Extent of Inoculation with Cowpox or Smallpox, 1801-1825.
Twenty-five years had now passed since cowpox became the rival or substitute of the old matter of inoculation. The history at this point requires some notice of the extent to which each of those methods was practised. Professional opinion, or that part of it which found expression, was for the most part in favour of cowpox. The Smallpox and Inoculation Hospital of London took the lead, under Woodville, in substituting cowpox for smallpox, and other public institutions, such as the Newcastle and Whitehaven Dispensaries, quickly followed. The new mode was practised upon larger numbers than the old. At the Newcastle Dispensary the inoculations of smallpox from 1786 to 1801 had been 3268; the inoculations of cowpox from 1801 to 1825 were 20,264. At the Whitehaven Dispensary 173 children were inoculated with smallpox in 1796, the total inoculations before that having been 906. To the end of 1803 the total vaccinations were 490, of which many were done during the severe outbreak of smallpox in 1803.
In Glasgow, where the old inoculation was either little practised or of little use, the Jennerian mode was received with favour, and was offered to the children of the working classes gratuitously at the Hall of the Faculty of Physicians and Surgeons. From the 15th of May, 1801, to the 31st of December, 1811, these public vaccinations numbered 14,500, an average of about 1400 in the year. In the next seven years they declined as follows:
| 1812 | 950 | |
| 1813 | 1162 | |
| 1814 | 875 | |
| 1815 | 926 | |
| 1816 | 980 | |
| 1817 | 820 | |
| 1818 | 650 |
On the revival of smallpox the Glasgow Cowpock Institution was opened on 28 August, 1818, and vaccinated 146 to the 1st of January, 1819. The smaller demand for even gratuitous vaccination of infants after 1812 was owing to the very small amount of smallpox in Glasgow in those years; in the six years, 1813-19, there were said (by Cleland) to have been only 236 deaths from smallpox in a total of 22,060 deaths from all causes, or 1·07 per cent. of all deaths[1115]. Not more than a fourth part of all the infants born in Glasgow had been vaccinated in the years 1812 to 1818, and that was the time when smallpox was at its lowest point among the infantile causes of death. In some of those years when smallpox was in abeyance measles was most destructive. It was currently said in Glasgow that vaccination, if it discouraged smallpox, predisposed to measles, an opinion of the populace which Malthus shared from the à priori point of view. But in a survey of the individual cases in their practice the Glasgow doctors did not find that those were the relevant circumstances, whatever the truly relevant things may have been. Thus, Dr Robert Watt, a good observer and cautious reasoner, who became president of the Glasgow faculty, wrote: “The only family within my knowledge where three died of the measles in 1808 was one where none of the children had been either vaccinated or had had the smallpox. I met with another family where two died in the same circumstances”—that is to say, five children, in two families, escaped smallpox to die of measles, no artificial interference having been attempted[1116].
Manchester was another populous district where vaccination had been freely offered to the poorer classes. Roberton, writing in 1827, says that it had been on the decline for several years, and gives the following figures for the earlier period, May, 1815, to May, 1823[1117]: At the Manchester Lying-in Charity the annual average of deliveries was 2667, while the number of infants brought back for vaccination averaged 1392 in a year. During the same eight years public vaccinations at the Manchester Infirmary averaged 1700 annually. Great numbers of infants were said, also, to have been vaccinated gratuitously by druggists. The decline in the number of vaccinations, which had perhaps begun some time before (as at Glasgow), was shown conclusively by the returns for the two years May, 1824—May, 1826. The births at the Lying-in Charity averaged 3285 per annum; but the vaccinations in the infants brought back to the charity, together with those brought to the Manchester Infirmary, averaged only 1309 per annum.
Newcastle, Glasgow and Manchester were probably favourable instances of the extent of public vaccinations in the first quarter of the century. In London the proportion of vaccinations to births is known to have been smaller, although there was more money going and at one time four public charities—the Vaccine Pock Institution, the Royal Jennerian Society, Walker’s offshoot from the latter, and the Inoculation Hospital. The following were the vaccinations at the Inoculation Hospital in four periods of five years each from 1806[1118]:
| 1806-10 | 7,004 | |
| 1811-15 | 9,339 | |
| 1816-20 | 13,348 | |
| 1821-25 | 16,666 | |
| 46,357 | ||
| Annual average | 2317. | |
At Norwich, Dr Rigby succeeded in 1812 in persuading the Board of Guardians to offer half-a-crown premium to parents for each child brought to be vaccinated. The premiums paid were as follows:
| 1812 (12 Aug.-31 Dec.) | 1066 | |
| 1813 | 511 | |
| 1814 | 47 | |
| 1815 | 11 | |
| 1816 | 348 | |
| 1817 | 49 | |
| 1818 | 64 |
—the annual births being from a thousand to twelve hundred[1119].
At the Canterbury Hospital the applications for free vaccinations fluctuated as follows:
| 1818 | 52 | |
| 1819 | 249 | |
| 1820 | 263 | |
| 1821 | 47 | |
| 1822 | 35 | |
| 1823 | 50 | |
| 1824 (Jan.-July) | 588 |
The sudden rise in 1819-20 and again in 1824 was owing to smallpox being epidemic in the city. During the severe epidemic of 1824 there were 250 vaccinations at the Dispensary, besides the 588 at the hospital[1120]. At Kendal the following is the Dispensary record of vaccinations for three years, the annual average of births being 390[1121]:
| 1819 | 221 | |
| 1820 | 102 | |
| 1821 | 73 |
These are examples of the spasmodic demand for vaccination in the towns. The following is an instance of general vaccination in a village during an epidemic:
The village of North Queensferry, near Edinburgh, had a population of 390. There was an epidemic of smallpox from 14 December, 1811, to 7 March, 1812, during which time 46 children, from one to fifteen years, were attacked, and seven died, the same number that had died in the last epidemic, in 1797. When the epidemic was over there were only nine persons in the village, most of them aged, who had neither had smallpox nor cowpox. Those who had been vaccinated numbered 132; while of those “formerly vaccinated” only two were included among the 46 children who caught smallpox in 1811-12. The adult population must have nearly all gone through smallpox in former epidemics[1122]. These general vaccinations during or towards the end of an epidemic were exactly comparable to the general inoculations by the old method. At Norwich, where a premium of half-a-crown was given to parents for each vaccination, the epidemic of smallpox in 1819 stimulated the practice somewhat, the increase in July and August having followed a public meeting of the inhabitants and a combined effort of the doctors:
| Progress of the mortality | Progress of premium vaccinations | |||
| January | 3 | 26 | ||
| February | 0 | 51 | ||
| March | 2 | 101 | ||
| April | 15 | 226 | ||
| May | 73 | 226 | ||
| June | 156 | 92 | ||
| July | 142 | 301 | ||
| August | 84 | 359 | ||
| September | 42 | 14 | ||
| October | 10 | 4 | ||
| November | 2 | 2 | ||
| December | 1 | 0 |
Cross estimated that a fifth part of the population of Norwich (50,000) were vaccinated—8000 before the epidemic of 1819, and 2000 during the epidemic. Many of the adults had been through the smallpox in the ordinary way in former epidemics. The state of vaccination throughout Norfolk and Suffolk was indicated in the answers made by ninety-one practitioners to the circular of queries sent out by Cross. Twenty-six had done 13,313 vaccinations during the epidemic of 1819. The whole number in the practice of those ninety-one from first to last had been 120,000, two of the practitioners having vaccinated none.
To sum up, as well as the records enable us to do, the extent of the new practice in the first quarter of the century, it was systematically carried out from year to year among the infants of large towns, such as Glasgow, Newcastle, Manchester and London, and in these the maximum of gratuitous vaccinations in proportion to the births may have been one-half. In smaller towns and in country parishes the inoculations of cowpox, like those of smallpox, appear to have been irregular or by fits and starts, the alarm of smallpox being the occasion for them. But after the epidemic of 1817-19, which was the most general since cowpox had been tried, it was not mere negligence or procrastination that kept parents back, it was distrust of the new practice and preference for the old.
The original mode of inoculation, with the matter of smallpox itself, was far from being supplanted by its rival. In Jenner’s first essay the latter was put forward tentatively, not indeed because of any want of confidence in asserting its protective powers, but because it was only in certain circumstances that a substitute was desired for the old inoculation. Some of those who took up the new matter soon discontinued the old altogether, as at the Newcastle and Whitehaven Dispensaries. At the London Inoculation Hospital the old practice was given up for out-patients after 1807, and for in-patients about 1821. In private practice, tastes or preferences differed. While ordinary people left it to the discretion of their medical advisers, commissioning them to inoculate their children “with either kind of pock,” the upper classes “judge for themselves, and those among them who are philanthropists and converts to the new faith inoculate their own children and those of the poor together[1123].” Moseley, in 1808, said that the “mere operative practice” in cowpox, by which phrase he meant to contrast the academic countenance of it by eminent physicians and surgeons, had been “chiefly carried on by lady-doctors, wrong-headed clergymen, and disorderly men-midwives,” Dr Pearson being named as the only man of letters or pretensions to science who had been practically concerned in it of late[1124].
There was really little to choose between the new method and the old so far as concerned facility of operating; if anything, the inoculation of smallpox was the more difficult of the two, although that also was largely practised by amateurs[1125]. Again, as regards remunerativeness, inoculation with smallpox no longer required the combined services of a physician, a surgeon and an apothecary; it had become a matter of simple routine, just as ill paid (or as well paid, according to circumstances) as inoculation with the matter from the cow. It was not on such grounds, but on grounds of scientific principle or of sentimental interest, that an active propaganda was kept up in favour of the old inoculation. The leading defenders of the latter, such as Moseley, physician to Chelsea Hospital, and Birch, surgeon to St Thomas’s Hospital, maintained that cowpox was alien in nature to smallpox and could not be received as its equivalent. The foreign protagonists, such as Dr Müller, of Frankfort, and Dr Verdier, of Paris, emphasized still more the radical unlikeness of cowpox to smallpox. Said Verdier: “The vaccinists appeal to experience, setting aside all objections based upon the unlikeness of cowpox to smallpox. We are to be made invulnerable by vaccine as Achilles was made invulnerable by being dipped in the waters of the Styx. Protection by cowpox contradicts the received principle of inoculation. It is in vain to appeal to experience against established principles: for true principles are the result of the experience of all ages, and become the touchstone of each successive empirical innovation.”
The English inoculators by the old method gave all sorts of reasons for their preference, and were doubtless actuated by the usual mixture of motives. There were medical families, such as the Lipscombs, who had an hereditary interest and pride in inoculation. It was a Lipscomb who had recited in the Sheldonian Theatre during the Oxford commemoration of 1772, a poem, “On the Beneficial Effects of Inoculation.” Inoculators to the third generation, it was not surprising that the Lipscomb family should have caused to be printed in 1807, as if to shame the changing fashion of the day, the prize poem of five-and-thirty years before, which contained such spirited lines as these:
“When, pierced with grief at sad Britannia’s woes,
Her country’s guardian Montagu arose:
Pure patriot zeal her ev’ry thought inspir’d,
Glow’d on her cheek, and all her bosom fir’d.
She saw the Tyrant rage without controul,
While just revenge inflam’d her gen’rous soul.
Full well she knew, when beauty’s charms decay’d,
Britannia’s drooping laurels soon would fade:
Pierc’d with deep anguish at the afflictive thought
And whelm’d with shame, a heav’n-taught Nymph she sought,
Whose potent arm, with wondrous power endued,
Had oft on Turkey’s plains the fiend subdued.
Obedient to her prayer the willing Maid
In pity came to sad Britannia’s aid.
‘Henceforth, fall’n Tyrant!’ cries the Nymph, ‘no more
Hope that just Heav’n will thy lost pow’r restore:
Let now no more thy touch profane defile
The sacred beauties of Britannia’s isle.
By me protected shall they now deride
Thy baffled fury and thy vanquish’d pride[1126].’”
Still it was just among those classes to whom the argumentum ad nitorem came home most forcibly that the fashion had changed. Before the end of the 18th century, the danger to beauty from an attack of smallpox had become a matter chiefly of historical interest, carrying the mind back to the Restoration or the early Georgian era. The richer classes, while they seem to have countenanced cowpox inoculation as a good thing in general, were probably apathetic on their own account. Lord Mulgrave said in the House of Lords on 8 July, 1814; “If their lordships recollected how many persons of the higher order were reluctant to introduce vaccination into their families, it really must appear to them a harsh and arbitrary measure to lay the poor under the necessity of adopting the practice.” The working class had been manifesting a devotion to the old practice which, indeed, they had never shown so long as it was unchallenged. Perhaps one reason to account for the undoubted preference of the poorer classes for the old inoculation was that they had only lately taken to it. Another was that a good deal of inoculation was done by amateurs of their own class—blacksmiths, farriers, tradesmen and women. A third reason was that the poorer classes, among whom smallpox prevailed most, saw their children take smallpox all the same, and cared little for the scientific explanation that a false or spurious kind of cowpox matter had been used. In October, 1805, a correspondent wrote from London to an Edinburgh journal: “The many late failures of supposed cowpock to prevent the smallpox have excited in some parts so much clamour among the lower orders of people that they insist upon being inoculated for the smallpox at some of the public institutions[1127].” A report on vaccination made to Parliament by the College of Physicians in 1807, deplores “the inconsiderate manner in which great numbers of persons ever since the introduction of vaccination are still every year inoculated with the smallpox.” When, in consequence of the same report, a vote was brought forward in Parliament to give Dr Jenner a national reward of twenty thousand pounds in addition to the ten thousand that he had got five years before, the populace were so angry that one of their leaders, John Gale Jones, himself a medical man, sent a message to Jenner at his lodgings in Bedford Place to advise him “immediately to quit London, for there was no knowing what an enraged populace might do[1128].”
Few particulars remain of the old inoculation at this time. One fact significant of the impression that the criticisms of cowpox had made is that Dr John Walker, director of the Royal Jennerian Society, who pushed “vaccination” among the poorer classes more than anyone in London, was all the while an inoculator in the old manner. He wrote to Lettsom, “I have from the first introduction of vaccination entertained an opinion respecting its nature different from those who suppose it a substitute only for smallpox.... I have, from an early part of my practice, been in the habit of diluting smallpox virus with water previous to its introduction into the system;” and this he had been doing in the name of Jenner, under the influence of a belief that, if cowpox were not smallpox, it ought to be, that it was a pity the disease had ever been called cowpox, and that the name (which was a very old one) “has only served to debase it in the eyes of the common people, and prevent its general adoption[1129].” The very director of the Jennerian institute was among the prophets of the old inoculation.
With the revival of smallpox in general epidemic diffusion in 1816-19 we begin to hear more of the old inoculation. The account already cited of the outbreak at Ulverston contains a table of fourteen previously cowpoxed children whom it was thought desirable during the epidemic to inoculate with smallpox, all of them receiving the infection in one degree or another. A practitioner at Dunse, Berwickshire, not only returned to the old inoculation (thereby incurring “much odium,” as he believed), but actually took his matter from the natural smallpox of his cowpox failures[1130].
When the epidemic reached the Eastern Counties, there were demands for the old kind of inoculation, not in Norwich only, but in numerous country parishes. Of ninety-one surgeons in Norfolk and Suffolk, who answered the queries of Cross, thirty-eight had practised the inoculation of smallpox in the epidemic of 1819; five of them, after having refused many private applications for inoculation in the old way, had at length yielded to the desire of the Overseers of the Poor, and had inoculated whole parishes. Cross’s correspondents also testified that there was much inoculation going on at that time in the Eastern Counties by the hands of farriers, blacksmiths, tailors, shoemakers and women.
Dr John Forbes, who then practised at Chichester, brought to light an exactly similar state of public feeling in Sussex in 1821-22[1131]. In the parish of Bosham there lived a farmer named Pearce who had an inherited skill in inoculating, his father having inserted smallpox into ten thousand persons in his day, without killing one of them. Pearce offered to wager with Forbes a considerable sum that he would inoculate any number of persons and that none of them should have more than twenty pustules. He believed that the smallpox matter became “as weak as water” by an uninterrupted transmission from one body to another.
In November, 1821, the Overseers of the Poor employed him to inoculate the pauper children, and his skill was soon in request for others, so that from two to three hundred in the parish were inoculated by him within a short time. He charged half-a-crown or a crown for each. From other parishes the people flocked to him in such numbers that he inoculated upwards of a thousand in the winter and spring of 1821-22. Before long he had three itinerant rivals, a knifegrinder, a tinsmith and a fishmonger, who claimed to have inoculated together a thousand persons, including four hundred previously cowpoxed. The surgeons of Emsworthy and Havant at length joined in the business, and in the space of six or eight weeks inoculated from twelve to thirteen hundred persons, who had not been previously vaccinated. Forbes also received from his medical friends in and around Chichester “an account of 680 cases of previously vaccinated individuals subjected by them to variolous inoculation.” In the great majority of these the constitutional symptoms were so slight as to be only just observable, the eruption consisting of only a few pustules, which were all that the Pearces, of Bosham, father and son, ever expected to get with inoculated smallpox where no infection of cowpox had preceded. Disappointments with the new inoculation had led to a great revival of the old also at Canterbury, the operators being mostly women.
The same thing happened in Cambridgeshire and in Bucks. In a parish within eleven miles of Cambridge several hundred persons were inoculated with smallpox in 1824, and in April, 1825, a medical practitioner inoculated a number in a village near[1132]. During a severe epidemic in the parish of Great Missenden, Bucks, which followed a general vaccination, and caused a prejudice against the latter, the old inoculation was generally resorted to[1133]. It looked for a brief period, about the time of the epidemic of 1824-26, as if the old inoculation were to return to favour even with the profession itself. Dr John Forbes wrote of the two kinds of inoculation in a studiously impartial manner. Dr Robert Ferguson, who was also destined to make a name, addressed in 1825 a letter to Sir Henry Halford in which he advocated a singular compromise, namely, two inoculations, one with cowpox, the other with smallpox, the cowpox to neutralize the contagiousness of the smallpox for the occasion, while the latter was to be the prophylactic against itself for the future[1134]. This reaction, if it deserves that name, corresponds in time to the great decline in the number of gratuitous vaccinations at Manchester, a decline which had been equally remarkable at Glasgow for some years before. There was at least an apathetic spirit towards cowpox inoculation during the epidemic of 1817-19, and for a good many years after it, while there was something like toleration, even among medical men, for the old inoculation.