CHAPTER XL.
SIMON’S DEFENCE AND HAMERNIK’S JUDGMENT.
An attack on Vaccination like that delivered by John Gibbs had to be met, and Mr. John Simon, Medical Officer to the Board of Health, was selected for the purpose. The answer appeared in 1857 in a quarto blue-book entitled Papers relating to the History and Practice of Vaccination,[288] 83 pages consisting of a defence of Vaccination, and 188 pages of illustrative and corroborative documents. Oddly enough the treatise of Mr. Gibb is never once mentioned, whilst the order of defence is obviously marshalled in front of his positions. The reason for this reserve was double: first, it was considered unadvisable to magnify or advertise so dangerous an antagonist; and second, it is considered unprofessional to discuss a medical question with one who is not in medical orders.
In reviewing Mr. Simon’s defence we are constantly reminded of Mill’s observation, that a doctrine is never truly judged until it is judged in its best form; and of Coleridge’s caution, that an adversary’s bad arguments are no evidence of the goodness of our own. It lay in the nature of things that many absurd and trumpery objections should be advanced against vaccination, but to cite and sneer at them was neither to appreciate nor to refute the objections that were valid. Had Simon been less scornful and less loftily disposed, condescending to deal with his antagonist verbatim, he might have proved no more successful, but he would have had at least the praise of judicial intention.
After the custom of the eulogists of vaccination, Mr. Simon opened with a chapter on “Smallpox before the Discovery of Vaccination,” consisting of terrible tales of the ravages of the disease among Mexicans, Indians, Greenlanders, Icelanders, Siberians, Hottentots, etc., as if disbelievers in vaccination were under any obligation to dispute them. It is not denied that smallpox may be a deadly epidemic: the contention is that vaccination would not abate its deadliness. At the same time, when terrible tales are told of the devastations of smallpox, it is but fair to press for proofs of their authenticity. Travellers and historians occasionally prefer the excitement of wonder to adherence to matter-of-fact. When, for instance, Mr. Simon gravely relates that “in Mexico 3½ millions were suddenly smitten down, leaving none to bury them,” it is permissible to inquire who was responsible for the Mexican census in the days of Cortez, and who counted the unburied dead? Further, it is idle to attach importance to isolated statements about smallpox, as if smallpox were an independent destroyer of mankind. It is a member of a group of destroyers, and its activity is usually coincident with a correspondent dormancy among its associates. Until the complete vital statistics of a community are in evidence, it is vain to assert whom smallpox present has slain, or absent has saved. It is the prevalence of death, and not the mode of death, that is the critical question.
Again, when the familiar list of great folk who died of smallpox in Europe in the 17th and 18th centuries is run over, the remark occurs, that considering the habits and habitations of the said great folk, their fate was in nowise surprising. Those who believe that smallpox is generated in unwholesome conditions of life are not to be confounded by facts that illustrate their contention. And the like is to be said of the equally familiar tale of London smallpox. It was to be expected that citizens housed and fed as Londoners were housed and fed should have been plagued with smallpox and its congeners. What is denied is that vaccination could have saved them from smallpox, or reduced their death-rate, their conditions of life remaining the same.
The extravagant exhibition of the horrors of smallpox is the customary preliminary to the presentation of Jenner as the saviour from them; and the part of showman in this respect was fulfilled with more than ordinary abandon by Simon, who thus depicted the situation and the rescue—
Medicine baffled and helpless! For millions of our race in after times the continued raging of that pitiless plague! A drearier picture could scarcely have saddened mankind.
That this despair was not lasting is due to the genius of an English surgeon; and the close of the 18th Century, which had much to darken it, will be remembered till the end of human history for the greatest physical good ever yet given by science to the world.
Then followed the Jennerian legend, related in highly fabulous form with sundry extensions from Simon’s private fancy. It is sufficient to reassert that Jenner did not introduce cowpox. On the contrary, he rejected cowpox for horsegrease cowpox; and such was his prescription because he knew from the evidence of his neighbourhood that cowpox afforded no protection from smallpox. It is true that when Pearson discredited horsegrease cowpox, and recommended cowpox, Jenner dropped his prescription, and put himself forward as the discoverer of cowpox; but it is also true that in subsequent years he resumed his original position, and indeed dispensed with the cow altogether, and, like Sacco of Milan and De Carro of Vienna, used and diffused horsegrease or horsepox neat, describing the equine virus as “the true and genuine life-preserving fluid.” Of all this, however, Simon was either ignorant, or preferred to say nothing. He, too, dropped cowpox as a disease of the cow. Referring to a conjecture by Jenner that cowpox was “smallpox in a milder form,” he maintained that the conjecture had been verified by Gassner in 1801; by Thiele in 1836; by Ceely in 1839; and commercially by Badcock of Brighton in 1840. Again and again Badcock derived fresh stocks of vaccine virus from cows artificially infected with smallpox; having vaccinated with such virus more than 14,000 persons, and having furnished supplies of it to more than 400 medical practitioners—
It has been made matter of almost familiar experiment that the infection of Smallpox may, by inoculation, be communicated from Man to Cow; that its result is an eruption of vesicles presenting the physical characters of Cowpox; that the lymph from these vesicles, if implanted in the skin of the human subject, produces the ordinary local phenomena of Vaccination; that the person so vaccinated diffuses no atmospheric infection; that the lymph generated by him may be transferred, with reproductive powers, to other unprotected persons; and that, on the conclusion of this artificial disorder, neither renewed Vaccination, nor inoculation with Smallpox, nor the closest contact and cohabitation with smallpox patients, will occasion him to betray any remnant of susceptibility to infection. (P. xiv.)
Thus were the discredited claims of Jenner revived and reasserted for a new variety of virus—for smallpox inoculated on the cow! Even revaccination was pronounced impossible, and logically; for revaccination implies susceptibility to infection. It was idle, however, to shelter this new development under Jenner’s authority. When Jenner said that cowpox was smallpox in milder form, he meant in process the reverse of Simon’s interpretation. He meant that smallpox came to man from the horse through the cow; and not that the cow contracted smallpox from man. Showing his nephew a horse with greasy heels, he said, “There is the source of smallpox.”[289] When the stock of cowpox for vaccination ran low, Jenner feared it might be difficult to enlarge the supply. Why? Because farmers exercised such precaution, since they learnt that cowpox was derived from horsegrease, that the disease among cows had become well nigh extinct. Possibly Jenner was mistaken: possibly cowpox originated in smallpox: but what Simon described as “settled” in 1857 exists to this day in vehement dispute. Simon’s prescription was practically a fresh discovery—a new departure in vaccination. It recalls the practice of the variolators who took virus for timid patients from healthy subjects inoculated with mild smallpox; the supposition being that the virulence of the mild pox was meliorated in them, they playing the part that Ceely and Badcock assigned to the cow. Thus when Dimsdale variolated the Empress Catharine, it was with smallpox mitigated in the person of a strong young man. Had Dimsdale substituted a cow for a man, he would not only have anticipated Jenner, but the later revelation and practice of Ceely and Badcock—“the greatest physical good ever given by science to the world.”
Simon next went on to describe “Smallpox since the Use of Vaccination,” concerning which these observations may suffice—
1st—Smallpox was abating over Europe prior to the introduction of vaccination, notwithstanding the stimulation of the disease by variolation.
2nd—The discredit cast upon variolation by vaccination threw smallpox out of culture, and to that extent abated smallpox.
3rd—It was absurd to ascribe the decline of smallpox to vaccination in countries where only a part of the people were vaccinated; and usually, as in England, a part least liable to smallpox.
These considerations, sufficiently developed in preceding chapters, nullify the conclusion, supported by elaborate statistical tables, that vaccination was the cause of the decline in smallpox. The asserted cause was incommensurate with the effect.
Another remark remains, namely, that all vaccination was taken by Simon for effective vaccination, except where smallpox followed, and then suspicion was thrown on the virus or the time and mode of its administration. But under his own definition of virus, namely, smallpox inoculated on the cow, the greater part, if not the whole, of the vaccinations accomplished were with virus altogether diverse—with cowpox that owed nothing to smallpox, with equine cowpox, with horsepox, and much else known only to omniscience. Yet it was to these heterogeneous inoculations, modified inscrutably in transit from patient to patient, that the subsidence of smallpox was attributed! In a word, whatever was anywhere or by anybody called vaccination, served, according to Simon, to exterminate smallpox. Where shall we find an epithet for such crass assurance, with neither science or common-sense to lend it the gloss of probability!
The succeeding chapter, “Alleged Drawbacks from the Advantages of Vaccination, and alleged Dangers of its Practice,” was as abusive as unfair. It is admitted that much nonsense has been written against vaccination, and, if the pot may call the kettle black, much more nonsense has been circulated in its favour. Vaccination was recommended for the improvement of health and the complexion, for the cure of skin diseases, for the Plague, for whooping-cough, for rot in sheep, and for distemper in dogs—Jenner himself vaccinating the King’s staghounds. But to what purpose such recrimination? The prime charge against vaccination is, that it is a disease which neither averts or mitigates smallpox; and the second is, that it frequently excites and sometimes conveys other diseases.
Simon waxed eloquent on the absurdity of referring the origin of certain scrofulous affections to vaccination, whilst describing such affections as notorious sequences of smallpox; but where was the absurdity if vaccination was (as he held) a mild form of smallpox?—the mild disease serving equally as a ferment or excitant of evil humours. In his furious contempt he forgot his science and logic, and implicitly conceded all for which rational adversaries of vaccination contended.
In the same reckless vein he asked, “Is properly performed vaccination an absolutely inoffensive proceeding?” and answered—
Not at all, nor does it pretend to be so. The very meaning of the thing is, that it shall artificially and designedly produce a transient and trifling indisposition; that for some days the infant shall be uncomfortable with a sore arm and a slight irritation of the adjacent axillary glands, and a perceptible amount of general feverishness. (P. lx.)
Here we agree, and here disagree—agree as to the disease, disagree as to the determination of its limits. First, the virus is in quality indefinite; and second, the recipient of the virus is a complex of qualities indefinite; so that, as Dr. Mead observed, when smallpox was used for inoculation, “it is more material into what kind of body it be infused, than out of what it is taken.” As pathologists freely allow, it is impossible to predicate the transformations of organic poisons in the animal frame. A vigorous infant may throw off the virus, designated vaccine, and suffer no apparent harm, but the same virus may operate very differently in contact with debility and disease; so that, in the words of James, we have to say, “Behold how great a matter a little fire kindleth!” The conditions of vaccination are essentially those of hazard; the issues are those of a game of chance; the result at the best being a risk for naught.
Simon, too, was positive as to the impossibility of the invaccination of syphilis—a fact no longer in question, save as to the degree of frequency. And here, also, in his recklessness he forgot consistency, saying—
When a child is born with the heritage of syphilis (a very frequent incident, if its parents have been suffering from that infection) the characteristic symptoms do not appear till some weeks after birth; and then the scandal discloses itself. (P. lxvi.)
Just so; and before disclosure the child is vaccinated, and serving as vaccinifer, the latent syphilis is inoculated and diffused.
Vaccination, according to Simon, was easy—“The mere manual trick is learnt from a minute’s teaching and an hour’s practice.” Difficulty begins in the selection of proper subjects for the rite, for which none are qualified, save the healthy; and for the recognition of health a trained eye is wanted—
If sickly children are vaccinated, children breeding other disorders, children having skin disease, children teething and the like, the results must be at least unsatisfactory, and possibly dangerous. (P. lxii.)
If such children are exempted from vaccination, how can vaccination ever approach universality? And when universal vaccination is effected, as it is frequently effected, how can it fail to be attended with “results, at least unsatisfactory, and possibly dangerous”?
More difficult than the selection of subjects is the selection of virus for the rite; and the manifold dangers and the requisite precautions were thus specified—
Especially as regards the quality of vaccine lymph, the careless or uneducated vaccinator is using a dangerous weapon. It is only during part of the course of a vaccine vesicle that its lymph is suitable for further vaccinations: for after a given moment, at which the contents of the vesicle possess their maximum of simple contagiousness, they tend more and more toward the quality of common inflammatory products; and matter now taken from the vesicle is no longer the simple agent of a specific infection, but has less efficiency for its real purpose, and is specially able to produce other undesired results.
A danger of somewhat similar kind is that of taking lymph from vesicles which already have been accidentally ruptured, or where from any other cause, local or constitutional, their specific fluid is likely to have been modified by common irritative processes.
The danger of taking matter from irritated vesicles, and from vesicles at too advanced a period of their course, is one which circumstances render frequent; and there is reason to believe that, in at least a very large proportion of those cases where abnormal effects have resulted from so-called vaccination, it has been the employment of this ambiguous irritative matter which has occasioned the mischief and scandal.
Still more critical changes occur in lymph when removed from the body, unless appropriate means be taken to preserve it; for, under the influence of air and moisture, it tends, like other dead organic matter, to putrid decomposition; and inoculation with it, when thus changing, can hardly be more useful or less dangerous than a casual scratch inflicted in the dissecting room. (P. lxii.)
No one who considers this limitation of vaccination to the healthy, and these prescriptions as to the collection and exhibition of “lymph,” can fail to see that the charges of injury and death brought against the common practice were allowed and accounted for—were, indeed, the unavoidable associates of that practice. Vaccination, as described by Simon, was an ideal operation—impracticable on any ordinary terms. His contention and his approbation were reserved for “properly-performed vaccination” on a healthy child, with innocuous virus, the proof of each condition being discovered in the result. If unsatisfactory or injurious, or deadly, then the vaccination could not have been “properly performed”—either the child was unhealthy, or the virus was at fault.
Nor can we wonder that the people, having experience of the uselessness and misery of the virulent practice should, undismayed by the terror of smallpox, decline its observance; nor that those who made gain thereby should, distrusting their power to prevail by reason, invoke legislation to enforce the imposture, calling in the policeman to support the doctor, as of old the soldier supported the priest.
Still further to sustain his case, Simon addressed the following Circular of Questions to upwards of 500 medical men—
I.—Have you any doubt that successful Vaccination confers on persons subject to its influence a very large exemption from attacks of Smallpox, and almost absolute security against death by that disease?
II.—Have you any reason to believe or suspect that vaccinated persons, in being rendered less susceptible of Smallpox, become more susceptible of any other infective disease, or of phthisis; or that their health is in any other way disadvantageously affected?
III.—Have you any reason to believe or suspect that lymph, from a true Jennerian vesicle, has ever been a vehicle of syphilitic, scrofulous, or other constitutional infection to the vaccinated person; or that unintentional inoculation with some other disease, instead of the proposed Vaccination, has occurred in the hands of a duly educated medical practitioner?
IV.—Do you (assuming due provisions to exist for a skilful performance of the operation) recommend that, except for special reasons in individual cases, Vaccination should be universally performed at early periods of life?
Whilst these questions were framed to draw the answers required, yet, however modified, the tenor of the returns would have been much the same. We might confidently predict uniform replies, if a circular were addressed to 500 clergymen soliciting their judgment as to the disendowment of the Church, to 500 Nonconformist divines as to the benefit of hearing sermons, to 500 military men as to the expediency of an imminent war, to 500 naval officers as to an enlargement of the navy, or to 500 publicans as to the justice of local option. Nor is there sense in attributing value to testimony to be had on demand by the yard. It is brought forth as of course, and to expect otherwise is to expect what is contrary to nature.
It will be said, “Do you really mean that medical men defend vaccination because it pays?” In no other sense, I reply, than as clergymen or publicans defend their vested interests. Medical men among themselves make no secret of their pecuniary interest in vaccination, as any one may see who reads their journals; and Simon’s advocacy culminated in a demand for more liberal pay, as the only guarantee for “properly-performed vaccination.”
We may view the matter in another light. Suppose a circular had been addressed to 500 medical men fifty years ago, as to the utility of bleeding, or blistering, or salivation, would not the tenor of the answers have been equally uniform with Simon’s in favour of vaccination? Where are these practices now? But suppose any one of them had obtained legislative sanction and endowment, can we doubt that it would have survived to this day, certified as salutary and harmless by the gross of the medical profession? Let us clear our minds of cant. The assumption that men’s convictions (I except the moral aristocracy) are not controlled by their selfish interests (often enough the reverse of their true ones) is cant.
Among those interrogated was Dr. Joseph Hamernik of Prague, whose developed answers form a paper which, by reason of the independence, acumen and philosophy displayed, constitutes the distinction of Simon’s collection of documents.
First, Hamernik inquired whether cowpox and smallpox had any relation to each other, deciding that they were diverse and independent diseases. Vaccinated persons may be attacked with smallpox during the development of the cowpox vesicle, or a few days after the drying-up of the same. When inoculation is made with a mixture of cowpox and smallpox, there ensue a vaccine vesicle on the site of the puncture and a variolous eruption over the body. In fact, it is not uncommon to find cowpox and smallpox flourishing simultaneously on the same individual. Under some conditions, the one disease appears to stifle the other. Thus a powerful epidemic of smallpox will prevent the development of cowpox, illustrating the Hippocratic aphorism, Duobus doloribus simul obortis—vehementior obscurat alterum, exactly as happens when other diseases simultaneously invade the human organism. Again, in well-marked epidemics, cowpox does not protect from smallpox, even after repeated vaccinations. Under stress of such experience, the confidence in such vaccination was much shaken in England during the epidemics of 1825 and 1838. Vaccination was likewise found useless in the epidemics of Paris in 1825 and Marseilles in 1828. “Nor can revaccination achieve what vaccination cannot,” said Dr. Brown of Musselburgh. The revaccinated die of smallpox like other people, as is proved by the official returns of the armies of Wurtemburg and Prussia—
Revaccinations among civilians in Bohemia are extremely rare, and hence I am unable to cite many cases. I only saw two persons who had been revaccinated die at the Prague Hospital—a Russian officer in the guards, and a physician from Bremen.
There is no validity in the statement that epidemics of Smallpox are arrested and made milder by rapid Vaccination and Revaccination; unless medical men could test the accuracy of their verdict, as lawyers do, by a new trial. Until they can do so, we must admit that there are cases and epidemics of Smallpox light and severe. It was so before Vaccination was heard of, and is likely so to continue longer than Vaccination will endure.
Second, turning to the examination of the characters of smallpox before and after vaccination, he observed—
If Vaccination really possessed the properties ascribed to it, a change must long ere this have taken place in the character of Smallpox, both of the sporadic and epidemic kind. Smallpox has been minutely described by pathologists before Vaccination was introduced, and in such a manner that one would think they had seen the disease in the wards of our hospitals. Indeed the best pathologists of our time, who have paid special attention to Smallpox, agree that they could add nothing to the descriptions of Rhazes (who died at Bagdad A.D. 930), of Sydenham, 1675, of Richard Mead, 1754, and of John Huxham, 1764. Mead admits a light and severe Smallpox, and Huxham observed such slight epidemics that no fever appeared in the whole course of the disease. At present, pathologists would hardly class such cases with Variola Vera; they would, perhaps, call them Variola Modificata; or let them figure in their tables as Varioloid and proofs of the good results of Vaccination.
It may be that in former centuries Smallpox assumed more frequently the malignant or hæmorrhagic type; but this circumstance can in nowise be explained by the intervention of Vaccination. Even as many individuals of the animal and vegetable kingdoms have disappeared, so also have great changes taken place in the number and severity of diseases. When scurvy, putrid fevers, dysentery, etc., were commoner, Smallpox was likely to be more malignant: so much was due to the prevalent poverty and scarcity throughout Europe. Pauperism, want and hunger, are always characterised by a proportionate frequency, gravity and diffusion of various diseases.
Then, too, much of the mortality of smallpox in former times was attributable to maltreatment; and Hamernik illustrated what was possible under good treatment, by adducing his own experience when the smallpox wards in Prague were under his care. “The recoveries were, very speedy, and the deaths less than five per cent.”
Third, he held that the doctrine of Jenner was opposed to recognised pathological principles. Observation has taught us that two severe diseases cannot affect an individual at the same time. Thus typhus cannot go on with scarlet fever or smallpox, nor tuberculous with cancerous disease. The rule, however, only holds good with diseases that affect the whole organism. It does not apply to trifling or local affections, to which latter category cowpox belongs. The best marked diseases pursue their course contemporaneously with cowpox; and the scars of the punctures through which it has been inoculated have no more influence in averting smallpox than any similar scars resulting from analogous cutaneous lesion—
I consider it as a general pathological law that morbid actions which have entirely run their course can have absolutely no influence whatever upon the subsequent pathological reactions of the individual. Hence it is possible to suffer repeatedly from smallpox, scarlet fever, typhus, pneumonia, tubercular disease, etc. Nay, Smallpox has been observed five different times upon the same patient. Keeping these incontestable facts in view, it becomes a matter of indifference what was Jenner’s doctrine relative to Cowpox, whether identical with Smallpox, or whether antagonistic to Smallpox or anything else. Nor can Variolation be advocated, if we pay attention to the same pathological law. A variolous attack, when once passed away, has no more influence, as regards future events, than any other disease. The reason why many escape Smallpox altogether, why some have it twice, why the inoculation of the disease has sometimes no effect, or why some can inhale its effluvia with impunity, is entirely concealed from us. As Cowpox is a disease foreign to man, it is particularly for graziers that further investigations can be interesting.
In answer to the Second Question, whether vaccinated persons, being less susceptible to smallpox, become more susceptible of any other infective disease, or of phthisis, Hamernik answered that the interrogation implied what, for reasons given, he disputed, namely, that the vaccinated were less liable to smallpox—
The assumption is perfectly gratuitous. Epidemics of Smallpox occur at widely varying periods, with different degrees of intensity, prevalence, and duration. The Vaccinated and the Unvaccinated suffer in every epidemic; and the influence of Vaccination cannot be determined from the character and progress of the disease in individual cases.
I am aware that the beneficial influence of Vaccination is inferred from the registers of public vaccinators; but I freely confess I consider these books as perfectly valueless; and I may add that the most intelligent of the gentlemen who keep them fully concur in my opinion. In this country we know full well how vaccinators are situated; and that little confidence can be placed in them is generally acknowledged.
To the Third Question, whether syphilitic, scrofulous, and other constitutional affections are communicable in vaccination, Hamernik answered with regret in the affirmative. It was true that the contrary opinion was written at large. Taupin testified that he had taken virus from children suffering from typhus, scarlet fever, measles, smallpox, itch, inflammation of the brain, the lungs and the intestines; from chorea, epilepsy, scrofula, tuberculosis, and ring-worm, and no harm had resulted to the vaccinated; and Launauzy agrees with Taupin, that it is mere prejudice and groundless to suppose that cowpox taken, from unhealthy children can inflict any hurt—
On this head, it will be sufficient for me to remark that to arrive at a knowledge of the amount of mischief such doctrine has brought upon mankind, it would be necessary to learn how much the promulgators gained by their unlimited favour for Vaccination.
Professor Waller, of Prague, has proved that syphilis may be inoculated by means of a patient’s blood; and as blood is often drawn with the virus of vaccination, no doubt can exist as to the possibility of doing in this manner a vast amount of mischief. Monteggio taught at Milan in 1814, that when a syphilitic child is vaccinated, the result is a vesicle containing both kinds of virus; and Carioli expressed the same opinion in 1821. Marcolini relates that, on 16th June, 1814, ten children were vaccinated from a syphilitic infant, who died at the end of a few months, and five of the ten children syphilised from her.
In answer to the Fourth Question, whether vaccination should be universally performed at early periods of life? Hamernik replied, that he obviously could not recommend a practice which put health, and even life itself, in jeopardy for no certain advantage. Any efficient examination of virus was impracticable. Vaccinators may set to work with zeal and care, but their energy soon cools, and they settle into perfunctory routine. Government should assume a passive attitude toward vaccination; or if people will be vaccinated, something might be done to minimise the danger. If the practice is assigned to salaried functionaries, they are sure to create evidence to justify and perpetuate their official existence. Left to common option—
Vaccinations would every year become fewer, until at last we should read with astonishment in old newspapers how much attention was once paid to the practice.
Whilst the majority of Simon’s correspondents conjured up arguments for vaccination, their facts, apart from their rhetoric, conveyed much that was instructive. For instance, a register was produced of the deaths in Christ’s Hospital, London, for the century, 1751-1850. The boys in that charity boarding-school numbered about 550; and in twenty-five years, 1751-75, there died of smallpox 22, and in twenty-five years, 1776-1800, there died 9. In the fifty succeeding years, 1801-50, there died 1, and he in 1820. Thereon we are asked to recognise the efficacy of vaccination! But what reduced the mortality from 22 in 1751-75 to 9 in 1776-1800? And if 550 boys in the centre of London, in the flux of constant coming and going, escaped with so few fatalities from smallpox, what comes of the asserted omnipresence and havoc of the disease in London before the introduction of vaccination? Across the street from Christ’s Hospital stands Newgate, which, during the same years, was haunted with jail fever; which fever was gradually suppressed, and by what charm? Certainly by no rite analogous to vaccination. Why, then, should we be required to admit an agency in the reduction of smallpox which played no part in the reduction of a cognate disease? In times when smallpox was frequent in Christ’s Hospital, about as little regard was paid to stench and ventilation as in the prison over the way. In later years a more wholesome atmosphere prevailed, and concurrently the diet of the scholars was altered and improved—changes in themselves as sufficient to account for the disappearance of smallpox from the school as for typhus from the jail.
The like indifference to variations of circumstance vitiated throughout the generalisations of Simon and his correspondents. Assuming that the conditions of life and the characters of disease remained unaltered, smallpox was treated as uninfluenced by aught but vaccination. It needs no words to condemn such procedure as radically unsound; and men, otherwise sane, only persist in it as they persist in similar hallucinations. Even the matter of vaccination they left undefined, or differently defined. Whatever was called vaccination was taken for vaccination, and the reduction of smallpox ascribed to it. In Jenner’s hands it was first horsegrease cowpox, then cowpox, and lastly horsepox. According to Simon true vaccination was effected with smallpox inoculated on the cow. Which, we demand, was the virus that wrought the numerous miracles we are summoned to believe? Is it indeed true that there is nothing certain about vaccination save the vaccinator’s fee? Is it that, as in other thaumaturgical performances, virtue resides in the performer, described by Simon as “the duly educated medical practitioner?” Is it argued that vaccination is a species of incantation, and that it matters little what is the vehicle of the rite, its efficacy being dependent on the credentials of the administrator? Or that what is believed to be good against smallpox is good against smallpox, the charm consisting in the faith wherewith it is received?
The belief in vaccination and its proofs is much akin to the belief in witchcraft and its proofs. To argue about witchcraft, and to answer its proofs, was to become a sort of partner in the delusion. Deliverance lay in the unqualified denial of the imposture; and from that firm ground difficulty was solved and the inexplicable disappeared. As soon as the position of absolute disbelief is taken up, the plausibilities in favour of vaccination resolve themselves into the element of phantasy, so powerful and yet so evanescent. The arts of its advocates then become manifest with all the dodges, conscious and unconscious, whereby the light of truth is shut out, and the gloom requisite for visions provided. The story of vaccination is the story of many other impostures which have bewildered and afflicted mankind, and the study of one is the revelation of others.