An Estimate of the True Value of Vaccination
as a Security Against Small Pox
------------------------------------------------------------------------
AN
ESTIMATE,
_&c. &c._
------------------------------------------------------------------------
Newcastle; Printed by T. & J. Hodgson,
Union Street
------------------------------------------------------------------------
AN
ESTIMATE
OF THE TRUE VALUE OF
VACCINATION
AS A
SECURITY AGAINST SMALL POX.
BY
T. M. GREENHOW,
MEMBER OF THE ROYAL COLLEGE OF SURGEONS IN LONDON;
SURGEON TO THE LYING-IN HOSPITAL, TO THE CHARITY
FOR POOR MARRIED WOMEN LYING IN
AT THEIR OWN HOUSES, AND TO THE
INFIRMARY FOR DISEASES OF
THE EYE, NEWCASTLE.
“And in order to stimulate the wise and good to aim strenuously at this
consummation (the total extirpation of Small Pox), let it be constantly
borne in mind, that the adversary they are contending with is the
greatest scourge that has ever afflicted humanity. That it is so, all
history, civil and medical, proclaims; for though the term Plague
carries a sound of greater horror and dismay, we should probably be
within the truth, if we were to assert, that Small Pox has destroyed a
hundred for every one that has perished by the Plague.”
_Sir Gilbert Blane._
LONDON:
PRINTED FOR BALDWIN, CRADOCK, AND JOY; AND
EMERSON CHARNLEY, NEWCASTLE.
1825.
------------------------------------------------------------------------
Preface.
My design, in entering upon the following little work, has been to
collect, and to compress within as narrow a compass as possible, the
principal facts and evidences upon which the claims of Vaccination are
founded; that the public may be furnished, in a concise but
comprehensive form, with the information which is essential to their
forming a correct judgment on this momentous question.
That much misapprehension and some prejudice prevail on this subject,
my recent observation and experience have convinced me; and when I
reflect on the pernicious effects, which, in Newcastle and its
neighbourhood, are at this time taking place in consequence of them,
and which they must continue to produce while they are permitted to
exist, I feel that a collective detail of the evidence calculated to
remove them is much needed, and that, being sensible of this, it
becomes a duty incumbent upon myself to endeavour to supply so
important a desideratum.
In making this attempt, I have been desirous of avoiding any
unnecessary delay, and have therefore, perhaps, been obliged to collect
facts, and to deduce arguments from them, with a degree of haste,
which, while it must have occasioned many imperfections in the
execution of my design, will, I trust, be admitted as some apology for
such defects: I am willing, however, to hope that they will not be
found of sufficient magnitude materially to interfere with the useful
tendency of the estimate.
The works of those writers whom I have consulted, and whose authority I
have quoted in support of the efficacy of Vaccination, are familiar to
the Medical Profession, and, with scarcely an exception I believe, its
members have drawn the same satisfactory conclusion from the facts
which are detailed in them. But as these works, are, for the most part,
strictly professional, they have not come before the public in general,
who have not, in consequence, had equal opportunities of convincing
themselves of the true value of Vaccination. It is, however, manifestly
more important, in proportion as their relative number is greater, that
the latter should be convinced of this, than the former only. The
present estimate, therefore, is more particularly intended to satisfy
the doubts, and to remove the apprehensions of the community at large;
though I trust, should I in any degree have succeeded in the attempt,
it may also be read by my professional brethren not without some
portion of satisfaction and of approbation.
But, after all, should my object in endeavouring to convince the more
enlightened parts of the community, (from whom alone I can hope for a
proper consideration of the evidence I have adduced,) be attained, much
will yet remain to be done: and I have endeavoured to point out the
necessity of a general co-operation, in order to give the fullest
effect to the paramount capabilities of Vaccination.—Amongst the
poorest and least informed classes of society, a written evidence of
this description, can scarcely be expected either to gain access or to
meet with the requisite consideration; and the ignorance, the
prejudices, and the _apathy_, which have been found to exist in some of
them, must therefore be overcome by other means. It is my wish to
direct attention more especially to the _latter_ difficulty, having
myself witnessed some instances, and having been informed of many
others, wherein the parents have regarded the health and lives of their
children so little, as not only to despise the security afforded by
Vaccination, but to omit the most ordinary precautions against Small
Pox infection, and to reject the gratuitous medical assistance which
was within their reach.[1]
-----
Footnote 1:
Mr. Wilkie (the respectable resident apothecary at the Dispensary in
this town) lately informed me that a woman, who resides in Sandgate,
after losing _three children_ from Small Pox, during the present
prevalence of that disease, would yet neither use precautions nor
remedial measures for the preservation of the remainder; although she
daily witnessed the efficacy of Vaccination among her neighbours,
even when performed during the existence of Small Pox itself in other
members of the same families.
-----
But there are links by which all the various classes of society, from
the highest to the lowest, are connected; and it is through the medium
of these that we must hope for the removal of the difficulties referred
to. There are few of the rich, who have not the power of influencing
some of the poor, nor do I believe there are any of the latter who may
not be influenced by some one or other of the former. Whether this
influence may be exerted through interest, through persuasion, or
through the conviction of reason, is a matter of less moment than the
attainment of the end in view—namely, _to induce all, without
exception, to have their children vaccinated during infancy_—and were
it employed in its fullest extent, this end might certainly be
accomplished.
It hence becomes of the utmost importance, that those should themselves
be convinced of the true value of Vaccination, who may possess the
power, by whatever means (never omitting, however, when possible, to do
it through the medium of _reason_) of extending the operative influence
of their conviction to others. From the wealthy, the intelligent, and
the educated parts of society then, I venture to hope that the
following Estimate will meet with some serious consideration, and that,
in whatever degree it may directly contribute to remove doubt, it may,
at least, excite such a spirit of candid and deliberate enquiry into
the subject of Vaccination, as may ultimately render its great value
universally acknowledged, and its practice in every instance adopted.
_Westgate Street, Newcastle,
November 20th, 1824._
------------------------------------------------------------------------
AN
ESTIMATE,
_&c. &c._
INTRODUCTION.
What reliance may safely be placed on Vaccination as a means of
exemption from Small Pox?
It may be affirmed, without hazard of contradiction, that no question
connected with the physical well being of mankind involves
considerations of more serious interest, or consequences of more vital
moment, than that which has just been proposed. During the last quarter
of a century, it has engaged a degree of attention, both from medical
practitioners and from society in general, proportionate to the great
importance of the subject; and though among the former, with very few
exceptions, one pretty uniform opinion may prevail respecting the true
value of the Jennerian discovery, I have reason to know, that many
doubts and apprehensions still linger in the minds of not a few of the
latter. These have been cherished or revived by circumstances, of a
nature, it must be admitted, well calculated to shake their confidence
in Vaccination as an absolute preventive of Small Pox; which,
unfortunately for the cause, on its first introduction into practice,
it was generally believed and asserted to be; but which subsequent
experience has proved can no longer be contended for. I trust, however,
to be enabled to prove, to the satisfaction of every impartial
enquirer, that the value of Vaccination is not essentially diminished
on that account; that an imperfect knowledge of its effects can alone
have given rise to the doubts and apprehensions referred to; and that
nothing is required for their entire removal but a more intimate
acquaintance with the subject. It is the purpose of the present Essay,
then, to bring under review the principal facts connected with the
history of Small Pox and of Vaccination which, in any way, bear upon
the question proposed; to arrange them in such order, and to place them
in such lights, as may best elucidate the subject, and enable those,
who have children not yet protected in any way from the infection of
Small Pox, to form a clear and satisfactory judgment; a judgment
unbiassed by prejudice, matured by a serious and candid consideration
of the evidence that will be laid before them, and on which may depend
life itself, or much that renders life desirable.
I have been led to believe that such an attempt may at this time prove
of considerable service, in consequence of facts which have lately come
under my own observation, and which have induced me to pay more
attention than I had previously done to this singularly curious and
interesting subject.
The facts to which I allude are—1st. The prevalence of Small Pox to a
considerable extent in the town and neighbourhood of Newcastle, by
which a number of deaths among children, _who had not been vaccinated_,
has been occasioned.—2dly. The occurrence of the disease in many
individuals, who had gone through the process of Vaccination; though in
every instance as far as I have been enabled to ascertain, it has been
so mitigated in the violence of the attack as to preclude any degree of
danger, and has never run the regular course of the genuine Small
Pox.—3dly. The impression, which these occurrences have made upon the
minds of those in whose families they have taken place,—an impression
not only unfavourable to Vaccination, but which has induced some to
entertain the idea of again having recourse to inoculation for Small
Pox.—And, 4thly. The occurrence of Small Pox itself a second time in an
individual, who bore ample marks of having already gone through that
disease, which she stated to have taken place naturally when young:
this patient was a servant in a family where three instances had
occurred after Vaccination, and, as in them, the disease was of a mild
and modified character.
In all the cases of Small Pox after Vaccination which I have myself
witnessed, or of which I have been enabled to obtain any distinct
account, the disease has been of so mild a character, and so curtailed
in its duration, that could it have been separated from the terrific
name of _Small Pox_, it would have excited no apprehensions in the
minds either of the patients themselves or of those around them. But it
unfortunately happens that this disease is associated in our minds with
so many terrific accompaniments (which were once indeed its constant
attendants and consequences, and which belong to it in its natural
form, but which, after the employment of Vaccination, have no existence
whatever), that it is difficult for the mind to break through this
association, and to feel satisfied that though Small Pox may still
appear as an occasional visitor, yet, to the _vaccinated_, it is
completely stripped of all that rendered it dangerous in its attack and
serious in its effects.
I have had repeated opportunities lately of pointing out this
satisfactory distinction to the parents of children who were affected
with Small Pox, both after Vaccination and when no such protecting
influence had been employed. The contrast between the characters of the
disease, as evinced in these different individuals, was too striking
not to carry immediate conviction to the minds of all present; and I
believe it has been of considerable service in inducing many to have
their children vaccinated, who would otherwise have omitted it
altogether. These cases occurred among the lower orders of society; and
I feel assured that this demonstrative proof of the utility of
Vaccination will do more to remove the prejudices of these people than
any abstract reasoning from facts of which they have not themselves
been witnesses, however numerous and well authenticated. I should,
therefore, strongly recommend it to every practitioner to take
advantage of any opportunities that may be afforded him of pointing out
this most marked distinction between the natural and modified Small
Pox.
------------------------------------------------------------------------
CHAP. I.
We shall best estimate the value of any means of removing an evil, by
enquiring, in the first place, into the extent of the effects of the
evil which it is our object to remove. And we shall also form the most
correct estimate of the value of the means which have been employed for
its removal entirely, or in part, by reverting to its extent previous
to the employment of such means, and comparing the amount of its former
ill consequences, with those which are still produced by it.
To satisfy ourselves on the subject of the present enquiry then, it
will be useful to put the following queries:—1st. What were the
destructive consequences of Small Pox previous to the introduction of
Vaccination? And, 2ndly, What influence has Vaccination exerted over
these consequences—1. by extensively superseding the cause—and 2. by
essentially interfering with the effect?
To answer the former question satisfactorily, it will be necessary to
enter, at some length into the history of Small Pox, before Vaccination
was proposed as a means of prevention. But it will be remembered, that
previous to that era, a means had been already long in use, for the
purpose of diminishing, at least, the danger of this terrific disease;
and that for half a century the Small Pox had been communicated to
thousands annually by inoculation, with the view of accomplishing this
very desirable end. This will naturally give rise to a second division
of the history of Small Pox. Our first enquiries will therefore be
directed to the time antecedent to the use of inoculation for Small
Pox, when no artificial measures were adopted for protecting mankind
from its fatal attacks.
Although from the vague accounts which earlier European writers have
given of the diseases which came under their notice, it is not always
easy to distinguish very accurately the precise extent to which Small
Pox proved fatal among the nations of Europe, it is yet pretty certain
that for a thousand[2] years before inoculation was introduced, it was
one of the most destructive scourges of the human race, frequently
destroying thousands and tens of thousands, in any district where it
occurred. It was at this time frequently included under the general
term plague or pestilence, which was applied to every destructive
epidemic that took place. It is not necessary, however, for my present
purpose to go back to these remote ages; for, independent of the
impossibility of obtaining sufficiently authentic information whereon
to found any accurate argument, it is not to be doubted that the
fatality of Small Pox, in common with that of every other disease,
would then be materially greater than in the present day, in
consequence of the want of cleanliness and ventilation in our cities
and houses, and of good medical treatment. It will not be difficult,
however, to produce ample proof of the great mortality occasioned by
this disease, at a period when these disadvantages were less felt, and
when the nature of it was sufficiently certain. For this purpose I have
drawn up tables from the bills of mortality of London, comprising a
period of 120 years, viz. from 1703 to 1823, which will form the basis
of my arguments.
-----
Footnote 2:
According to Mr. Moore, (History of Small Pox, p. 66-7) the Small Pox
was first introduced into Europe during the invasion of Spain by the
Saracens, in the commencement of the eighth century: after which, the
infection rapidly spread into France and other countries.
-----
Mr. Moore, in his History of Small Pox, (p. 243) tells us that “Dr.
Jurin took the lead in replying to the opponents of this practice
(inoculation for Small Pox): and being a calm man, well skilled in
calculation, his writings were composed with great good sense and good
temper. He drew his arguments chiefly from an accurate examination of
the London bills of mortality for forty-two years, and from accounts
collected from a few large cities: and he compared the numbers who died
of the Small Pox with the general mortality. From all which he
concluded,
“That of all the children that are born there will, some time or other,
die of the Small Pox, _one in fourteen_.” And “that of persons of all
ages, taken ill of the natural Small Pox, there will die of that
distemper _one in five or six_.”
In other countries this disease appears to have been yet more fatal
than in England. I shall, however, revert to the documents which I have
myself collected on the subject.
The tables, which I have constructed, embrace a period of 20 years
before inoculation was at all employed in this country—the whole period
during which it was in use—and the time which has elapsed since the
introduction of Vaccination. We shall thus be enabled, at a single
glance, to compare the mortality of Small Pox under each of these
several circumstances. In the first column of the table (No. 1.) is
shewn the total number of deaths which occurred within the bills of
mortality during each successive year, and in the second column, the
number occasioned by Small Pox alone.
The table (No. 2.) is divided into periods of five years each—it
consists of four columns—the first of which exhibits the total number
of deaths during each period of five years—the second the number of
deaths from Small Pox—the third shows the proportion of the latter in
each thousand of the former—and the fourth points out the relative
proportion of deaths from Small Pox compared with the whole. I am aware
that the two latter columns may be considered as a repetition of the
same statement, but I think it may appear more striking when placed in
this double form.
When we compare the calculation of Dr. Jurin, which has been quoted
above, (published I believe about the year 1723,) with the first twenty
years of these tables, we shall find, that, with the exception of the
first five years, it is rather below than above the results which they
exhibit; that, according to them, for the fifteen years from 1708 to
1723 inclusive, the deaths from Small Pox exceeded one in twelve of the
whole,—that in 1710 it was about one in seven, and that in 1719,
although the relative number was not quite so great, being in the
proportion of one in eight only; yet that the actual number was greater
than in 1710, amounting to no fewer than 3229, the total number of
deaths being 28,347.
Such was the destructive nature of Small Pox before the introduction of
inoculation. Its ill effects, however, were not confined to those whom
it precipitated into the tomb. A very large proportion of the living,
who were fortunate enough to escape its fatal effects, yet suffered
essentially for the remainder of their lives from its injurious
attacks, not only in the loss of that beauty of countenance which we
all value both in ourselves and in our friends, but frequently in the
serious injury or total destruction of one or both eyes,[3] or of the
general health of the constitution, which was, in many cases, never
afterwards entirely restored, although death was not the immediate
result.
-----
Footnote 3:
“It appears, by a report of the Hospital for the Indigent Blind, that
two-thirds of those who apply for relief, have lost their sight by
Small Pox,”—_Sir G. Blane on Vaccination, p. 9._
-----
Instances, wherein the beauty of the human countenance has been
materially injured by the occurrence of Small Pox in the early stages
of life, are now happily much more rare than formerly, especially in
the higher ranks of society, and I trust will, in the course of another
age, become entirely unknown. There are few of us, however, who are not
still acquainted with some, and who cannot recall many more: and we
every now and then meet with cases of blindness, which had succeeded to
this formidable disease. I have myself had opportunities of seeing
several such instances; and it is but a few weeks since my opinion was
asked respecting a child, who was recovering from the Small Pox in its
worst form, with a countenance dreadfully disfigured, and one eye
entirely destroyed.[4]
-----
Footnote 4:
Since this was written, I have been consulted on account of a little
girl, of seven years of age, who has just sustained the same very
serious deprivation, in consequence of an attack of Small Pox.
-----
That a disease so destructive of human life, and which frequently
entailed on the living such indelible proofs of its severity, should
have been anticipated with peculiar feelings of dread and apprehension
we can well believe, and it was natural that any method, which afforded
a probability of diminishing its danger, and of rendering its attacks
of a milder character, should excite no ordinary degree of public
attention.
How far these ends were accomplished by the artificial communication of
Small Pox by inoculation, we shall now proceed to inquire.
------------------------------------------------------------------------
CHAP. II.
The first individual in England on whom the operation of inoculation
for Small Pox was performed, was the daughter of the celebrated Lady
Mary Wortley Montague. She had witnessed, when in Turkey, the mildness
of this disease as produced by inoculation, and her son had already
passed through the process with safety. “The engraftment of her son
having succeeded; after Lady M. W. M. returned to London in 1722, she
sent for Mr. Maitland, the surgeon, who had attended the boy at
Constantinople; and desired him to engraft her daughter with Small Pox.
He solicited a delay, on account of the weather, and entreated that two
physicians should be consulted. These requests were refused, yet he
obeyed her Ladyship’s injunctions; but when the fever commenced, an old
family apothecary and three physicians were permitted to witness the
process. As the success was complete, Dr. Keith, one of the above
physicians, was tempted to request Mr. Maitland to engraft his child
also, which likewise succeeded; and these cases were rumoured through
the town.”[5]—An experiment was afterwards tried, at the request of the
Princess of Wales, upon “six condemned felons” with success, and her
own children passed through the operation with safety. After this,
inoculation was partially employed for some years, and was again
discontinued—but, about the middle of the last century, great exertions
were made to bring it into general use, and with a considerable degree
of success. We shall presently endeavour to ascertain what influence it
exerted over the prevalence and fatality of Small Pox. But, in the
first place, I think it will be useful to enquire into some of the
arguments which were adduced in support of the practice; and, it may
be, to allude to a few which were opposed to it.
-----
Footnote 5:
Moore’s History of Small Pox, p. 228-9.
-----
The principal arguments, on which the employment of inoculation for
Small Pox was supported, appear to have been the following:—
1. The infectious nature of the disease, which was so virulent as to
permit few individuals to pass through life without being at one time
or other affected by it.
2. Its fatality—destroying at least one in five or six of those
attacked by it.
3. The generally received opinion that no individual could be affected
by it oftener than once. And
4. That, when communicated by inoculation, it was rendered
comparatively mild and devoid of danger, while it afforded equal
security against any future attack of the disease.
The two former of these positions need not engage our attention in this
place—the highly infectious nature of Small Pox has always been
admitted; and I have already brought forward sufficient proof of the
danger to human life which it occasions.
The third proposition is of most material importance; for I am well
convinced that upon a proper understanding of this question depended
the true value of inoculation as far as regarded _individuals;_ and on
it also rests the true value of Vaccination as regards _society in
general_.
It was unfortunate for the cause of inoculation that its early
advocates maintained the absolute impossibility of Small Pox occurring
a second time in the same individual. They thus furnished their
opponents with weapons against themselves, in the cases, which
repeatedly occurred, of those who had passed through the process of
inoculation being afterwards affected by the natural Small Pox; and
were put to the necessity of having recourse to expedients equally
unmanly and uncandid—either of denying that the second disease was
genuine Small Pox, or of asserting that the inoculating process had
been imperfectly performed. Whereas a little attentive observation and
research into the former history of Small Pox, might have satisfied
them, that although in a great majority of cases this formidable
disease did not occur a second time in the same person, yet that
repeated instances took place wherein it did so occur. And that while
it might be assumed as a general rule that the same individual would be
affected once only with Small Pox—it was a rule admitting of
exceptions.
That a second attack of Small Pox may take place in the same
individual, may be proved by a mass of evidence which appears to me to
be perfectly irresistible; and as I consider it very important to the
object of this enquiry that every doubt should be removed on the
subject, I must be permitted to dwell on it longer perhaps than may at
first sight appear necessary. I have great pleasure in acknowledging my
obligation to the valuable “Historical Sketch of Small Pox,” by
Professor Thomson of Edinburgh, for a large share of the evidence which
I shall lay before my readers, to prove the frequency of the recurrence
of Small Pox. Soon after the introduction of inoculation into France,
“a son of M. Delatour, about nine years of age, was inoculated in 1756
for Small Pox, by Surgeon Martin, under the inspection of M. Tronchin,
and passed through the disease in a satisfactory manner. This boy
remained in good health for upwards of two years, when an eruption,
supposed by some to be Small Pox, appeared upon him, as well as upon
four of his companions in the same boarding-school. The different
opinions formed of the nature of this eruption by the medical
practitioners who saw it, and who seem to have judged of it according
to the preconceived notions they entertained with regard to the
possibility of the recurrence of Small Pox, present (says Dr. Thomson)
so true a picture of what has occurred in similar cases since the
introduction of Vaccination, and of the manner in which doubtful cases
of varioloid eruptions continue still to be judged of, that I cannot
avoid giving you an abstract of the discussions to which this case gave
rise.”[6]—Dr. Thomson goes on to say, that “M. Gaulard, Physician in
ordinary to the King, was called to see the son of Delatour on the
third day of the eruption, which he declared to be a mild case of Small
Pox, of the kind commonly called, he says, though improperly so,
Chicken Pox, and the disease in the boy’s companions he considered of
the same nature.”—Four physicians were called in to consult with Mons.
Gaulard, who[7] “gave an account of the progress of the disease which
contains a description of varioloid eruptions, very similar to those
which have of late been described under the denomination of modified
Small Pox.
-----
Footnote 6:
Dr. Thomson’s Sketch, &c. p. 53.
Footnote 7:
Dr. Thomson’s Sketch, &c., p. 54.
-----
“These gentlemen mention also, that _two_ of the other children
affected, had previously passed through natural Small Pox; and conclude
with declaring that, from these circumstances, they believe that the
disease in Delatour and his companions, _was neither the Small Pox nor
the Chicken Pox, but a chrystaline eruption, with which they were well
acquainted_.”
It is, I think, from this sufficiently evident, that nothing but the
preconceived opinions of the physicians consulted in these cases could
have prevented their acknowledging the true nature of the disease; and
there cannot, I conceive, be a doubt, that it was no other than Small
Pox rendered milder in its character by the previous occurrence of it
in these children. It is of importance too to remember that they afford
examples of the recurrence of the disease after both _natural_ and
_inoculated_ Small Pox. Delatour had been inoculated upwards of two
years before, and “two of the other children affected had previously
passed through natural Small Pox.” I shall here adduce some further
extracts from Dr. Thomson’s work. He tells us that “M. Hosty, who had
been sent over to England in 1755, to acquire information upon the
subject of inoculation,” “enters into a discussion with respect to the
recurrence of secondary Small Pox, in which he allows that there are
several eruptive diseases with which a person may be affected, _so like
the Small Pox, as scarcely to be distinguishable from them_, and, on
that account, liable to give rise to many mistakes; and he states, that
although he does not deny absolutely the possibility of the recurrence
of Small Pox, he believes this to be rare,” (p. 55-6). “To Hosty’s
opinion, with regard to the unfrequency of the occurrence of secondary
Small Pox, Gaulard replied, that he had at that time under his charge
two unequivocal examples of secondary natural Small Pox, and that a
nephew of the Archbishop of Paris, had a month before passed through
the Small Pox, under the care of the celebrated M. Astruc, although he
bore marks on his body of having formerly undergone the disease.”—(p.
59.)
Gaulard then declares, “that though reason dictates, and _experience
actually demonstrates_, that this process (inoculation for Small Pox)
does not infallibly afford protection against a subsequent attack of
natural Small Pox, he was still disposed to believe that it may be
possessed of some real advantages” (p. 59). “Dr. Cantwell, in 1755,
published a dissertation upon inoculation, the avowed object of which
was to _undeceive_ those who believed in the efficacy of that practice.
In this Essay, a great number of cases of Small Pox, which had occurred
both after natural and inoculated Small Pox, are mentioned” (p. 64).
“He (Dr. Cantwell) seems to have been well acquainted with those
varioloid eruptions which, previous to the introduction of inoculation,
had received a variety of names, such as Swine Pox, Chicken Pox, &c.
and which were considered not as specifically different from Small Pox,
but as spurious and bastard species of that disease. These eruptions,
in his opinion, were nothing else than mild varieties of the true Small
Pox. His own words are” (p. 37), “after all, what are the Swine Pox,
the Duck Pox, and the Chicken Pox, which are observed among the English
and the Irish? What is the _petite verole volante_ which is seen in
France? Many distinguished authors attest, that they have seen Small
Pox occur twice in the same individual; and have not we reason to
believe that, in these cases, the second attack was true Small Pox, of
which the infection was slight, and in which the vital actions were too
weak to carry it to a certain extent?” All this appears to me most
strictly consistent with truth. But Dr. Cantwell was arguing against
the use of inoculation. How then did he account for the fact that “the
infection was slight,” and that “the vital actions were too weak to
carry it to a certain extent,” if it did not arise from these
individuals having already passed through the disease of Small Pox?
“De Haen (a celebrated physician of Vienna,)” says Dr. Thomson (p. 68),
“collected into a body the numerous cases of secondary Small Pox, which
are to be found in the writings of physicians, who lived previous to,
and in the infancy of, the practice of inoculation in Europe. Had the
number of these cases, and the respectability of the individuals by
whom they are related, been duly considered, they surely were more than
sufficient to have satisfied the minds of the most incredulous, of the
possibility, and even of the frequency of secondary Small Pox.” De
Haen, however, was an opposer of inoculation, and the facts he adduced
were not permitted to have the weight which they merited, in
consequence of the arguments he deduced from them.
I shall conclude my extracts from the fund of evidence collected in the
work of Professor Thomson, with the following:—
“M. Strack, professor of medicine at Mayence, in a letter upon
inoculation, addressed to M. Roux in 1765, (Journ. de Med. tom. xxii.)
maintains that natural Small Pox do not, any more than the artificial,
protect against a second attack. In proof of his opinion, he mentions
six cases of secondary Small Pox which he himself had attended. The
argument which he uses in support of inoculation, in opposition to
those who were hostile to that practice, and who asserted that it does
not protect against a subsequent attack, though novel at the time it
was employed, has since been sufficiently confirmed by repeated
observation. He says, that those who have passed through the Small Pox
twice, whether naturally or artificially, have, in general, escaped
without danger; those patients, he adds, who have had the Small Pox at
two different periods, are fortunate, because if the variolous miasma
had operated with its full force during the first attack, they probably
would have fallen victims to the disease” (p. 77).
Mr. Moore remarks (Hist. of Small Pox, p. 278) that, “besides the
foreign authorities, the English Medical Journals contain several
authentic examples of persons whose faces were strongly pitted with
Small Pox, and who were afterwards destroyed by a second attack of that
disease,”—he goes on (p. 279) to relate “an incident frequently
repeated by the late Dr. Reynolds, Physician to his Majesty, who was
sent for by a lady unknown to him, and conducted by her maid, rather
mysteriously, into a handsome bed-chamber; where he saw, lying in a
splendid bed, a lady masked. Being a good deal surprised, the maid
stifled a laugh, while her mistress, in a soft toned voice, apologised
for concealing herself even from a professional gentleman. This (she
said) had become proper, from the peculiarity of her situation. At
present she stood greatly in need of his superior medical talents, and
was extremely anxious for his opinion on her case, which she understood
from others, was a very rare one. The doctor being thus put upon his
guard, enquired minutely into all the symptoms, and examined critically
a pustular eruption which was spread over the lady’s person: he then
pronounced the disease to be, without all doubt, the Small Pox. On
which the patient unmasked, and displayed features seamed with the
disorder.”
Dr. Thomson (in his Historical Sketch, p. 279) informs us, that out of
_eight hundred and thirteen_ cases of Small Pox, which had come under
his notice since June, 1818, “_seventy-one_ had previously passed
through Small Pox.” And in the sequel many other instances will be
referred to.
In a late number of the London Medical Repository, Dr. Carter, of
Canterbury, gives the details of a case of secondary Small Pox
occurring in a girl, which proved fatal. And a young lady (a family
connection of my own), who had satisfactorily passed through the
disease, from inoculation, when young, had a second attack of Small
Pox, when on a visit at Liverpool, to which she very nearly fell a
sacrifice. To this mass of evidence I shall add the case to which I
have before alluded, as having come under my own notice. In this young
woman the eruption was confined to the shoulders and face, and was not
numerous, but it was preceded for several days by considerable
feverishness and head-ache; and although it did not proceed beyond the
fourth or fifth day, I consider the nature of the disorder as quite
unequivocal; if what I conceive to be the only true test of this be
admitted, namely, that it was produced by Small Pox infection, and was
capable of communicating it to others. Fortunately this test was left
incomplete in this instance, no other individuals having become
infected in consequence; but the following facts which have since come
to my knowledge, seem to warrant the inference, that this might have
happened had any unprotected persons been allowed to have communication
with the patient.
A lady, residing at Gateshead, who passed through inoculated Small Pox
many years ago, became lately (during her confinement) affected a
second time with this disease. And notwithstanding that it was of the
same mild character as in the last case, and that the eruption turned
on the eighth day, her infant caught the infection. The eruption in the
child was of the confluent kind, and occasioned its death eight days
after the appearance of the disease.
Having succeeded, I trust, in proving to the entire satisfaction of
every candid enquirer the possibility, if not the frequency, of the
occurrence of Small Pox a second time in the same individual, it would
be both interesting and useful, were it possible to ascertain what
proportion such cases bear to those who escape a second attack; but
many insurmountable difficulties present themselves in making such a
calculation. Dr. Thomson tells us (p. 67), that “according to Tissot,
the proportion of cases of secondary Small Pox, is as 1 in 100;
according to Heberden, as 1 in 5000; and, according to Condamine, as 1
in 10,000. How uncertain the data!”—It is, however, enough to know,
that while the relative number is sufficiently great to prevent the
rule, That no individual can be affected by Small Pox oftener than
once,—from being considered absolute, it is yet too small reasonably to
shake our confidence in the fact, that a very large proportion will
escape a recurrence of that disease. One other fact of considerable
importance has, I trust, been also established by the preceding
enquiry—That when secondary Small Pox does take place, it is usually a
very mild disease, unattended with danger.
The fourth argument in support of the employment of inoculation for
Small Pox,—that it was rendered comparatively mild and devoid of
danger, while it afforded equal security against any future attack of
the disease with natural Small Pox itself, need not detain us long.—The
latter part of the proposition has been generally admitted; and its
truth or falsity will not affect the object of our present enquiry. Mr.
Moore (History of Small Pox, p. 302) tells us, that “at the
commencement of inoculation in England, the proportion of fatal cases
appears to have been fully one in fifty. But after the last improvement
in treatment had been established, probably not more than one in two
hundred were lost.”—Mr. Moore continues—“of those who contract the
casual Small Pox, and are treated with medical care, it has been
admitted that generally about one in six are lost: but in countries
where the medical arts are unknown, the Small Pox is so fatal a disease
that few of those who are seized with it survive its malignity.” The
immense difference between these proportions is amply sufficient to
prove the great advantage derived from inoculation by those on whom it
was practised.
Such then were the data on which the practice of inoculation for Small
Pox was established. But it will be remembered, that on its
introduction, and for many years after it had been extensively used, it
met with a very warm opposition both from medical men and others,
especially from some zealous divines, who stigmatised it as “a
diabolical invention of Satan,” and uttered anathemas against all who
should practise it. I shall not enter into any examination of the
arguments made use of by the opposers of inoculation; some of them have
been already alluded to, and their fallacy pointed out. Taken
altogether, it is remarkable how nearly they resembled those which have
been opposed to the introduction of Vaccination. Now, that distance of
time has enabled us to view the facts of the case with coolness, and to
reason upon them without prejudice, while we admit the individual
security which arose from the practice of inoculation, we must in
candour confess its tendency to encrease the general destruction of
life from Small Pox, by forming so many new sources of infection. This
was the only rational argument against inoculation, but it was
certainly one of great force, and the actual encrease of deaths from
Small Pox during the prevalence of inoculation, seems to prove that it
was never sufficiently considered. The encreased number of deaths from
Small Pox in 1723 and 1725, might fairly be imputed to this cause,
although it was denied at the time by Dr. Jurin. Mr. Moore (History of
Small Pox, p. 243) very satisfactorily replies to Dr. Jurin’s argument
in the following extract. “And as in the year 1723 a great increase of
the mortality by Small Pox took place in London; Dr. Jurin expressed
his opinion that this ought not be imputed to inoculation, as the
numbers who had been inoculated did not exceed sixty. This was a very
inadequate answer. A single person may bring the plague into a town or
into a nation, and be the cause of the destruction of an innumerable
multitude. The Small Pox is fully as infectious a disease as the
plague; and sixty inoculations were more than sufficient to account for
the augmented mortality, and were probably the cause of it.”
If we refer to the tables (No. 1 and 2), we shall find that from the
years 1752 to 1798 inclusive (the period during which inoculation was
most extensively employed in this country), the average mortality from
Small Pox, during periods of five years each, was occasionally so high
as one in eight of the whole, and rarely less than one in ten. And that
during individual years, it three times (in 1752, 1781, and 1796)
amounted to nearly one in five; and in 1772 was little less than one in
six. This is surely a fearful encrease on Dr. Jurin’s calculation—“That
of all the children that are born, there will some time or other die of
Small Pox _one in fourteen_.” There can be no doubt, however, that this
immense encrease of mortality from Small Pox was owing to the extended
practice of inoculation; and until this could have been pursued more
generally, and with greater precautions, so as at once to diminish the
numbers capable of being infected by the inoculated, and the hazard of
the latter coming into contact with the unprotected, I am disposed to
think this fact was in itself sufficient ground for discontinuing
inoculation for Small Pox altogether. Could every child have been
subjected to the process of inoculation, before any exposure to the
infection of natural Small Pox had taken place, the case would have
been widely different: but it can scarcely be considered either just or
politic to render one individual secure at the risk of endangering
many, or with a certainty of destroying some. It may fairly be
concluded, then, that inoculation for Small Pox, as practised for the
last fifty years of the eighteenth century, although certainly _a great
individual good_, was, in reality, without a doubt, a _most serious
general evil_.
From what has been hitherto stated, I conceive, we are authorised in
assuming the following as facts, which will furnish a satisfactory
answer to the first of the questions proposed, What were the
destructive consequences of Small Pox previous to the introduction of
Vaccination?
1. Small Pox is a disease of so infectious a nature, that few
individuals passed through life without suffering from an attack of it.
2. It was attended with so much danger as to occasion the death of one
in five or six of those affected by it in the natural way; and previous
to the use of inoculation, one in fourteen of the whole number of
children born, at one time or other, died of the Small Pox.
3. Of those who recovered, many suffered materially from its effects,
not only in the disfigurement of countenance occasioned by it, but
frequently in the loss of one or both eyes, or in irreparable injury of
their constitutions.
4. After having been once affected by Small Pox, a very considerable
proportion of individuals resist entirely a second attack: but still in
very many instances a recurrence of the disease is proved to have taken
place.
5. Secondary Small Pox is, for the most part, very mild in its
symptoms, and of shorter duration than a first attack, insomuch as to
have frequently given rise to doubts respecting the real nature of the
disease.
6. Secondary attacks of Small Pox have, nevertheless, occasionally
proved fatal.
7. When artificially produced by inoculation, the Small Pox is rendered
materially milder in its character, so that one in two hundred only of
those to whom the disease has been thus communicated, have been found
to die in consequence.
8. The Small Pox, when communicated by inoculation, is probably as
secure a preventive of any future attack of the disease as when it has
taken place naturally.
9. Notwithstanding the undeniable advantages which accrued to those who
passed through the process, it was, nevertheless, the direct effect of
inoculation, by multiplying the sources of infection, materially to
encrease the aggregate mortality occasioned by Small Pox.
------------------------------------------------------------------------
CHAP. III.
Such having been proved to have been the destructive consequences of
Small Pox, previous to the introduction of Vaccination, we are fully
prepared to enter upon the second query proposed,—What influence has
Vaccination exerted over these consequences—1. by extensively
superseding the cause—and 2. by essentially interfering with the
effect?
The name of Dr. Jenner is too intimately associated with the subject of
Vaccination to admit of the latter being referred to without some
allusion being made to the former; and I should ill testify my sense of
the truly valuable blessing which Jenner has been the means of
conferring upon mankind, were I altogether to omit any expression of my
admiration of the superior perception which enabled him to infer the
probable consequences of facts, which must have been long familiar to
hundreds without having given rise to any important suggestion, and of
the zeal and ability with which he prosecuted his enquiries on the
subject, or my high esteem for the generous disinterestedness with
which he made known to the world his most useful discovery. “It will,”
(to use the words of Sir Gilbert Blane,) “in the eyes of future ages,
be deemed an epocha in the destinies of the world, and one of the
highest boasts of the country in which it took its rise, with a sense
of unrequitable obligation to the individual who first disclosed and
promulgated the secret, by drawing it from the dark recesses of rural
tradition, and rendering it available to the whole human race.”