Edgar M. Crookshank
History And Pathology of Vaccination 1889)
Chapter XVI: Progress of Vaccination in England.
Edgar M. Crookshank. M.B.
Professor of Comparative Pathology and Bacteriology in, and
Fellow of King’s College, London.
Author of Papers on the Etiology of
Scarlet Fever; Anthrax in Swine;
Tuberculosis and the Public Milk Supply;
The History and Pathology of Actinomycosis;
in Reports of The Agricultural Department of
The Privy Council, Etc.
Author of A Manual of Bacteriology, etc.
IN this Preface I have thought it necessary to lay before the profession, the circumstances which have led to the production of these volumes.
I had devoted myself for some time to pathological researches in connection with the communicable diseases of man and the lower animals, when the discovery of an outbreak of Cow Pox, in 1887, led me to investigate the history and pathology of this affection. At that time I accepted and taught the doctrines, in reference to this disease, which are commonly held by the profession, and are described in the text-books of medicine.
In endeavouring to discover the origin of this outbreak, it was proved beyond question that the cows had not been infected by milkers suffering from Small Pox. This fact, together with the clinical characters of the disease in the cows, and in the milkers infected from the cows, and the certainty, that I had to deal ”not with an infectious disease like cattle-plague or pleuro-pneumonia, but with a disease which is communicated solely by contact” convinced me that the commonly accepted descriptions of the nature and origin of Cow Pox were purely theoretical. As the natural Cow Pox had not been investigated in this country for nearly half a century, it was obvious that a much neglected field of comparative pathology had been opened up for further inquiry.
My interest in this subject was further stimulated by Sir James Paget, who very kindly examined one of the milkers casually infected from the cows, and while so doing drew my attention to a copy of Dr. Creighton’s work on Cow Pox and Vaccinal Syphilis, then just published. The question naturally arose, whether my observations supported or refuted the conclusions arrived at by Dr. Creighton as the result of his historical researches.
While attending at the National Vaccine Establishment of the Local Government Board, I was unable to obtain any exact details, clinical or pathological, of the source of the lymph which was employed there. From my experience of this and other vaccination stations, I found that both official and unofficial vaccinators were completely occupied with the technique of vaccination, to the exclusion of any precise knowledge of the history and pathology of the diseases from which their lymph stocks had been obtained. Thus, at this early stage of my investigation, I felt that what Ceely said, in 1840, was still true: “The imperfect knowledge which we at present possess on many points connected with the natural history of the variolæ vaccinæ, and the numerous and formidable impediments to the improvement and extension of that knowledge, demand the continuance of vigilant, patient, and diligent inquiry.”
In January, 1888, while I was studying the literature of the subject at the Library of the Royal College of Surgeons, Mr. Baily, the librarian, to whom I am indebted for much courteous assistance, was engaged in re-cataloguing the Library. He found a parcel of MSS., which he thought might prove of interest to me. It contained letters from Hunter to Jenner, and a manuscript which was thought to be the MS. of Jenner’s Inquiry. On carefully perusing it, I discovered that it differed in many respects from the published Inquiry; it was, in fact, Jenner’s Communication to the Royal Society. I was so struck by the contents of this paper, and the small amount of evidence upon which Jenner had first ventured to propose the substitution of Cow Pox inoculation or vaccination for the old system of Small Pox inoculation or variolation that I was induced to carefully look into the life of Jenner and the early history of vaccination, as contained in Baron’s Biography, and in the correspondence and articles on the subject in contemporary medical and scientific periodicals
Now that the value of Jenner’s MS. and the interest attached thereto, have been pointed out, it has been carefully preserved, and entered in the catalogue of the Library, and may be consulted by any one desiring to do so. From a letter, dated 1877, which will be found in the parcel, it will be seen that Hunter’s letters and Jenner’s MS. were given to Sir James Paget, by a lady into whose possession they had passed on the death and by the will of her cousin, the late Colonel Jenner, son of Dr. Jenner. On June 4th, 1879, Sir James Paget wrote to Mr. [now Sir John] Simon, President of the College, presenting the MSS. to the Library of the College. The MSS. appear to have remained in a drawer until they were brought to light under the circumstances which I have just related.
I gradually became so deeply impressed with the small amount of knowledge possessed by practitioners, concerning Cow Pox and other sources of vaccine lymph, and with the conflicting teachings and opinions of leading authorities, in both the medical and veterinary professions, that I determined to investigate the subject for myself. From antiquarian booksellers in Paris, Berlin, and in this country, I succeeded in a very short time in obtaining a large number of works dealing with the early history of vaccination.
They at the same time forwarded many works on Small Pox inoculation, and thus my interest was aroused in this subject also, and its bearing upon the history and pathology of vaccination was soon apparent.
In February, 1888, I resolved to consult the leading authorities in France, and to obtain, if possible, the history both of the Bordeaux Lymph, and of the outbreaks of Cow Pox which had been met with in that country during the time that the disease was supposed to be extinct in this.
I take this opportunity of thanking M. Hervieux for much information, and for his kindness in affording me opportunities for observing the system of public vaccination in Paris.
To M. Cagny, I cannot sufficiently express my indebtedness both for introductions to his colleagues, and for presenting me with a copy of the work of Auzias-Turenne containing his classical essays on Cow Pox and Horse Pox.
From Paris, I proceeded to Bordeaux where Dr. Layet and M. Baillet received me with the greatest courtesy, and afforded me every opportunity of obtaining information concerning the Municipal Vaccination Service; and we discussed the details of the recent outbreaks of Cow Pox which they had observed. I also succeeded in obtaining, through the kindness of Dr. Dubreuilh a full account of the “spontaneous” outbreak which was the source of a recent official Stock of vaccine lymph now employed in this country, though abandoned at the Animal Vaccine Station at Bordeaux. At Toulouse, at the Veterinary School, I was able to obtain further information about the nature, clinical characters, and origin of Cow Pox and Horse Pox. M. Peuch, the distinguished Professor of Veterinary Pathology, furnished me with the details of his remarkable investigations into Horse Pox, and has since granted me permission to reproduce the coloured plates illustrating this subject. M. Peuch ‘s researches and observations will be of the greatest value in bringing to light a disease of the horse which is still unrecognised by practical veterinarians in this country.
I also had the opportunity of studying the clinical characters, and the results of inoculation of Sheep Pox.
At Montpellier, I visited the Vaccine Establishment of M. Pourquier, and obtained from him some interesting information. On returning to Paris, I was most kindly received by M. Chauveau, who discussed with me the affinities of Cow Pox, and showed me the beautiful and valuable drawings which had been prepared for the Report of the Lyons Commission, but unfortunately had been withheld from publication owing to the expense that would have been entailed.
On returning to England, I renewed my investigations in Gloucestershire, Wiltshire, and Dorsetshire. I obtained additional information with reference to cases of Cow Pox in this country, and fully realised that the belief that this disease is extinct in England has resulted from the determined and often successful attempts which are made by farmers (for obvious reasons) to conceal outbreaks when they occur. I also followed up the history of Mr. Jesty, by visiting Worth Matravers in the Isle of Purbeck, and obtaining all the local information possible.
Lastly, for reference to some works, copies of which I have not hitherto succeeded in obtaining, I have availed myself of the British Museum and our medical libraries.
The difficulty in gaining access to these works is no doubt the reason why the originals have been so little read. It would hardly be possible for the practitioner with but little time at his disposal, and, if in the country, without access to many medical libraries, to undertake such an inquiry; but I trust that the system which has been followed in this work of giving copious extracts will induce others to study the original authorities. All the selections from Jenner’s correspondence have been drawn from Baron’s Biography, with the exception of one letter, which was obtained for me by Mr. W. K. Dale. I desire to thank him; and also the owner for permission to reproduce it in fac-simile. The essays composing the second volume have been reprinted with the object of affording references in a handy form.
My best thanks are due to Mr. James Ceely for approving of the proposal to reprint his brother’s classical papers, and to Mr. Badcock for granting me permission to reprint his pamphlet.
In conclusion, I desire to thank Messrs. W. K. Dale and E. F. Herroun for their assistance in passing the proof sheets through the press. Messrs. Vincent, Brooks, Day, & Son are to be congratulated upon the success with which they have reproduced the coloured plates.
Edgar M. Crookshank.
24, Manchester Square, W., April 1889
PROGRESS OF VACCINATION IN ENGLAND.
I HAVE already dealt with the life and letters of Edward Jenner, from the study of which an insight may be obtained into the history of vaccination in England up to the year of Jenner’s death (1823).
Before passing on to the period which followed, I will point out how it was that after Cow Pox inoculation had been adopted by the profession in this country, the doctrine of Cow Small Pox came to be considered as essential. It will no doubt be a surprise to many to learn the origin of the theory that Cow Pox is modified Small Pox, as it is so universally regarded as the outcome of clinical observations and pathological experiments. To explain this point fully, I will again refer, and at some length, to the assumption, by Jenner, of the term variolæ vaccinæ.
The title of Jenner’s original paper was “On the Cow Pox,” but in the published Inquiry he inserted the words, variolæ vaccinæ. Whether this term was invented by Jenner himself, or whether it was suggested by one of the friends to whom he had shown his manuscript, history does not relate. At any rate, Jenner made himself responsible for it; and it is therefore necessary to investigate his views as to the relation which was supposed to exist between the two diseases. In the first place, the statement which has been recently made, that Jenner believed that Cow Pox was derived from human Small Pox, and hence that the term variolæ vaccinæ was justifiable, is entirely without foundation. The facts of the case are, that Jenner believed that the Cow Pox was derived from the diseased heels of the horse; he also believed that Small Pox and some other diseases arose from the same source. When the boy Phipps was inoculated with Cow Pox, Jenner was struck with the similarity to some cases of inoculated Small Pox, and he felt convinced that, at least, Cow Pox and Small Pox were derived from the same source. The idea that Cow Pox arose through the agency of milkers suffering from human Small Pox never occurred to Jenner.
Jenner’s theory of the origin of Cow Pox from horse grease was well known to his contemporaries. According to Fraser, Woodville strongly objected to it, and recommended Jenner to omit it from his original paper.
“I deeply regret that he did not follow the advice which Dr. Woodville gave him upon being requested to peruse the manuscript of his first treatise on this subject, prior to its publication. The part which Dr. Woodville objected to, was the opinion broached relative to the origin of this disease, than which nothing can be more contrary to philosophy, analogy, and experiment.”
Pearson also criticised the term which Jenner had substituted for Cow Pox.
“For the sake of precision in language, and of consequence, justness in thinking, and considering that there is no way of disabusing ourselves from many of the errors of physic, but by the use of just terms, it is not unworthy of our attention to guard against the admission of newly appropriated names which will mislead by their former accepted import.
“Variola is an assumed Latin word, and its meaning will be popularly understood in the English tongue by saying that it is a name of a disease, better known by another name—the Small Pox. Granting that the word ‘Variola’ is a derivative from Varius and Varus used by Pliny and Celsus to denote a disease with spots on the skin, the etymological import of Variola is any cutaneous spotted distemper; but one of the most formidable and distinct of the cutaneous order is what is called the Small Pox, and therefore, as I apprehend, the name, Variola has been used technically to signify this kind of spotted malady, and no other.
“Now as the Cow Pox is a specifically different distemper from the Small Pox in essential particulars, namely, in the nature of its morbific poison, and in its symptoms,—although the Cow Pox may render the constitution not susceptible of the Small Pox,—it is a palpable catachresis to designate what is called the Cow Pox by the denomination Variola vaccinæ; for that is to say, in English, Cow Small Pox, and yet the Cow is unsusceptible of infection by the variolous poison.”
It is interesting to note that after the publication of Pearson’s pamphlet, and after the discovery of cases of Cow Pox arising independently of horse “grease,” Jenner avoided, for a time, any further reference to the origin of the disease.
It was Fraser who was led by the term variolæ vaccinæ to regard Cow Pox as modified Small Pox. After setting aside the Jennerian theory, that Cow Pox is modified horse grease, Fraser wrote:—
”My own opinion of the origin of this disease is certainly original, and I believed till lately that it was also singular; but my learned friend, Dr. James Simms, has broached the same idea in a paper read before the Medical Society of London, and published in the last volume of their memoirs. I believe that the Small Pox and the Cow Pox are one and the same disease under different modifications; and I have found, in course of conversation with some of the most eminent medical and chirurgical doctors in the metropolis, that after having attentively listened to many of the arguments which may be fairly adduced in favour of this opinion they have appeared often to incline to the same belief. I am aware that the proposition may be considered, by some, equally fanciful and absurd with Dr. Jenner’s, but at the same time let them remember that it is at least supported by analogy, philosophy, and, of course, probability, although not in the present state of our knowledge by experiment. I do not intend to insist upon this doctrine as incontrovertible, nor even to enter largely, at present, into its merits with a view of establishing it, but shall content myself with observing that such a circumstance would answer the most important and useful purposes.”
Before seeing what those useful purposes were, it is as well to mention that Fraser concluded this paper by asserting that his view was established on the “solid and imperishable foundation of truth;” but, however carefully one may read his memoir, no evidence can be found in support of his doctrine.
Nevertheless, he adopted the theory, and pointed out the following as the two great reasons for believing it:—
“Firstly, It would render the practice of vaccine inoculation general by reconciling the minds of the people who are now imposed upon and intimidated, and in fact shocked at the idea of its filthy ancestry.
“Secondly, It would place Dr. Jenner’s discovery upon a rock by depriving the antagonists of vaccination of their only successful line of argument.”
Thus the assumption that Cow Pox exercised a specific effect on the constitution, rendering it proof against Small Pox, led to the invention of an ingenious theory, which satisfied the minds of those who were willing to accept a plausible explanation, though it was opposed to all practical knowledge of the disease in the Cow.
But the great question, after all, was whether this disease did or did not protect from Small Pox; and there were two ways in which this was put to the test. Were persons after vaccination insusceptible of inoculation with Small Pox, and were they proof against exposure to infection? A sufficient answer to the first question is the fact that Jenner discountenanced the variolous test as unfair, and it is therefore unnecessary to detail the cases in which inoculation of Small Pox succeeded after vaccination. With regard to the test of exposure to infection, evidence—especially towards the last few years of Jenner’s life— was equally overwhelming; but the failures were attributed to the use of improper lymph, or to badly or inefficiently performed vaccination, or the Small Pox was regarded as malignant Chicken Pox. The reports of these failures proved a crushing blow to Jenner. Never before was he involved in so many perplexities; he even seemed ready to acknowledge that the “spontaneous” Cow Pox which Pearson and Woodville had led him to pronounce as a source of genuine ”vaccine” was, after all, of no value; and it would appear as if he were preparing, just before his death, to fall back upon horse grease as the only source of the “true life preserving fluid,” although in his earlier researches he had satisfied himself that equine lymph was of no value. With regard to the instances of the inefficacy of Cow Pox which were brought to Jenner’s notice, I will give a short account of Dr. Alexander Monro’s observations ”on Small Pox after perfect vaccination.” Dr. Monro wrote:—
“Ever since the publication of Dr. Jenner’s discovery respecting the Cow Pox, there have been various rumours afloat of Small Pox occurring after Cow Pox. In consequence of the experience which I myself have had as to the antivariolous effects of Cow Pox, I confess I was led to suspect that some mistake had been committed, either as to the nature of the disease, or as to the previous vaccination. At length, about nine years ago, all doubt from my mind was removed, in consequence of my having had ocular and very distinct evidence of perfect vaccination having failed to produce the promised security.”
Dr. Monro not only made his own observations, but he corresponded with other members of the profession. Mr. Cooper informed him that “cases of Small Pox after Cow Pox are now daily occurrences.”
The statements made by Dr. Alexander Ramsay, of Dundee, were still more striking. In a letter to Dr. Monro, dated 27th June, 1818, Dr. Ramsay said:—
“Though our confidence, no doubt, is limited, yet it (vaccination) does appear to us of great value, and to possess many advantages over variolous inoculation. We are inclined to think that much depends on effecting the vaccine disease in its most perfect form, and preserving the pustule entire, which hitherto has not been the case.
“It must, indeed, be admitted that facts do not bear us out fairly in the conclusion that vaccination has resisted the attack of this eruptive disease in proportion to the perfection of its character. On the contrary, several of the most distinctly marked cases of Small Pox have occurred in those who have been vaccinated apparently in the most satisfactory manner, and where the cellulated marks on both arms are still as perfect as possible.
“In most cases, however, the pustules had not been preserved entire, but in several they were so; and in those no circumstance whatever could be found, on the strictest examination, to invalidate the evidence of Small Pox in its perfect form having succeeded to vaccination in its perfect form.”
After this independent testimony, Dr. Monro described the cases in his own family, and not the least striking incident in their history is the fact that they had been vaccinated by Mr. Bryce, and submitted to his test.
The first case was Dr. Monro’s eldest son, aged fifteen.
“He had been vaccinated, according to my father’s notes, on the left arm by Mr. Bryce with Cow Pox matter, on Saturday, October 29th, 1803.”
Fifteen years afterwards, the boy caught Small Pox. The following is the full history of the case:—
“Edinburgh, February 28th, 1818.
“A. M., æt. fifteen, was this morning seized with headache, lassitude, drowsiness, and considerable general oppression.
“He went to church, but on returning home from the morning service was still more oppressed; his face was much flushed, and his eyes red; had severe headache; was very drowsy; threw himself on the sofa, where I found him sleeping at one o’clock p.m.
“His skin was then hot; pulse but little affected; had no appetite, and took no dinner. In the evening, his pulse became quick; he was more flushed; eyes redder, and headache more severe. Got 3i of the compound powder of jalap. Passed a very restless night; frequently started up, and talked a great deal in his sleep.
”Monday.—Pulse 110. Still more flushed and oppressed; had hot and cold fits. Had a stool from the jalap, which was natural as to colour and quantity. Was frequently sick; 10 grains of ipecacuanha were prescribed. Vomited freely a considerable quantity of yellow-coloured fluid like bile. Passed a still more restless night than the preceding, and talked a great deal in his sleep. Was occasionally sick during the night.
”Tuesday.—Pulse 120. Skin hotter; face still more flushed and swollen; more thirsty; tongue white; complained of cold.
No stool. Got 3i of compound powder of jalap and 4 grains of calomel. Complained much of coldness of the feet.
“Wednesday (1st day of cruption).—Skin hot and red; much thirst; had three or four stools from the medicine. He sneezed frequently. There are several small, red, round spots, like a flea-bite, on the back of the left hand, and on the little finger, and also on the forehead; the red colour of which is not removed b}’ pressure, and pressure is painful. Tongue white; still complained much of cold, especially of the extremities. There is a slight moisture on the face. Pulse 120.
“Thursday (2nd day of eruption).—The number of red spots on the forehead is now much greater, and there are also a number on the cheeks, nose, ears, lips, arms, and legs; the skin between these is of a florid red colour. The cheeks and eyelids are swelled and red. Eyes slightly inflamed; he cannot bear the light, and sneezed a good deal. Pulse 60. Passed a good night. Little appetite. Starting in sleep; much disturbed b}’ dreaming, and talked a great deal during his sleep.
“Friday (third day of eruption).—The red spots on the skin are considerably broader, and not of uniform size over the whole body, nor equally prominent; those on the face and neck are farthest advanced. Each spot has a distinct red line round its basis; in the centre of many of those on the face, neck, and breast-bone, there is a small quantity of a serous fluid, with a depression in the centre. Eyes more inflamed, and more tender. There are a number of pimples among the hair, especially on the back of the head, which are very itchy. Had a good deal of sneezing. Tried to sit up, but it produced acute headache, and he could not do so above ten minutes. Has slight soreness of his throat, which he refers to the larynx. Has no difficulty in swallowing. Several pustules on the face have run together. No stool. A tablespoonful of syrup of senna was prescribed at 11 o’clock A.M., and a second similar dose given at half-past 11 at night.
“Saturday (fourth day of eruption).—Nearly in the same state as yesterday. Had three or four loose stools from the medicine.
“Sunday (fifth day of eruption).—Passed a good night; no thirst; no fever. He had a free motion in the morning. Appetite improved. The pimples on the face and lobe of the ears are of different sizes, and filled by a watery fluid. The transparent vesicles have distinct necks, and are very like blisters occasioned by boiling water.
“I conceive that the transparent vesicles were formed on the top of the original pimples. Dr. Rutherford, however, holds a different opinion as to the origin of the transparent vesicles, and supposed, that in consequence of inflammation of the skin, a serous fluid was suddenly effused under the scarf skin, and formed vesicles at the side of the Small Pox pimples.
“The vesicles filled by transparent water are more numerous on the face than those filled by pus, for there are not above hall” a dozen of pustules on the face filled by pus, which have a manifest depression in the centre. The pimples on the breast, those on the back, arms, thighs, and legs, are exactly like the pimples of the Small Pox, and are filled with pus. The progress of the pimples on the face has been quicker than that of those nearer to the centre of circulation. The pimple over the breastbone, which had made the greatest progress, was punctured with a lancet by Mr. Bryce, and was found to contain pus; and Mr. Bryce said, he had no doubt but that it would, by inoculation, communicate the Small Pox.
“Skin not so itchy to-day. The vesicles which were filled by a watery fluid, in the course of four or five hours lost considerably of their prominence, were less tense, and were by no means so transparent, and seemed filled with whey, and some of them burst on turning the head and pressing on them. This day, Mr. Lizars made a drawing from the face, which conveys a more accurate idea of the appearances than verbal discription. (Vide Plate 111.) Got at 12 o’clock p.m. a tablespoonful of syrup of senna.
“Monday, March 2nd (sixth day of eruption).—Slept a good deal yesterday afternoon; passed a good night; took his breakfast with appetite. The pustules on the face are not so tense as yesterday The medicine has operated twice. No thirst; no fever. The pimples on the arms and legs are now become pustular, and Dr. Rutherford and Mr. Bryce think them perfectly like those of Small Pox. Mr. Bryce punctured one of them, which was found to be filled with thick viscid pus. The cuticle over the pimples on the arms and legs is thicker than that of those of the face; and hence the pustules are more of a grey colour. The cuticle of those vesicles of his face which are filled with a watery fluid, is shrivelled, of a yellow colour, and in some of them there are a few opaque white spots. Many of the pimples on the leg seem to have gone back. The face and legs are now less swelled. The spaces between the pustules of the face are less red than yesterday.
“I observed about nine in the evening, that the vesicles on the face which had been filled by a transparent fluid, had shrunk very considerably. Pulse 6o. Was at nine in the evening in a sound sleep, from which he did not awake though a candle was held near to his eyes. Pulse 64.
“Tuesday, March 3rd (seventh day of eruption).—Passed a good night. Pulse 60, and regular. The greater number of the larger vesicles which contained the clear fluid have burst. On some of them, the scarf-skin is much shrivelled, and these are filled by a small quantity of yellow fluid. No stool. Eyes less tender. There is now but little redness on the skin of the body between the pimples.
“The progress of the pimples has been very irregular; those on the left hand are to the touch, hard, and of a light grey colour, though they first appeared. The progress of these pimples has not been nearly so rapid as of many in other parts of the body. On one of them being opened, it was found to contain purulent matter. Many of the smallest pimples on every part of the body have gone back, and on pressing the skin, no hardness is perceptible. The pimples on the breast have not gone on to suppuration faster than those of the extremities of the body.
“There is a diffused redness between the pimples on the extremities, but it never was so great as between the pustules on the face.
“None of the pimples which resembled those of Small Pox were above a quarter an inch in diameter, and many as small as pin points.
“Mr. Syme made his drawing between 11 and 12 o’clock from the pustules on the left arm, and also of the one on the back of the hand. “No headache, thirst, or heat of skin.
“Wednesday, March 4th (eighth day of eruption).—Passed a good night. Pulse 64. Skin cool; no thirst. A small crust of a deep brown colour is formed over many of the pustules; in a few on his forehead, there is no matter. The skin between the pimples of the face is now of the natural colour, and the swelling of face and lips is gone. The pimples on the left hand and fingers which appeared first are still of a grey colour, feel hard, are painful when pressed, and there is no matter now in them; but there are other pustules on the back of the hand which evidently still contain matter. Mr. Bryce opened one of them, and found it filled by very viscid yellow matter. Many of the pimples on both thighs are still filled by matter; in the centre of others, there is a slight scale, which gives the appearance as if the pustules were depressed in the middle. Skin still very itchy.
“Thursday, March 5th (ninth day).—Passed a very good night. Appetite to-day very keen. Pulse 60. The greater number of the pustules have now dried up; there are, however, still a few containing purulent matter upon the hands and thighs. The crusts of the pimples on the face, which resembled the blisters from burns, are of a light yellow colour, and are surrounded by crusts of a dark brown colour formed on the pustules, which resembled those of Small Pox. Many of these crusts on the face have now fallen off, but the skin under them is rough, and slightly elevated. Dr. Rutherford supposes that a little crust was formed upon the skin after the larger crusts had fallen off.
”Friday, March 6th (tenth day).—Passed a good night. Pulse 64. No headache; no thirst; appetite good.
”Saturday, March 7th (eleventh day).— All the pimples are now dry in the outer layers. A great many of the dry crusts have fallen off. On drawing the fingers along the skin, there is an evident elevation where the pimples were; for a few of the layers of the dried vesicles still remain. Pulse natural; no headache; feels himself now much stronger.
”Sunday, March 8th (twelfth day).—The crusts still continue on the face, and those on the thighs, arms, and hands have a considerable degree of hardness and transparency. Is in all other respects quite well.
“Saturday, March 14th (eighteenth day of eruption).—There are still some crusts on his face, and a great many on the thighs, arms, and hands, though he took the warm bath last night. There are three very evident pits of a triangular form on the left temple, the bottom of which is very irregular. The cuticle over the crusts on the hands has burst, and now forms a white line around the basis or rather circumference of the dried crust.
“March 17th—Many of the crusts on the extremities of the body, and especially those on the arms, have not fallen off.
“March 19th (twenty-first day since eruption appeared).—There are still many of the crusts on the arms and legs.
“March 22nd (the twenty-second day since the eruption appeared).—Three pimples of different sizes, and in different states of progress, were observed to-day on the right thigh, and at no great distance from each other. One was like a flea-bite, of a pale red colour, and felt globular when the finger was drawn along. A second has a circle of a deeper red within the paler red, and there is a clear spot on the top; in a third, the crimson ring is still more apparent, and the centre of it seems filled with a liquor like whey, evidently depressed, and had every appearance of the genuine Small Pox pimples.
“March 23rd—The pimples which have appeared on the thigh continue to follow the usual course of the pimples of the modified Small Pox.
“A number of crimson-coloured blotches appeared on the skin after the crusts fell off, and these were not obliterated at so late a period as the 2nd of June. During the progress of the disorder, a dish with nitrous fumigation was constantly kept in the room.”
I do not propose to quote in full the particulars of the other cases in the family, but the history of the vaccination is important.
“J. M. was inoculated in his left arm on Wednesday, December 17th, 1806, when three months and three days old. A pustule has formed, about one-sixth of an inch in diameter, which is red at the edges, and its middle rises into a point, from which matter has oozed out, and, by drying, formed a yellow crust. On Monday, December 22nd, 1806, five days after the inoculation, Mr. Bryce inoculated him with matter from his left arm: instead of laying the lancet flat upon the arm, and rubbing off the matter while the point of the lancet was under the cuticle, he punctured the arm, with the point placed perpendicularly, three or four times.
“December 23rd— Thirty-two hours afterwards, a pimple about one-tenth of an inch in diameter, and of a red colour, had formed on his right or last punctured arm. The vaccination was at the time considered complete.”
- M., æt. 11, Monday, March 16th. 1818. suffered from symptoms which developed into an attack of Small Pox.
The third child, K.M., had also been inoculated with Cow Pox, and tested by Mr. Bryce, and, at the time, Mr. Bryce, and Dr. Monro and his father, regarded the vaccination as perfect. On March 15th, 181S, K.M., ait. thirteen, had symptoms which proved to be those of an attack of Small Pox.
Among other cases reported to Dr. Monro, was the son of Dr. Hennen. This boy contracted Small Pox, and at first, as the boy had been vaccinated, the disease was considered as Varicella. But the source of infection was a soldier, in whom the disease was ascertained to be Small Pox. Dr. Hennen wrote:—
“This boy was vaccinated by myself when three months old, and I had every reason to be satisfied with the genuineness of the matter; he has often been exposed to variolous contagion in Spain, France, and Portugal, and particularly last year at Portsmouth.”
Another letter of great interest was received from Dr. Smith of Dunse, 2nd June. 1818. Dr. Smith wrote:—
” I had, indeed, seen several cases of Small Pox supervening upon vaccination, which I mentioned at the time to Dr. Farquharson; but as he seemed to think lightly of them, I judged it prudent to take no further notice of the circumstance. Even now, though I have seen a multitude of cases in which Small Pox has, in every possible shape, taken place after vaccination, I feel myself placed in the painful situation of bringing forward many facts to which gentlemen of the first eminence in the profession will probably give little or no credit. …
“It is now about three months since Small Pox appeared in the east coast of Berwickshire, particularly at Coldinghame, Eysmouth, and Ayton. Several young people, who had not been vaccinated fell victims to the disease. In the course of a few weeks afterwards, this pestilential malady extended itself over other parts of the country, and whole families were in consequence promiscuously laid up, whether vaccinated or not. I have seen a number of cases wherein great crops of Small Pox took place after vaccination. I attended two in particular that were confluent, and watched the progress of the disease with much anxiety, …
“I am perfectly sensible I may have incurred much odium in the opinion of many for having had recourse to inoculation after it has so long been exploded. … Vaccination either does, or it does not, resist the variolous affection. If the former, vaccination cannot possibly do harm; but, if the latter, we are imperiously called upon to communicate the Small Pox in the mildest way we can, and not leave the rising generation to the scourge of a loathsome and dangerous disease.”
Practitioners had so committed themselves to a belief in the protective power of Cow Pox that even when Small Pox occurred after perfect vaccination it was impossible for many to believe it.
The disease, they said, must be Malignant Chicken Pox. This, for example, was the view taken in the case of a boy at Inverness, two years old, who had Small Pox “after having passed through the Cow Pox in its most perfect state.” But Dr. Robertson set the question at rest by inoculating a child, and the child so inoculated not only had the common Small Pox, but had it severely. Dr. Smith, of Dunse, had similar experiences, and “repeatedly practised inoculation with matter taken from those who had the Small Pox after the Cow Pox.”
Dr. Monro was unable to free himself from his previous convictions in regard to the prophylactic efficacy of Cow Pox, and he concluded, that the disease was milder than might otherwise have been the case.
These were not the only outbreaks of Small Pox about this time which afforded similar experiences; and it is not surprising, therefore, that Jenner was surrounded with perplexities.
Vaccination, it is true, was in a great measure discredited, but it still survived, and was gradually reinstated. This was due partly, no doubt, to the favourable reports of the officials of the National Vaccine Establishment; but the revival was certainly brought about more particularly by the exertions of John Baron, the friend and biograher of Jenner.
Jenner’s notes and correspondence had been placed by his executors in Baron’s hands. From his intimate acquaintance with Jenner, he was regarded as the most suitable person to prepare a biography. All Jenner’s early letters were bequeathed to Baron by Edward Gardner. But Baron’s object was not merely to write a biography of Jenner; his work was intended to restore the shattered credit of vaccination. Thus he wrote in the Introduction:—
“The recent prevalence of Small Pox in different parts of Europe, and the corresponding diminution of confidence in the virtues of the Variolae Vaccinae rendered it an object of no inconsiderable importance to endeavour to restore and increase that confidence, by showing that Dr. Jenner clearly foresaw the deviations which have been observed; that his doctrines, if properly understood, satisfactorily account for them; and that nothing, in fact, has occurred which does not strengthen and confirm his original opinions both with regard to the variola and the Variolae Vaccinae. I would hope that something may have been done in these respects that shall tend to promote the universal adoption of a practice capable of effecting so much good.
“Nothing, I am persuaded, can ever accomplish this object except a real knowledge of the nature of that affection which might be made to lake the place of Small Pox. A very sincere wish to accelerate this event has led me to the discussions contained in the present volume, the publication of which at this time, I would humbly hope, may not be without its use.”
No one can possibly read Baron’s Life of Jenner without feeling the prejudices and the strong bias displayed all through the work; and no one with any knowledge of comparative pathology, can possibly Study it without being impressed with the gross fallacies to which Baron committed himself. His historical investigation, as I have already pointed out, resulted in proving to his own satisfaction that Jenner’s Cow Pox was the remnant of an outbreak of Cow Small Pox and thus he justified the term, variolæ vaccinæ, and endeavoured to establish the protective power of Cow Pox. But his elaborate statement proved to be a tissue of blunders, for the disease described as Cow Small Pox had nothing to do with Cow Pox; it was, in fact, Cattle Plague. At the time, however, Baron’s teachings were accepted, and thus his blunders fulfilled his purpose. Criticised in the light of modern information, the only value of Baron’s work is to be found in the publication of Jenner’s correspondence, by which we are able to judge of the way in which vaccination was conducted from 1798 to 1823.
Baron employed other channels for spreading his ideas, and he so far succeeded that he misled the medical profession. Thus he was made Chairman of a Committee of the Provincial Medical and Surgical Association, and in their report, signed, and probably entirely written by the Chairman, the pathological fallacies in Jenner’s biography were repeated in a description of the affinities between Human Small Pox and the so-called Cow Small Pox, and we are told that, “upon a due understanding of this portion of the subject everything that is valuable in the practice of vaccination depends,” Then follows an elaborate dissertation on the disease described by Layard in this country, and by Frascatorius, Lancisi, Lanzoni, Ramazzini, and others, in Italy, in other words, on Rinderpest or Cattle Plague. Thus was Cow Pox dogmatically asserted to be Cow Small Pox; and Fraser’s theory, which obscured the great fallacy in Cow Pox inoculation, was admitted as a pathological fact.
In support of the theory, Baron related that Mr. Bree, of Stowmarket, had written to say—
“During the prevalence of Small Pox in this neighbourhood, several dairies became affected with Cow Pox; which supports the opinion of the identity of the two diseases, the latter being probably modified by being developed in the cow.”
Baron also referred to a statement made by Dr. Waterhouse, of Massachusetts, in a letter to Jenner.
“At one of our periodical inoculations, which occur in New England once in eight or nine years, several people drove their cows to an hospital near a populous village, in order that their families might have the daily benefit of their milk. These cows were milked by persons in all stages of Small Pox. The consequence was, the cows had an eruptive disorder on their teats and udders, so like the Small Pox pustule, that every one in the hospital, as well as the physician who told me, declared the cows had the Small Pox.”
The whole of this anecdote was hearsay. It was probably a coincident outbreak of one of the common eruptive affections of the teats; and so little interest was taken in the event at the time, that no inoculations were made from the cows to test the nature of the eruption. And yet Baron writes:—
“It is impossible, we conceive, to doubt the fact that on this occasion the Small Pox had been conveyed from man to the cow, just as it had been communicated, in the dairies of Gloucestershire, from the cow to man.”
But though Baron succeeded in carrying the general opinion of the profession in favour of vaccination, there were individual vaccinators who, occasionally, spoke out candidly enough. Thus, Estlin, in 1837, wrote to the editor of the Medical Gazette:—
”Allow me, in the first place, to premise that, having been engaged in vaccinating (at one time rather extensively) for thirty years, I have watched, with regret, a decided decline in the activity of the virus; and for many years, I have been endeavouring in vain to renew the lymph from its original source. On the diminished anti-variolous power of the present stock of vaccine matter I need make no remark; the public are too painfully aware of the fact.”
Badcock was led to undertake his experiments by the following occurrence in 1836:—
”Towards the end of the year 1836, I suffered severely from a dangerous attack of Small Pox, which happened but a few months after revaccination; and my mind having previously been impressed with an idea that the old vaccine had lost its protective influence by passing through so many constitutions during the long period of forty years, I was exceedingly anxious to procure some fresh from the cow, for the purpose of having my own children revaccinated.”
And, again, speaking of his experiences up to 1845, Badcock wrote:—
“From whatever cause it may arise, the fact has been of late years already ascertained, that the ordinary vaccine virus has lost a great deal of its protective power against Small Pox. A greater number of cases in which that disease has occurred after vaccination are met with than formerly, and in some instances those are very severe, and occasionally even terminate fatally.”
In fact, an alteration in the quality of the lymph had now become one of the stock apologetics for Cow Pox failures, and the profession was still persuaded to believe in “that most precious boon of Jenner to a suffering world.” According to Badcock, similar experiences were met with abroad. Out of 547,646 vaccinated, 11.773 were attacked with Small Pox, 1,294 became disfigured or infirm, and 1,379 died in consequence of the disease. Indeed, in France, vaccination was credited with having no effect over malignant Small Pox; while in England, when a less malignant variety attacked the vaccinated, the argument was used that if it had not been for vaccination the attack might have been worse.
Even Ceely, one of the most accurate observers, who had convinced himself that Cow Pox arose “spontaneously” in the cow, and had never been able in all his practical investigations to find any other explanation for its origin, was nevertheless so influenced by Baron’s teachings, that when he succeeded in raising a vesicle on the cow by inoculation of human variola, a vesicle which had the physical characters of the vaccine vesicle, he was led to believe that he had succeeded in producing Cow Pox by inoculation of human Small Pox. Thus, Baron’s historical researches, and Ceely’s misinterpreted investigations, were summed up by Baron in the words, “Vaccination is now, indeed, placed upon a rock.” There was not only no hesitation in substituting the term Cow Small Pox for the original Cow Pox, but although outbreaks of Cow Pox were discovered perfectly independently of any human variola, Baron’s historical researches, Ceely and Badcock’s experiments, and the incidents related by Waterhouse and Bree, led to the theory of Cow Small Pox, being regarded as an established fact.
In 1857, vaccination obtained further support from the Blue Book on vaccination compiled by Simon. It would be out of place, here, to analyse that report, but it remains as evidence of the extraordinary hold which the Jennerian doctrine had upon the minds of even distinguished sanitarians. It is, however, much to be regretted that the teachings and fallacies of Baron should have been reproduced, and Jenner’s Inquiry described as a masterpiece of medical induction—a similar comment to that of Blumenbach on Jenner’s researches on the cuckoo.
Not only were Baron’s blunders with regard to Cattle Plague quoted with approval, but the Cow Small Pox theory again comes to the front under cover of Ceely’s variolation experiment.
“It was not till forty years afterwards that science supplied an authentic interpretation of Jenner’s wonderful discovery; he, indeed, had suspected the solution, and had hinted his meaning when he called the Cow Pox by the name of “Variolae Vaccinae,” for such in fact it is—the Small Pox of the cow.”
Simon also endorses the following statement to show that “a host of theoretical objections to vaccination might have been met, or indeed anticipated, if it could have been affirmed sixty years ago, as it can be affirmed now,”
” ‘This new process of preventing Small Pox is really only carrying people through Small Pox in a modified form. The vaccinated are safe against Small Pox, because they, in fact, have had it. Their safety is of the same sort as if they had been inoculated under the old process, or had been infected by the natural disease. The trifling disorder which they suffer, those few tender vesicles on the arm, the slight feverishness which they show, is Small Pox of the most modified kind; Small Pox so modified by the intermediate animal organisation through which it has passed, that when thus reintroduced into the human body it excites but insignificant disturbance, and no general exhalation of infected material.’ ”
Thus Fraser’s creed led to a pathological error, which, in turn, was officially commended on the ground that it met a host of theoretical objections. The same theory having been officially accepted, has been reproduced in our medical text-books, and the student is led to believe that Cow Pox arises from milkers suffering from Small Pox, and Cow Pox is, therefore, Small Pox modified by transmission through the cow. But the fallacy of this doctrine is too obvious; for in the numerous outbreaks in cows and horses from which “vaccine lymph” has been procured, if the source of the disease were Human Small Pox, there would have been little or no difficulty in tracing the infection. But never, in any outbreak of Cow Pox or Horse Pox, has a connection with Human Small Pox been established.
The reply may be made to this, that Cow Pox is so excessively rare a disease that there have not been sufficient opportunities for observation; and that further, the rarity of the disease harmonises with the belief that it arises from Human Small Pox. Such a statement is in direct opposition to facts. Cow Pox and Horse Pox have been met with and studied again and again. If these diseases were derived from Human Small Pox, the observation would have been established with as much certainty, as that hydrophobia in man results from the bite of a rabid dog. To emphasize this point, I will give a brief summary of the outbreaks of Cow Pox which have occurred in this and in other countries.
In England, Jenner found Cow Pox in 1770, 1780, 1782, 1791, 1794. 1796. In 1798, he raised his first stock of lymph. In 1799, Cow Pox was raging in the dairies in London, and was described by Woodville, Pearson, and Bradley. In the same year, Cow Pox broke out at Norton Nibley, in Gloucestershire, and lymph was taken for Jenner’s use. Later, a fresh stock was raised from the dairies in Kentish Town. Pearson and Aikin described the prevalence of Cow Pox in Wilts, Somerset, Devon, Buckingham, Dorset, Norfolk, Suffolk, Leicester, and Stafford; and Barry described its prevalence in Ireland.
From this time onwards, for a long period, natural Cow Pox received little or no attention in this country. Fresh stocks of lymph were occasionally raised, but no further attention was paid to the disease in the cow.
In 1836, Leese met with an outbreak, and raised a stock of lymph which was introduced among the current stocks. In 1838, Estlin met with an outbreak in Gloucestershire, and raised a fresh stock of lymph. Cow Pox was observed in 1838-39 by Mr. Fox, of Cerne Abbas; and again in 1839, in Dorsetshire, by Sweeting, of Abbotsbury; and in 1838, 1840, 1841, and 1845, fresh stocks of lymph were raised by Ceely, Cow Pox being frequently met with in the Vale of Aylesbury. From this time onwards, outbreaks of the disease in the cow have not been recorded, but several practitioners met with the disease, and raised fresh stocks.
Thus, when inquiries were made in 1857, it was found that several medical men had employed fresh vaccine lymph; Mr. Donald Dalrymple, of Norwich (on two occasions); Mr. Beresford, of Narborough, in Leicestershire; Mr. Gorham, of Aldeburgh; Mr, Alison, of Great Retford; Mr. Coles, of Leckhampton; Mr. Rudge, of Leominster, and one or two others. Mr. Sweeting had met with the disease in two instances, and had disseminated lymph obtained by the vaccination of persons from each source. Another stock of lymph was raised by Ceely in 1845, and lastly, in 1887, I investigated an outbreak of Cow Pox in Wiltshire.
In Italy, Cow Pox was found by Sacco in 1800, in the Plains of Lombardy, and by other practitioners in 1808-9. In 1812, it was observed at Naples by Miglietta; in 1830, in Piedmont; and in 1832, and 1843 at Rome, by Dr. Maceroni. Quite recently several outbreaks of Cow Pox have been encountered, and the stocks of lymph renewed.
In France, in 1810, Cow Pox was found in the Department of La Meurthe, and in 1822, at Clairvaux; at Passy, Amiens, and Rambouillet in 1836; at Rouen in 1839; at Saint Illide, at Saint Seine, and at Perylhac in 1841; in 1842, at Pagnac; in 1843, at Deux Jumeaux, where, during the previous thirty years several fresh stocks of lymph had been raised and circulated. Cow Pox broke out in a cow belonging to M. Majendie in 1844; and it was found at Wasseloune in the Department of Bas Rhin in 1845; it occurred in three Departments in 1846; at Rheims, and in the Department of Eure et Loire in 1852; in the arrondissement of Sancerre, and at Beziers in 1854; and at Guyonville in 1863. On farms in three villages near Nogent in 1864 (the disease was introduced by newly purchased cows; milkers were infected, and from one of these milkers a lymph stock was established); in 1864, also at Petit Ouevilly. near Rouen; and in April 1866, at Beaugency; in 1881, at Eysines, near Bordeaux, and again at the same place in 1883; and in 1884, at Cérons.
In Germany, as soon as attention had been drawn to the disease. Cow Pox was frequently discovered. It was also ascertained that it had been referred to in a Gottingen newspaper published in 1769. The disease appears to have been well known there, and milkers who contracted the disease by milking the cows had the same tradition as the dairymaids in Gloucestershire, as to its protective power against Small Pox. In 1802, Cow Pox was met with, according to Bucholz, in different parts of Germany—in Mecklenburg, Holstein, Brandenburg, Silesia, and the neighbourhood of Gresen and Erlangen. In 1812, Cow Pox was discovered in Berlin and its suburbs by Bremer; near Luneburg by Fischer; and in Greifswalde by Mende; in 1816 at Seggerde in Brunswick, by Giesker; and in other parts of Brunswick.
In Holstein, from 1813 to 1824, Luders met with five epizootics in the farms of Bustorf, Berensbrook, Ornum, Eichthal, and Holstein, and also a great number of isolated cases, Ritter found this disease very common in Schleswig-Holstein. It was found, in 1829, by Riss, at Neu Busach, and by Albeis, near Stralsund, in 1834.
In Wurtemberg. between the years 1825 to 1837, numerous outbreaks were reported. The great number in 1829, corresponds with the publication of a description of Cow Pox:—
In sixty-nine places the vaccinogenic property of the lymph, from eighty-four cows, was established by inoculation. One hundred and twenty-six children, and a girl twenty-two years old, were vaccinated with success, and the stocks of lymph were circulated in other countries. After 1830, fresh lymph was sent to the vaccine institutions at Stuttgart, and employed successfully; so that in ten years many hundreds of children were vaccinated with Cow Pox lymph collected in Wurtemberg.
In Holland, according to Numann, Cow Pox was found in 1805, in 1811, and in 1824.
In Denmark, it was found by Niergaard, at Fünen, in 1801.
In Russia, in 1838, an epizootic occurred among the cows in a village in the neighbourhood of St. Petersburg.
In North America it was found by Dr. Buett, of Massachusetts, and by Drs. Norton and Trowbridge, of Connecticut, in 1801.
In South America it was found in the valley of Ablixco, in the neighbourhood of Valladolid de Mechoacan, and in the district of Calabozo, in the province of Caraccas; and by Humboldt in Peru, and was known, according to Pepping, among the cows in Chili.
Hence it is evident that natural Cow Pox is far from being a rare disease, as many have supposed, who are unacquainted with the subject; and, further, in not one of these numerous outbreaks has any causal relationship with Human Small Pox been established.
To assert, therefore, the theory of Cow Small Pox on the ground of Ceely and Badcock’s experience, is to substitute experimental fallacies for common clinical observation. I must again assert that there is no proof whatever that the disease, Cow Pox, was produced by the inoculation of cows with Human Small Pox. After a number of trials a vesicle was produced possessing the physical characters of inoculated Cow Pox; but, inasmuch as cattle plague, when inoculated, produces a vesicle with the physical characters of Cow Pox, that Sheep Pox and Horse Pox can also be so cultivated as to produce similar appearances, there is no more reason for supposing that Human Small Pox was transformed into Cow Pox, than there is for believing that Cow Pox, Horse Pox, Human Small Pox, Cattle Plague, and Sheep Pox are all manifestations of one and the same disease.
The practical student of Cow Pox is at once convinced, without any further evidence, that the two diseases, Small Pox and Cow Pox, are specifically distinct. Cow Pox is a disease communicable solely by contact. Small Pox is a disease which, though inoculable, is also highly infectious. Cow Pox begins as a local affection, and is followed by constitutional symptoms. Small Pox is an acute disease, characterised by sudden and severe fever, which is followed after forty-eight hours by a generalised eruption.
If we study inoculated Cow Pox in early removes from the cow, we observe the formation of a papule, a vesicle, an ulcer with surrounding induration enlargement of the lymphatic glands, and secondary eruptions or vaccinides. Cow Pox, in fact, as Auzias-Turenne pointed out in 1865, is strictly analogous to syphilis, and it is only by a comparison with this disease that we can really follow its natural history. In most of our medical text-books, the description of Cow Pox is not the description of the natural disease; it is simply an account of the appearances which result after it has been artificially cultivated on the arm of a child or the belly of a calf. The ordinary description of vaccinia stands in the same relation to the disease Cow Pox as a description of the benign vesicle of variolation to the full cycle of the natural Small Pox. It is only when we have to deal with the early removes from the cow, or when the lymph reverts to its original untamed character, that we really appreciate what the symptoms of Cow Pox are. Jenner has given many instances, which stand in striking contrast to the mitigated affection described as “tender vesicles with slight feverishness.” We know that Jenner met with what, at the present day, are called vaccinal accidents; these are manifestations of the disease in its unmitigated form; it is then associated with violent constitutional symptoms, the development of corroding ulcers, and generalised eruptions. Bousquet met with similar experiences. Estlin has fully described the results which followed from the use of lymph recently derived from the cow and Ceely also met with similar accidents.
In speaking of Small Pox inoculation, I have referred to the differences which resulted from taking lymph at different periods; and there can he no question that the same laws which apply to Small Pox inoculation, apply also to Cow Pox inoculation. Cow Pox lymph taken at a late stage will tend on some subjects to revert to its original virulency, or, as Busquet calls it, sauvagerie, just as Small Pox lymph taken at a late period and ingrafted on a suitable soil may induce, not a transient papule or a benign vesicle, but an attack of confluent Small Pox.
I have already stated that Auzias Turenne was the first to point out that Cow Pox is analogous to syphilis; but even the earliest opponents of vaccination regarded the disease as lux bovilla, and it had even been suggested that the cow had derived the complaint from milkers who were affected with syphilis. There is no more ground for believing in the latter theory than there is for believing that Cow Pox is produced by milkers suffering from Small Pox. It is the course which the malady runs which brings it so closely into relation with syphilis; and I find that in Horse Pox, the parallel is still closer, inasmuch as Horse Pox is transmitted by coition. In this country, Creighton has pointed out how closely the inoculated syphilis runs parallel with the natural Cow Pox; so much so that he has a tendency to regard all cases of so-called vaccinal syphilis as truly vaccinal, being reversions to the original type of the disease in the cow. This may be too sweeping an assertion, for there appears to be very little doubt that syphilis may be transmitted by vaccination; but many cases which are attributed to syphilis are unquestionably the full effects of the Cow Pox virus; and nothing could more clearly point to the analogy between the two diseases than the difficulty in diagnosing the exact nature of these vaccinal accidents.
Again, if we study the effects of syphilis artificially inoculated on the human subject, the appearances in some cases are strikingly similar to inoculated Horse Pox. Without entering into a prolonged discussion of this subject, I will refer, as an example, to the progress in Ricord’s cases of syphilisation. As in inoculated Horse Pox we have the stages of papule, vesicle, ulcer, scab, and scar; and no one can compare his plates with Jenner’s (see Plates IV. and XXIH.) without being struck with the similiarity in their appearances. The results of the artificial inoculation of syphilis were unknown to Jenner, but if they had been he would scarcely have failed to have observed the likeness between them. So striking indeed are the appearances, that it is possible that, by judicious selection, a strain of syphilitic lymph might be cultivated which would produce in time all the physical characters of the “vaccine” vesicle.
As the result of an investigation into the history, and especially the pathology, of “vaccination,” I feel convinced that the profession has been misled by Jenner, Baron, the Reports of the National Vaccine Establishment, and by a want of knowledge concerning the nature of Cow Pox, Horse Pox, and other sources of “vaccine lymph.” Though in this country, vaccine lymph is generally taken to mean the virus of Cow Pox, yet the pathology of this disease, and its nature and affinities, have not been made the subject of practical study for nearly half a century. We have submitted instead to purely theoretical teaching, and have been led to regard vaccination as inoculation of the human subject with the virus of a benign disease of the cow, whereas the viruses in use have been derived from several distinct and severe diseases in different animals.
The statement that the protective measures which have been introduced by Pasteur, such as inoculation for chicken cholera, anthrax, and rabies, are analogous to Jenner’s vaccination as a protective against Small Pox, is the most recent extension of the fallacious theory of Cow Small Pox. Pasteur’s system is the same in principle as the old method of Small Pox inoculation. Variolation, though a dangerous practice, can at least claim to be based upon scientific grounds, viz., the prevention or modification of a disease by artificially inducing a mild attack of that disease. Jenner’s substitution of Cow Pox inoculation was a purely empirical treatment based upon folklore, and involved a totally different pathological principle—the protection from one disease by the artificial induction of a totally distinct disease—a principle which was not and has not been since, supported by either clinical experience or pathological experiments. The Jennerian method has for nearly a century struggled for existence with the support of the Cow Small Pox theory and the numerous and ingenious explanations of failures embodied in the assertions of spurious Cow Pox, inefficiently performed vaccination, inferior quality of lymph, deficiency in the number and quality of marks; and the misinterpretation of statistics.
Inoculation of Cow Pox does not have the least effect in affording immunity from the analogous disease in man, syphilis, and neither do Cow Pox, Horse Pox, Sheep Pox, Cattle Plague, or any other radically dissimilar disease, exercise any specific protective power against Human Small Pox. Inoculation of Cow Pox, Horse Pox, and Cattle Plague have totally failed to exterminate Small Pox; and for the eradication of this disease we must in future resort to methods similar to those proposed by Haygarth, which in modern times have been so successful in STAMPING OUT diseases of the lower animals, such as Cattle Plague, Foot and Mouth Disease, and Sheep Pox.
In the case of the lower animals this has been effectually performed by notification, combined with either slaughter, isolation, or muzzling. It has been stated that rabies might be stamped out of this country in twelve months by universal muzzling; with equal truth may it be said that Small Pox might be stamped out in the same time by notification and a rigid system of isolation. And if any practical benefit is to be derived from Pasteur’s system of protective inoculation, I cannot see any scientific reason why nurses and other attendants upon cases of Small Pox, should not be protected by inoculation with attenuated Small Pox within the walls of a Small Pox hospital, and with due precaution to prevent the spread of infection.
There can be no doubt that ere long a system of COMPULSORY NOTIFICATION and ISOLATION will replace vaccination. Indeed, I maintain that where isolation and vaccination have been carried out in the face of an epidemic, it is isolation which has been instrumental in staying the outbreak, though vaccination has received the credit.
Unfortunately a belief in the efficacy of vaccination has been so enforced in the education of the medical practitioner, that it is hardly probable that the futility of the practice will be generally acknowledged in our generation, though nothing would more redound to the credit of the profession and give evidence of the advance made in pathology and sanitary science. It is more probable that when, by means of notification and isolation, Small Pox is kept under control, vaccination will disappear from practice, and will retain only an historical interest.
 Report of the Medical Officer of the Local Government Board. 1882. p. iv.
 British Medical Journal. July 14th, 1888.
 Vol. ii., p. 87.
 Henry Fraser, M.D. Observations on Vaccine Inoculation. 1805, VOL. I.
 Monro. Observations on the Different Kinds of Small Pox. p. 144.
 Compare Duncan Stewart. Report on Small Pox in Calcutta, and Vaccination in Bengal. 1827-44. Vol. ii., p. 518.
 Vol.. I.
 Vol. ii., p. 517;.
 Vol. ii., p. 365.
 Vol. ii., p. 552.
 Creighton, Cow Pox and Vaccinal Syphilis.
 Vide p. 163.