Once a Week (magazine)/Series 1/Volume 9/Smallpox in London
SMALLPOX IN LONDON.
An epidemic of smallpox in London in the year 1863;—people packing and running into the country;—letters in the "Times" giving "certain" cures for this loathsome disease; other letters detailing the best means of preventing "pitting;"—persons blotched with scarcely-dried pustules meeting you in every street! Shade of Jenner, is the merciful shield which thy genius has held over us for more than half a century pierced and broken at last? And are we to mourn the reappearance of a once conquered plague, and to bewail afresh its ravages upon youthful beauty? There is scarcely warranty for all these fears, but there is quite enough warning given, to show us that although the shield is as impervious as ever, we are neglecting from time to time to use it. The Registrar-General's returns for these last eight or nine months prove that smallpox is gradually gaining upon us, and that for months past the deaths from this disease have averaged something higher than sixty weekly.
The cause of all this is the difficulty of getting the public to take even the smallest trouble for the sake of warding off a merely prospective evil; or perhaps we may rather ascribe it to that immobility of the human mind which is such a bar to progress of every kind.
Without going into a detailed history of the proceedings of Jenner, we may say that the tardy discovery of vaccination itself affords one of the best examples of the length of time the seed of an idea calculated to save an enormous amount of human suffering to all posterity, will sometimes lie in the mind before it bears fruit. Let us take inoculation as an instance.
At a time when smallpox was as destructive as the plague itself, Lady Mary Wortley Montagu happening to be at Adrianople, was struck with the fact that the Turks were in the habit of making terms with the disease, by receiving it into their system by way of the skin, instead of by the lungs, as in the natural mode of infection. Possibly the lively nature of the lady's letters had more to do with the sensation this new practice created in England than the magnitude of the truth she made known, and to this day we believe that the public have some idea that it was a discovery made by her ladyship, and which she had the boldness to put in practice upon her own son. Yet no fact is more certain than that throughout Asia the practice of inoculation had obtained for ages; and that the Chinese—the inevitable nation to which we have always to go back for the birth of any great discovery—systematically employed inoculation as early as the sixth century. Yet strange to say, in Asia this precious knowledge came to a dead stand-still; and had it not been for the lively English lady, inoculation might not have been introduced into England for another half century, and possibly vaccination would even now be in the womb of time.
That inoculation was a grand step towards the practice of vaccination there can be little doubt, although science did not at the time appreciate the fact. It taught us that the disease received into the circulation by the skin was infinitely less dangerous than the disease "caught" by inhalation through the lungs, a circumstance which medicine cannot explain to this day. The deaths from smallpox during some of the severe epidemics of the last century were not less than a third of those attacked, but the improved practice of inoculation reduced these deaths to one in two hundred!
This in itself, no doubt, was a grand result, but unfortunately it told only for those who were inoculated, for inasmuch as it was the practice of physicians to send their patients into the open air, and as inoculated smallpox was as contagious as the disease pure and simple, those persons in their turn became centres of contagion. If it had been possible to have insulated every inoculated person until he had passed the stage of infection, it is just possible that vaccination might not yet have been discovered, inasmuch as half measures often keep off for a long time sweeping reforms; but as this was not possible, inoculation only made matters worse.
This fact was clearly proved by the London Bills of Mortality, which showed that during the first thirty years of the eighteenth century (before inoculation), out of 1000 deaths, those from smallpox were seventy-four, whilst during an equal number of years at the end of the century, after inoculation, they amounted to ninety-five—thus proving that the practice had increased the deaths in a proportion of five to four. This result, however, came from putting the practice in force in a crowded city; no doubt the result would have been widely different in country places and among thinly-populated districts, otherwise it would not have been handed down for centuries over vast continents.
But the extreme difficulty with which the idea of vaccination germinated was still more remarkable than the slow progress made by inoculation. It must not be supposed that Jenner was the first to discover that the inoculation of the matter from pustules in the cow's teat afforded a protection to the milkers against smallpox. So far from this being the case, the fact was noticed in a Gottingen paper as early as 1769; and at Keil, in Germany, and also in Holstein, the protective influence of the cowpox irruption was recognised nearly as early. Strange to say, in Asia also, in the province of Lus, the milkers have a disease long known as Photo-Shooter, contracted from milking the camel in the same way as cowpox is contracted from milking the cow, and it is found to be equally protective against the smallpox. It was Jenner's glory that, having become acquainted with the fact from the Gloucestershire dairymaids, by a pure process of induction he proved the value of the protective agent, by first inoculating the boy Phipps with the cowpox, and after the lapse of some little time, testing its protective power by inoculating smallpox, the failure of which to produce the dread disease affording the final proof of the value of vaccination. From the lymph taken from this boy's arm, he drew and put in circulation the new life-protecting agent. All the early vaccinations were made from him, and indeed there can be no doubt that a large quantity of the vaccine matter at present in existence took its rise from the ferment promoted in the boy's blood by the original operation performed in 1796. In justice, a bas-relief of this bold youth should have been placed on the basement of the statue to Jenner, as a reward for allowing so doubtful an experiment to have been tried upon his own person for the good of mankind.
Although he suspected the fact, it was not certainly known to Jenner, that smallpox and cowpox were the same thing; or rather, that the latter is only a modified form of the former, its venom having been destroyed by passing through the body of the cow.
In the year 1801, Dr. Gassner, of Gunzburg, after many trials, managed to inoculate smallpox into a cow, and from the lymph thereby produced, he vaccinated four children successfully; and forty years afterwards Dr. Thiele, of Kasan, not only repeated this experiment, but carried it a step farther by placing the vaccinated children in the same bed with smallpox patients, and even had them vaccinated with smallpox matter, with perfect impunity. Since that time, Mr. Badcock, of Brighton, has put this discovery to a highly practical use, inasmuch as by inoculating cows with smallpox he has from time to time been enabled to put large quantities of vaccine lymph into circulation,—a very important matter, as there can be little doubt that the old stock has become deteriorated, and has ceased to be so protective in its influence as heretofore.
Dr. Jenner, we know, put upon record "his full and perfect confidence that it (the protective influence of vaccine lymph) might be continued in perpetuity by inoculating from one human being to another in the same way as smallpox," and this opinion the Vaccine Board has very lately endorsed. Theoretically this is perhaps true; nevertheless, there is good reason to doubt the fact practically, as operators sometimes take their lymph from imperfectly formed or overripe vesicles, a known cause of enfeeblement of its action. It is well known, at all events, that fresh lymph from the cow "takes better," gives signs of producing more constitutional disturbance, and forms a truer Jennerian vesicle, the great proof of successful vaccination, than is produced by lymph which has passed through a long descent from the cow. As this is a statement which especially refers to the comparatively deficient quality of the general current lymph of the country, it is highly important, and, as Mr. Simon very justly says, it points "to the necessity for a periodical renewal of lymph."
It is pretty generally allowed, however, that even when vaccination is performed on children in the most perfect manner with the purest lymph, there is a necessity for a re-vaccination about the age of puberty; hence the rush we see for a re-assurance against infection during the existing epidemic.
We have no longer, it is true, the absurd charges against vaccination so strongly urged at the commencement of the present century. Boys are no longer instanced who, in consequence of the influence of the "beastly vaccine matter" introduced into their blood, have been "heard to bellow;" we hear no more of patches of hair resembling cow's hair; horns have ceased to grow from children's foreheads; but the cry is not altogether dead, and we hear from time to time of eruptions over the head and body following the lancet's puncture.
These are mild charges, faults which the great discovery can afford to have placed to its debit, even when untruly made; but in France a far graver offence has been of late imputed to vaccination, and one which has attracted the attention of all the scientific professors of medicine. It was asserted that vaccination was chargeable with inoculating a loathsome disease into the blood. The evidence given was pretty conclusive, and for a time Jenner's discovery seemed to be placed once more upon its trial. The discussion which ensued did not reach the public ear, but it was fierce enough to shake the faith for a moment of good men and true. At last, however, to the intense relief of medicine, it was ascertained that although the disease had undoubtedly been transmitted with the vaccine lymph, yet it had not been transmitted in it,—an unskilful vaccinator having removed some of the blood as well as the lymph of an infected child, the consequence was that the next child vaccinated received a double infection. This was no charge against vaccination, but only against the manner in which the act had been performed. As there is but one blood disease that can possibly be thus inoculated, and that but under the rarest possible combination of circumstances which may never recur again, all fear under this head may be said to have gone by.
Thus the last chance has passed away of justifying the extraordinary epitaph erected in the church of Hood-lane, City, by the sister of Mr. Birch, one of the surgeons of St. Thomas's Hospital, which commemorates that "the practice of cow-poxing, which first became general in his day, undaunted by the overwhelming influence of power and prejudice, and the voice of nations, he uniformly and until death (1815) perseveringly opposed." Mankind are fond enough of proclaiming themselves true prophets after the event, but perhaps this is the first instance on record in which a man's friends have been so proud of his having been a false prophet as to proclaim the fact in enduring stone.
But, it will be asked, how was it, vaccination having been so thoroughly proved an absolute protection against smallpox, that we meet persons in crowded places with the eruption still full upon them, and that more people died in the months of March and April last, from a disease we had fondly imagined banished, than in any two previous years? Nay, so severe has it become, especially among children, that there has been a regular panic in town respecting it, and there were, at one time, fears among the West-end tradesmen that it would cause the "session" to come to an untimely end.
Let us admit it at once. This result is only one example of the price we pay for our determined opposition to centralisation. We put the liberty of the individual above every other consideration, and we see that public danger is the result.
In comparison with most of the great European nations, England, the very source of vaccination, is by far the worst protected against smallpox of them all. Sweden, Denmark, Prussia, and Austria stand particularly high in this respect, for the simple reason that children are vaccinated in those countries with the same certainty that they are registered at birth in this.
Some ten or twelve years ago, chiefly at the instance of the medical profession, a compulsory Act was passed, directing that all children should be vaccinated within four months from birth. The sages, however, who passed this law forgot to enact machinery by which it could be worked. There were penalties, it is true, for non-compliance with the Act, but no reasonable means of putting them in force. When the Act first passed, the public for a time were frightened into a steady compliance with its requirements; but they soon found out that the law if it barked could not bite, and by degrees parents, especially among the poorer classes, began to neglect an act which, for the preservation of their children's lives, was just as essential as their clothing and food.
Moreover, the duty of vaccination was, by some unaccountable blunder, placed under the direction of the Poor-law Board, which contracted with medical men for the vaccination of their respective districts. In some cases there is at present such competition for these contracts, that there are two vaccinators for one child, consequently poor parents imagine that they are conferring a favour upon the vaccinator in allowing the child to be protected against death; and they will attempt to make a bargain with the doctor, saying, "You shall vaccinate baby if you will give so and so a bottle of physic," or if you will "give us a pot of beer." The most rooted antipathy to allow children to be vaccinated—we are again told by the Inspector of Vaccination—is removed by twopence, or the presentation of a toy. Can anything be more absurd than this? If there are faults upon the part of parents, there are also faults in the kind of vaccination which is offered or rather thrust upon them. Upon the efficient manner in which the act of vaccination is performed depends the success of the operation. It is a delicate, if not a difficult, act to perform; but will it be believed that a duty which is necessary to shield the population from a terrible disease is not taught in one of our public hospitals?
The student passes from these great places of study as ignorant of vaccination as the savage in the woods. When he gets into practice he manages to pick up his information as best he can. Consequently, the method of transferring the vaccine lymph from arm to arm, or from the vaccine point to the arm, differs as widely as the ideas of men can differ who have to act without any previous knowledge on a given subject. Some merely scratch the skin, others make a deep puncture, in some cases only two incisions are made, but the perfect vaccinator will always make three incisions on each arm. In many cases through ignorance the lymph is taken from the arm when it is over-ripe, and the consequence is not only a source of failure in its power of protection, but a fear that it may cause many of those unsightly eruptions which are known to follow the act of vaccination from impure lymph.
We have said enough, and more than enough, to show that in the present state of the law we can never be certain either that the population is well vaccinated, or that the lower stratum of it is vaccinated at all. When an epidemic arises people rush to the vaccination stations to protect their little ones against the arrows of death which they see flying around them and striking here and there to the death; but the epidemic passes, and their fears with it—a new crop of unvaccinated children springs up, and a new epidemic, to be repeated every four or five years, sweeps off these neglected children, and spreads terror and contagion among adults.
The Government have yet to realize the fact, that we must create a standing army of well-trained medical men, well officered, and ready to meet this enemy day by day, and beat him in detail, and not to allow him to overwhelm us by sudden onslaughts. To give this protective force due efficacy, it should have a medical organisation, and not be frittered away among poor-law boards, vaccine boards, or the many conflicting authorities which now create such friction, and make the working of the Vaccination Act a perfect nullity. We have an officer of health; why should not the working of the machinery of vaccination be entrusted wholly to him? and if, having given him the proper instruments and subordinates for the due carrying out of Jenner's discovery, he fails (which he would scarcely do), we should dismiss him, and appoint another, as our Yankee friends are now doing with those commanders-in-chief who have failed against the public enemy in the field. A. W.