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

CHAPTER XXX.

DIFFUSION OF VACCINATION THROUGHOUT EUROPE.

Vaccination was accepted as a revelation, and diffused as a religion, and was almost everywhere received gladly. We have to bear in mind, however, that the way had been made straight for it by the practice of inoculation with smallpox; which practice, after a struggle prolonged over many years, had become an established part of medical art, and was only limited in its application by the inconvenience and risks that attended it. The promise of the primitive vaccinators was, that the security which resulted from inoculation with smallpox was to be had from inoculation with cowpox, with absolute certainty, absolute safety, and absolute permanence. The argument was, that since no one could have smallpox twice (however slight the attack), and as cowpox was a mild form of smallpox, it sufficed to be inoculated with cowpox to be safe from smallpox through life; and if only the infliction of cowpox were made universal, smallpox would be extirpated. Such was the plausible doctrine; so plausible that it had only to be stated to command assent; whilst so great was the elation over the discovery (as much, perhaps, for deliverance from inoculation with smallpox as from smallpox itself) that it was accounted a sacred duty to diffuse its benefits over the whole earth. Greater good on easier terms it was difficult to imagine. With a scratch of a needle one of the worst penalties attached to over-crowding, to filth, and to ill-living, might be avoided and done away with for ever.

The first cowpox missionaries were Dr. Marshall and Dr. Walker. £100 was teased out of the Admiralty, and £100 out of the War Office toward their expenses, and placed on board the Endymion, they proceeded, on 1st July, 1800, to the Mediterranean. At Gibraltar, Minorca, and Malta, they vaccinated soldiers and sailors, first operating on orphans and foundlings to give the gallant fellows courage. Then Walker accompanied Sir Ralph Abercrombie to Egypt, from whence, after a variety of adventures, he returned to London to serve as domestic apostle, and vex Jenner for the remainder of his life. Marshall proceeded to Sicily and Naples. In Palermo, in the preceding year, 1799, there had been an epidemic, in which, it was said, 8,000 had perished, and Marshall appeared on the scene as a belated messenger of salvation. At Naples he had a cordial reception from the wretched Ferdinand IV. and his wretched court, who, with general indifference or enmity to what was good, were ready to show themselves gracious toward cowpox. Marshall went through the customary performances of the variolous test and the exposure of the vaccinated to infection; and without further ado an hospital was opened, and all who would be saved from smallpox were entreated to hasten and receive the new inoculation.

When Marshall was at Gibraltar, Lord Keith issued the following memorandum to the fleet—

I may observe, in passing, that there was little delay in introducing vaccination to the British navy. Sir Gilbert Blane was urgent, Earl Spencer, first Lord of the Admiralty, acquiescent, and Dr. Trotter, physician to the fleet, enthusiastic. So early as 9th December, 1800, Trotter was prophesying—

Smallpox was one of the pests of the service. Trotter, writing 20th February, 1801, said—

These outbreaks were invariably referred to an origin external to the ship; as if anywhere smallpox could have had a more congenial breeding-place than the crew of a man-of-war! As Dr. Johnson observed, “When you look down from the quarter-deck to the space below, you see the utmost extremity of human misery; such crowding, such filth, such stench!”[252] Incited by the enthusiastic Trotter, the medical officers of the Fleet subscribed for a gold medal, and presented it to Jenner. On the obverse, Apollo was represented introducing a young seaman recovered from cowpox to Britannia, who, in return, extended a civic crown, on which was inscribed Jenner; above were the words, Alba nautis stella refulsit, and below the date, 1801. On the reverse was an anchor and over it Georgio Tertio Rege, and under it Spencer Duces. The medal was presented to Jenner in February, 1801.

The dates are worth noting afresh. Jenner’s Inquiry was published in the summer of 1798; and thus we see that within three years his prescription for the prevention and extermination of smallpox was adopted in a branch of the public service where obstinate conservatism was the ruling temper; and an assertion that only time could test was accepted without hesitation as verified and certain. If vaccination had answered to the claim made for it, the haste wherewith it was acknowledged would have been unjustifiable, and wholly unlike the struggle that truth has commonly to pass through in order to obtain supremacy in the intellect and practice of mankind.

The first attempts to inoculate with cowpox in France proving futile, Dr. Woodville went over to Paris in 1800 to show in practice the method of operation. He had a warm reception, and the Quaker was overwhelmed with the exuberant attentions to which he was subjected. In the Moniteur he was described as “a learned man, animated with generous zeal, and worthy of gratitude and praise;” who had inoculated six thousand children with invariable success; and that cowpox as a preventive of smallpox could only be spoken of as something miraculous. A house was opened as a vaccine station, and men, women, and children, flocked thither to receive the benign fluid and life-long protection from a dreadful malady.

When the negotiations for the peace of Amiens were in progress, 1802, an address was presented with much pomp to the Marquis Cornwallis by the Medical Committee of the Somme, claiming brotherhood with the physicians of England, eulogising Jenner, denouncing his detractors, stigmatising variolators as acting neither from the love of truth nor for the glory of their profession, but, from avarice and hatred of improvement; whilst, as the result of numerous experiments, “the discovery made in England had been stamped with the seal of infallibility in France.”

At first, vaccination in France was left to voluntary effort, and made little progress in face of a strenuous resistance developed by alarmed variolators; but a severe smallpox epidemic in 1802 incited the Government to action. A medical commission was appointed to investigate and report, and in 1804 it was determined to spare no effort to extend vaccination over the whole of France. A Central Committee for Vaccination was constituted, and appeals and commands were addressed to the clergy and officials of all orders to have those under their authority and influence inoculated with cowpox. Some préfects were content to recommend and warn, but others adopted more vigorous measures, such as the exclusion of the unvaccinated from schools, from employment, from charities—in short, anticipating much legislation that has come into force, or that fanatics wish to bring into force. Nevertheless, the progress made did not satisfy Napoleon, and seeing that until vaccination was everywhere paid for by the State, its performance must remain irregular and perfunctory, a manifesto was issued to the effect that his Majesty the Emperor and King had learned from the reports of the Central Committee that the preservation and increase of his vast dominions were immediately related to systematic and universal vaccination; wherefore, his Majesty, wishing to give a signal mark of his paternal solicitude for his subjects, had granted to his Excellency the Minister of the Interior, an annual special credit, destined to provide for the expenses necessary for extending the new practice, and for forming centres of issue of vaccine virus in twenty-four of the chief cities of the Empire—these, then, including Brussels, Florence, Parma and Turin. And his Majesty had also, out of his paternal benevolence, provided annual prizes as incentives to emulation in propagating vaccination, so that the scourge of smallpox might be completely banished from his territories.

It would be idle to speculate as to how much serious faith lay within this apparent zeal for vaccination; for, as Professor Seeley observes, “Napoleon seemed to care for no opinion, though he adopted, with studied artificial vehemence, every fashionable opinion in turn.” There might be, I dare say, something piquant to his theatrical genius in opposing his odious contempt for human life to the rigorous enforcement of what was considered a supreme prescription for its preservation. Jenner availed himself of the Emperor’s histrionic instinct in soliciting the release of English travellers detained in France. To one of these occasions we owe the artless anecdote of the arrest of Napoleon’s refusal by the interposition of Josephine, who exclaimed, “Jenner!” The Emperor paused and said, “Jenner! ah, we can deny nothing to that man!” It is sad to relate, the favour was not reciprocated. When Jenner, at the suggestion of Baron Corvisart, appealed to the British Government for similar indulgence to a Frenchman, he had to report that there was no charm in his intervention among his countrymen.

That vaccination should have a welcome in Spain was not surprising, after its reception in Naples. The craze was universal, and diffused through the lowest intelligences. Cowpox was introduced to Madrid with the certificate of France under that of England; and, spite of the distractions of the time, excited much attention. Mr. Allen, secretary to Lord Holland, writing to Jenner from Madrid in 1803, observed—

There were philosophising doctors in Madrid who did not see why cowpox should possess a singular efficacy, and induced the King, in 1804, to order that all the children in the foundling hospital should be inoculated with goatpox. They did not, perhaps, know that Jenner had inoculated his son with swinepox, and that the child underwent the variolous test on several occasions with impunity.

The great event in connection with Spain was the expedition of Dr. Francis Xavier Balmis, physician to his Catholic Majesty. He obtained a concession to introduce vaccination to the colonies in America and Asia, and to defray expenses by freely trading in merchandise. He sailed from Corunna, 30th November, 1803, with twenty-two children for the propagation of virus. The Canary Islands were first visited, then Porto Rico, and at Caracas the party divided, Don Francis Salvani proceeding to Peru and Chili, whilst Balmis attended to Cuba and Mexico, crossing the Pacific to the Philippines with twenty-six children to maintain the succession of the virus, and proceeding from thence to Macao and Canton. Having circumnavigated the globe as vaccinator and trader, Balmis re-appeared in Madrid with great éclat, and kissed the King’s hand on 7th September, 1806. Philanthropy and business were successfully combined, for as Moore, writing in 1817, observes—

The expedition of Balmis naturally excited much attention, and its progress and results were described in terms of inflated rhetoric. Thus, we read in Baron’s Life of Jenner—

Thus not only the Spanish Americans were brought under the dominion of cowpox, but the Indians, yea, all the Indians; and not reluctantly, but joyfully, and became experts in the practice of the rite! Baron continues—

Indian and savage statistics in connection with smallpox and vaccination are usually little else than exercises in imaginative desire—less what is true than what is wished to be true, or to be taken for true. We know the difficulty of vaccinating populations dwelling within defined limits and under highly organised governments, and we can therefore estimate the claims made for Balmis and his partners as roving traders and quacks in the territories occupied by Spaniards and Indians. Yet it was with yards of mythical rubbish of this sort that English vaccinators tried to divert the attention of their countrymen from the failures of vaccination within their own experience; and when worried with ever-recurring disasters at home, it was in turning to Mexico and Peru that Jenner professed to find consolation.

Dr. Sacco, of Milan, was described as “the apostle of vaccination in Northern Italy,” and “unquestionably the greatest vaccinator in the world.”[256] His operations received the sanction of the Napoleonic administration, and as early as 1801 he was appointed Director of Vaccination to the Cisalpine Republic. “Strong measures,” writes Moore, “were adopted; proclamations were read from every pulpit; vaccination was practised in every church; and the clergy gave such effectual aid, that the Professor and his associates in three years vaccinated 70,000 persons, and extinguished smallpox in Lombardy.”[257] In other words, the vaccination of 70,000 persons extinguished smallpox in a population of several millions! Baron enlarges the numbers, saying that Dr. Sacco and his assistants in the course of eight years vaccinated 1,300,000 persons; and cites a letter from Sacco, dated from Trieste, 5th January, 1808, with the following extraordinary statement—

Moore’s 70,000 is a credible number, whatever may be thought of its vicarious operation; but Sacco’s 600,000 by his own hand in eight years! Ah, well! when we are lost in the fabulous, it is unnecessary to waste our strength in the discrimination of the greater from the less in falsehood. Nevertheless, taking Sacco’s figures, we have to observe that the vaccination of 1,300,000 saved 6,000,000 from smallpox. That Italy was freed from smallpox is true, and the exemption of the population, whether vaccinated or unvaccinated, was prolonged over nearly thirty years. The disappearance of the disease had, however, set in before vaccination was heard of, but the subsidence was claimed for Sacco, although it extended to millions of Italians who owed nothing to the new prophylactic. As already observed, from some cause undefined, the area and intensity of smallpox was signally diminishing toward the close of last century, and this in spite of the stimulus applied to the disease by variolous inoculation. It may have been so stimulated as to have been worked out—forced, as it were, to exhaustion, after the habit of much else, good and bad, when developed to the extremity of existence.

As a grand vaccinator Dr. De Carro, of Vienna, was scarcely less distinguished than Sacco. He was a Swiss from Geneva, who had studied and graduated at Edinburgh, and settled in Vienna. He performed the first vaccination on the Continent, in 1799, with virus conveyed on a couple of threads from Dr. Pearson; and in 1802 he succeeded in transmitting the first effective virus to India. De Carro conducted his operations with great energy and tact, and in 1802 he induced the Austrian Government to issue an ordinance conferring on vaccination Imperial sanction and recommendation. Concurrently with this activity, smallpox was abating, and post hoc was converted into propter hoc. De Carro was credited with the extinction of smallpox in Vienna; but as no more than a portion of the citizens had been vaccinated, Vienna thus supplied another instance of the vicarious influence of the Jennerian rite.

Sacco and De Carro corresponded with Jenner, and it is worth noting that both concurred with him in the opinion that cowpox originated in horsegrease; and, further, that horsegrease was as good against smallpox as horsegrease cowpox itself. Indeed, Sacco set up a stock of virus derived from horsegrease, operated with it, and supplied De Carro, who used it so freely in Vienna that, as he said, he could not tell the vaccinated from the equinated. Writing to Jenner, on 21st June, 1803, De Carro observed—

The favour shown for vaccination by the English Court facilitated its adoption throughout Germany; and yet it might be said the craze went of itself, compelling patronage and exacting advocacy. The King of Prussia opened a Royal Inoculation Institute in Berlin, and tracts and medals, speeches and sermons, were brought into requisition to recommend the new rite. From the furore created, many were led to believe that all Prussia was vaccinated, and as smallpox ceased to prevail, cowpox had the credit. To vaccinate a nation, however, is far from easily accomplished, and when we refer to the official accounts, we discover that, notwithstanding great ado, the numbers operated upon constituted less than a tithe of the people. Jenner cites a report of Professor Avelin, of Berlin, in a letter to Moore, 15th February, 1812, as authority for these statistics—

Supposing a million had been vaccinated in Prussia in the course of ten years, let me ask once more, how could they have saved the remaining millions from smallpox? Yet, with knowledge of these figures, Moore, the Director of the National Vaccine Establishment in London, did not hesitate to write—

Russia, of course, followed suit in cowpox inoculation. At the coronation of Alexander in Moscow in 1801 a foundling was operated on, christened Vaccinoff, pensioned for life, and dispatched to St. Petersburg to serve as a source of virus for other foundlings. Then followed imperial decrees prescribing vaccination, and Dr. Crichton was directed to organise a medical staff for the performance of the rite in each province of the Empire. In 1811 a ukase was issued commanding all Russians to be vaccinated within three years. As measuring the possibilities of despotism in such a matter, we learn from Dr. Crichton that between 1804 and 1812 there were 1,235,597 vaccinations performed in Russia—a similar number to that which Sacco professed to have accomplished in Northern Italy in the same time. It was estimated in Russia that of every seven children born, one perished of smallpox, and therefore Crichton argued the lives of 176,514 had (up to 1812) been saved by vaccination. The calculation illustrates the facility with which the early vaccinators deceived themselves—first, as to the certainty of their prophylactic; second, as to its vicarious efficacy; and, third, in assuming that a reduction in smallpox represented a reduction in mortality.

From Crichton, too, we learn that there were anti-vaccinists in Russia in those days—

To complete this rapid survey of the diffusion of vaccination throughout Europe, there remain Sweden with Finland, and Denmark with Iceland; but as the case of Sweden is specially interesting and instructive from the fulness and precision of its vital statistics, coupled with the claim made by vaccinators that Sweden affords irrefutable evidence of the efficacy of their prescription, I reserve it for a special chapter. There is nothing pleasanter than finding the strongholds of one’s antagonists, capturing, and occupying them.