PUNCTURES, ONE OR SEVERAL.
Another excuse was advanced in the report of the National Vaccine Establishment in 1814. It was said the failures in vaccination appeared to result from the practice Of making only one puncture for the insertion of virus. One puncture ineffective! Why, if one puncture were ineffective, how were the early miracles of vaccination to be accounted for, all of which had been effected by means of single punctures?
MR. RIGBY’S PROTEST.
There was in those days a surgeon of eminence in Norwich, Edward Rigby, and he at once entered his protest against the novel doctrine. Writing to the Medical and Physical Journal of August, 1814, he said, “No physiological reason is assigned for this, and I believe it would be difficult to prove that a single perfect vesicle, which goes through the usual stages and exhibits the characteristic appearances of this singular disease, can be less the effect of a constitutional affection than any given number would be.... It cannot surely be doubted that a single perfect vesicle affords as complete security against Variola as any indefinite number; and, if so, there would seem to be an obvious objection to unnecessarily multiplying the vesicles, which in all cases go through a high degree of inflammation, are often attended with painful tumefaction and even suppuration in the axilla, and, if exposed in the later stages to any act of violence, are apt to assume a very disagreeable ulceration, more especially as young children, now the principal subjects of vaccination, are most liable to suffer in this way.” Rigby had the better side of the argument. As he observed, no physiological reason was assigned for the recommendation of plural punctures; nor was any such reason ever assigned. It is the rationale of vaccination that a virus is injected into the system which begets a fever equivalent to an attack of smallpox; and as smallpox rarely recurs in a lifetime, it is hoped that Nature may graciously recognise the substitute for the reality. Organic poisons such as vaccine operate like fire or ferment. Quantity is of no account. So that the fever be kindled, excess is waste. A scratch at a dissection is as deadly as a gash. One bite of a mad dog is as likely to beget hydrophobia as a dozen. The sting of a cobra may be almost invisible, but the puncture is enough for death. Sir James Paget says of vaccine virus that “inserted once, in almost infinitely small quantity, yet by multiplying itself, or otherwise affecting all the blood, it alters it once for all.”
Such is the rationale of vaccination, and if I were a vaccinator, I should hold the position assumed by Rigby, and maintain that one puncture is as effective as a dozen, inasmuch as with one it is possible to excite that fever which is the essential of vaccination; adding, in Rigby’s words, that as one puncture is in all cases attended with a high degree of inflammation, and often with painful tumefaction, and even suppuration in the arm-pits, which in case of violence are apt to pass into very disagreeable ulceration, especially in young children, it is most undesirable to increase the number of such dangerous wounds.
MR. (MARKS) MARSON.
I do not know that the condemnation of single punctures at that time, seventy years ago, had much effect. Two punctures became common, chiefly to guard against the possible failure of one. It is of late years that the resort to many punctures has become fashionable. Mr. Robert Lowe, now Lord Sherbrooke, in the House of Commons in 1861 spoke of “the beautiful discovery which had been made, that the security of vaccination may be almost indefinitely increased by multiplying the number of punctures”! The chief author of this remarkable discovery was Mr. Marson, for many years surgeon of the Smallpox Hospital at Highgate. He estimated the efficacy of vaccination by marks, and made so much of marks that I usually think of him as Marks Marson. He said—“A good vaccination is when persons have been vaccinated in four or more places leaving good cicatrices. I define a good cicatrix in this way: a good vaccine cicatrix may be described as distinct, foveated, dotted, or indented, in some instances radiated, and having a well, or tolerably well, defined edge. An indifferent cicatrix is indistinct, smooth, without indentation, and with an irregular or ill-defined edge. When I find that a person has been vaccinated in at least four places, leaving good marks of the kind which I have described, that person invariably, or almost invariably, has smallpox in a very mild form.”
Reading a statement like this, we revert to the rationale of vaccination, and ask what can marks have to do with its efficacy? Remember, Marson offered no explanation of his statement. He was satisfied to say thus and thus have I observed, and you may take my word for it. But in science we take no man’s word. We must see, or, like Trelawney’s Cornishmen, we must know the reason why. Marson appeared before the House of Commons’ Vaccination Committee in 1871, and set forth his marks doctrine with all the qualifications and inconsistencies which characterise the victim of a fad in contact with facts which his fad fails to include or account for.
MR. WHEELER’S RESEARCHES.
Fatal cases of smallpox are confluent cases, and in confluent cases vaccination marks rarely show up so as to answer to Marson’s description of marks distinct, foveated, dotted, or indented, with a well, or tolerably well-defined edge. And in this matter our acute and industrious friend, Mr. Alexander Wheeler, has explored the records of the Smallpox Hospitals, and proved that vaccination marks many or vaccination marks few have no influence whatever on the character or issue of smallpox. As Mr. Wheeler shows, the classification of smallpox into discrete and confluent is the only clue to the right estimation of the fatality of the disease. Smallpox in the discrete form, that is, when the pustules are distinct and separate, is not dangerous when uncomplicated with other disease, the overwhelming majority of patients recovering, vaccinated or unvaccinated. The contest between life and death is waged among the confluent cases, where the pustules are so close that they run together; and it is on these confluent cases, and the conditions and antecedents of the sufferers, that attention should be concentrated. There is a third form of smallpox, the malignant, chiefly confined to persons of irregular life, which is almost invariably fatal, and, as vaccinators themselves allow, vaccination in malignant smallpox affords no odds to its victims.