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.
The Smallpox Epidemic of 1825-26.
Compared with the epidemic of 1837-40, which was the first in England to be recorded under the new system of registration of the causes of death, the smallpox of 1825-26 makes a poor figure in the records. Yet there is reason to believe that it was an epidemic of the same general kind, if not of the same duration or fatality. At the Newcastle Dispensary far more children in the smallpox were visited in 1825 than in any year since its opening in 1777, namely, 113 cases, with 28 deaths, which would have been a small fraction of all the cases in Newcastle. At the Rusholme Road Cemetery, Manchester, which received about a fourth part of the burials, 112 children, all under seven years, were buried from smallpox in the six months, 18 June to 18 December, 1826[1135]. At Bury St Edmunds smallpox began to be epidemic about the end of 1824, when the guardians ordered a general vaccination, and reached its worst in July, 1825, the type being confluent in many of the cases[1136]. It was in Cambridgeshire villages the same year, and is casually heard of in Bucks[1137]. It had been severe at Oxford and Canterbury in 1824. At Glasgow the prevalence of fever is known for the corresponding years, but the smallpox deaths have not been taken out of the burial registers. The evidence from London is perhaps the best indication that the smallpox of 1825 was one of the more severe periodic visitations.
The extensive prevalence of smallpox was heard of in Paris before the epidemic attracted much notice in London; the news of persons of distinction dying by smallpox in the French capital reads like the old notices of it in 17th century letters. In the same year it was very severe also in Sweden after a long period of quiescence. As to London, Dr George Gregory, physician to the Smallpox Hospital, said[1138]: “It may be inferred that smallpox has been nearly as general in 1825 as in any of the three great epidemics of the preceding century”—the demand for admission to the Hospital being, in his opinion, a fair index; while private information confirmed the estimate of its truly epidemic prevalence, and of its incidence chiefly upon the lower classes[1139]. In the years of the 18th century to which he referred, and in four maximum years of the 19th century, the cases and deaths at the Smallpox Hospital had been as follows[1140]:
London Smallpox Hospital.