JENNER'S SUCCESSIVE DISCLAIMERS.

The story of vaccination is a story of failures, and as each failure has become manifest, it has been more or less artfully apologised for.

Much is given to assurance. People like infallible prescriptions. They prefer an unequivocal lie to an equivocal answer. This adventurers understand, and discourse accordingly. Hence when Jenner solicited Parliament for largess, he did so in no doubtful terms. He boldly declared that cowpox was "inoculated on the "human frame with the most perfect ease and safety," and was "attended with the singularly beneficial effect "of rendering through life the person so inoculated per"fectly secure from the infection of smallpox." Again he said, "The human frame, when once it has felt the in"fluence of genuine cowpox, is never afterwards, at any "period of its existence, assailable by smallpox."

It is needless to point out that Jenner was without warrant for his assertions. His experience did not cover more than a few years; and he could not, therefore, know that his specific would secure its subjects from smallpox for life. He believed, or affected to believe, his own assurance, and assurance being infectious, it widely spread. The inoculation of cowpox became fashionable among busybodies, male and female. Ladies especially were numbered among Jenner's favourites and experts, operating, as he described, "with a light hand." Cobbett relates, "Gentlemen and ladies made the beastly "commodity a pocket companion; and if a cottager's child were seen by them on a common (in Hampshire at least), "and did not quickly take to its heels, it was certain to "carry off more or less of the disease of the cow."

It so happened that prior to the introduction of vaccination, a marked decline in the prevalence of smallpox had set in, and for the continuance of this decline the vaccinators took credit. "See," they cried, "see what "we are doing!" But they failed to observe that the decline prevailed among millions who did not participate

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in the cowpox salvation. Soon, however, cases of smallpox among the vaccinated began to be reported. first they were denied. They were impossible. When the evidence became too strong for contradiction, it was said, "There must have been some mistake about the "vaccination; for it is incredible that any one can be pro"perly vaccinated and have smallpox: the human frame, "when once it has felt the influence of genuine cowpox, “is never afterwards, at any period of its existence assail"able by smallpox." Either some carelessness on the part of the vaccinator, or some defect in the cowpox served for a while to reassure the faithful; but ultimately these reassurances utterly broke down. Persons vaccinated by Jenner himself caught smallpox and died of smallpox. Then said Jenner, "I never pretended that vaccination "was more than equivalent to an attack of smallpox, "and smallpox after smallpox is far from being a rare "phenomenon; indeed, there are hundreds of cases on "record, and inquiry is continually bringing fresh ones "to light." True; very true; but what then of the assurance and prediction under which £30,000 of the people's money had been pocketed-"The human frame, "when once it has felt the influence of genuine cowpox, is never afterwards, at any period of its existence, assail"able by smallpox"? Nay, more; Jenner descended even lower. He not only likened vaccination to smallpox, but to variolation, that is to the former practice of inoculation with smallpox; and as, he said, variolation was well known to be no sure defence against smallpox, why should people be offended when smallpox in like manner occasionally followed vaccination? Why, indeed! but then the promise ran-"The human frame when "once it has felt the influence of genuine cowpox, is never 'afterwards, at any period of its existence, assailable by "smallpox." In a letter to his friend Moore in 1810, Jenner said, "Cases of smallpox after inoculation are "innumerable." And again, "Thousands might be col"lected; for every parish in the kingdom can give its "case." And he asked another correspondent, Dunning,

in 1805, "Is it possible that any one can be so absurd as "to argue on the impossibility of smallpox after vaccina"tion!" And this from Jenner, who had deceived the nation in 1802 with the assurance that, "inoculated cowpox was attended with the singularly beneficial effect "of rendering through life the person so inoculated perfectly secure from the infection of smallpox"!

Such was Jenner; such his inconsistency; and such the admissions he was driven to make under stress of failures many and manifest.

SMALLPOX MADE MILDER.

As vaccination failed to afford the protection originally guaranteed, various explanations were devised to enable those who had talked too loftily to eat humble pie without painful observation. One of the commonest excuses was that if vaccination did not prevent smallpox it made it milder; and inasmuch as no one knew, or could know, how severe any attack of smallpox would have been without vaccination, it was an assertion as indisputable as the reverse-namely, that vaccination not only made smallpox severer, but frequently induced the disease. There are many assertions with which there is no reckoning, for it would require omniscience to check them. Let us beware of such assertions. Let us neither make them, nor suffer ourselves to be imposed upon by them.

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

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against the novel doctrine. Writing to the Medical and Physical Journal of August, 1814, he said, "No physio"logical 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 suppura"tion in the axilla, and, if exposed in the later stages 66 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. 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."

Sir

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 num"ber 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 inade 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 cica"trices. 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 hav"ing 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 small'pox in a very mild form."

Reading a statement like this, we revert to the ration