Cowpox.
Much has been said, in previous sections of this chapter, as to the efforts of inoculators to reduce the effects of inoculated virus “to as low a degree as we could wish.” What kind of matter do you use? one inoculator would ask of another. The comparative trials of Watson had shown that serous or watery matter from an unripe pustule of smallpox, preferably from the unripe pustule of a previous inoculation on the arm, was most “successful,” the success being measured by the slightness of the effect produced at the time. The comparative trials of Mudge had confirmed that, but had gone a little farther in showing that these slight effects of crude or unripe matter left the constitution still open to the same effects by the same means, or to more severe effects by more severe means. What kind of matter to use was, accordingly, still an open question, which offered some scope for originality and ingenuity. Among other sources of crude or watery matter with bland properties was the glassy or watery variety of eruption called swinepox, which, like its congener chickenpox, was peculiar to man; and among those who tried that source of non-purulent matter for inoculation was Jenner, of Berkeley. It was in 1789 that he inoculated his child, aged eighteen months, with matter from the so-called swinepox of man. There was still another pox bearing the name of a brute animal, which was, however, a true affection of brutes—the cowpox or pap-pox. A farmer at Yetminster, Dorset, named Benjamin Jesty, had used matter from that source for the inoculation of his wife and two young children in 1774, with the result that the arm of the former was much inflamed and had to be treated by a surgeon. There seemed to be no good reason for preferring matter of such dangerous tendency, and the experiment was not repeated. A few years after, an apothecary of Lyme, in Dorset, is said to have heard of another case of the domestic use of cowpox matter for inoculation by the mistress of a farm house, and to have pressed this fact upon the attention of Sir George Baker; who, although a supporter of the mild or Suttonian inoculations with crude lymph, and by his own avowal a friend of experiments, did not favour the trial of matter from the pap-pox of cows, probably for the reason that he should have been departing from the ground-principle of inoculating for the smallpox if he were to go outside the class of variolous disease for his matter. The true virtuoso, however, has no antecedent objection to experimenting with anything. Sometime after Jenner had used the swinepox matter, he began to talk among his medical neighbours of using cowpox matter. But it was known that cowpox matter had properties and effects of its own, and that it would be a radical innovation to use it, a departure toto coelo from every modification hitherto tried in the inoculation procedure. Although it was also a pox by name, and although cowpox to the apprehension of a man of words or notions might seem to be in the same class as swinepox, glasspox, hornpox, waterpox or chickenpox, yet those who had ever seen it on the chapped hands of milkers would hardly admit that matter from such a source could serve for inoculation purposes unless upon wholly independent and original proof of efficacy. Jenner’s colleagues are reported to have denied that cowpoxed milkers escaped natural smallpox any more than their fellows[1071]. About the year 1794 Jenner began to press the subject upon the attention of his friends. His clerical neighbour, Worthington, mentioned it in one of his letters to Haygarth, of Chester, who replied, on 15 April, 1794:
“Your account of the cowpox is indeed very marvellous, being so strange a history, and so contradictory to all past observations on this subject, very clear and full evidence will be required to render it credible. You say that this whole rare phenomenon is soon to be published, but do not mention whether by yourself or some other medical friend. In either case I trust that no reliance will be placed upon vulgar stories. The author should admit nothing but what he has proved by his own personal observation, both in the brute and human species. It would be useless to specify the doubts that must be satisfied upon this subject before rational belief can be obtained. If a physician should adopt such a doctrine, and much more if he should publish it upon inadequate evidence, his character would materially suffer in the public opinion of his knowledge and discernment[1072].”
It is clear that Haygarth, who was well acquainted with epidemic smallpox and with inoculation, saw in this Gloucestershire idea something quite new as well as antecedently improbable. What the real novelty was will appear from the next historical reference to cowpox in an original work upon Morbid Poisons by Joseph Adams, a writer of the Hunterian school. All that Adams knew of the nature of cowpox previous to March, 1795, came from Cline, surgeon to St Thomas’s Hospital, who had been a fellow student of Jenner’s five and twenty years before, and kept up some correspondence with him. Adams is writing on the peculiar danger of ulceration and sloughing, or phagedaena, from transferring animal matters from one body to another, his last illustration having been the notorious phagedaenic ulceration of the gums, with rashes of the skin and constitutional effects so severe as to be fatal, which followed the transplantation of fresh teeth from one person to another in a number of cases about the year 1790 and led to the speedy abandonment of that unnatural practice[1073]. He proceeds to say, “Thus far we have only traced the poisonous effects of matter applied from one animal to another of the same class,” and then he brings in the illustration of cowpox to finish the chapter:
“The cowpox is a disease well known to the dairy-farmers in Gloucestershire. The only appearance on the animal is a phagedaenic ulcer on the teat, with apparent inflammation. When communicated to the human subject, it produces, besides ulceration on the hand, a considerable tumour of the arm, with symptomatic fever, both which gradually subside. What is still more extraordinary, as far as facts have been hitherto ascertained, the person who has been infected is rendered insensible to the variolous poison[1074].”
Jenner’s own essay on the cowpox, when it appeared at length in 1798, confirmed these statements as to the phagedaenic or corroding ulcerous character of the milkers’ sores, in his brief accounts of several cases, of which it will suffice to mention these two: William Stinchcomb, farm servant, had his left hand severely affected with several corroding ulcers, and a tumour of considerable size appeared in the axilla of that side; his right hand had only one small sore. A poor girl, unnamed, “produced an ulceration on her lip by frequently holding her finger to her mouth to cool the raging of a cowpox sore by blowing upon it[1075].” Inquiries made by Dr George Pearson in various other dairy counties of England brought out the same character of cowpox in milkers: the painful sores might be as large as a sixpenny piece, and might last a month or two, causing the milker to give up his work[1076].
As to the pap-pox itself, or cowpox in the cow, the most circumstantial account was obtained, a few months after Jenner’s first essay, by interrogating a veterinary surgeon or cow-doctor, one Clayton, who attended at most of the farms within ten miles of Gloucester:
“That the chief diseases of the cow are the lough, swellings of the udder, and cowpox; that the two former are the most common, the latter being rarely seen except in spring and summer.
That cowpox begins with white specks upon the cow’s teats, which, in process of time, ulcerate; and, if not stopped, extend over the whole surface of the teats, giving the cow excruciating pain.
That, if this disease is suffered to continue for some time, it degenerates into ulcers, exuding a malignant and highly corrosive matter; but this generally arises from neglect in the incipient stage of the disease, or from some other cause he cannot explain.
That this disease may arise from any cause irritating or excoriating the teats; but that the teats are often chapped without the cowpox succeeding. In chaps of the teats, they generally swell; but in the cowpox, the teats seldom swell at all, but are gradually destroyed by ulceration.
That this disease first breaks out upon one cow, and is communicated by the milker to the whole herd; but if one person was confined to strip the cow having this disease, it would go no farther.
That the cowpox is a local disease, and is invariably cured by local remedies.
That he never knew this disease extend itself in the highest degree to the udder, unless mortification had ensued; and that he can at all times cure the cowpox in eight or nine days[1077].”
No account of cowpox in the cow has ever been given which differs materially from that of this experienced Gloucester cow-doctor in 1798[1078]. Cowpox is not only a local disease, but it is peculiar to certain individuals of the species, namely cows in milk; in them it occurs on the teats, so that it was correctly known in Norfolk by the name of pap-pox. The common observation has been that one cow starts it, and that an infection is rubbed into the teats of others by the fingers of the milkers. The cow which develops this ulceration of the paps is usually either a heifer in her first milk, from which the calf has been taken away, or a cow in milk which has been bought in a market, with the udder “overstocked” or left distended for appearance sake, but as yet with no blemish of the paps. The cause of cowpox is the rough handling of a highly sensitive part, which was originally adapted only for the lips and tongue of the calf. Ceely, a correct observer in the Vale of Aylesbury, uses no exaggerated phrase when he speaks of “the merciless manipulations of the milkers.” Men milkers are well known to lack the delicate tact of women; and cowpox has been most common in the great dairying districts where men-milkers are employed. But in some animals cowpox may be produced even under gentler handling or with slighter provocation, of which I give a recent case from my notebook, taken during a visit to the country:
27 April, 1891. Case of cowpox. A maid in the service of Mr J. R. has on the ulnar side of the fore finger of the right hand, over the joint of the first and second phalanges, a collapsed bleb the size of a sixpenny piece, pearly white round the margin, bluish towards the centre, which is brown. The forefinger, as well as the wrist and hand generally, bears traces of recent inflammation, and was said to have been greatly swollen and painful, the pain extending up the arm. There is a symmetrical rash of bright red papules on both arms as high as the elbows, more copious and bright on the right arm but abundant on the left also. The papules are elevated and pointed, with a small zone of bright redness of the skin round the base of each. The history is as follows: A cow was bought four or five weeks ago to supplement the supply of milk from the three ordinarily kept. The new comer proved “tough” to milk, so that the maid was obliged, contrary to usual practice, to take the paps in the cleft of the fore and middle fingers; under this mode of “stripping,” the animal would hardly stand quiet to be milked. After a time it was found that one of the paps had a black crust upon it, which might have covered originally a chap of the skin. The crust would have been displaced in the milking, and would have grown again; the sore beneath soon healed. Only one pap was affected. None of the other cows was infected. The “tough” cow was at length sold as an unsatisfactory milker, and had been sent to a distance on the morning of the day on which these notes were made. The maid’s finger began to be affected after two or three weeks of milking the cow, the beginning of the large and tumid bluish-white vaccine vesicle having been like a small wart.
Jenner’s opinion that cowpox was a specific disease “coeval with the brute creation,” and that it had been the parent of the great historical smallpox of mankind, is not now received as correct. His other opinion, that cowpox was derived from the hocks of horses affected with “grease,” which held a central place in his original essay, especially in connexion with his doctrine of “true” and “spurious” cowpox, was rejected by most of his contemporaries, and is perhaps unsupported by anyone at the present time[1079].
In the title-page of his first essay, Dr Jenner called this singular malady of the cow’s paps by a new name—variolae vaccinae, or smallpox of the cow. Pearson, the earliest and most ardent of Jenner’s original supporters, and for several years thereafter a convinced vaccinist, at once took exception to the name variolae vaccinae “for the sake of precision of language and justness in thinking.” It is a palpable catachresis, says he, to designate what is called the cowpox by the denomination variolae vaccinae, because the cowpox is a specifically different distemper from the smallpox in essential particulars, namely, in the nature of its morbific poison and in its symptoms[1080].
That the term variolae vaccinae in Jenner’s title-page is used tropically can hardly be doubted; but it is not so easy to say which of the great classical tropes it is. It may be objected that “catachresis” is too general for the misuse of a word when that word is a scientific one and occurs in the leading title of a scientific book. Here we have the somewhat specific and purposeful use of a word in an unwonted sense, which, if it fall under any of the scholastic figures of speech, ought to be a figure more specifically defined than mere catachresis. In a matter so important as this one should find the exact figure if possible; but at the outset a difficulty arises, namely whether we should look for it in the usage of the rhetors, as Isocrates teaches, or in the usage of the logicians, as Aristotle lays down the definitions of tropes. If among the former class, the nearest is perhaps the hypocorisma, or attractive, agreeable name for something that is not so nice in itself. If among the latter, we shall hardly find a better than the metalepsis, which is a change more of mood than of meaning, namely the transition without proof from a supposition to an assertion. But in truth no single figure of the ancient teachers suits this modern instance. We require at least two. Metalepsis carries us so far, but synecdoche must supplement it. The term variolae vaccinae is a synecdoche in that it names the cause from the effect; it is a metalepsis in that it passes abruptly from the hypothetical mood to the categorical; and in respect that it does both at a stroke it is probably unique, and without precedent among the examples known to the ancients. Or again, leaving the graver figures, and translating the Latin name of Jenner’s title-page, one may try the figurative conversion of cowpox into smallpox by the standard of pure and legitimate paronomasia, of which there is a familiar English example in the conversion of a plant into an animal by the verbal play of horse-chestnut and chestnut horse in the minor premiss.
Some in more recent times, mistaking the figurative or rhetorical intention of Jenner, have understood his Latin name of cowpox as if there really were a smallpox of the cow (although not of the bull, nor of the steer, the maiden heifer or the calf of either sex). Not being able to find a smallpox of the cow in the natural way, they have thought to satisfy the legitimate requirements of proof by manufacturing it. Certain Germans of the Lower Rhine, where the cows ordinarily wear blankets, have wrapped the blankets taken from smallpox beds round the bodies of cows, after clipping the hair close; nothing was found to ensue in these interesting experiments except an occasional pimple which had probably been caused by the shears in the preliminary clipping. Others in England, France, America and India, have succeeded in raising a smallpox pustule at the point of puncture in the epidermis of the cow or in the more delicate transitional epithelium, the matter from which has produced smallpox in its turn[1081]. But these are academic exercises. The natural cowpox of the cow has been likened by none to the natural smallpox of man in a sustained comparison of all the anatomical and epidemiological particulars of each; nor, I am persuaded, will anyone ever attempt to draw out such a comparison. Variolae vaccinae as a name for cowpox was a figure of speech, and it is to misunderstand its original use to treat it as anything else.
The proof that cowpox had some power over smallpox consisted in trying to inoculate with the latter those who had been previously inoculated with the former. The accepted mode of testing the power of inoculated smallpox itself was to inoculate it again; at first the test for cowpox was to inoculate with smallpox, but after a few years the testing inoculation was done with cowpox itself. The effects of Suttonian inoculation with smallpox, as we have seen, were nearly always slight, and sometimes invisible (as in Watson’s practice at the Foundling Hospital). A previous inoculation with cowpox made them slighter still; but even with cowpox in the system, the pustules of smallpox rose where the matter had been inserted on the arm. It may be thought that there were only fine shades of difference between the effects of inoculation after cowpoxing and the effects of the same in a virgin soil; but some difference must have been perceived, for it was upon that, and upon nothing else, that the authority in favour of cowpox as a substitute for smallpox in inoculation was promptly established. The relationship between cowpox and smallpox was admitted by all to be in the nature of things “extraordinary,” as Jenner said, or a mystery, as others said; but as an empirical fact many believed it to be true, because the cowpoxed had less to show for the effects of inoculation with smallpox than if they had not been cowpoxed. Jenner himself is known to have made only two variolous tests. He used crude or watery matter from the local pustule of inoculated smallpox, and advised all his readers to do the same. In one of his two trials, a child Mary James had nearly the same effects from inoculation after cowpox that her mother and another child had from it without having been cowpoxed, namely the pustule or confluent group of pustules at the place of puncture, and the eruptive fever at the ninth day[1082].
In the earliest tests made independently of Jenner, five at Stonehouse[1083], near Stroud, and five at Stroud[1084], in the first months of 1799, the cowpoxed received smallpox afterwards by inoculation “in the usual slight manner.” In the practice at the Smallpox and Inoculation Hospital, London, in the spring and summer of 1799, many of the cowpoxed took smallpox by contagion from the atmosphere of the hospital, so that Woodville, after a period of perplexity, at length concluded that cowpox, while it was still active upon the arm, did not shut out the action of the smallpox virus in the constitution[1085].
The antecedent objections to cowpox, arising out of its non-variolous nature, were met by appealing to the results of experiments. The authority in favour of cowpox was speedily established on that ground, and has been continuous to the present time. The experimenters had to decide very nice points both in the way of observation and of reasoning. They had to appraise the margin of difference between the effects of Suttonian inoculation where cowpox had preceded and where it had not preceded. They had to allow for the first virus causing a swelling in the absorbent glands, which would obstruct the entrance of the second testing virus into the blood. They had to average the varying effects of Suttonian inoculation for its own sake, and the equally varying effects of it as the variolous test, and to find a broad difference between the two averages. Having decided that preceding cowpox infection did make a real and appreciable difference to the number of pustules resulting, at the spot or elsewhere, from the insertion of inoculated smallpox matter, or to the amount of fever, they had next to consider whether that degree of resistance by a cowpoxed person to inoculation were a good measure of his power to resist contagion reaching his vitals in the natural way. Their diligence and acumen may or may not have been equal to these things—it was a slack tide in medical science. Also they received little or no help from Dr Jenner himself, whose inventive genius was of the kind that is apt to leave the practical value, and even the theoretical probability, of the project to be tried by others. The inventor made interest with great personages—with the king, the duke of York, and the aristocracy of his county. His priority, and the merits of his project, were referred in 1802 to a Committee of the House of Commons, with Admiral Berkeley as chairman, which entered on its labours with a strong recommendation from the king, endorsed by Addington, the prime minister. They decided in favour of Dr Jenner’s claim for remuneration on all the issues, and on 2 June, 1802, the Committee of the whole House unanimously voted: “That it is the opinion of the Committee that a sum not exceeding £10,000 be granted to his Majesty to be paid as a remuneration to Dr Edward Jenner for promulgating the discovery of the Vaccine Inoculation, by which mode that dreadful malady the smallpox was prevented[1086].” On 29 July, 1807, a farther sum of £20,000 was voted to him; and on 8 June, 1808, a National Vaccine Establishment was appointed, at an annual cost of about £5,000.