THE NATIONAL VACCINE ESTABLISHMENT--1841-50.
Along with the prohibition of Variolous Inoculation in 1840,
Parliament passed an Act for the provision of Vaccination out of
the poor-rate. A scheme had been formulated and petitioned for
by the Provincial Medical and Surgical Association in 1838, with
the expectation that the Government might be induced to create
a multitude of places for “regularly educated vaccinators, with
suitable salaries, in districts sufficiently numerous to embrace
the whole of the poor population of the country.” The House of
Commons being of a thrifty turn in those days, did not however
favour such a magnificent development of place and pay under
the National Vaccine Establishment, and disposed of the project
by referring the provision of vaccination to the parochial
authorities, who might be trusted to do what was needful with due
regard to economy. In every union, and in every parish that was
not in union, it was provided that there should be one or more
medical practitioners appointed by the Guardians for the gratuitous
vaccination of the inhabitants, with remuneration from the rates
according to the number operated upon.[278] This accession to
their burdens met with anything but welcome from the ratepayers
in general. Contracts for vaccination at so much per head were
submitted for competition, and those who accepted the rite at the
public expense were spoken of as paupers, and in some places had
their names published to “shame them.” To remove the stigma of
pauperism from the parish prophylaxy, an Act was passed in 1841 in
which it was declared that public vaccination was not of the nature
of “parochial relief, alms, or charitable allowance,” and did not
therefore deprive the recipient of any “right or privilege,” or
subject him “to any disability or disqualification whatsoever.”[279]
The reports of the National Vaccine Establishment from 1841 to 1850
continued to be of the same perfunctory character. They usually
started with a profession of confidence in vaccination, after the
fashion of Mrs. Micawber’s resolution never to desert Micawber; the
signature to which declaration by the President and Senior Censor
of the Royal College of Physicians, and the President of the Royal
College of Surgeons being accompanied with a douceur of £100 to
each. For example, we read--
1841.--Smallpox has prevailed epidemically with considerable
severity since our last Report; but we do not abate an iota of
our confidence in Vaccination as the best protective against its
malignant influence.
1845.--The unabated confidence with which we continue to regard
Vaccination, etc., etc.
1847.--Nothing has occurred to diminish our confidence in the
protective influence of Vaccination. It is true that Smallpox
has now and then reappeared; and lately to an extent which has
called for additional efforts on the part of all the officers of
the Establishment; but we regard such recurrence as due to the
ordinary operations of those periodical influences which give to
the disease its epidemic character; and in some localities, as in
Ireland, to that distress with which contagious diseases are so
invariably associated.
The reporters apparently forgot that according to the doctrine
of which they were the representatives, vaccination excluded the
possibility of smallpox under whatever circumstances of atmosphere,
filth, or privation. If only effective in the absence of the
ordinary conditions of smallpox, wherein consisted the benefit of
the rite?
Ceely of Aylesbury in 1839, and Badcock of Brighton in 1840,
succeeded in inoculating cows with smallpox, and the resulting
virus was described as cowpox, and used for vaccination far and
wide. Apparently the procedure was not approved by the Vaccine
Establishment, for we read in the report--
1841.--The matter we employ is obtained by succession from the
original virus communicated by Dr. Jenner himself, and that we
find is as effectual as ever. We may be excused therefore, we
hope, if we discourage an incautious dissemination of matter
obtained from new sources, which has not stood the test of ample
experience.
The original virus communicated by Jenner himself! What was it?
When the National Vaccine Establishment was instituted in 1808,
the virus in circulation in London was accepted as stock, and
it certainly had several origins. It was cowpox as discovered
by Pearson; it was horsegrease cowpox and horsepox as derived
from Jenner; and there is reason to believe it was smallpox from
Woodville and others. The claim, therefore, to the possession of a
specific variety of matter communicated by Jenner was fictitious.
Again, through the recurrent failure of vaccination to avert
smallpox, the Board had to discountenance the assertion that their
virus had lost its virtue through prolonged transmission--a reason
which led some to prefer the fresh variolous stocks of Ceely and
Badcock--
1840.--The experience of another year has afforded proofs of the
propriety, in the present state of our knowledge, of preferring
Vaccine Matter, the produce of the original virus furnished by
Dr. Jenner, which has now passed happily through successive
generations of subjects in the course of 43 years, and which
forms the principal source of our supply, to any which may have
been recently taken from the cow.
Here we have “the original virus furnished by Dr. Jenner” set forth
as no more than “the _principal_ source of supply.” The reports are
characterised by many similar inconsistencies--
1845.--We regard as erroneous the belief that Vaccine Virus
undergoes deterioration by being kept; in proof of which we are
prepared to establish, by unquestionable documents, the striking
fact, that Lymph which had been conveyed to and from India has
retained its protective properties wholly unimpaired after a
lapse of 20 years.
Another vexation of the Board was due to the assertion that the
protective virtues of vaccination gradually wore out, and that
the repetition of the rite was necessary for the maintenance of
salvation. In the _London Medical Gazette_, 2nd August, 1844, it
was proclaimed--
We are sorry to announce the extensive prevalence of Smallpox at
this time among us. REVACCINATE, REVACCINATE, say we.
Such advice was essentially heretical and damnable; for Jenner
affirmed and maintained--
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 Smallpox.
If revaccination were possible, smallpox after vaccination was
possible; and if so much were conceded, on what ground was
vaccination to be defended? Whatever the facts, the members of
the Board resolved to stand loyally by the primitive Jennerian
doctrine, and in their Report for 1851 thus testified--
It may be expedient to remind the public of the established fact
which the Board upon former occasions anxiously insisted upon,
that the restriction of the protective power of Vaccination to
any age, or to any term of years, is an hypothesis contradicted
by experience, and wholly unsupported by analogy.
Notwithstanding the prohibition of Variolous Inoculation, the
Board had repeatedly to deplore its continuance especially in
Ireland. Thus we read--
1850.--The Board again entreat the attention of the Government to
the fact that Inoculation for the Smallpox still continues; and
that the disease is communicated by vagrants to those unprotected
by Vaccination in town and country. The contagion is carried
throughout the land by wandering Irish, and no care, however
great, can be successful in eradicating Smallpox, whilst the
neglect of Vaccination and the practice of Variolous Inoculation
are permitted in Ireland.
It was Jenner’s practice to attribute to wilful blindness and
innate depravity any scepticism as to the efficacy of vaccination;
and throughout the Reports of the Establishment this habit of
imputation was maintained. Vaccination was treated as a sort
of divine revelation, plenary and manifest, which could only
be disputed or resisted from deliberate perversity, or, more
charitably, from abject dulness or ignorance; and it would be
easy to construct a catena of piquant deliverances under this
semi-theological persuasion. Such observations as the following
were of the order of matter-of-course--
1850.--We regret to learn that in our own country the spread of
Vaccination is still materially impeded by influences emanating
from ignorance and prejudice in the lower orders, and from
prejudices in many who cannot plead the excuse of ignorance.
1851.--It is lamentable to observe not only the indifference, but
the active hostility displayed by the community to Vaccination.
Deeply-rooted prejudices and absurd superstitions are ever
opposing its adoption.
The Reports of the Establishment year after year displayed in
full measure the familiar complacency of official routine--where
pay is constant and wheels propelled from office desks revolve
smoothly in space--so many Londoners vaccinated, so many charges
of virus distributed, and confidence in the sacred prophylactic
unabated. A revolution was, however, impending. The attitude of
the public mind toward disease had become transformed. Faith in
sanitation as a preventive of fevers had been created, and a
popular demand for sanitary improvement had set in. Under cover of
this new enthusiasm some of the shrewder advocates of vaccination
conjectured that it would be possible to effect its endowment
and establishment on a scale hitherto unattempted in England. It
was true that vaccination had no relation to sanitation; but the
reforming and philanthropic mob were madly in favour of whatever
bore the promise of health, and were not likely to show themselves
hypercritical or obstructive.
The first movement toward a new advance is discernible in the
Report of the Establishment for 1850 wherein we read--
The Board have had to solicit the attention of Her Majesty’s
Government on several occasions to the deplorable fact that a
very large proportion of the children of the poorer classes
in the Metropolis, and in England and Wales generally, but
above all in Ireland, remain year by year without the benefit
of Vaccination. Their testimony on this important part of the
sanitary condition of the population has been derived from the
reports of numerous competent medical witnesses in all parts of
the United Kingdom, and from the frequent recurrence of rapid
and fatal invasions of Smallpox, to which their attention has
been repeatedly called by urgent applications for Vaccine Lymph.
It is satisfactory to find that the representations which the
Board have made are most unequivocally confirmed by the report of
Mr. Grainger, from which it appears that the number of persons
under one year who were vaccinated during the year ended 29th
September, 1848, in 627 Unions of parishes in England and Wales
(exclusive of those vaccinated at the cost of their parents)
amounted to no more than 33 per cent., compared with the total
number of births registered in the same period.
These figures are worth noting. Dating from 1840, an effort was
made to overtake the vaccination of the people by the agency of
the poor law; and yet so late as 1848, not more than one-third
of the children born were accounted for as Jennerised. Adding to
this third the offspring of the upper and middle classes, we may
safely conclude that up to 1850 not half the inhabitants of England
and Wales were vaccinated; and the unvaccinated half included the
lower classes most subject to smallpox--victims of that “distress
with which contagious diseases are so invariably associated,” to
cite the words of the Report for 1847. The point is especially
worth noting because the decline of smallpox, which set in last
century, is continually ascribed to vaccination. A true cause
however must be commensurate with the effect; and yet here we see
the asserted cause of the fall in smallpox did not apply in 1848 to
half the English people; in which half, moreover, lay nine-tenths
of the field in which smallpox was possible. The Report for 1850
continues--
The Board lament that they have no means of adopting or enforcing
such measures as are obviously necessary for the prevention of
Smallpox. They have no power of instituting domiciliary visits,
or house to house visitation; and indeed hitherto such have been
deemed too much of an encroachment on the liberty of the subject.
They have no power to punish officially the practice of illegal
Inoculation, or the exposure of infected persons; and they have
only had the means granted to them of prosecuting such offenders
in two cases, in order to establish the fact of the illegality of
Variolous Inoculation. They can only recommend and aid, but they
cannot enforce Vaccination.
The progress of Vaccination is more rapid in Foreign Countries
where municipal measures or legislative enactments are adopted
to promote its dissemination; and they beg to express their
conviction that if England is to be free from Smallpox, the
interposition of the Legislature alone, by wise and comprehensive
measures, can disarm the Pestilence of its terrors, and realise
the fond hopes and prayers of the Friends of Humanity for its
extinction.
In these observations is revealed the movement of a new spirit--of
a revived resolution to obtain for vaccination the force of
law. Similar projects had from time to time been advanced by
enthusiasts, and swept aside by statesmen. Canning, for instance,
had declared that he could not imagine any circumstances
whatever that would induce him to consent to the compulsory
infliction of vaccination; and, at a later date, Sir Robert Peel
expressed himself to like effect, saying, “To make vaccination
compulsory, as in some despotic countries, would be so opposite
to the mental habits of the British people, and the freedom of
opinion wherein they rightly glory, that I never could be a
party to such compulsion.”[280] But Peel died in 1850, and a
strong public opinion in favour of sanitary reform had come into
existence without much scruple as to methods. Diseases, hitherto
regarded as supernatural inflictions, were traced to conditions
of life, remediable or avertible; so that the submission and
terror which sickness formerly inspired gave place to widely
different sentiments--a temper of intolerance with illness, and
a determination to extirpate its infectious forms with those who
in ignorance or wilfulness should persist in their generation and
diffusion.
FOOTNOTES:
[278] 3 & 4 Vict., cap. 59.
[279] 4 & 5 Vict., cap. 32.
[280] _Report of Royal Jennerian and London Vaccine Institution_,
1853.