When Jenner died in 1823, the judgment of the majority of the people was pronounced against cowpox inoculation; but medical men, who are expected to know something, and do something, against every ailment, rarely surrender a prescription until it can be replaced by another. The doctors therefore held by vaccination, but on modified terms; and the position to which they had been reduced is set forth in an article in the Edinburgh Review, for November, 1822, concerning which Jenner wrote to Gardner, 13th January, 1823, a week before his death—
I have an attack from a quarter I did not expect, the Edinburgh Review. These people understand literature better than physic. It will do incalculable mischief. I put it down at 100,000 deaths at least. Never was I involved in so many perplexities.
What an extraordinary article! working mischief incalculable, and bad for at least one hundred thousand deaths! A criticism in the Quarterly is said to have killed Keats, upon which Byron remarked—
’Twas strange the mind, that very fiery particle,
Should let itself be snuffed out by an article.
If, however, Jenner was right, it will be allowed, I think, that the murder of a poet was exceeded in atrocity by the slaughter of at least one hundred thousand ordinary mortals. Wherefore, to discover the manner of the great iniquity, I looked up the Edinburgh Review and discovered the diabolical article. It is entitled “Vaccination and Smallpox”; is obviously written by the editor, Jeffrey; and the rock of offence was at once apparent. Doubt is thrown on the efficacy of vaccination to prevent smallpox; ergo, vaccination thus discredited will be neglected; ergo, vaccination thus neglected will enlarge the domain of smallpox; ergo, at least one hundred thousand persons will perish. Q.E.D. But it will be asked, “What did Jeffrey say?” The article thus opens—
Vaccination, we are perfectly persuaded, is a very great blessing to mankind; but not quite so great a blessing, nor so complete a protection, as its early defenders conceived it to be. The proof of this has been admitted with great reluctance; but it has unfortunately become too strong for denial or resistance. The first answers given to the instances of failure, with which the friends of Vaccination were pressed, were, either that the disease which had occurred after Vaccination was Chickenpox, and not Smallpox; or that the process of Vaccination had been unskilfully or imperfectly conducted; or that it was one of those very rare cases which occurred in the times of Inoculation, and from which Vaccination itself did not pretend to be wholly exempt.
The Report of the Vaccine Pock Institution for 1803 is cited, as follows, to show how absolute was the confidence in vaccination in the days of inexperience—
We have been alarmed two or three times with intelligence of Smallpox occurring several weeks or months after our patients had undergone the Cowpox. We thought it our duty to visit and examine these patients, and also to inquire into their history among their attendants, and by these means we obtained the completest satisfaction that the pretended Smallpox was generally the Chickenpox.
As time went on, cases of smallpox after vaccination kept multiplying, and the various excuses to account for their occurrence, though obstinately asserted, utterly broke down. There remained no doubt whatever that to be vaccinated in the most approved fashion afforded no guarantee against smallpox. In 1820, said Jeffrey, the Board of the National Vaccine Establishment was compelled to make the following melancholy admission—
It is true that we have received accounts from different parts of the country of numerous cases of Smallpox having occurred after Vaccination; and we cannot doubt that the prejudices of the people against this preventive expedient are assignable (and not altogether unreasonably perhaps) to this cause. These cases the Board has been industriously employed in investigating; and though it appears that many of them rest only on hearsay evidence, and that others seem to have undergone the Vaccine Process imperfectly some years since when it was less well understood, and practised less skilfully than it ought to be; yet, after every reasonable deduction, we are compelled to allow that too many still remain on undeniable proof, to leave any doubt that the pretensions of Vaccination to the merit of a perfect and exclusive security in all cases against Smallpox, were admitted at first too unreservedly.
The significance of a confession like the foregoing is not to be estimated literally. It was exacted under irresistible pressure of facts, numerous, definite and undeniable, after every method of excuse and prevarication had been exhausted. In short, it was an authoritative retractation of the flaming medical testimony with which vaccination had been commended to the public in 1800, when the heads of the profession thought it their duty to declare in the newspapers—
That those persons who have had the Cowpox are perfectly secure from the future infection of the Smallpox.
And of Jenner’s emphatic assurance—
That the human frame, when once it has felt the influence of the genuine Cowpox is never afterwards, at any period of its existence, assailable by the Smallpox.
The occasion of Jeffrey’s article was the publication by Dr. John Thomson of a treatise on a violent epidemic in Edinburgh, and other parts of Scotland, in 1818-19.[224] The disease differed from ordinary smallpox in respect of the smallness of the pustules, which contained a milky fluid, and began to dry up on the fourth or fifth day. In Thomson’s words—
The epidemic appeared to exhibit all the varieties of Smallpox from the mildest to the most malignant; and it was curious to observe that the mildest forms, as well as the most malignant, were strictly vesicular eruptions, in which scarcely a trace of purulent matter was to be seen from their commencement to their termination.
Whether this epidemic was smallpox or chickenpox, was the question. It was chickenpox said some. It was modified smallpox said others. It probably was chickenpox said Thomson; and if so, he argued, chickenpox should be accounted a variety of smallpox. The chief cause of uncertainty was, that the vaccinated constituted the majority of sufferers—
Had the unvaccinated alone been attacked [wrote Thomson], nothing, it appears to me, but the most unreasonable scepticism could ever have suggested a doubt of the disease being genuine Smallpox.
Thomson reported 556 cases in Edinburgh of which—
310 had been Vaccinated;
41 had had Smallpox; and
205 had neither been Vaccinated nor had Smallpox.
And William Gibson, surgeon at Robert Owen’s mills, New Lanark, had 322 cases, of which—
251 had been Vaccinated.
11 had had Smallpox, spontaneous or inoculated.
57 had neither been Vaccinated nor had Smallpox.
3 had had Smallpox and Cowpox simultaneously.
As is usual in epidemics of smallpox, it was the young who were the majority of sufferers; Thomson saying—
The epidemic has been observed to attack those chiefly who were under ten years of age; increasing years appearing in general to lessen the susceptibility to Smallpox contagion.
Thomson supported his opinion that chickenpox and smallpox were interchangeable varieties of variola with much cogent evidence and argument. He cited instances in which they occurred together, one constitution bringing forth chickenpox where another brought forth smallpox, whilst the infection of one appeared at times in the manifestation of the other. The controversy is not one on which it is necessary to pronounce judgment beyond saying that the whole drift of philosophic pathology is now in Thomson’s favour; and indeed at the time he wrote, his position would not have been seriously contested, save for the discredit it accumulated upon vaccination. One of Thomson’s correspondents, P. Mudie, M.D., of St. Andrews, stated the difficulty with artless force. He wrote, 18th October, 1818—
Of late years I have remarked, that the disease called Chickenpox has been much more severe than formerly; and many of the cases occurring after Vaccination, so much resembled Smallpox, that if my mind had not been prejudiced against the possibility of such an occurrence, I should have pronounced the eruption to have been of a variolous nature.
Notwithstanding his experience, Thomson held firmly by vaccination. Whilst compelled to admit that it did not avert either form of variola, he maintained with curious fervour that it made the disease milder, as if to excuse his partial surrender of faith. We all see more or less according to our prepossessions, and we need not blame Thomson if with his perspicacity he was unequal to the entire truth. The vaccinated belonged to classes who were better housed, better fed, and better cared for than the unvaccinated; and if their ailment had been measles or pneumonia in place of chickenpox, they would have all the same made better recoveries. Precisely the same error is made at this day: what is due to kindlier conditions of life is ascribed to vaccination.
Some tried to account for the manifest failure of vaccination on the supposition that the original virus had lost its force in transmission from arm to arm, but Thomson would not allow that it had deteriorated. He said—
The Vaccine Virus used in Edinburgh for a series of eighteen years produces exactly the same appearances as are delineated by Dr. Jenner as characteristic of Cowpox. I know, also, that the appearances of the vaccine vesicle produced by this matter, which must have passed through a succession of at least 900 individuals, agree exactly with those exhibited by vesicles produced by inoculation, with the more recent equine matter with which I have been, lately favoured by Dr. Jenner.
The latter words are noteworthy. When Jenner’s ascription of the origin of Cowpox in Horsegrease is referred to, the answer frequently is, that Jenner was mistaken, and that he did not persist in his opinion. It is true that he did preserve a judicious silence about horsegrease when he saw that it would mar rather than make his fortune. But when he obtained all he was likely to get, he resumed the expression of his original opinion, and used and diffused what he described as horsegrease; and the vesicles raised by the virus, and the cicatrices which remained were identical with those induced by so-called Cowpox.
Another point developed in Thomson’s evidence was the mistake made crediting vaccination with the prevention of smallpox where there was no smallpox to prevent. The victories ascribed to vaccination were victories either over an imaginary or a retreating enemy. We cannot too firmly insist upon this point in presence of the claim continually advanced for the subjugation of smallpox by vaccination. For some cause undefined, and, probably in its full extent, undiscoverable, a subsidence of smallpox over the whole of Europe set in toward the close of last century, and continued during the early years of the present; and to this subsidence the favour that vaccination met with was largely due. The decline in the disease concurrently with the introduction of vaccination, was ascribed to vaccination, although the decline prevailed among an overwhelming majority who had never received vaccination. To make good the claim for vaccination it would have been necessary to maintain that the vaccine rite, as applied to 2 or 3 per cent. of Europeans, effected the salvation of 98 or 97 per cent. For example, a great point was made by Jenner and his friends of the extinction of smallpox in Vienna, according to the following table—
| Years. | Total Deaths. | From Smallpox. | |||
| 1791-1800 | average | 14,600 | 835 | or one in | 17½ |
| 1801 | 15,181 | 164 | 93 | ||
| 1802 | 14,522 | 61 | 238 | ||
| 1803 | 14,383 | 27 | 582 | ||
| 1804 | 14,035 | 2 | 7,017 |
Yet it was never pretended that in these years more than a fraction of the Viennese were vaccinated, or that the death-rate of the city was reduced by the disappearance of smallpox. The like fatuity characterised the whole of the vaccinators’ statistics. Smallpox had declined, therefore, they argued, vaccination is the cause of the decline, and multitudes were convinced by the illicit logic. When vaccination was, however, brought to the test of epidemic smallpox, its inefficacy became manifest, and thus Thomson had to avow, as the result of his experience in the Edinburgh epidemic of 1818-19—
It is to the severity of this epidemic, I am convinced, that we ought to attribute the greatness of the number of the vaccinated who have been attacked by it, and not to any deterioration in the qualities of the Cowpox Virus, or to any defects in the manner in which it has been employed. Had a variolous constitution of the atmosphere, similar to that which we have lately experienced, existed at the time Dr. Jenner brought forward his discovery, it may be doubted whether it ever could have obtained the confidence of the public.
Such was the article which Jenner “put down for 100,000 deaths at least.” Yet neither Jeffrey nor Thomson renounced vaccination. They agreed that whilst it could no longer be trusted to prevent smallpox, it made the disease milder in those it attacked. When a cherished belief is surrendered, it is rarely unconditionally: it is only by degrees that full concession is made unto truth.
[224] An Account of the Varioloid Epidemic which has lately prevailed in Edinburgh and other Parts of Scotland; with Observations on the Identity of Chickenpox with Modified Smallpox. By John Thomson, M.D. London, 1820. Pp. 400.