SMALL-POX HOSPITAL NURSES
LONDON SOCIETY FOR THE ABOLITION OF COMPULSORY VACCINATION, 1882
PREFACE TO THE FOURTH EDITION.
The persistent attempts that are now being made to create panic over the increase of small-pox in London have so far met with little success. What evidently is wanted is to drive the people in flocks to the doctors for re-vaccination. The "roaring trade" that was done during the epidemic of 1871 is remembered with fervour, and such another "good time" is earnestly prayed for. It is lucrative work vaccinating troops of terrified middle and upper class Londoners. They hear of "carefully selected vaccine" with touching simplicity; drop their guineas with grateful alacrity; and retire persuaded that they are fortified for at least seven years from possibility of infection. Here we see old sorcery and witchcraft under new forms without essential difference.
One of the fictions resorted to by the Medical advisers of the Local Government Board, echoed with parrot-like simplicity and persistency by the Press, and blindly accepted as Gospel truth by Boards of Guardians, is the oft-repeated tale of the immunity of the Small-Pox Hospital Nurses; as glaring a specimen of the "suggestio falsi" as was ever promulgated, which the compiler of the following pages has endeavoured to expose, with the aid of truth, and well attested facts.
THE SMALL-POX HOSPITAL NURSES AND RE-VACCINATION
THE oft repeated argument respecting the immunity from small-pox enjoyed by the nurses at the Small-pox Hospitals, owing to re-vaccination, is the sheet anchor of the vaccinators logic. Without any attempt at verification, without any suspicion of subjacent fallacy, this argument has been adopted with unquestioning faith and published with amazing industry by the leading dailies, weeklies, and monthlies throughout the country.
In 1871 the College of Physicians put it thus :" For more than thirty years all the nurses and servants at the Small-pox Hospital, who had not previously had smallpox, have been re-vaccinated before entering on their duties; and not one case of small-pox has occurred among these persons, although living in an atmosphere of concentrated infection."
The Times of the 26th September, 1878, expresses itself as follows :" From the foundation of the first Small-pox Hospital till now there has not been a single instance of a nurse contracting the disease."
Mr. Ernest Hart in his "Truth about Vaccination," speaks of the "absolute protection afforded by re-vaccination to nurses of the Small-pox Hospital."
Dr. W. B. Carpenter, writing to the Spectator, April 23rd, 1881, remarks on "the absolute security afforded by thorough re-vaccination," and observes that "not one of the re-vaccinated nurses was attacked by small-pox."
A card issued at public vaccination stations to mothers, by order of the Local Government Board, says, "The nurses of the Small-pox Hospitals are always re-vaccinated before commencing their work. This has been the rule for over fifty years. None of them have taken small-pox since this rule has been observed."
Having thus enunciated the proposition we propose to examine it more closely.
I. Is it true? Have the re-vaccinated nurses at the Small-pox Hospitals enjoyed complete immunity from the disease? And the answer is No.
At the Stockwell Hospital three of the re-vaccinated nurses and attendants contracted smal1pox )Pall Mall Gazette, April 23rd, 1877.)
At the Fulham Hospital three of the re-vaccinated attendants under Dr. Makuna took smallpox (Smallpox and Vaccination. Dr W.T. Iliff, Pp 10) and, the same hospital, Dr Sweeting recently stated in public that four of his re-vaccinated nurses had taken the disease.
At the Deptford Hospital one attendant took small-pox eight days after re-vaccination.
At the Halifax Hospital, in April, 1881, the matron and a nurse contracted small-pox from a patient; t(British Medical Journal, May 7th, 1881) the matron had been previously vaccinated, while the nurse had been re-vaccinated only a week before she was taken ill.
At the Sheffield Small-pox Hospital the medical officer and an attendant, both previously vaccinated and re-vaccinated, took the disease.
At the Lewes Fever Hospital a nurse who had been vaccinated and re-vaccinated suffered from an attack of smallpox in November, 1881.
Dr. Bakewell, of the Trinidad Hospital, took small-pox after he had been re-vaccinated six times. So that the allegation of absolute immunity is proved in limine to be absolutely false.
II.Is there no underlying fallacy which vitiates the conclusions drawn respecting the alleged immunity of the nurses? Is there no disturbing cause? Is no other explanation possible? Now it has frequently been asserted that many of the small-pox nurses have had the disease before they are engaged, nay, are frequently patients retained after recovery, and this assertion is in great measure true, especially of the old Small-pox Hospital at Highgate. Mr. Marson, the Resident Medical Officer, thus expressed himself before the Select Committee of 1871 :
Q4218. "Have any of the nurses in your hospital had smallpox before they have been engaged as nurses? Some of them."
Q. 4225. "As to your answer to the Right Hon. Member for New Shoreham, with reference to some of the nurses having had small-pox before you engaged them, will you explain that statement which has been made to the Committee, that some of the nurses of the Small-pox Hospital have been seen to be marked with small-pox? Yes; but that very nurse that was alluded to was a person who had remained with us after being a patient." Question (4226):"That case was the case of a person coming in as a patient, and engaged as a nurse after she recovered? Yea, she came in as a patient, and she was for some years the matrons housemaid. She left us for a short time, and came back again, and is now our head nurse. We never had so many employed in the hospital as we have at this time who came in as patients, for, in consequence of the want of nurses, we have employed those who have come in as patients, and were willing to stay."
And, again, in answer to Q. 4220: "Do you consider that small-pox itself is as great a protection as vaccination?" he said" Yes, much greater, as you see from the returns. There are a few cases of persons who have had small-pox after small-pox; and in the first tables which I gave, the number was less than 1 per cent, of small-pox after small-pox, whereas it was 53 per cent, of smallpox after vaccination."
At a lecture at the Eleusis Club, Chelsea, April 18th, 1881, a nurse from the Fulham Hospital confessed that she herself had contracted small-pox, although vaccinated, and had become a nurse after convalescence in Highgate Hospital, and further admitted that many hospital nurses had, like herself, been hospital patients.
Then, again, at the Hampstead Hospital no less than 50 of the employees, and at the Fulham Hospital 23, had previously had small-pox.
Hence it follows that the relative immunity from smallpox among hospital nurses is in part, at least, due to antecedent small-pox, which, on Mr. Marsons showing, is a much greater protection than vaccination.
III.It is found that where vaccination is neglected, the same immunity is found, the following cases furnish us with purely differential evidence.
Dr. Porter in the Medical Press and Circular, No. 1729, March 27th, 1872, observes :" With reference to re-vaccination, I have no faith in it. Not one of the 36 attendants at the South Dublin Union sheds has taken small-pox. Only 7 of the number were re-vaccinated, and as the remaining 29 enjoy the same immunity, wherein is the necessity of the operation? I have known gouty inflammation, abscess of the breast, and augioleucitis to result from the operation. I cannot, in the face of such facts, approve of it, and moreover the sense of the profession is against it. It is only to be employed when there is no evidence of the success of infantile vaccination, and even then it seems to do more harm than good, at least, so far as I have seen."
And again :--" The personnel of Bicetre (where 8000 soldiers, suffering from smallpox, were treated), nearly two hundred in number, suffered little from small-pox, one only dying from it. Of forty medical attendants none took the disease, in spite of the negligence of most of them with respect to vaccination". Still more remarkable was the complete exemption of forty nurses, who lived in the centre of the hospital and attended the patients day and night." (Medical Times and Gazette, October 18th, 1873.)
Dr. Borel, of Neufchatel, in a medical paper printed in the "Correspondent Blatt fur Schweizer Aertzte (Corresponding Journal for Swiss Medical men)," published at Basle, on July 1st, makes the following remarks :" It is impossible to deny acclimatisation; or to explain myself more clearly, the special disposition acquired by those who are constantly exposed to the same infectious agents; the immunity for example, which, undeniable though doubtless relative, protects all persons occupied in pathology. All evidence is in favour of such a phenomenon of acclimatisation. My two friends, Professors Kleinwachter and Jirus, assured me that they had frequently observed during their sojourn as house surgeons in the small-pox ward of the Prague Hospital, that the nurses and hospital attendants, who had been some time in the service, never caught small-pox, although not protected by previous artificial vaccination."
Then, again, it is extremely rare for visitors to patients in small-pox hospitals to contract the disease, in spite of neglecting re-vaccination, and taking only rational precautions against infection.
Dr. Bridges, in his Report, observes that "of 796 visitors who paid 1118 visits, only 3 were afterwards admitted into the hospital with small-pox."
Mr. Sweeting, of the Fuiham Hospital, writes :" 33 patients were visited by 48 persons, who made altogether 76 visits; only one of the visitors was afterwards admitted with small-pox." (Report for the year 1880.)
Dr. Bernard, of the Stockwell Hospital, writes :" 1056 visits were paid into the wards of the hospital. It is interesting to be able to say that, as far as I have heard, no one caught small-pox thereby ;" the following rules are observed:
1.Not to enter any of the wards when in a weak or exhausted state. 2. To partake of food before entering the hospital 3. To avoid touching the patient or exposing themselves to his breath, or to the emanations from his skin.4. To sit on a chair at the bedside, at some little distance from the patient (Annual Report for 1880)
IV. The relative immunity of nurses and doctors from infection is proverbial, and has been observed in diseases other than smallpox and in smallpox before vaccination was in vogue.
This immunity, whether due to so-called seasoning, or to that remarkable condition of insusceptibility, otherwise known as health, is so well recognised as hardly to need evidence in support of it; but the following may be cited for the sake of the sceptical : "This well known phenomenon attending small-pox will appear less singular when we reflect that the same observation has been made respecting the plague, a more virulent contagion, the history of which shows, in every invasion of that dreadful malady, that many escape, though constantly employed about the sick, or infants sucking their infected mothers." (Small-pox. R. Walker, M.A., London, 1790.)
Nurses being generally advanced in years, habituated to fatigue, and little liable to worry of spirits, do not readily receive infection." (Instructions relative to Contagious Diseases, London, 1801.)
Dr. Lionel S. Beale in his work on "Disease Germs," 2nd edition, pp. 322 and 323, says : "The fact of the escape of the attendants of the sick, in spite of their continual exposure, ought to suffice to relieve the alarm of the most timid, and prove to them that exposure does not imply contraction of disease. The body in its normal state of health has the power of resistance; and the fact that many members of the medical profession and nurses, although exposed time after time to the influence of contagious disease, reach old age without having suffered from a single attack, ought surely to encourage and afford a justification to those who, having determined to devote themselves to the service of the sick, must be continually exposed to contagion."
Wilson Philip, M.D., in his "Treatise on Fevers," 4th edition, page 177, says:
"One powerful means of fortifying the body against infection, on many accounts deserves attention, viz., the frequent exposure to contagion. It is well ascertained that those who are frequently exposed to contagion become at length, in some measure, hardened against its effects. Thus nurses and physicians often escape infection."
Lord Bacon says :" The plague is not easily received by such as are continually about them that have the plague, as keepers of the sick and physicians."
Miss Florence Nightingale, in her Notes of Nursing, observes :.-" True nursing ignores infection, except to prevent it. Cleanliness, fresh air from open windows, are the only defence a true nurse either asks or needs."
V. if, however, Re-vaccination is so eminently protective in the atmosphere of a small-pox hospital, it seems strange that its saving power should fail so conspicuously under the less severe test of the outer world. Small-pox after re-vaccination is of common occurrence. Dr. Copland says,--- "Re-vaccination has been adopted in many places, and has often failed, natural small-pox having notwithstanding appeared in the re-vaccinated, both in those in whom the measure appeared to have succeeded, and in those in whom it failed." (Dictionary of Practical Medicine, pp. 829.)
The report of the Deptford Hospital for 1879, gives notes of 10 cases of small-pox after re-vaccination, one of whom died of black small-pox, while another was in hospital nearly a year with a severe confluent attack; and the superintendent, Dr. MCombie, gracefully adds :"It would appear from this, then, that cases of small-pox do occasionally occur after apparently successful re-vaccination."
Every soldier and sailor is re-vaccinated, and yet from 1859 to 1876, there were 1306 cases of small-pox in the army with 94 deaths, and 686 cases In the navy with 42 deaths. (Vide Appendix to "The Truth about Vaccination.") If re-vaccination will not protect the general public, the army and the navy, is it re-vaccination that protects the nurses?
The foregoing premises warrant the following conclusions:That some re-vaccinated nurses do take small-pox, though many, whether from a process of seasoning or mental and-bodily vigour arising from due regard to healthy regimen, or some other cause, resist it altogether, and that the same immunity is observed where re-vaccination is neglected,. while not a few of the nurses have received the additional protection which an attack of small-pox affords. This fashionable action, then, of absolute immunity of the hospital nurses owing to re-vaccination, is both false in its statement and fallacions in its reasoning.