There is much of the like order of "facts in favour of vaccination" current concerning other European populations, which only pass muster because they are rarely subjected to criticism; because vaccination is considered such a benign invention that to question its credentials is wicked; and because it is held that if even some of the claims made for it are touched with fable, yet their effect on the popular mind is so clearly for good in inspiring confidence and overwhelming occasional mishaps, that it is inexpedient to be over-scrupulous. But, however instructive and wholesome may be the exposure of such sophistications, it is necessary to restrain ourselves, and for the remainder of my Story we shall keep to English ground. From the preceding details we see how far vaccination in Sweden, Denmark and Iceland fell short of the claims made for it by Jenner and his successors. Jenner, it is true, died in 1823, before the more pronounced refutations of his assertions had been evolved, but, as said, it is questionable whether he ever realised that the names of countries stood for millions of men, women and children whose vaccination could only be overtaken by organised exertion in the process of years. His various boasts, therefore, of vaccinated nations and exterminated smallpox are to be taken as proofs of defective arithmetical capacity and of that scientific imagination which runs with possibility and matter-of-fact. * Report on the Vaccination Act (1867) from the Select Committee of the House of Commons, 1871. P. 414. CHAPTER XXXII. NEWCASTLE SMALLPOX: A COMMON STORY. To examine the statistics of the larger English towns in order to determine whether vaccination has had any influence on the abatement of smallpox, would involve us in discussion interminable. For our immediate purpose it may suffice to select three examples; 1st, NEWCASTLE-ON-TYNE, as an instance of a common story; 2nd, NORWICH, as an instance of a smallpox epidemic; and 3rd, GLASGOW, as an instance of smallpox displaced and replaced as a factor of mortality. THE NEWCASTLE DISPENSARY. We often hear of "the statistics of the Anti-Vaccinators;" to which the summary answer is that Anti-Vaccinators have no statistics. Their statistics are the statistics of the Vaccinators, in which they provide the material for their own condemnation; which is probably the reason why the so-called statistics of the AntiVaccinators are so intensely disliked, avoided, and unanswered. The Newcastle Dispensary in 1877 completed its hundredth year, having been founded in 1777, and Dr. Monteith prepared a concise history of the institution, which was published in 1878 by order of the Committee.* The report is especially valuable as a record of the comparative incidence of disease in a large industrial population, where, if anywhere, smallpox might be expected to show itself in severe form. In 1781 the population of Newcastle was estimated at 23,000; in 1821 it had risen to 41,794; in 1851 to 87,784; and in 1871 to 128,443; and through all these years and changes, the Dispensary * Report of the Newcastle Dispensary, from its Foundation in 1777. Printed by order of the Committee. Newcastle-upon-Tyne, 1878. continued in active operation, the percentage of the patients to the population being maintained with remarkable uniformity. It is needless to add that the majority of the patients have been from the ranks of the poor, among whom smallpox has always its chief seat. As Dr. Monteith observes They are the class intermediate between the well-to-do workingman and the pauper. The state of distress in which these people continually live is known to few. The patient, when visited by the doctor, is usually found lying in "poverty, hunger, and dirt,' and the treatment of the cases is undertaken in circumstances very unpropitious to success. Medical advice and medicine are not the only things needed. Good food, warmth, and judicious nursing are imperatively required, and are seldom if ever attainable. Before turning to the Dispensary's record of a century of smallpox, it may be well to observe that Variolation. was practised in Newcastle with great assiduity, and that the Dispensary took a lead in the business, the surgeons inoculating any one who applied. Dr. Monteith relates By the year 1777 the arguments in favour of Variolation had so far triumphed over the habits and prejudices of the profession that there is no instance mentioned in our reports of any medical man in Newcastle opposing it. It is always spoken of as one of the best established facts of medical science. With the general public the case was different. Their prejudices were as strong as ever, and they exhibited a horror of Variolation which would satisfy the most ardent Anti-Vaccinator. To combat these prejudices various means were tried-sermons from the pulpit, pathetic exhortations in the newspapers, etc. The last and most convincing argument consisted of a pecuniary reward to parents who should allow their children to undergo the operation. The sum offered was 5s. for one child, 7s. for two, 9s. for three, and 10s. for four, and upwards. The success of this expedient was remarkable. Parents came flocking in with their children in great numbers. Tempted by the rewards, they subjected their little ones to an operation which, unless their sentiments had greatly altered, they believed to be barbarous and hurtful in the extreme, and a clear temptation of Providence. Variolation on these terms commenced in the spring of 1786; and every year thereafter, until 1801, children were operated on at the Dispensary at the rate of over 200 per annum. In 1801 there had been in all 3,268 operated upon. As soon as Vaccination came into vogue, Variolation was denounced as the chief cause of the existence of smallpox. It was said that what was done to avert the disease from the individual diffused it among the multitude. Vaccinators long maintained that they could easily exterminate smallpox, if only Variolators would refrain from keeping it alive. Variolation gradually ceased, and was formally prohibited in 1840, and by and by Vaccination was made compulsory. Nevertheless, the confident prophecy of the Vaccinators remains unfulfilled, for smallpox is not exterminated. The change from Variolation to Vaccination at the Newcastle Dispensary was immediate. Dr. Monteith says It is creditable to the good sense and enlightenment of the Dispensary authorities that they at once abolished Inoculation of Smallpox, and substituted Vaccination in its stead. In 1801, the first year, 215 children were vaccinated. The annual number rapidly rose until it reached its maximum in 1813, when 1,874 were vaccinated, after which the numbers as rapidly declined. For this decline various reasons were assigned, such as the increase of the private practice of vaccination, and the disposition to undervalue every benefit, however great, that is purely eleemosynary. It is forgotten that Vaccination fell off as its illusory character became more and more manifest, and as the promises made on its behalf were, one and all, indisputably belied. When Jenner died in 1823, he passed away amid indifference, if not contempt. His bubble had burst. The furore for vaccination witnessed in the present generation is by no means a continuation of the original furore. That passed away. Our furore is a revival, dating from the popularity of sanitary reform, to the back of which a new generation of medical men contrived to attach vaccination! In the hundred years, 1777 to 1877, the Dispensary had to deal with 2,616 cases of smallpox, of which 428 terminated fatally, which as to years and mortality may be thus classified The progressive reduction in mortality is, of course, ascribed to vaccination having made the disease milder; though the report informs us that "the mortality from smallpox reached its highest point-33.3 per cent. in the five years from 1802 to 1807," the very time when enthusiasm in favour of the Jennerian rite was at its acme. We, on the other hand, would attribute the lower mortality, as did Dr. Andrew Combe, to better modes of treatment, even neglect being preferable to much of the old-fashioned regimen for smallpox. Considering the figures, Dr. Monteith observes Of Smallpox I desire to speak with circumspection, for in Newcastle Anti-Vaccinators are somewhat rampant. Figures, however, are stubborn things, and their import is not easily explained away. Like the vast majority of medical men, I have always firmly believed in the good results of Vaccination. Without admitting that my faith has been shaken by considering these statistics, I must confess that I have been a good deal disappointed with them. I had expected to find this terrible disease regularly decimating the population every year until the epoch of Jenner's discovery, and afterwards diminishing, rapidly and steadily, almost to nothing. These figures do not warrant us in taking so sanguine a view of the matter. Whilst, therefore, we observe considerable improvement in the figures, I am of opinion that they leave us in this dilemma-either that there now exists a grossly exaggerated impression of the prevalence and fatality of Smallpox in former times, or else that they had begun to decrease long before the discovery of Vaccination, the beneficial effects of which must, therefore, have been at least assisted by other causes. Here we have an honourable confession from out the bonds of professional prejudice, and a reluctant exposure of the legend of a world decimated by smallpox, and ceasing to be decimated after the advent of Jenner. There is nothing singular in the Newcastle evidence that |