Sunday 29 August 2010

Not a square half-inch of original skin

Smallpox was one of the few contagious diseases (the only one?) against which the Victorians had some defence, and legislation was introduced to enforce vaccination, which would, in turn, spark an anti-vaccination movement.

Here's a good BBC programme about the subject here

The article below (which sparked this post) is a response to the 1853 Vaccination Act:


This "act, further to extend and make compulsory the practice of vaccination," has been in operation since August last. Under its provisions, the parents or guardians of every child are required to have it vaccinated within three months from the date of its birth, and afterwards inspected by a medical officer, so as to receive from him a certificate of the success of the operation. We propose briefly to narrate some of the interesting facts which have rendered such an enactment necessary.
    The title of the act implies two things: first, that the safeguard against smallpox has been too little used; and, secondly, that it is thought by the government no longer advisable to leave the use or neglect of vaccination to the discretion of the great body of the people. The want of education makes itself felt in this direction also. Vaccination is practised wherever individuals recognise the full value of health, and know how it may be most effectually conserved; but it is neglected to a lamentable extent among the uninstructed poor. In some countries, where education is more generally diffused than in England, it has been compulsory for a long period; and these localities have been comparatively free from smallpox in consequence. If we have suffered from the disease to a larger extent, however, we may ascribe it, perhaps truly, to the slight abuse of agreat good the wholesome fear our rulers have of legislating upon matters which admit of being settled by the force of public conscience and judgment. But, in this instance, abundant evidence might be adduced to prove the wisdom of interference on the part of the legislature. The private law of parental affection and prudence has not been found strong enough to render unnecessary the help of the external public enactment. We propose now to glance rapidly at some of the evidence on this subject which was laid not long since before the House.
   It is now fifty-five years ago since Dr. Jenner published the result of his investigations into the nature of the vaccine disease, and introduced the practice of vaccination into the world. To estimate duly the value of his discovery, we must remember the fact, that one out of every four or five persons attacked by small -pox, in its unmitigated form, used to perish ; and that if death were escaped, the victims of the disease were liable to disfigurement, deformity, and other physical ills, to an amount frightful to contemplate. When lady Wortley Montague found the practice of innoculation in Turkey, she rejoiced at the mitigation of evil its introduction into her own country promised. She wrote from Constantinople, in 1718, as follows :- " The French ambassador says, pleasantly, that they take the small-pox here by, way of diversion, as they take the waters in other countries. There is no example of any one that has died of it, and you may believe I am well satisfied of the safety of this experiment since I intend to try it on my dear little son. I am patriot enough to take pains to bring this useful invention into fashion in England, and I would not fail to write to some of our doctors very particularly about it, if I knew any one of them that I thought had virtue enough to destroy such a con- siderable branch of their revenue for the good of mankind. But that distemper is too beneficial to them, not to expose to all their resentment the hardy wight that should undertake to put an end to it. Perhaps, if I live to return, I may, however, have courage to war with them. Upon this occasion, admire the heroism in the heart of your friend."
    When Lady Mary returned, in 1721, and put in practice this determination, she was sorely tempted to repent it. Torrents of abuse assailed her : she was denounced from the pulpits, and upbraided as an unnatural mother by the ignorant ; and so virulent was the feeling of the faculty against her, that when her daughter was inoculated, and four eminent physicians appointed to watch the progress of the experiment, she says she feared to leave her child a moment alone with them, lest they should in some way mar its success, and injure her. The court and people found out, at length, however, the value of lady Mary's knowledge and courage, and the practice of inoculation spread through England and many parts of the world. It was a very imperfect mitigation of the original evil : it took for granted that every individual must have the disease ; and though, when produced thus artificially, it appeared in a milder form, and ended fatally very much less frequently, it spread the infection, and left behind the saute liability to other illnesses and disfigurement, though in diminished severity. But it turned the attention of medical science towards the discovery of further remedies, and this perhaps was its moat valuable result.
    It was a happy thing that Dr. Jenner resisted the allurements of a partnership in London, and settled down quietly to a country practice in his native town. Had he accepted John Hunter's offer, the dairymaids in Gloucestershire might probably have enjoyed immunity from smallpox for no one knows how many years, without the world at large gaining by it. But Dr. Jenner had a love for country things ; and at Berkeley, it seems, possessed a large power of patient observation and research ; he studied the vaccine disease for twenty-three years, and then announced to the community that he had discovered a safeguard against small-pox. Inoculation had paved the way for the new wonder, and it was received with less opposition than falls to the lot of many fresh discoveries. The duke of York introduced the practice of vaccination into the army : it spread through England, was welcomed on the continent, in South America, the United States, and China ; and its beneficent influence has been extending ever since, more and more generally.
   To mark its appreciation of Dr. Jenner's services, parliament voted him a sum of 10,000l., in 1802, and an addition of 20,000l. five years afterwards, and the national vaccine establishment was instituted to promote the knowledge and extension of them. And so, at length, poison met poison, and the virulence of the most destructive was abated. The pestilence, that had been generated under the fierce sun of Africa, and had stalked through the nations to lay them waste, met its antidote in the peaceful meadows of Gloucestershire.
    So simple and so efficacious is the remedy thus introduced, that it may well excite our wonder that it has not long since been universally used. That many of our poor people were not fully aware of the value of vaccination, or that they neglected to avail themselves of it, is clearly shown in the disproportion between the vaccinations and births, exhibited in "Returns, made by the Guardians of the Poor relative to the progress of Vaccination in 1851-2 in England and Wales." In the former year, 592,347 births were registered, while the number of vaccinations was only 349,091; in 1852, the births amounted to 601,839, the vaccinations to 397,128, Of the children vaccinated, a very large proportion indeed were registered as being above one year old.. This is a somewhat serious matter, for diseases are most likely to seize infants under that age, who accordingly ought to be guarded against smallpox as early as possible after birth.
     In 1850, the board of the vaccine establishment, after regretting "that the protective power of vaccination was still so much neglected as to permit a frightful amount of mortality from smallpox in the united kingdom," reminded the government that the progress of vaccination was more rapid in countries where it was promoted by legislative enactments, and expressed their conviction that the legislature alone could effectually help to extinguish the pestilence. In that year a bill carrying out the views of the board was introduced into the house; a variety of valuable information relative to small-pox and compulsory vaccination was collected and arranged by the committee of the Epidemiological Society; and in the results set forth in their report, the act now in operation has been framed. This report contains much that is interesting. We find from its tables, for instance, that mortality from small-pox exists everywhere in proportion to the greater or lesseg lest of vaccination ; wherever the latter is compulsory there are fewer victims to the disease. Thus, in England and Wales, while the average number of deaths from small-pox, compared with the total mortality during eight years ending 1850 or 1851, was 21.9 per 1000, that in Saxony (the highest of the averages returned), was 8.33 per 1000 ; while in Bohemia Lombardy, and Sweden, it was little above 2 per 1000. The continental states have various methods of enforcing vaccination : some, as Prussia Bavaria, and Hanover, by fines or imprisonment others, by requiring the production of a certificat testifying the success of the operation, from apprentices, servants, candidates for admission into public schools, alms-houses, etc. Zealous public vaccinators are rewarded with gold and silver medals in France and Belgium. In Austria, no child is allowed to attend either public or private schools, and no person is permitted to seek relief from the charity boards, without having been vaccinated. In Denmark, we find it stated, on the highest medical authority, that variola had at one time disappeared before the defensive influence of compelled vaccination, though, it is added, "that chance, and a careless security engendered by the absence of the pest, have led to its re-introduction there."
   Dr. Cannon, of Simla, states, "that in June, 1850, small-pox broke out along the left bank of the Sutlej. Dr. C. immediately set his vaccinators to work along the right bank. The results were, that the disease along the left bank, where there was no attempt made to arrest it, destroyed from fifty to sixty per cent., but along the right bank from five to six per cent. only ; and in many of these cases the proper performance of vaccination was doubtful."
    All the facts in the report from which we have quoted have one tendency—to prove to any who yet entertain any doubt of it, the efficacy of vaccination, and the necessity of enforcing the use of the safeguard upon those who, from carelessness or ignorance, neglect to avail themselves of its protection. "If it admit of doubt," write the committee, " how far it is justifiable in this free country to compel a person to take care of his own life and that of his offspring, it can scarcely be disputed that no one has a right to put in jeopardy the lives of his fellow-subjects. The principle of using one's own so as not to injure another's is one which has always been acted upon in our legislation as regards property and personal nuisances, and we submit that it is but an extension of this principle to apply it to the questions of life and health."
    Yes, legislation must step in while education grows! When the latter spreads through our land with its enlightening and elevating influence, such enactments as the one under consideration may, we trust, become obsolete. The parents who have knowledge as their handmaiden, an enlightened conscience as their guide, and duty as their watchword, will need them little. Let present educators take heed that they be training such!

I came across this personal reminiscence from Alfred Rosling Bennett's superb 1924 biography, a little while back:

A recrudescence of smallpox at Gloucester and elsewhere has recently caused alarm, which would have been no smaller had it been possible to throw on the screen some of the sights I knew when a boy. Persons badly pitted by the disease were too numerous to excite remark, while those blinded by it were many. At a butcher's in Camberwell there was a shopman whose face and neck were so covered with marks that certainly not a square half-inch of original skin remained; and there were others within my purview nearly as bad. An insect undertaking a voyage over such a countenance would have been like an Arctic sledge party in the presence of very hummocky ice. Persistent vaccination - then much less satisfactory than now, for lymph was taken from one person for use on another, and mothers were wont to be cheered by the family doctor saying that he knew a splendidly healthy baby "coming on" and she might depend on her own darling getting a supply from it - so improved matters, however, that, had it not been for the forgetfulness and carelessness inherent in British human nature, the disease would probably have entirely disappeared. And conscientious objections - a phrase more blessed than even Mesopotamia to shirkers of every class -  helped not a little in keeping it alive.

'Not a square half-inch of original skin remained' ... now, let's count our 21st century blessings again, eh?

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