A History of Epidemics in Britain, Volume 2 (of 2) / From the Extinction of Plague to the Present Time

by Charles Creighton

Legislation for Smallpox after the Epidemic of 1837-40.

The epidemic of smallpox in 1837-40, which was fatal chiefly to infants and young children, was one of the greatest, like the corresponding epidemic of typhus among adults, in the whole history of England. The troubles of the working class had been more or less chronic ever since the booming times of the Peninsular War had come to an end; the climax was reached in the thirties; the enormous sums spent upon railway construction gave a relief in the forties; and the permanent cheapening of food by Free Trade made an entirely new era, which became visible in the public health after the contagion of the Irish famine had ceased in 1848. The great and hitherto permanent decrease of typhus was brought about by social and economic causes. There, at least, laissez faire was all powerful: “Let us be saved,” said Burke, “from too much wisdom of our own, and we shall do tolerably well.” But there has been at no time since the 18th century the same passiveness towards smallpox; that is a disease against which we must always be doing something direct and pointed. The legislation against smallpox began in England (nothing was done for Ireland and Scotland until long after) with the Act of 1840.

It is a singular instance of the changes in medical opinion and of the vicissitudes of things that the first statute against smallpox should have been instigated by a desire to suppress the old inoculation. Parliament was first moved to action by the Medical Society of London through a petition presented by Lord Lansdowne; but things had been moving that way for some time before in the councils of the British (then the Provincial) Medical Association, under the influence of Dr Baron, the executor and biographer of Dr Edward Jenner. The Bill of 1840 was brought into the House of Lords by the second Lord Ellenborough, and conducted through the Commons by Sir James Graham, who was not then in office. It purposed to enable the poorer classes to get their children vaccinated, if they so desired, at the cost of the ratepayers, and to prohibit under penalties the practice of the old inoculation by amateurs or empirics. Blomfield, bishop of London, said in the Lords’ debate that many of the ignorant poor, in agricultural districts, were strongly prejudiced against inoculation with cowpox, and that they paid much greater attention to empirics, meaning inoculators by the old method, than to the advice of the clergy. In the Commons, Mr Wakley, who was a Radical and the proprietor of one of the weekly medical journals, declared that “no one could be ignorant that the working classes entertained great prejudices against vaccination,” although he did not explain why they were prejudiced. According to this medical authority, whom the House took seriously on that subject if on no other, the epidemic of smallpox which the country had just passed through had been in effect due to the contagiousness of the smallpox matter used in inoculating; and he succeeded in carrying an amendment to put down the old practice, not only in the hands of amateurs but also in those of medical men. The eighth clause of the Act decreed that any person convicted before two justices in Quarter Sessions of having wilfully procured the smallpox by inoculation shall be liable to a penalty of imprisonment for a term not exceeding one calendar month. The penal clause against the original inoculation was an indirect compliment to its vitality. Lord Lansdowne also paid it a compliment by recognizing the correctness of its principle; the rival inoculation-matter of cowpox, he said, was “perfectly identical” with smallpox, “although the symptoms were different.” This will be a convenient point in the history at which to review the rise and progress of the idea that the inoculation of smallpox was a wilful spreading of contagion and therefore a public nuisance.

The risk of spreading the contagion of smallpox by inoculating the disease was one of the objections to the practice raised by Wagstaffe in his letter to Dr Freind in 1722: “I have considered,” he says, “how destructive it may prove to spread a distemper that is contagious.” Still more explicit was Dr Douglass of Boston, New England, writing on 1 May, 1722: “I oppose this novel and dubious practice ... in that I reckon it a sin against society to propagate infection by this means, and bring on my neighbour a distemper which might prove fatal, and which, perhaps, he might escape (as many have done) in the ordinary way.... However, many of our clergy have got into it, and they scorn to retract[1160].” Within a few months there was a striking instance of the alleged danger in one of Maitland’s inoculations at Hertford, an inoculated child, with only twenty pustules, having been supposed the probable source of the natural smallpox in five domestics, of whom one died. The death of the Duchess of Bedford by the natural smallpox in 1724 happened “after two of her children were recovered of that distemper, which they both had by inoculation[1161].” That risk, however, was little made of in the controversy, although it may have been one of the tacit reasons that led to the total abandonment of inoculation during the ten or twelve years after 1728. On the revival of the practice after 1740, when the serjeant-surgeons, the physicians and the apothecaries were all making it a considerable part of their business among the richer classes, the danger from contagion was either non-existent or it was not realized. In 1754 the College of Physicians of London, by a formal minute, recommended inoculation as “highly salutary to the human race,” without one word of warning on the risk of contagiousness. That objection was raised again when Sutton’s practice in 1765-67 was drawing large crowds to be inoculated. He was put on his trial at the Chelmsford Summer Assizes in 1766 on a charge of spreading the contagion of smallpox, which was epidemic in the town; but the grand jury, charged by Lord Mansfield, threw out the bill. Sutton’s defence was to have been that he never brought into Chelmsford a patient capable of spreading the smallpox, that is to say, an inoculated person with smallpox enough on him to spread contagion[1162]. Shortly after came the controversy between Lettsom and Dimsdale as to inoculation of infants at their homes, which turned upon the risk of increasing the natural smallpox by a constant succession of artificial cases. Lettsom’s position was the same as Sutton’s, that the quantity of smallpox matter (he might have said the quality also) produced by inoculation was not sufficient to create an appreciable risk. As to the matter of fact, the quantity was indeed small: Sir William Watson declared that a single limb of an adult person in a moderate attack of the natural smallpox had as many pustules on it as all the seventy-four children, in one of his inoculations at the Foundling Hospital, had on their whole bodies. In the theory of contagion, an infinitesimal quantity is sufficient; but in reality it appears that contagion must be in excess to be effective, just as, in the nearest physiological analogy, fertilization seems to depend upon the copiousness of the pollen or seminal particles[1163].

The opposition to Lettsom’s project of general inoculations among the infants of the working classes in cities shows that the risk of contagion was made to serve at least an argumentative purpose. As to experience, Lettsom in 1778 declared that he knew no instance of contagion from that source during two years of inoculations among the poor of London[1164]. One writer of the time (1781) appealed boldly to the experience of sixty years: “Upon the first introduction of inoculation, physicians, divines, and innumerable other writers [who were they?] cried out that the infection would be spread, and the community suffer a greater loss; but after sixty years’ experience, we should expect those arguments, as well as the writers, had all died away, and that at this day the same stale dregs of ignorance and obstinacy would not be again retailed[1165].” The risk, however, was not altogether imaginary. Some cases of smallpox caught from the inoculated were known. In Vienna at that time the rule was to allow no inoculations except on groups of subjects isolated for the purpose. When Jenner, in 1798, enumerated the advantages of cowpox over smallpox for inoculation, in certain specified circumstances, one of his points was its non-contagiousness[1166].

The favourable reception of his project seems to have been determined more upon that point than upon any other. The theoretical risk of contagion from inoculated smallpox became at once an actual danger to the community when it was perceived that they had in “smallpox of the cow” a non-contagious variety. Jenner was not slow to use that growing sentiment so as to discredit the old practice. As early as 1802 he began to urge privately the statutory prohibition of smallpox for inoculation, and Wilberforce, among others, took the matter up publicly. The College of Physicians, having been asked by Parliament in 1807 to inquire into the causes that hindered the progress of Jenner’s inoculation, inserted the following paragraph in their report:

“Till vaccination becomes general, it will be impossible to prevent the constant recurrence of the natural smallpox by means of those who are inoculated, except it should appear proper to the Legislature to adopt, in its wisdom, some measure by which those who still, from terror or prejudice, prefer the smallpox to the vaccine disease, may in thus consulting the gratification of their own feelings, be prevented from doing mischief to their neighbours[1167].” The same year, in the court of King’s Bench, a medical practitioner was sentenced to fine and imprisonment for having neglected to prevent an inoculated person from communicating with others[1168].

Next year, 1808, a bill was brought into the House of Commons by Mr Fuller, with the following preamble: “Whereas the inoculation of persons for the disorder called the Smallpox, according to the old or Suttonian method, cannot be practised without the utmost danger of communicating and diffusing the infection, and thereby endangering, in a great degree, the lives of his Majesty’s subjects.”... This bill, which had clauses also for notification and compulsory isolation of smallpox cases, the churchwardens to be the authority, was not persevered with. The inoculators by the old method opposed it, and they were joined by Joseph Adams, who had been the first English writer to mention cowpox, in 1795, and had been a staunch vaccinist subsequently[1169]. In 1813 another attempt was made to restrict the practice of inoculating the smallpox on the ground of danger from its contagion, and to get cowpox substituted for it among the poorer classes. The Vaccine Board were the promoters, Lord Boringdon (afterwards Earl of Morley) having charge of the bill in the House of Lords. It was successfully opposed by the Lord Chancellor (Eldon) and by the Lord Chief Justice (Ellenborough), the latter contending that the common law was a better remedy than a statute against the nuisance of contagion from inoculated smallpox. Next year, 1814, Lord Boringdon brought in a new bill, which did not directly harass the inoculation interest, but made the rival method of cowpox obligatory upon the poor. Its provisions were ridiculed by Lord Stanhope, who got help from Lords Mulgrave and Redesdale to throw it out. Therewith ceased for many years the talk about the contagiousness of inoculated smallpox, together with the attempts in Parliament to enforce the rival inoculation. The next attempt, in 1840, was successful in making variolation a felony, and in throwing on the rates the cost of vaccinating the infants of the poorer classes. The danger of contagion from inoculated smallpox in 1840 was no greater than it had ever been, and it had never been appreciable among the things favouring an epidemic.

The common-law maxim, “sic utere tuo ut alienum non laedas,” which gained statutory force as against inoculation by the Act of 1840, was farther extended and specifically applied in the Act of 1853, which enforced the inoculation of cowpox upon all infants before they were three months old. Legislation, as we know, broadens down from precedent to precedent. Parliament in 1853 did not debate the preamble of the Bill, but accepted the principle established by the Act of 1840,—in the constructive sense that to leave infants without the inoculation of cowpox was, in effect, “to expose them so as to be infectious,” because they were sure to take smallpox, and so to become nuisances to others “unprotected” as well as (less obviously) to their cowpoxed neighbours.