing, that there was little delay in
introducing vaccination to the British navy. Sir Gilbert Blane was
urgent, Earl Spencer, first Lord of the Admiralty, acquiescent, and
Dr. Trotter, physician to the fleet, enthusiastic. So early as 9th
December, 1800, Trotter was prophesying--
The Jennerian Inoculation will be deservedly recorded as one of
the greatest blessings to the navy of Great Britain that ever was
extended to it.
Smallpox was one of the pests of the service. Trotter, writing 20th
February, 1801, said--
Within the past seven years there have been more than a hundred
instances in which the seamen have been infected; twenty having
occurred in the last six months in the Channel fleet alone.
These outbreaks were invariably referred to an origin external to
the ship; as if anywhere smallpox could have had a more congenial
breeding-place than the crew of a man-of-war! As Dr. Johnson
observed, “When you look down from the quarter-deck to the space
below, you see the utmost extremity of human misery; such crowding,
such filth, such stench!”[252] Incited by the enthusiastic
Trotter, the medical officers of the Fleet subscribed for a gold
medal, and presented it to Jenner. On the obverse, Apollo was
represented introducing a young seaman recovered from cowpox
to Britannia, who, in return, extended a civic crown, on which
was inscribed JENNER; above were the words, _Alba nautis stella
refulsit_, and below the date, 1801. On the reverse was an anchor
and over it _Georgio Tertio Rege_, and under it _Spencer Duces_.
The medal was presented to Jenner in February, 1801.
The dates are worth noting afresh. Jenner’s _Inquiry_ was published
in the summer of 1798; and thus we see that within three years
his prescription for the prevention and extermination of smallpox
was adopted in a branch of the public service where obstinate
conservatism was the ruling temper; and an assertion that only time
could test was accepted without hesitation as verified and certain.
If vaccination had answered to the claim made for it, the haste
wherewith it was acknowledged would have been unjustifiable, and
wholly unlike the struggle that truth has commonly to pass through
in order to obtain supremacy in the intellect and practice of
mankind.
The first attempts to inoculate with cowpox in France proving
futile, Dr. Woodville went over to Paris in 1800 to show in
practice the method of operation. He had a warm reception, and the
Quaker was overwhelmed with the exuberant attentions to which he
was subjected. In the _Moniteur_ he was described as “a learned
man, animated with generous zeal, and worthy of gratitude and
praise;” who had inoculated six thousand children with invariable
success; and that cowpox as a preventive of smallpox could only be
spoken of as something miraculous. A house was opened as a vaccine
station, and men, women, and children, flocked thither to receive
the benign fluid and life-long protection from a dreadful malady.
When the negotiations for the peace of Amiens were in progress,
1802, an address was presented with much pomp to the Marquis
Cornwallis by the Medical Committee of the Somme, claiming
brotherhood with the physicians of England, eulogising Jenner,
denouncing his detractors, stigmatising variolators as acting
neither from the love of truth nor for the glory of their
profession, but, from avarice and hatred of improvement; whilst, as
the result of numerous experiments, “the discovery made in England
had been stamped with the seal of infallibility in France.”
At first, vaccination in France was left to voluntary effort, and
made little progress in face of a strenuous resistance developed by
alarmed variolators; but a severe smallpox epidemic in 1802 incited
the Government to action. A medical commission was appointed to
investigate and report, and in 1804 it was determined to spare no
effort to extend vaccination over the whole of France. A Central
Committee for Vaccination was constituted, and appeals and commands
were addressed to the clergy and officials of all orders to have
those under their authority and influence inoculated with cowpox.
Some préfects were content to recommend and warn, but others
adopted more vigorous measures, such as the exclusion of the
unvaccinated from schools, from employment, from charities--in
short, anticipating much legislation that has come into force, or
that fanatics wish to bring into force. Nevertheless, the progress
made did not satisfy Napoleon, and seeing that until vaccination
was everywhere paid for by the State, its performance must remain
irregular and perfunctory, a manifesto was issued to the effect
that his Majesty the Emperor and King had learned from the reports
of the Central Committee that the preservation and increase of his
vast dominions were immediately related to systematic and universal
vaccination; wherefore, his Majesty, wishing to give a signal mark
of his paternal solicitude for his subjects, had granted to his
Excellency the Minister of the Interior, an annual special credit,
destined to provide for the expenses necessary for extending the
new practice, and for forming centres of issue of vaccine virus
in twenty-four of the chief cities of the Empire--these, then,
including Brussels, Florence, Parma and Turin. And his Majesty
had also, out of his paternal benevolence, provided annual prizes
as incentives to emulation in propagating vaccination, so that
the scourge of smallpox might be completely banished from his
territories.
It would be idle to speculate as to how much serious faith lay
within this apparent zeal for vaccination; for, as Professor
Seeley observes, “Napoleon seemed to care for no opinion, though
he adopted, with studied artificial vehemence, every fashionable
opinion in turn.” There might be, I dare say, something piquant to
his theatrical genius in opposing his odious contempt for human
life to the rigorous enforcement of what was considered a supreme
prescription for its preservation. Jenner availed himself of the
Emperor’s histrionic instinct in soliciting the release of English
travellers detained in France. To one of these occasions we owe
the artless anecdote of the arrest of Napoleon’s refusal by the
interposition of Josephine, who exclaimed, “Jenner!” The Emperor
paused and said, “Jenner! ah, we can deny nothing to that man!” It
is sad to relate, the favour was not reciprocated. When Jenner,
at the suggestion of Baron Corvisart, appealed to the British
Government for similar indulgence to a Frenchman, he had to report
that there was no charm in his intervention among his countrymen.
That vaccination should have a welcome in Spain was not surprising,
after its reception in Naples. The craze was universal, and
diffused through the lowest intelligences. Cowpox was introduced to
Madrid with the certificate of France under that of England; and,
spite of the distractions of the time, excited much attention. Mr.
Allen, secretary to Lord Holland, writing to Jenner from Madrid in
1803, observed--
There is no country likely to receive more benefit from your
labours than Spain; for, on the one hand, the mortality among
children from the Smallpox has always been very great; and, on
the other hand, the inoculation for the Cowpox has been received
with the same enthusiasm here as in the rest of Europe; though
I am sorry to add that the inoculation of the spurious sort has
proved fatal to many children at Seville, who have fallen victims
to the Smallpox after they had been pronounced secure from that
disease.[253]
There were philosophising doctors in Madrid who did not see why
cowpox should possess a singular efficacy, and induced the King,
in 1804, to order that all the children in the foundling hospital
should be inoculated with goatpox. They did not, perhaps, know that
Jenner had inoculated his son with swinepox, and that the child
underwent the variolous test on several occasions with impunity.
The great event in connection with Spain was the expedition of
Dr. Francis Xavier Balmis, physician to his Catholic Majesty. He
obtained a concession to introduce vaccination to the colonies
in America and Asia, and to defray expenses by freely trading in
merchandise. He sailed from Corunna, 30th November, 1803, with
twenty-two children for the propagation of virus. The Canary
Islands were first visited, then Porto Rico, and at Caracas the
party divided, Don Francis Salvani proceeding to Peru and Chili,
whilst Balmis attended to Cuba and Mexico, crossing the Pacific
to the Philippines with twenty-six children to maintain the
succession of the virus, and proceeding from thence to Macao and
Canton. Having circumnavigated the globe as vaccinator and trader,
Balmis re-appeared in Madrid with great _éclat_, and kissed the
King’s hand on 7th September, 1806. Philanthropy and business were
successfully combined, for as Moore, writing in 1817, observes--
Nearly three years were nobly spent by this excellent man in
putting a Vaccine Girdle round the globe; and it is an additional
pleasure to learn that by trading during his circumnavigation, he
acquired an easy fortune. He now enjoys at Madrid the distinction
he has merited, and patronises the diffusion of Vaccination
through the Peninsula.[254]
The expedition of Balmis naturally excited much attention, and its
progress and results were described in terms of inflated rhetoric.
Thus, we read in Baron’s _Life of Jenner_--
The conductors of the expedition were _everywhere_ welcomed
with the _utmost enthusiasm_. It was to be expected that the
representatives of the Spanish Monarch, and all the constituted
authorities, would gladly co-operate; but it was scarcely to be
anticipated that the unenlightened minds of the Indians would so
soon appreciate the value of the mission. It is, nevertheless,
most gratifying to know that the numerous hordes which occupy
the immense tract of country between the United States and the
Spanish colonies _all_ received the precious fluid with _the
utmost readiness_. They acquired the art of vaccinating, and soon
performed the operation with great dexterity.
Thus not only the Spanish Americans were brought under the dominion
of cowpox, but the Indians, yea, _all_ the Indians; and not
reluctantly, but joyfully, and became experts in the practice of
the rite! Baron continues--
Fame had preceded the arrival of Salvani at Santa Fé. On
approaching the capital, he was met by the Viceroy, the
Archbishop, and all the civil and ecclesiastical authorities.
The event was celebrated with religious pomp and ceremonies;
and in a short time more than fifty thousand persons were
vaccinated. Similar honours awaited the expedition _throughout
its whole course_. At Quito they were greeted with boundless joy
and festivity. Such expressions well became them. The people of
Colombia, the Indians more especially, having been often scourged
by the horrid ravages of Smallpox, regarded it as the most
terrible affliction which Heaven could send them. On its first
appearance in a village, a panic seized every heart; each family
prepared an isolated hovel, to which those who were supposed to
be infected were banished. _There_, without succour, without
remedy, and with a very insufficient supply of food, they were
exposed to the alternations of a very variable climate, and
left to their fate. _In this way whole generations perished._
Under Viceroy Toledo the population of the native Indians had
amounted to 7,500,000; but at the time of the Balmis expedition,
the number was supposed to be reduced to one-fifth--that is
1,500,000.[255]
Indian and savage statistics in connection with smallpox and
vaccination are usually little else than exercises in imaginative
desire--less what is true than what is wished to be true, or
to be taken for true. We know the difficulty of vaccinating
populations dwelling within defined limits and under highly
organised governments, and we can therefore estimate the claims
made for Balmis and his partners as roving traders and quacks in
the territories occupied by Spaniards and Indians. Yet it was with
yards of mythical rubbish of this sort that English vaccinators
tried to divert the attention of their countrymen from the failures
of vaccination within their own experience; and when worried with
ever-recurring disasters at home, it was in turning to Mexico and
Peru that Jenner professed to find consolation.
Dr. Sacco, of Milan, was described as “the apostle of vaccination
in Northern Italy,” and “unquestionably the greatest vaccinator
in the world.”[256] His operations received the sanction of the
Napoleonic administration, and as early as 1801 he was appointed
Director of Vaccination to the Cisalpine Republic. “Strong
measures,” writes Moore, “were adopted; proclamations were read
from every pulpit; vaccination was practised in every church;
and the clergy gave such effectual aid, that the Professor and
his associates in three years vaccinated 70,000 persons, and
extinguished smallpox in Lombardy.”[257] In other words, the
vaccination of 70,000 persons extinguished smallpox in a population
of several millions! Baron enlarges the numbers, saying that Dr.
Sacco and his assistants in the course of eight years vaccinated
1,300,000 persons; and cites a letter from Sacco, dated from
Trieste, 5th January, 1808, with the following extraordinary
statement--
During eight years I reckon more than 600,000 vaccinated by my
own hand, and more than 700,000 by my deputies in the different
departments of the kingdom. I assure you, out of a population
of 6,000,000 to have vaccinated 1,300,000 is something to boast
of; and I flatter myself that in Italy I have been the means of
promoting Vaccination in a degree which no other kingdom of the
same population has equalled.[258]
Moore’s 70,000 is a credible number, whatever may be thought of
its vicarious operation; but Sacco’s 600,000 by his own hand
in eight years! Ah, well! when we are lost in the fabulous, it
is unnecessary to waste our strength in the discrimination of
the greater from the less in falsehood. Nevertheless, taking
Sacco’s figures, we have to observe that the vaccination of
1,300,000 saved 6,000,000 from smallpox. That Italy was freed from
smallpox is true, and the exemption of the population, whether
vaccinated or unvaccinated, was prolonged over nearly thirty
years. The disappearance of the disease had, however, set in
before vaccination was heard of, but the subsidence was claimed
for Sacco, although it extended to millions of Italians who owed
nothing to the new prophylactic. As already observed, from some
cause undefined, the area and intensity of smallpox was signally
diminishing toward the close of last century, and this in spite of
the stimulus applied to the disease by variolous inoculation. It
may have been so stimulated as to have been worked out--forced, as
it were, to exhaustion, after the habit of much else, good and bad,
when developed to the extremity of existence.
As a grand vaccinator Dr. De Carro, of Vienna, was scarcely less
distinguished than Sacco. He was a Swiss from Geneva, who had
studied and graduated at Edinburgh, and settled in Vienna. He
performed the first vaccination on the Continent, in 1799, with
virus conveyed on a couple of threads from Dr. Pearson; and in 1802
he succeeded in transmitting the first effective virus to India.
De Carro conducted his operations with great energy and tact, and
in 1802 he induced the Austrian Government to issue an ordinance
conferring on vaccination Imperial sanction and recommendation.
Concurrently with this activity, smallpox was abating, and _post
hoc_ was converted into _propter hoc_. De Carro was credited with
the extinction of smallpox in Vienna; but as no more than a portion
of the citizens had been vaccinated, Vienna thus supplied another
instance of the vicarious influence of the Jennerian rite.
Sacco and De Carro corresponded with Jenner, and it is worth noting
that both concurred with him in the opinion that cowpox originated
in horsegrease; and, further, that horsegrease was as good against
smallpox as horsegrease cowpox itself. Indeed, Sacco set up a stock
of virus derived from horsegrease, operated with it, and supplied
De Carro, who used it so freely in Vienna that, as he said, he
could not tell the vaccinated from the equinated. Writing to
Jenner, on 21st June, 1803, De Carro observed--
The means of making your discovery were everywhere; yet nobody
before you had the least idea of the singular connection between
the Horsegrease, the Cowpox, and the Smallpox.[259]
The favour shown for vaccination by the English Court facilitated
its adoption throughout Germany; and yet it might be said the craze
went of itself, compelling patronage and exacting advocacy. The
King of Prussia opened a Royal Inoculation Institute in Berlin,
and tracts and medals, speeches and sermons, were brought into
requisition to recommend the new rite. From the furore created,
many were led to believe that all Prussia was vaccinated, and as
smallpox ceased to prevail, cowpox had the credit. To vaccinate a
nation, however, is far from easily accomplished, and when we refer
to the official accounts, we discover that, notwithstanding great
ado, the numbers operated upon constituted less than a tithe of
the people. Jenner cites a report of Professor Avelin, of Berlin,
in a letter to Moore, 15th February, 1812, as authority for these
statistics--
The anniversary of the invention of the Cowpox Inoculation, or
the Jennerian Feast, was celebrated very solemnly at Berlin
on 14th May. By public accounts, it appears that there were
inoculated in all the Prussian States--
In 1801 9,772
1802 17,052
1803 50,054
1804 102,350
1805 43,585
At these times the population was about 9,743,000. From 1806 to
1810 (since the horrible war and the diminution of the population
to 4,338,000) the inoculated were 160,329. Dr. Bremer alone at
the Royal Institute in Berlin inoculated 14,605. The total, as
officially and voluntarily sent to the Government, amounted to
402,720 vaccinated, but certainly one-half was not officially
mentioned. It may certainly be at least 600,000, or even
800,000.[260]
Supposing a million had been vaccinated in Prussia in the course
of ten years, let me ask once more, how could they have saved the
remaining millions from smallpox? Yet, with knowledge of these
figures, Moore, the Director of the National Vaccine Establishment
in London, did not hesitate to write--
The King of Prussia directed his children to be vaccinated,
and also issued orders that Vaccination should be immediately
employed in the Army; and the new practice encountered no
further difficulties. By which, and by the total abandonment of
Variolous Inoculation throughout Germany, the Smallpox rapidly
declined; and in a few years was extinguished in some of the
largest cities, from whose purlieus infectious diseases are
expelled with great difficulty. Thus even in Vienna, where full
four hundred persons had annually been destroyed by the Smallpox,
this mortality diminished rapidly after the introduction of the
Vaccine, and in five years absolutely ceased.[261]
Russia, of course, followed suit in cowpox inoculation. At the
coronation of Alexander in Moscow in 1801 a foundling was operated
on, christened Vaccinoff, pensioned for life, and dispatched to St.
Petersburg to serve as a source of virus for other foundlings. Then
followed imperial decrees prescribing vaccination, and Dr. Crichton
was directed to organise a medical staff for the performance of the
rite in each province of the Empire. In 1811 a ukase was issued
commanding all Russians to be vaccinated within three years. As
measuring the possibilities of despotism in such a matter, we learn
from Dr. Crichton that between 1804 and 1812 there were 1,235,597
vaccinations performed in Russia--a similar number to that which
Sacco professed to have accomplished in Northern Italy in the same
time. It was estimated in Russia that of every seven children
born, one perished of smallpox, and therefore Crichton argued
the lives of 176,514 had (up to 1812) been saved by vaccination.
The calculation illustrates the facility with which the early
vaccinators deceived themselves--first, as to the certainty of
their prophylactic; second, as to its vicarious efficacy; and,
third, in assuming that a reduction in smallpox represented a
reduction in mortality.
From Crichton, too, we learn that there were anti-vaccinists in
Russia in those days--
Notwithstanding the supreme order of His Imperial Majesty, that
all his subjects he vaccinated within three years, we find that,
powerful as his Majesty is, this cannot be executed. There is
a power greater than sovereignty, namely, the conscience of
religious opinions of men, and in one or two of the distant
governments there exists a peculiar religious sect belonging to
the Greek Church, who esteem it a damnable crime to encourage
the propagation of any disease, or to employ any doctors, or
to swallow any medicines under the visitations of God. Reason
has been employed in vain with these poor people; they have
been threatened with severe punishments in case they remain
refractory, but all to no purpose. You may well imagine that
no punishment has been resorted to, though threatened, and the
Government has come to the wise conclusion of leaving the dispute
to time.[262]
To complete this rapid survey of the diffusion of vaccination
throughout Europe, there remain Sweden with Finland, and Denmark
with Iceland; but as the case of Sweden is specially interesting
and instructive from the fulness and precision of its vital
statistics, coupled with the claim made by vaccinators that Sweden
affords irrefutable evidence of the efficacy of their prescription,
I reserve it for a special chapter. There is nothing pleasanter
than finding the strongholds of one’s antagonists, capturing, and
occupying them.
FOOTNOTES:
[252] Boswell (Croker’s Ed.) vol. vii. p. 102.
[253] Baron’s _Life of Jenner_, vol. i. p. 604. Allen little
suspected that there never was any spurious Cowpox; that it was
only “spurious” when it did not prevent Smallpox.
[254] _The History of Vaccination._ By James Moore. London, 1818.
P. 279.
[255] Baron’s _Life of Jenner_, vol. ii. pp. 80-2.
[256] Baron’s _Life of Jenner_, vol. ii. p. 234.
[257] _Ib._ vol. ii. p. 112.
[258] _History of Vaccination_, London, 1817. P. 263.
[259] Baron’s _Life of Jenner_, vol. ii. p. 432.
[260] Baron’s _Life of Jenner_, vol. ii. p. 378.
[261] _History of Vaccination_, p. 245.
[262] Baron’s _Life of Jenner_, vol. ii. p. 186.