The Story of a Great Delusion in a Series of Matter-of-Fact Chapters

CHAPTER XXIX.

INTRODUCTION OF VACCINATION TO INDIA AND THE EAST.

The enthusiasm for cowpox in England was reproduced with fury among the English in India. It is always so. What is the fashion at home is an intenser fashion abroad.

When we say India, we speak as of a country when we are dealing with a continent—of not one but many peoples, of races numerous and tongues various: wherefore, in naming India, I would be understood as limiting my remarks to the portion designated, and to the population affected by English influence. In several parts of India smallpox is endemic—begotten in permanently unwholesome conditions of life, and cultivated and propagated by inoculation. When, therefore, it was heard that cowpox might be substituted for smallpox, and that the mild served every purpose of the severe disease, there arose a demand among the English for the virus, alike for their own and for native use. Dr. Underwood, writing to Jenner from Madras, 28th Feb., 1801, observed—

It was easier to ask than to obtain. There was no cowpox to be heard of in India, and the long voyage round the Cape, and the tropical heat were fatal to its transmission. Repeated attempts were made, but all ended in failure. Jenner proposed to place a number of picked men on board an East Indiaman, and to have them successively vaccinated in the course of the voyage, so as to land with fresh virus in Bombay or Calcutta; but the East India Company declined the proposal. An attempt was then made to raise a subscription for the purpose, Jenner putting his name down for 1,000 guineas; though it was difficult to imagine where the 1,000 guineas were to come from, unless out of the pockets of some of his admirers.[232]

These efforts were, however, superseded by the energy and ingenuity of Dr. De Carro, of Vienna. Lord Elgin, British ambassador to the Porte, had made acquaintance with De Carro, and had received virus from him with which his infant son and others were vaccinated at Constantinople. The news spreading abroad, Lord Elgin was entreated to meet the Indian demand, sending the vaccine overland to Bombay by way of Bagdad and Bussora. He made several futile attempts, and thereon determined to place the matter in the hands of De Carro; and for that purpose addressed himself to the Hon. Arthur Paget, British ambassador at Vienna, saying—

De Carro accepted the commission with alacrity. He had already had an application from Bagdad, and, dismissing the vehicles which had been tried and failed, such as lancets of steel, silver, gold, and ivory, and threads enclosed in quills, he saturated lint with virus, and, placing it between glasses, in one of which was a cavity for its reception, tied them together, sealed the edges, and, taking them to a wax chandler, had them dipped until enclosed in a ball of wax, which was packed in a box stuffed with shreds of paper. In this manner virus was conveyed through Constantinople, across the deserts to Bagdad, where it was received on 31st March, 1802, still liquid, and was used “with complete success.” The like success was reported from Bussora, Muscat, and Bushire. From Bussora virus was conveyed to Bombay, arriving, after a three weeks’ voyage, early in June. Twenty or thirty were inoculated with the Vienna virus, but only one “took,” namely, Anna Dusthall, a child about three years of age, who was operated upon by Dr. Helenus Scott. The progress of the case was watched with intense anxiety, and correspondent satisfaction when the symptoms developed according to the recognised description. On the eighth day five children were vaccinated from Dusthall’s arm, and loud was the rejoicing when it was known that for India was secured the genuine Variolæ Vaccinæ. From Bombay “the precious fluid” was in due course conveyed to Ceylon, Madras, Calcutta, and wherever English influence prevailed. De Carro was naturally elated with his success. The virus he transmitted was originally obtained from the stock of Dr. Sacco, of Milan, who had it off some Lombard cows.[234]

Jenner wrote to De Carro to congratulate him, 28th March, 1803—

The imported cowpox was diffused and recommended with energy and with fraud. Jenner, writing to Dunning, 2nd November, 1804, observed—

Here is the paper which sets forth the energetic policy pursued—

Much of this policy was due to the Marquis Wellesley, the Governor-General, whose habit it was to convert conviction without delay into performance. To what extent it was found practicable to substitute vaccination for variolation among the natives does not clearly appear. It was comparatively easy to operate upon those immediately dependent upon their conquerors; but it was a different matter to disarm the aversion of the external myriads. Supposing the variolators preferred their ancient practice because it was more lucrative, a number of them were brought to Calcutta, and inquiry made as to the amount of their gains, which ascertained, they were offered double pay if they would adopt vaccination. The offer was readily accepted, and other variolators, hearing of it, volunteered their services on similar terms, and were instructed and enrolled as official vaccinators. A declaration was drawn up and signed by twenty-six of these converted variolators, recommending vaccination to the Eastern world. The declaration was published in the Calcutta Gazette, printed in four languages, and widely circulated throughout India.[236]

So much was possible to Government; but other means of persuasion were not neglected. It was at first imagined that pox from the cow would exactly suit people who held that animal in reverence; but, on the contrary, the fact was converted by the Brahmins into an argument against its use, they contending, and justly, that cowpox was impure. To meet this difficulty, various pious frauds were attempted. It was pretended that vaccination was no novelty in India, and that it was known, sanctioned, and practised from time immemorial. Baron, Jenner’s biographer, relates these details without animadversion—

The Sanscrit work from which this passage was asserted to be taken was never forthcoming, and by competent authorities was pronounced “nothing more than a well-meant device for the reduction of ignorant prejudices,” the native physician who put the leaves into the hands of Mr. Gillman being included in the fiction. Baron continues—

These impostors were not priests, but medical men; not Jesuits, but Protestants; not Levantines, but Englishmen in the service of the Honourable East India Company. To what extent their frauds were operative is not related. They were probably too contemptuous of native acumen. For good and for evil the Hindoo listens to English advice courteously and without contradiction, but persists in his accustomed way of life with the equanimity of indifference. That vaccination was an ancient practice in India came to be repeated in Europe and seriously believed, when, Jenner’s originality being impugned, the truth came out, that old Indian vaccination was a device limited to Indian circumstances, and never designed for Western acceptance.

In Madras vaccination was practised with much energy. Jenner, writing on 7th May, 1808, said, “Wonderful to relate, the numbers vaccinated in that Presidency in the course of last year amount to 243,175.”[238] In Bombay it was claimed that smallpox was extirpated; Dr. Helenus Scott reporting, 5th December, 1806, that “in this island, swarming with mankind, no loss from smallpox has been suffered for several years since the introduction of vaccine inoculation.”[239] It was not pretended that all the inhabitants of Bombay had been vaccinated, or even a considerable portion of them; but the early vaccinators appear to have regarded vaccination as a sort of charm, the possession of which kept off smallpox; that by the vaccination, say, of one-tenth of any population, the unvaccinated nine-tenths were protected. This faith in the vicarious efficacy of vaccination was not expressly avowed, but was implied in the numerous reports of extirpated smallpox in circumstances where no attempt was made, or was indeed possible, to effect universal vaccination.

Confuted and frustrated in England, it was Jenner’s habit to sigh, and turn from his ungrateful country to the vast realms of Europe and Asia and America. Writing to Dunning, on 23rd December, 1804, he observed—

Mark the words—Smallpox totally exterminated in some of the largest cities in 1804; that was to say, after, at the utmost, five years’ acquaintance with vaccination! A miraculous time—was it not? Jenner went on—

Omne ignotum pro magnifico est. What inference worth a straw could Jenner or anyone else draw from the introduction of vaccination to India? The number of the various Indian peoples was unknown; and the periods and prevalence of smallpox among them; also the extent to which they practised variolation. In the absence of such elementary information, tales of the triumphs of vaccination in India were so much romance.

So far as vaccination displaced variolation, it might be taken as the substitution of a less evil for a greater; and much is accounted for in some of the early records of vaccination when it is remembered that the new practice was welcomed as a deliverance from the inconveniences and horrors of the old; and that the discredited practice was frequently abandoned without resort to its successor. A cessation of variolation was a cessation of the culture and diffusion of smallpox; and vaccination had often the credit of the reduction of smallpox when the credit was due to the abatement of variolation. As to the propagation of smallpox by variolation, no one was more emphatic than Jenner, as for example—

If then it be taken as conceded that variolation spread smallpox wherever practised, can it be fair to omit the consideration of the consequences of its abatement when estimating the results of the introduction of vaccination? Yet scarcely an advocate of vaccination permits the fact to enter into his reckoning!

The gratitude of the English in India to Jenner did not evaporate without substantial expression. A subscription was started, and between 1806 and 1812 he received remittances to the amount of £7,383, the contributors being—

An amusing instance of Jenner’s ignorance of India is found in a letter to Dunning, 14th March, 1807, wherein he ascribes his English money from India to the gratitude of Hindoo women—

Jenner, in returning thanks to Dr. Fleming, of Calcutta, for the first remittance of cash in 1806, took occasion to communicate some English news, which is not without interest at this day. He wrote—

These prints were, many of them, intended for fun, and could have no serious influence. The decline of faith in vaccination was due to the general discovery that it did not prevent smallpox, and that it did excite other ailments. “It made smallpox milder” was the apology even then coming into vogue. As for the epidemic of smallpox raised in London and the whole island by the neglect of vaccination and a return to variolation, it was a creation of Jenner’s fancy. There was less smallpox in London in 1806 than in 1805; but if there was not more, the bold Jennerian would answer, there ought to have been, and it could only be through the mercy of Providence that there was not.

Throughout the century, the English in India have spared no pains to diffuse and enforce vaccination among the inhabitants, numerous medical men finding place and pay in the futile occupation. Smallpox can only be overcome by systematic sanitation, which is laborious and difficult; and among peoples whose conditions and habits of life freely generate zymotic disease, vaccination is as likely to be effective as any other sort of incantation. Sir Richard Temple states the position at this day in these words—

We now come to Ceylon, in which vaccination was held to have had a perfect triumph. “To Sweden and to Ceylon,” says Baron, “Dr. Jenner was in the habit of pointing when he wished to prove what his discovery might accomplish; or when he lamented that fatal obstinacy of his fellow-creatures which, with such examples before them, could induce them to reject blessings within their reach.”[246] Sweden we shall discuss in another chapter, and of Ceylon I may observe that a portion of the island was taken by the British from the Dutch in 1795, and that in several parts it was extremely unhealthy. Smallpox was a frequent and deadly epidemic, but to what extent there is no evidence save hearsay and estimates from hearsay. The Dutch did not concern themselves with the health of the natives, but when the English took over their settlements in 1800 in the midst of a severe epidemic, they opened hospitals for smallpox and for inoculation with smallpox under the supervision of Dr. Christie.[247] He, hearing the glad tidings of vaccination, resolved to introduce the practice, and having in 1802 received virus from Dr. Scott, of Bombay, he set to work with systematic energy and perseverance. Supported by the authority of successive Governors, he closed the hospitals, forbade variolation, organised a staff of vaccinators, and kept them employed, until the greater part of the population under English influence was vaccinated. In the words of Moore, writing in 1816—

That smallpox had been exterminated by vaccination in Ceylon was set forth by vaccinators as something indisputable; but there were two observations to make—first, that smallpox was often suppressed in the sense that for a time there was no smallpox in a certain population, and especially subsequent to a severe epidemic; and second, that variolation was suppressed. Granted that smallpox ceased in Ceylon coincidently with the introduction of vaccination, it may be fairly held that the exhaustion induced by the preceding epidemic, and the cessation of variolation, were sufficient to account for the phenomenon. What remains to be said of Ceylon, I shall leave Dr. George Gregory, physician of the London Smallpox and Vaccination Hospital, to say for me. He wrote—

Vaccination was introduced to China from the English factory at Canton, and Sir George Staunton translated into Chinese a tract on Cowpox, and had it printed at Canton in 1805, the translator’s name and the foreign origin of the practice being suppressed. Jenner, writing to Dunning, 10th December, 1806, said—

The Chinese had their own system of variolation, namely, the use of pulverised smallpox scabs as snuff; but some of them accepted vaccination, tried it, and dropped it when they found it did not keep off the disease as warranted. Smallpox in China is almost exclusively a disease of childhood, and is little dreaded. Dr. D. F. Rennie, medical officer to the British Embassy at Peking in 1861-62, says of that city—

Persia was sometimes referred to in the ravings that went on as to the triumphs of vaccination in the East; but what was known of Persia? The practice was introduced where Europeans were resident, but it never became general. Dr. C. J. Willis has recently described surgery and medicine in Persia as extremely rude and superstitious, and that “vaccination is not in favour, whilst inoculation, or the direct communication of the disorder, by placing the patient in the same bed with one suffering from smallpox of the most virulent type, is the method pursued.”[251]

It was natural enough for Jenner, in presence of failure and contempt in England, to appeal to success in the East, and to try to overwhelm his adversaries with evidence which they could not overtake; but any one of judicial temper must have perceived that if vaccination was to be vindicated, data of a very different order would have to be forthcoming. Where the number of the population in a distant region was unknown, where the ordinary prevalence of smallpox among the people was undefined, where the extent of artificial variolation was unspecified, and the existence and intensity of related forms of zymotic disease were undescribed, what conclusion could be drawn as to the efficacy of vaccination that a man of science was bound to respect? Why should certain knowledge in England be surrendered for assertion from abroad.