VACCINATION.
On the western side of Trafalgar Square, beneath the shadow of the great sea-lion Admiral Lord Nelson, might have been seen, until recently, the statue of a pensive-looking almost beardless man seated in a chair. But a new location in Kensington Gardens has been selected for this statue, which is that of Dr Jenner, the discoverer of vaccination.
Edward Jenner was born at Berkeley, in Gloucestershire, in 1749, his father being vicar of that place. He was apprenticed to a doctor at Sudbury, and afterwards came to London, where for a time he served under John Hunter. After taking his diploma, he returned to his native place, and it was here that he practised his profession, and also made that great discovery which has proved such an inestimable benefit to mankind. When he had become famous, and universal appreciation bespoke him a great man, he received many tempting offers and solicitations to take up his abode in the metropolis; but nothing succeeded in enticing him from the rural scenes amidst which his medical triumphs had been conceived. His life sped tranquilly on amidst the rustics he loved so well until the year 1823, when death somewhat suddenly terminated his earthly career.
As the village and neighbourhood in which Jenner served his apprenticeship was mostly a grazing country, he was thrown much amongst farmers and their servants. At a time when smallpox was raging among them, his attention was attracted by hearing a milkmaid say that she had once caught cowpox from the cows, and therefore smallpox wouldn’t hurt her. He was much struck with this remark; and on making inquiries, he found it was a common belief about there, that whoever caught this disease from the cows was not liable to take smallpox. It is rather curious that just about the time that Jenner was making these inquiries, the same fact had been noted in Sweden, and some inquiries were also set on foot there to investigate the matter.
With that talent for close observation and investigation which distinguished him, he pondered much over this remark of the milkmaid’s, and made many inquiries of the medical men of the district. From them he obtained but little encouragement; they had often heard the tale, but had not much faith in it. The subject seems to have impressed itself greatly on his mind; for we find him, some three years later, when he was in London with John Hunter, mentioning it to him; and that distinguished man appears to have been struck with Jenner’s earnestness in the matter, and gave him good advice: ‘Don’t think, but try; be patient; be accurate.’ This advice he perseveringly followed on his return to his native place; and by careful experiments elaborated the great life-saving truth, that cowpox might be disseminated from one human being to another to the almost total extinction of smallpox.
The eastern practice of inoculation was first made known in this country by Lady Wortley Montagu, who was the wife of our ambassador at Constantinople, where she had seen it tried with good effect. Inoculation consisted in transferring the matter of the smallpox pustule from the body of one suffering from the disease to that of one not as yet affected by the disease. It is a fact that the form of smallpox thus communicated through the skin was less severe, and consequently less fatal, than when taken naturally, as was abundantly proved in this country. But, unfortunately, inoculated smallpox was as infectious as the natural smallpox—this fact forming the great distinction between inoculation and vaccination. The inoculated person became a centre of infection, and communicated it to many others. It was found after the introduction of inoculation that the mortality from smallpox increased from seventy-four to ninety-five in one thousand; and many of those that recovered, lost the sight of one or both eyes, or were otherwise disfigured. It is not to be wondered at, with such a state of things as this existing, and the whole medical profession at their wits’ end for a remedy, that Jenner should be looked upon, as soon as vaccination became established, as a saviour of his race.
It was while the ravages of smallpox were being felt and deplored over the whole country, that Jenner was quietly investigating and experimenting in his native village; and gradually little facts and incidents relating to cowpox were collected, until in his own mind an opinion was firmly rooted that this disease communicated by the cow was a safeguard against smallpox. About the time when he had formed this opinion, an accidental case of cowpox occurred in his neighbourhood, and he caused drawings of the pustules to be made, and took them with him to London. He showed them to some of the most eminent surgeons and physicians of the day, and explained his views; but from none of them did he receive any encouragement, and from some, nothing but ridicule. Fortunately, however, he was not a man to be easily turned aside from a purpose, or disabused of an opinion that he saw good cause for entertaining. On returning home, he was still as full of the idea as ever, and determined to persevere in his efforts; although he saw he must have proofs before he could get his professional brethren to listen to his theories.
It was on the 14th May 1796—a day which is still commemorated in Berlin as a festival—that a boy was vaccinated with matter taken from the hands of a milkmaid. The disease was thus communicated to the boy, and he passed through it satisfactorily. But now came the anxious and critical trial for Jenner. The same boy on the 1st of July following was inoculated with the smallpox virus, but he did not take the disease. In 1798 Jenner published his first pamphlet On the Causes and Effects of Variola Vaccine; and later, in the first year of the present century, he wrote that it was ‘too manifest to admit of controversy, that the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice.’ Soon after this, a parliamentary Committee investigated and reported on the new discovery in terms of the most emphatic approbation; and a declaration was signed by seventy of the chief physicians and surgeons in London expressing their confidence in it. The Royal Jennerian Society was formed, with Jenner as President; and thirteen stations for the vaccination of the public were opened in London, in the hope of exterminating smallpox.
Jenner’s essay which explained his discovery had in the meantime been translated into several foreign languages, and had also found its way to America, where President Jefferson vaccinated, by the help of his sons-in-law, about two hundred of his friends and neighbours. From this time forward, vaccination may be said to have taken a firm hold of the civilised world.
That vaccination has not done all that was claimed that it would do by Jenner, is true, as the occasionally recurring epidemics of the disease only too fatally testify. But the gain from the time when cities were depopulated and a large percentage of the whole human race was scarred and disfigured by it, to a time when no such suffering is now experienced, is a gain indeed, although it be but an imperfect one. It is, however, almost beyond a doubt that had more attention been primarily paid to vaccination, and had it not been performed in the perfunctory manner in which it often was by medical men, we should now be in a better position with regard to smallpox than we are at the present moment. For it is a melancholy fact that although the first to give vaccination to the world, England has not made such good use of it as most other nations. Feeling secure in the relief which it gave to the vast amount of mortality, we have in a measure let pretty well alone, while other nations have meanwhile enormously profited by the discovery.
It was Mr Simon, the late medical officer of the Privy Council, who published three admirable Reports on the subject, and probably brought together more practical truths on vaccination than had ever before been collected, that gave an impetus some few years ago to further inquiry. It was stated at that time, and with every appearance of truth, that the vaccine lymph becomes enfeebled in its protective power by a long course of transmissions from arm to arm. It was therefore proposed that means should be taken for establishing a well-devised system of renewal, which would be likely to give greater certainty of results and afford more permanent protection. Various attempts and suggestions were made in this country to introduce vaccine matter from its original source, the cow, or, better still, from the calf; and Mr Ceeley, a medical gentleman, who, like Jenner, worked hard at the subject amidst the worries and anxieties of a private practice, made many experiments, and did much to popularise the idea.
Early in 1882, the local government Board set up a small establishment in London for the purpose of affording facilities for vaccination directly from the animal. Some time previously, a case of spontaneous cowpox was accidentally discovered at Bordeaux, and from this case our government procured the virus which they are now imparting to a regular succession of healthy calves, each of which, before undergoing the ordeal, is carefully examined by a Privy-council veterinary officer, to insure its being in perfect health. The animal is then weighed, and led away for a few days to a comfortable stall, and fed on sweet hay, new milk, and oil-cake. An animal taken in on Monday would on Thursday be led into the vaccinating-room, and securely strapped to the top of a table which is ingeniously constructed to tip down into a vertical position. The top of the table is then thrown over and secured horizontally, the calf lying upon its side, and presenting the under surface of its body conveniently for the surgical part of the proceeding. The hair is first shaved off, and then some slight incisions about an inch long are made in the skin, and the virus introduced. This operation is performed in one part of a large room divided by a wooden partition. To the other part of the room, parents will in a few days bring their children, and have them vaccinated directly from the animal thus prepared, and may thus escape whatever evils, real or imaginary, pertain to the practice of arm-to-arm vaccination. The calf having done its involuntary service to humanity, is, before dismissal, again weighed, and is usually found to have increased considerably—not, it may be presumed, in consequence of vaccination, but from the good feeding it has received.
The practical results of vaccination from the animal direct, are in some respects somewhat dubious. Belgium and Holland have long been familiar with it; but still there appears to be a lack of trustworthy records as to the efficacy of the process as compared with the arm-to-arm system. Whether the animal lymph is as potent a protector from smallpox as that which has been passed through the human system, cannot as yet be determined, though there would seem to be no ground for any reasonable doubt upon the subject. That the humanising process does in some way, at present quite inscrutable, affect it, seems evident from the fact that the vaccine from the calf loses its efficacy somewhat sooner than that from the human subject. It cannot be stored for so long a time as the humanised lymph, and this renders its distribution somewhat difficult. The best authorities, however, are now inclined to the opinion that the difference in this respect is not after all so great as was at first supposed. The two scientific men in charge of this station are, however, enthusiasts in this department of medical investigation, and it may be hoped that with the enlarged sphere of operations which government is understood to be contemplating, and aided by a well-appointed laboratory in connection with this establishment, an important advance may soon be made in their knowledge of the subject.
Compulsory vaccination has done much in other countries to free them for long periods from this loathsome disease. Sweden and Denmark enjoyed absolute immunity for twenty years; and in Austria, where very stringent measures of compulsion are resorted to, they succeeded in extirpating smallpox for long periods.
It was in 1853 that compulsion was first established in this country, and as at first nearly every one obeyed the law, it was attended with very beneficial results. At the registration of a birth, the registrar has to give notice of the necessity of having the child vaccinated within four months, and the penalty for neglect. From the registrar’s return, it is seen at the local government Board if a medical certificate attesting the vaccination as duly performed, has been returned. Assuming that every child is registered, this system no doubt would answer well; but there is much reason to fear that many children in London escape being registered, and these do not come within the cognisance of the local government Board. It is a question whether some return should not be required from medical men of every child born alive, with the address of its parents.
Absolute care in vaccination and its universal adoption, combined with a compulsory re-vaccination on arriving at the age of puberty, would without doubt have by this time fulfilled Jenner’s most sanguine expectations, and smallpox would have become extinct. At the same time, if the government make vaccination compulsory, they have a most important duty to the public to perform. In the first place, they should undoubtedly ascertain that every known precaution is taken by all public vaccinators to protect from harm, or disease likely to arise from vaccination, those whom they compel to undergo the operation. Secondly, none but properly certified practitioners should be appointed to the stations. It is not alone sufficient that they be skilful vaccinators, they should also be able to take lymph skilfully from the vesicles without the admixture of the minutest particle of blood. An ignorant or careless vaccinator may do more harm than it is possible to trace. Thirdly, no lymph whatever should be used but that which is microscopically examined by one who thoroughly understands his work, and the public should be permitted to have a choice of either the humanised lymph or lymph direct from the calf. If these precautions were conscientiously carried out, we should soon have less objection to compulsion, and we should be in a fair way to seeing smallpox stamped out.
In America, according to the Asclepiad, the subject has received careful attention. The Report of Dr Joseph Jones, President of the Board of Health, of the State of Louisiana, extends to four hundred pages, and embraces everything connected with smallpox, vaccination, and spurious vaccination; while drawings are freely interspersed to illustrate, from point to point, the author’s histories, views, or conclusions. Amongst the general conclusions which the author draws at the close of his treatise, the following are some of the most important: (a) Vaccination, when carefully performed on Jenner’s method, is as complete a protection from smallpox now as it was in the early part of the century; (b) Without vaccination, the application of steam and navigation and land travel would have, during the past fifty years, scattered smallpox in every part of the habitable globe; (c) Vaccination has not impaired the strength and vigour of the human race, but has added vastly to the sum of human life, happiness, and health; (d) Inoculation for smallpox, which preceded vaccination, induced a comparatively mild and protective disease, but multiplied the foci of contagion, kept smallpox perpetually alive, and increased its fatal ravages among mankind.