History of the Small Pox Vaccine

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VACCINATION AND SMALL-POX

Among the greatest self-created scourges of civilized humanity are the group of zymotic diseases, or those which arise from infection, and are believed to be due to the agency of minute organisms which rapidly increase in bodies offering favourable conditions, and often cause death. Such diseases are: plague, small-pox, measles, whooping-cough, yellow fever, typhus and enteric fevers, scarlet fever and diphtheria, and cholera. The conditions which especially favour these diseases are foul air and water, decaying organic matter, overcrowding, and other unwholesome surroundings, whence they have been termed "filth diseases." The most terrible and fatal of these--the plague--prevails only where people live under the very worst sanitary conditions as regards ventilation, water supply, and general cleanliness. Till about 250 years ago it was as common in England as small-pox has been during the present century, but a very partial and limited advance in healthy conditions of life entirely abolished it, its place being to some extent taken by small-pox, cholera, and fevers. The exact mode by which all these diseases spread is not known; cholera, typhus, and enteric fever are believed to be communicated through the dejecta from the patient contaminating drinking water. The other diseases are spread either by bodily contact or by transmission of germs through [[p. 6]] the air; but with all of them there must be conditions favouring their reception and increase. Not only are many persons apparently insusceptible through life to some of these diseases, but all the evidence goes to show that, if the whole population of a country lived under thoroughly healthy conditions as regards pure air, pure water, and wholesome food, none of them could ever obtain a footing, and they would die out as completely as the plague and leprosy have died out, though both were once so prevalent in England.

     But during the last century there was no such knowledge, and no general belief in the efficacy of simple, healthy conditions of life as the only effectual safeguard against these diseases. Small-pox, although then, as now, an epidemic disease and of very varying degrees of virulence, was much dreaded, because, owing chiefly to improper treatment, it was often fatal, and still more often produced disfigurement or even blindness. When, therefore, the method of inoculation was introduced from the East in the early part of the eighteenth century, it was quickly welcomed, because a mild form of the disease was produced which rarely caused death or disfigurement, though it was believed to be an effectual protection against taking the disease by ordinary infection. It was, however, soon found that the mild small-pox usually produced by inoculation was quite as infectious as the natural disease, and became quite as fatal to persons who caught it. Towards the end of the last century many medical men became so impressed with its danger that they advocated more attention to sanitation and the isolation of patients, because inoculation, though it may have saved individuals, really increased the total deaths from small-pox.

     Under these circumstances we can well understand the favourable reception given to an operation which produced a slight, non-infectious disease, which yet was alleged to protect against small-pox as completely as did the inoculated disease itself. This was Vaccination, which arose from the belief of farmers in [[p. 7]] Gloucestershire and elsewhere that those who had caught cow-pox from cows were free from small-pox for the rest of their lives. Jenner, in 1798, published his Inquiry, giving an account of the facts which, in his opinion, proved this to be the case. But in the light of our present knowledge we see that they are wholly inconclusive. Six of his patients had had cow-pox when young, and were inoculated with small-pox in the usual way from twenty-one to fifty-three years afterwards, and because they did not take the disease, he concluded that the cow-pox had preserved them. But we know that a considerable proportion of persons in middle age are insusceptible to small-pox infection; besides which even those who most strongly uphold vaccination now admit that its effects die out entirely in a few years--some say four or five, some ten--so that these people who had had cow-pox so long before were certainly notprotected by it from taking small-pox. Several other patients were farriers or stable men who were infected by horse-grease, not by cow-pox, and were also said to be insusceptible to small-pox inoculation, though not so completely as those who had had cow-pox. The remainder of Jenner's cases were six children, from five to eight years old, who were vaccinated, and then inoculated a few weeks or months afterwards. These cases are fallacious from two causes. In the first place, any remnant of the effects of the vaccination (which were sometimes severe), or the existence of scurvy, then very prevalent, or of any other skin-disease, might prevent the test-inoculation from producing any effect.¹ The other [[p. 8]] cause of uncertainty arises from the fact that this "variolous test" consisted in inoculating with small-pox virus obtained from the last of a series of successive patients in whom the effect produced was a minimum, consisting of very few pustules, sometimes only one, and a very slight amount of fever. The results of this test, whether on a person who had had cow-pox or who had not had it, was usually so slight that it could easily be described by a believer in the influence of the one disease on the other as having "no effect"; and Dr. Creighton declares, after a study of the whole literature of the subject, that the description of the results of the test is almost always loose and general, and that in the few cases where more detail is given the symptoms described are almost the same in the vaccinated as in the unvaccinated. Again, no careful tests were ever made by inoculating at the same time, and in exactly the same way, two groups of persons of similar age, constitution, and health, the one group having been vaccinated the other not, and none of them having had small-pox, and then having the resulting effects carefully described and compared by independent experts. Such "control" experiments would now be required in any case of such importance as this; but it was never done in the early days of vaccination, and it appears never to have been done to this day. The alleged "test" was, it is true, applied in a great number of cases by the early observers, especially by Dr. Woodville, physician to a small-pox hospital; but Dr. Creighton shows reason for believing that the lymph he used was contaminated with small- [[p. 9]] pox, and that the supposed vaccinations were really inoculations. This lymph was widely spread all over the country, and was supplied to Jenner himself, and we thus have explained the effect of the "vaccination" in preventing the subsequent "inoculation" from producing much effect, since both were really mild forms of small-pox inoculation. This matter is fully explained by Dr. Creighton in his evidence before the Royal Commission, printed in the Second Report. Professor E. M. Crookshank, who has made a special study of cow-pox and other animal diseases and their relation to human small-pox, gives important confirmatory evidence, to be found in the Fourth Report.

     This brief statement of the early history of vaccination has been introduced here in order to give what seems to be a probable explanation of the remarkable fact that a large portion of the medical profession accepted, as proved, that vaccination protected against a subsequent inoculation of small-pox, when in reality there was no such proof, as the subsequent history of small-pox epidemics has shown. The medical and other members of the Royal Commission could not realize the possibility of such a failure to get at the truth. Again and again they asked the witnesses above referred to to explain how it was possible that so many educated specialists could be thus deceived. They overlooked the fact that a century ago was, as regards the majority of the medical profession, a pre-scientific age; and nothing proves this more clearly than the absence of any systematic "control" experiments, and the extreme haste with which some of the heads of the profession expressed their belief in the lifelong protection against small-pox afforded by vaccination, only four years after the discovery had been first announced. This testimony caused Parliament to vote Jenner £10,000 in 1802.

     Ample proof now exists of the fallacy of this belief, since vaccination gives no protection whatever, as will be shown later on. But there was also no lack of [[p. 10]] proof of this failure to protect in the first ten years of the century; and had it not been for the unscientific haste of the medical witnesses to declare that vaccination protected against small-pox during a whole lifetime--a fact of which they had not and could not possibly have any evidence--this proof of failure would have convinced them and have prevented what is really one of the scandals of the nineteenth century. These early proofs of failure will be now briefly indicated.

     Only six years after the announcement of vaccination, in 1804, Dr. B. Moseley, Physician to Chelsea Hospital, published a small book on the cow-pox, containing many cases of persons who had been properly vaccinated and had afterwards had small-pox; and other cases of severe illness, injury, and even death resulting from vaccination; and these failures were admitted by the Royal Jennerian Society in their Report in 1806. Dr. William Rowley, Physician to the St. Marylebone Infirmary, in a work on Cow-pox Inoculation in 1805, which reached a third edition in 1806, gave particulars of 504 cases of small-pox and injury after vaccination, with seventy-five deaths. He says to his brother medical men: "Come and see. I have lately had some of the worst species of malignant small-pox in the Marylebone Infirmary, which many of the faculty have examined and know to have been vaccinated." For two days he had an exhibition in his Lecture Room of a number of children suffering from terrible eruptions and other diseases after vaccination.

     Dr. Squirrel, f