All the world assenting, and continually repeating and reverberating, there soon comes that singular phenomenon, which the Germans call Swarmery, or the "Gathering of Men in Swarms," and what prodigies they are in the habit of doing and believing, when thrown into that miraculous condition.

Singular, in the case of human swarms, with what perfection of unanimity and quasi-religious conviction the stupidest absurdities can be received as axioms of Euclid, nay as articles of faith, which you are not only to believe, unless malignantly insane, but are (if you have any honour or morality) to push into practice, and without delay see done, if your soul would live!—Thomas Carlyle

THERE are few matters among educated people upon which opinion is so absolute and so ill-informed as vaccination. They will tell you it has stopped smallpox and does no harm, and if you venture to question either assertion you are set down as an abettor of " those ignorant and fanatical anti-vaccinators." If undeterred you inquire when smallpox was stopped, and which is the harmless variety of vaccination, you will probably be told that these are medical questions, whilst the facts are indisputable; the answer running in the line of Old Kaspar's to Little Peterkin, inquisitive as to the good of Blenheim—

I am not complaining of this attitude of mind. We all accept more or less on bare authority. In the multiplicity and unsearchableness of knowledge, it is unavoidable. Some years ago a venerable friend urged me to write against vaccination, which, he said, was working endless mischief to the public health. He would have the book published, and provide whatever was requisite for my satisfaction. I pleaded prior engagements, and turned the conversation, thinking how sad it was that one so good, and, in other respects, so enlightened should be subject to so strange an illusion—I, then, taking vaccination on trust as one of the numerous blessings conferred upon mankind in the course of the present century.

I am therefore disposed to make large allowance for the credulous attitude of the public toward vaccination whilst at the same time insisting on its correction : and for this reason especially, that vaccination is no longer a matter of private concern. We are free to entertain what notions we please, but if we proceed to enforce them on unbelievers, we cannot complain if we are required to answer for our aggression or encounter rough usage. Enforced by the law of England, vaccination is related to the life and intelligence of every citizen, and it is consequently vain to claim for it exemption from vulgar discussion. Apart from its compulsory infliction, vaccination might be and remain an esoteric rite, the very mystery of mysteries; but with compulsion the privilege of sanctity is impossible.

VARIOLATION.

It has been said that beliefs and observances in themselves most irrational wear a different aspect when viewed in the light of their origin and history. It is so with vaccination. Had it come upon the world as we know it, with failure and disaster, equivocation and apology, rejection would have been inevitable; but when we turn to the past we discover that our damnosa hoereditas has a tradition that goes far to account for, if not to excuse, the folly which remains.

Vaccination was the successor of Inoculation (or, more precisely, Variolation), entering into a possession already acquired in the human mind.

It had been observed from of old that some forms of disease rarely recur in the same person in a lifetime; and thus when scarlet fever, or measles, or smallpox broke out in a family, it was considered prudent to let the disease have its course, and thereby obtain immunity from fear of future infection.

It was this confidence, that smallpox once undergone was finally disposed of, that was the justification of the practice of inoculating the disease when introduced from the East in the first quarter of last century. Inasmuch, it was argued, as none can have smallpox more than once, why not induce it artificially, and pass through the illness at a convenient season ? But Nature, though compliant, does not always accept the course we ingeniously prescribe for her. Smallpox as naturally developed (so to speak) is a crisis of impurity in the blood, and if the requisite conditions are absent, it cannot be adequately exited. Hence variolation was an uncertain and hazardous operation. It took with some and was indistinguishable from an attack of ordinary smallpox; it took partially, or not at all with others; and the operation was frequently followed by malaise, disorders of the skin, and grave constitutional derangements. Nor were the variolated secure from smallpox. They occasionally had smallpox with their neighbours, and then it was said, "There must have been some mistake about the "inoculation; for it is impossible that anyone can be successfully inoculated and have smallpox." Further, the variolated, while labouring under the induced malady, conveyed the disease to their attendants and visitors; and thus smallpox was propagated by the means intended to avert it.

THE PRECURSOR OF VACCINATION.

At the close of last century, variolation had become the custom of the upper and middle classes of England. The trouble and the peril were disliked, but were accepted in the name of duty. The variolation of their children was an anxiety that weighed like lead on the hearts of affectionate parents; and glad and grateful they were when the operation was accomplished without serious mishap. Patients designed for variolation were dieted, purged, and bled; and smallpox from sufferers of sound constitution was diligently inquired for. Mild smallpox was in great demand and was propagated from arm to arm. When Dr. Dimsdale operated on the Empress Catharine he did not venture to convey smallpox direct to the imperial person. He looked out a case of "benign smallpox " with which he inoculated a strong young man, and from the young man the Empress. Unless we realise the inconveniences, the uncertainties, the disasters and the horrors of the practice of variolation, albeit minimised, excused and denied by its professors, we can never understand the enthusiasm with which vaccination was received as its substitute. The promise conveyed in vaccination was a relief inexpressible, bearing with it a show of reason that was well nigh irresistible. The argument ran thus : No one can have smallpox twice, and the mildest attack is as protective from subsequent attack as the severest. Therefore it is that in inoculation with smallpox we find security. But inoculation with smallpox is an uncertain operation with dangerous issues. Here, however, in cowpox is discovered a mild variety of smallpox, which may be inoculated with perfect ease, and with no possibility of harm. And inasmuch as the mildest smallpox is as preventive of future smallpox as the severest, it follows that this gentle cowpox must serve as a full equivalent for smallpox itself.

IMMEDIATE TRIUMPH OF VACCINATION.

It was in this plausible shape that vaccination had an immediate triumph. The way was made straight for it and every difficulty removed by the existing practice of variolation. Dr. W. B. Carpenter says that vaccination was more strenuously resisted at the beginning of the century than it is at this day. He is completely mistaken. Vaccination came upon a generation prepared for it—which saw in it a prescription in full accord with common-sense. The entire medical profession, with a few exceptions, the King, Queen and court, were converted straight off, and parliament and society followed suit. It was, I confess, a natural development of opinion; and we need have little doubt that had we lived in those days we should have found ourselves shouting with the genteel mob. The limited resistance offered to vaccination was not based on physiological or sanitary science: such science did not then exist. It was the resistance of variolators who were satisfied with the established practice and resented its disturbance; professing at the same time immeasurable horror at the profanation to humanity by infection with bovine disease. Whilst we have no reason to identify ourselves with that resistance, we have to recognise the service rendered by the variolators in observing the results of vaccination—the persistency with which they traced and exposed its failure to prevent smallpox and the injuries and deaths it caused. So far as the maintenance of variolous inoculation was concerned, they fought a losing battle; but drove the vaccinators from post to post (cursed as they did so as malignant false witnesses possessed by the devil) and at last compelled the admission that their infallible preventive could not be guaranteed to prevent, but only to make smallpox milder—a safe assertion because unverifiable, as disputable as indisputable in particular instances.

JENNER'S PROCEDURE.

About the matter of this prophylactic there was from the first a curious confusion which continues to this day.

Jenner was a country doctor at Berkeley in Gloucestershire, a dairy country, where the maids believed that if they caught cowpox in milking they could never afterwards catch smallpox. Jenner when a young man was inclined to accept the dairymaids' faith; but when he discussed it with his medical acquaintance, they ridiculed him. They said, "We know that such is the dairymaids' faith, but we also know that it is untrue; for we know dairymaids who have had cowpox, and afterwards had smallpox notwithstanding their cowpox." Jenner was convinced and said no more about cowpox.

To this point let me draw special attention. No man knew better than Jenner that cowpox as cowpox was no preventive of smallpox.

Toward middle-life he had what he conceived to be a happy thought. Cowpox as cowpox he had dismissed as impracticable; but there was a variety of cowpox which he resolved to recommend.

Cows in Gloucestershire were milked by men as well as by women; and men would sometimes milk cows with hands foul from dressing the heels of horses afflicted with what was called grease. With this grease they infected the cows, and the pox which followed was pronounced by Jenner to have all the virtue against smallpox which the dairymaids claimed for cowpox.

HORSEGREASE COWPOX.

According to Jenner, then, the dairymaids were right, and they were wrong. They were right when the pox they caught was derived from the horse through the cow, they were wrong when the pox they caught originated on the cow without the horse. He thus discriminated a double pox—cowpox of no efficacy against smallpox, and horsegrease cowpox of sure efficacy.

Further, in this connection, it is to be observed, that farriers believed that when they got poisoned in handling horses with greasy heels, they too, like the dairymaids, were safe from smallpox.

It is not therefore for cowpox, but for horsegrease cowpox that Jenner is answerable. In cowpox he had not, and could have no faith.

In 1798 Jenner published his famous Inquiry, treatise much more spoken of than read, wherein he distinctly set forth the origin of his chosen prophylactic. If was not, I repeat, cowpox: it was horsegrease cowpox. He carefully discriminated it from spontaneous cowpox which, he said, had no protective virtue, being attended with no inflammation and erysipelas, the essential sequences of inoculation with effective virus.

REJECTION OF JENNER'S PRESCRIPTION.

I have said that the world gave a cordial and unhesitating welcome to Jenner's revelation, but the observation requires a startling qualification. Jenner's revelation as conveyed in his Inquiry was summarily and ignominiously rejected—was absolutely rejected. I wish emphasise this point. Jenner published his Inquiry in order to recommend horsegrease cowpox, and what I have to say is, that the public declined to have anything to do with horsegrease cowpox.

The origin of cowpox was scouted as an intolerable origin. It was disgusting. Why a diseased secretion from horses' heels should be more repulsive than a similar secretion from cows' teats was not explained; but, as we all know, there is no accounting for tastes. Various attempts were to verify Jenner's prescription by inoculating cows with horsegrease, but they ended in failure — fortunately, it was said, in failure ; for as Dr. Pearson (chief among primitive vaccinators) observed, "The very name of horsegrease was like to have damned the whole thing." What did Jenner do under these circumstances? Did he confront the public and assert the efficacy of horsegrease cowpox ? Not he. He wanted money. He saw how the wind was blowing. He said not another word about horsegrease cowpox; and as the public were eager at any price to escape from the nuisance of smallpox inoculation, and disposed to substitute cowpox as a harmless substitute, why then he resolved to go in for cowpox, and pose as its discoverer and promoter.

JENNER'S TRANSFORMATION.

I am not making what is called a constructive charge against Jenner, but simply setting forth plain, undeniable matter-of-fact. I ask any one in doubt as to what I say to read Jenner's Inquiry, published in 1798, the prescription of which is horsegrease cowpox, and the condemnation of cowpox. Turn then to his petition for largess, addressed to the House of Commons in 1802, and what do we find ? Not one word about horsegrease cowpox, but this audacious assertion: — "That your Petitioner has discovered that a disease which occasionally exists in a particular form among cattle, known by name of Cowpox, admits of being inoculated on the human frame with the most perfect ease and safety, and is attended with the singularly beneficial effect of rendering through life the person so inoculated perfectly secure from the infection of Smallpox." Why, that was not Jenner's discovery! It was the notion of the dairymaids, and, so far as concerned spontaneous cowpox, was known by Jenner to be untrue. Yet, strange to say, the claim was in a measure allowed |by the House of Commons, and £10,000 awarded to the imposter, and subsequently £20,000 in 1807.

HORSEGREASE COWPOX KEPT OUT OF SIGHT.

As evidence of how completely Jenner's prescription of horsegrease cowpox was put out of sight, I may refer to the treatise of Dr. Willan On Vaccine Inoculation, published in 1806, wherein all that was thought important concerning the new practice was set forth ; and although Jenner was freely cited, yet neither horsegrease nor horsegrease cowpox was referred to from the first page to the last. Instead, cowpox, after the fancy of the dairymaids, was exalted as the true prophylactic, apparently without a suspicion of its questionable character.

As I have said, Jenner not only offered no resistance to this amazing transformation, but conformed to it, and assumed the issue as his own. Since the public preferred cowpox to horsegrease cowpox, he saw no reason why he should object, especially as the same foolish public lusted after some one to worship for their deliverance from the plague of variolation. The world resounded with praises of the immortal Jenner, the saviour of mankind from smallpox. Enveloped in the smoke of such incense, it is scarcely surprising that the idol came to believe that his worshippers knew him better than he did himself.

SPURIOUS COWPOX.

The promise of vaccination, its absolute security and harmlessness, was speedily belied. The vaccinated caught smallpox; they fell sick after the operation; they were afflicted with eruptions and swellings; they died. These mishaps were at first denied—stoutly denied; and when denial was no longer possible, it was attempted to explain them away. The cowpox used could not have been genuine cowpox, but spurious; and for awhile spurious cowpox did yeoman's service in the way of apology; but by-and-by the excuse began to work more harm than good. Mishaps were so numerous that people became afraid of this omnipresent spurious cowpox, and to ask what it was, and how it could be avoided. How can there be spurious pox ? Whoever heard of spurious disease ? Milkmen vend spurious milk, grocers spurious sugar, smashers spurious coin; but surely cows are not to be numbered with such malefactors as producers of spurious pox! The thing was absurd on its face, and absurd it proved. When Jenner was under examination by a committee of the College of Physicians in 1806, he was pressed hard for a definition of spurious cowpox, when he "owned up." He knew nothing of spurious cowpox. The words had been employed, not to describe my irregularity on the part of the cow, but certain irregularities in the action of cowpox on the part of the vaccinated : which was to say that when the vaccinated recovered creditably and did not catch smallpox, the cowpox was genuine; but when the sequences were otherwise, why then it was spurious! Ingenious and convenient, was it not ?

HORSE VIRUS VINDICATED.

Reverting to Jenner's suppression of the origin of cowpox in horsegrease, it may be suggested that he had changed his mind: but he had not changed his mind. As observed, various attempts were made to inoculate cows with horsegrease, and that these attempts were failures; but subsequent attempts were successful. Tanner, a veterinarian, of Rockhampton, Gloucestershire, succeeded to Jenner's complete satisfaction. Dr. Loy of Whitby dispensed with the cow altogether, and inoculated with horsegrease, or horsepox, producing vesicles identical with those of cowpox. The great success, however, in this line was reserved for Sacco of Milan. From the hand of a coachman poisoned with horsegrease he inoculated nine children, and from the virus thus engendered operated on every side. Writing to Jenner in 1803 Sacco said—"It is now admitted and settled that grease is the cause of vaccine, and we cannot too soon alter the designation to equine." De Carro of Vienna received this equine from Sacco, and used it s freely and successfully among the Viennese, that, in his own words, it became impossible to say which of the citizens were equinated and which vaccinated.

What did Jenner make of these confirmations ? He was adjudged mistaken in asserting that the cowpox good against smallpox was derived from horsegrease. Did he appeal with triumph to the evidence of Sacco, and say, "You thought me wrong, but see, I was right!" Not he. He kept silence. He consented to be treated as in error. He stood by and allowed cowpox to be used in which he had no confidence whatever. Nay more. He consented to be rewarded and honoured as the discoverer of a pox (which he did not discover) in which he was without faith, and had at the outset of his career expressly rejected and condemned. He recognised that it was expedient that the connection between horsegrease and cowpox should be denied. He had his bill to settle with the English people, and it was not for him to make difficulties. When, however, he had obtained all he could expect from public favour, and had got clear of London and the oppression of its savants, why then he resumed the expression of his original opinion; and still further, like Sacco of Milan, he dispensed with the cow, and inoculated straight from the horse. He supplied the National Vaccine Establishment with horse virus; he sent it to Edinburgh; he distributed it among his medical acquaintances ; he described it as "the true and genuine life-preserving fluid." What more need I say? Such was Jenner; such were his tactics; and whoever assumes his defence will assume a task in which he not to be envied.

WHICH SHALL IT BE?

Jenner died in 1823, and at that date three kinds virus were in use; first, cowpox from horsegrease or horsepox; second, cowpox; third, horsepox. These of course were subject to inscrutable modification in transition from arm to arm: it is the distinct sources we have to recognise. A patient intent on vaccination might have said to himself, Which shall it be ? Shall I be cowpoxed ? or, shall I be horsepoxed ? or, shall I be horsepoxed cowpoxed ? How such an inquirer would have been answered had he set his perplexity before his medical adviser, I can only conjecture. Probably he would have been rebuked for his intrusion into matters outside his province. The little girl who quenched the scepticism of her comrade with the dictum, "It is so, for ma says so; and if it is'nt so, it is so, if ma says so," illustrates the manner of rebuff administered to those who pry into professional mysteries. It is for you to pay and for us to think is a formula by no means limited ecclesiastics.

SMALLPOX COWPOX.

Jenner was pleased to describe cowpox as a mild form of smallpox; but for what reason, outside his pleasure, did not explain. Nevertheless the suggestion has borne fruit. When virus has fallen short, it has been asked, Why, if cowpox be mild smallpox, should not cows be inoculated with smallpox, and a crop of virus be led ? Various such attempts have been made, in which Mr Badcock of Brighton has been especially distinguished. Mr. John Simon, writing in 1857, said, " Mr. Badcock, from 1840 to the present time, has again and again derived fresh stocks of vaccine lymph from cows artificially infected by him ; having vaccinated with such lymph more than 14,000 persons, and having forwarded supplies of it to more than 400 medical practitioners.' Then it is remembered that virus for half a dozen or more vaccinations is taken from a single arm, and that this process of reproduction is repeated every week, some may be formed of the extent to which this smallpox cowpox has been diffused over the country. The original assertion that vaccination conferred life-long immunity from smallpox was unwillingly abandoned under stress of experience, until no respectable practitioner pretended that the rite afforded more than a partial or temporary security. In promotion of smallpox cowpox, however, Jenner's most extravagant claims were revived. In Mr. Simon's words, for the recipient of smallpox cowpox, "Neither renewed vaccination, nor inoculation with smallpox, nor the closest contact co-habitation with smallpox patients, will occasion him to betray any remnant of susceptibility to infection." Untrue even of variolation, it is unnecessary to controvert such a figment: it suffices to place it on record.

The hypothesis was, that smallpox inoculated on the cow lost somewhat of its virulence ; but if so, why should not such cowpox inoculated on man resume its virulence? We are apt to forget that the nature of things is not controlled by our wishes, and that our interest in the conversion of smallpox into cowpox, and its maintenance as cowpox, is no warrant for fulfilment. I may also remark that though smallpox cowpox has entered so largely into currency, there is no evidence to what extent it has displaced the preceding issues of horsegrease cowpox, cowpox and horsepox. So far as we know, they are all existent in the common blood, indistinguishable, the stronger surviving, the weaker dying out: nobody knows, nor can know.

CONDEMNATION OF SMALLPOX COWPOX.
That smallpox cowpox is in any sense cowpox is, however, widely disputed, much confidence being placed in the researches of the Lyons Commission in 1855 presided over by M. Chaveau. This Commission, says Dr. Charles Cameron, "proved incontestably that smallpox can no more be converted into cowpox by passing it through a cow than by stunting an oak it can be converted into a gooseberry bush." Cowpox, it is held, is a disease of the cow, with no relation to smallpox. The vesicles of each may be apparently identical, as are the vesicles excited by the application of tartar emetic; but that is no proof of essential identity. According to Dr. George Wyld, "Smallpox inoculation of the heifer produces not vaccinia, but a modified smallpox, capable of spreading smallpox among human beings by infection;" and Dr. Cameron boldly attributes the recent increase of smallpox to the use of smallpox cowpox for vaccination.

Nor is Dr. Cameron singular in this opinion. Some time ago, the Galway Guardians ran short of virus for vaccination, when it was proposed to inoculate a calf with smallpox. As soon as the Local Government Board in Dublin became aware of the project, it was forbidden. Why? Here is the deliverance of the Secretary— "because smallpox virus taken from the calf would communicate that disease to the human subject, and be thereby a fertile source of propagating the disease; and would, moreover, render the operator liable to prosecution under the Act prohibiting inoculation with smallpox." Thus the virus current in England, and credited with miraculous virtue by Simon, is denounced as dangerous and its use unlawful in Ireland !

COWPOX REVIVED.

The constant disasters of vaccination, the certain and suspected communication of human diseases with the virus propagated from arm to arm, have induced a wide resort to cowpox under the designation of " animal vaccination," in contempt of the fact that disease in cattle is as rife as among men, and inoculable. Still the dread of the invaccination of syphilis is so intense, and so justifiable, that other risks are encountered if that may be avoided.

This cowpox is commended as "pure lymph from the calf," a sweet periphrase with a savour of Daphne and Chloe, of Flora and the country green—a periphrase used in craft or ignorance, " pure lymph "being as incapable of producing vaccinia as pure milk or pure saliva. The prescription takes us back to Jenner's time and Jenner's procedure. As has been said, the Gloucestershire dairymaids believed that after cowpox they were safe from smallpox, and that Jenner was much impressed with their belief until he discovered that it was untrue. Had he found it true, he might have advertised the prophylactic thirty years in advance of the publication of his Inquiry; but if anything was certain, this was certain, that cowpox did not avert smallpox. Satisfied that cowpox per se was of no avail against smallpox, he defined a variety of cowpox generated by the application of horsegrease, to which he was pleased to ascribe sovereign efficacy. Why, I ask, did he discriminate and prescribe that variety of cowpox if cowpox per se was effective ? The question answers itself. I will not say the cowpoxers treat Jenner's evidence with disrespect; for such is their ignorance, that I question if they are aware of its existence; moreover, that which is undesirable to know, is instinctively avoided and kept out of sight. They recommend their "lymph" as wonderfully mild, being attended with no erysipelas, the pest of arm-to-arm vaccination — a description that tallies exactly with Jenner's of impotent cowpox. " The pustules," says Jenner, “are of a much milder nature" than those of horsegrease cowpox. "No erysipelas attends them, and "they are incapable of producing any specific effect on "the human constitution."

A COWPOX CHARLATAN.

Yet, incredible as it may appear, it is with the praise of this impotent cowpox, attended with no erysipelas, that the public have been deafened, and for which the most extravagant assertions are made. Dr Martin, one of the chief producers and vendors of the article, appeared at the British Medical Association in 1881, saying, " I am called upon at times, at the very shortest notice, to vaccinate whole cities; and when I left America, I had just completed the vaccination of the city of New Haven. The custom is to send for me, or my son, wherever smallpox breaks out, with order; to vaccinate at once the entire population of the city, town, or neighbourhood. It is done immediately, the result being that an epidemic is completely stopped in a week.”

Thus spoke the charlatan, with the acquiescence of the medical assembly. When churchmen deplore the scepticism of the age, and the decay of faith, it is to be observed that the habit of mind is limited to certain modes of opinion, and that in general we are as credulous as ever. Human nature in its structure is curiously immutable. Wherein is the advantage to disbelieve in witchcraft and to believe that epidemics of smallpox can be stopped with cowpox?

A DECOROUS UNANIMITY.

Such are the leading varieties of virus used for vaccination—starting with Jenner's horsegrease cowpox, then cowpox, then horsepox, then smallpox cowpox, and finishing with cowpox revived; each of them inscrutably modified in transit from child to child and from beast to beast. We are continually hearing of miracles wrought by vaccination in the past and present--especially the past, at home and abroad—especially abroad, the assumption being that vaccination is, and has been, everywhere the same. On the contrary, the condition precedent to serious consideration of any vaccine miracle is a definition of the variety of vaccination practiced. It is, we admit, convenient for the administrators of the rite that it should pass for uniform, however multiform ; for the practice has become a great and lucrative business—a world-wide poll-tax ; and whatever internal differences of the priesthood, it is their obvious interest to exhibit a decorous unanimity in presence of their customers. Hence the uneasiness recently excited by indiscreet advocates of "pure lymph from the calf" has been judiciously allayed, not by resistance, but by concession and damnation with faint praise; the commercial instinct dictating caution, for if the public did get behind the professional screen, and discovered the mysteries of pox, what might not befall the craft of vaccination!

JENNER'S SUCCESSIVE DISCLAIMERS.

The story of vaccination is a story of failures, and 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 perfectly secure from the infection of smallpox." Again he said, " 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."

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 in the cowpox salvation. Soon, however, cases of smallpox among the vaccinated began to be reported. At 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 properly 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 assailable 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 peoples 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, assailable 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 collected ; 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 vaccination!" 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 against the novel doctrine. Writing to the Medical and Physical Journal of August, 1814, he said, "No physiological 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 suppuration in the axilla, and, if exposed in the later stages 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. Sir 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."

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 number 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 made 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 cicatrices. 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 having 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 smallpox in a very mild form."

Reading a statement like this, we revert to the rationale of vaccination, and ask what can marks have to do with efficacy ? Remember, Marson offered no explanation of his statement. He was satisfied to say thus and thus have I observed, and you may take my word for it. But in science we take no man's word. We must see, or, like Trelawney's Cornishmen, we must know the reason why. Marson appeared before the House of Commons Vaccination Committee in 1871, and set forth his marks doctrine with all the qualifications and inconsistencies which characterise the victim of a fad in contact with which his fad fails to include or account for.

MR. WHEELER'S RESEARCHES.

Fatal cases of smallpox are confluent cases, and in confluent cases vaccination marks rarely show up so as to answer to Marson's description of marks distinct, foveated, dotted, or indented, with a well, or tolerably well-defined edge. And in this matter our acute and industrious friend, Mr. Alexander Wheeler, has explored the records of the the Smallpox Hospitals, and proved that vaccination marks many or vaccination marks few have no influence whatever on the character or issue of smallpox. As Mr. Wheeler shows, the classification of smallpox into discrete and confluent is the only clue to the right estimation of the fatality of the disease. Smallpox in the discrete form, that is, when the pustules are distinct and separate, is not dangerous when uncomplicated with other disease, the overwhelming majority of patients recovering, vaccinated or unvaccinated. The contest between life and death is waged among the confluent cases, where the pustules are so close that they run together; and it is on these confluent cases, and the conditions and antecedents of the sufferers, that attention should be concentrated. There is a third form of smallpox, the malignant, chiefly confined to persons of irregular life, which is almost invariably fatal, and, as vaccinators themselves allow, vaccination in malignant smallpox affords no odds to its victims.

MR. ROBINSON’S OPINION.

Nevertheless, as Mr. Enoch Robinson has pointed out, there is something to be said for what Marson called good vaccination marks. The bit of reality that constitutes the basis of the marks illusion is this, that a well-formed vaccine cicatrix represents a strong vitality with vigorous healing power; whilst an ill-formed cicatrix represents a contrary habit of body; and, pari passu, those who heal well under vaccination stand likely to make the best recoveries in the event of smallpox. Good marks are simply notes of good constitutions, and the rest follows. Aught beyond is mere medical rubbish, on a par with faith in omens and divination in tea-cups.

CRUELTY OF MARKING.

Vaccination, in whatever form, is bad, but this faith in marks aggravates its cruelty. Mr. Claremont, vaccinator for St. Pancras, operates on infants by the thousand, and inflicts on each four marks. At a recent inquest on an infant, the victim of his handiwork, I heard him say, " The mothers nearly always protest." Of course they do. What kind of mothers would they be if they did not protest! Apart from the venom, the shock to an infant's life from such wounds is very serious. Mr. Young was called the other day to see a dying infant vaccinated by this Claremont. Previous to vaccination it was perfectly healthy, but never afterwards. From the time of the operation it fell under a blight. " In its " coffin," said Mr. Young, "it lay like a child's doll—the poor babe had wasted away.''

I was glad to see in the Times about a year ago a letter from Dr. Allnatt of Cheltenham protesting against the cruelty of vaccination as practised upon the children of the poor. He recalled the days when he was a pupil of Dr. Walker, in 1825-26, and his instructions were to dip the point of the lancet into the fresh lymph, and insert it tenderly without drawing blood, under the cutis of the forearm, and protect the wound with a slight compress.

“But the case is altered now," he says. " Some of the vaccinators use real instruments of torture. Ivory points are driven into the flesh, and wounds ensue which become erysipelatous, and in the delicate constitutions of weakly children fatal."

The case is altered now, says Dr. Allnatt; but why is the case altered now? Why, because, under the old terms vaccination was more and more seen to be no defence against smallpox; and to preserve the rite, and the gains from the rite, the marks doctrine was invented, or, father, revived, and hailed as a sort of revelation from heaven.

REVACCINATION INTRODUCED.

When vaccination was seen to be no preventive of smallpox, it was conjectured that it might require renewal, a suggestion which distressed Jenner exceedingly. It was calculated, he said, " to do unspeakable mischief," depriving his discovery " of more than half its virtues." But as experience continued to belie the claim made for vaccination as a permanent defence, it was natural that those interested in its performance should endeavour to retrieve its waning credit. Thus revaccination began to be practised. Between 1830 and 1835 there were 13,861 revaccinations effected in the army of Wurtemburg. Dr. Holland (subsequently Sir Henry) after recording the accumulating proofs of the futility of vaccination in 1839, recommended revaccination as a probable resource, and the recommendation gradually acquired authority. The London Medical Gazette in 1844 boldly proclaimed, " Revaccinate, revaccinate!" But so late as 1851 the National Vaccine Establishment protested against the innovation, saying, " The restriction of the protective power of vaccination to any age, or to any term of years, is an hypothesis contradicted by experience and wholly unsupported by analogy." Whatever the experience, however, and whatever the analogy, there was the indisputable fact, that vaccination in most unimpeachable form did not avert smallpox, and that if the public faith and the public money were to be retained soc fresh artifice was essential. It was hard to surrender the original claim of the equivalence of vaccination to small pox; but it needs must when the devil drives; and so it has come to be admitted that Jenner was mistaken, and the vaccine rite to be effectual must be renewed.

VACCINISATION

Dr. Colin expresses what is now the common medical opinion in saying, "We must not stop at a single vaccination. We must establish the firm conviction in the public mind, that vaccine prophylaxy is only real and complete when periodically renewed;" and Dr. Warlomont, chief of Belgian vaccinators, goes yet further in advising and practising what he calls Vaccinisation; which is, that every subject of the rite be vaccinated again and again until vesicles cease to respond to the insertion of virus. Then, and then only, can the victim be guaranteed from smallpox! Such are the shifts to which vaccinators have been reduced. If their insurance were valid, the premium would exceed the principal, whilst there is no reason to believe the new security is a whit better than the old. In these frantic prescriptions we see the quackery in its death-throes.

ABSURDITY OF REVACCINATION

As for revaccination keeping off smallpox, it is absurd, and ought to be known for absurd. The chief incidence of smallpox is among the young, in whom it cannot be pretended that the influence of primary vaccination is exhausted. The subjects of revaccination are passing, or have passed out of the smallpox age; and as the statistics of the army and navy prove, our soldiers and sailors are no more exempt from smallpox than the unrevaccinated civil population of corresponding years. In this matter, the old words stand true, Populus vult decipi; decipiatur.

THE REDUCTION OF SMALLPOX.

From whatever side regarded, the original and successive claims made for vaccination are seen to have broken down ; but a practice endowed and enforced as a poll-tax for the benefit of the medical profession is not lightly surrendered. Instead a variety of defences, more or less ingenious, are thrown out.

1. One of these is the reduction of smallpox. It is said “Smallpox was once a common disease, and is now comparatively rare one—How are we to account for this improvement otherwise than by the introduction of vaccination ?"

The answer is, that smallpox was declining before vaccination was introduced, and that, too, in spite of the extensive culture of the disease by variolation; and the decline continued during the first part of the present century whilst as yet nine-tenths of the people were unvaccinated. Several diseases once common have abated or disappeared; and why should we attribute to an incommensurate cause a similar abatement in smallpox? Leprosy, once extensively prevalent in England, has disappeared. Why? It died out gradually; but suppose some rite, analogous to vaccination, had been brought into vogue contemporaneously with its decline, would not the rite have had the credit, and would not its practitioners have called the world to witness the success of their prescription ?

HAS VACCINATION SAVED LIFE?

2.—In the same line of defence, we have the claim made for an extraordinary salvation of human life. Thus Sir Spencer Wells in a recent speech observed, “Jenner is immortal as a benefactor of mankind. It may not be generally known, but it is true, that Jenner has saved, is now saving, and will continue to save in all coming ages, more lives in one generation than were destroyed in all the wars of Napoleon."

The answer to such a statement is to call for proof of the lives saved. There is no proof. At the close of last century, 20 per cent, of the mortality of Glasgow was due to smallpox. Smallpox abated, but did mortality abate? Not in the least. Dr. Kobert Watt in 1813 recorded the fact with amazement over it. And what was true of Glasgow was true of other cities and other populations. There may be a cessation of smallpox, but (unless the result of sanitary improvement) the work of death is merely transferred to cognate agencies. There is no saving of life. What was a mystery to Watt is less of a mystery since the development of sanitary science. Zymotic disease in its various forms is a definite evolution from definite insanitary conditions. It is not affected by medical repression, nor by the spontaneous substitution of one variety of fever for another. In the words of Dr. Farr, " To save people from smallpox is not enough whilst exposed to other forms of disease. Thus in a garden where the flowers are neglected, to keep off thistle-down merely leaves the ground open to the world of surrounding weeds." To lower the zymotic death-rate it is necessary to reduce the conditions in which zymotic disease is generated. Citing Dr. Farr once more, "To operate on mortality, protection against every one of the fatal zymotic diseases is required; otherwise the suppression of one disease-element opens " the way for others." Dr. Watt and Dr. Farr alike believed that vaccination stopped smallpox, and alike realised that the disappearance of smallpox was accompanied with no saving of life. Sir Spencer Wells is of a contrary opinion, which he shares with a number of people who prefer the free play of the prejudiced imagination to the sobriety of exact information.

WHO ARE THE UNVACCINATED ?

3.—Then we are asked to believe that though vaccination may not keep off smallpox, it makes it milder, and in proof we are entertained with low rates of mortality among the vaccinated and high rates among the un vaccinated.

We reply, to make a fair comparison between the vaccinated and the unvaccinated, it would be necessary to compare class with class, physique with physique, age with age. In other words, the subjects of smallpox should be constitutionally equal, their difference being limited to vaccination present or vaccination absent. So much is obvious.

But when or where has such comparison been even been attempted? Nor would it be easily practicable : for the vaccinated comprise the best portion of the community, physically; but who are the unvaccinated ? They are waifs and strays of civilisation, the offspring of the miserable and the vagrant, who, without fixed domicile, escape the attention of the vaccination officer. These, whatever their ailment, whether measles, pneumonia, diarrhoea, would exhibit a higher rate of mortality than vaccinated; but would it therefore be safe to argue that vaccination was not only good against smallpox, but against measles, pneumonia, and diarrhoea ? Yet it in, the lowest physically and most neglected of the population, who drift into smallpox hospitals, who are exhibited as fearful examples of the neglect of vaccination. It might be added, they are unbaptised as well as unvaccinated, and probably the one defect may be as prejudicial as the other.

UNVACCINATED DEATH-RATES.

Our contention does not end here. Such is the prejudice in favour of vaccination that a bad case of smallpox is assumed to be an unvaccinated case. Over and over again has it been proved that vaccinated patients dead of smallpox have been registered as unvaccinated, their death being taken as evidence of the absence of the saving rite. Again in severe smallpox, when vaccination marks are invisible, the sufferer is frequently set down as unvaccinated. Dr. Russell, of the Glasgow hospital, relates that patients entered as unvaccinated, showed excellent marks when detained for convalescence. Had they died, they would have gone to swell the ranks of fearful examples.

It is thus that the high death-rates of the unvaccinated are accounted for, the framers of hospital reports appearing to vie with each other in extravagance. We are continually adjured in the newspapers to confess our folly and repent, because 40 or 60 or 80 per cent, of the unvaccinated have perished in this or that hospital because unvaccinated. To us such statistics have fraud written on their face, and the more they are sworn to, the more unscrupulous do their vendors reveal themselves. When all were unvaccinated last century, the hospital death-rate of smallpox ranged about 18 per cent. Now we are asked to believe that death-rate has doubled, trebled, quadrupled, and for no other reason apparently than to make for the glory of vaccination.

NURSES EXEMPT FROM SMALLPOX.

4.—It is further said that nurses in smallpox hospitals never contract smallpox because they are revaccinated.

To establish this assertion, it would be necessary to prove that prior to the introduction of vaccination, or rather of revaccination, it was common for nurses to fall victims to the disease. The attempt is not made, and wisely, for failure would be conspicuous. Jenner never recommended vaccination as a protective for nurses. Their general immunity, along with that of physicians, is noted throughout our older medical literature ; nor is the reason far to seek. Smallpox is predominantly an affection of the young, and it is no more surprising that a nurse should be proof against it than that she should be proof against measles, whooping cough, or scarlet fever. Nurses occasionally incur these maladies, and they occasionally incur smallpox.

If revaccination preserves nurses from smallpox, to which they are exposed in the intensest form, it should much more preserve soldiers, sailors, policemen and postmen, whose exposure is incomparably less intense; yet these servants of the state (as already observed) are as liable to smallpox as their unrevaccinated fellow citizens of correspondent ages.

To speak plainly, the selection of a vocation so arduous and repulsive, marks off a smallpox nurse as unimpressionable, and little apt to catch anything. Smallpox too, is like tobacco : custom fortifies the constitution against its immediate effects. If the atmosphere of a small hospital is endured for a fortnight, it is likely to continue endurable. On the other hand, if a volunteer sickens on probation, she is not reckoned among nurses. Lastly, many nurses have entered hospitals as patients, have accepted service in default of other occupation. On these grounds, the nurse argument breaks down irretrievably. At first sight, it seems something, but on scrutiny it proves nothing.

POCK-MARKED FACES.

5.—Another favourite argument for vaccination is the disappearance of pock-marked faces. People say when they were young such faces were common, whilst now they are rare ; and demand, What can have wrought the change if not vaccination?

A medical man at a public meeting tried to dispose of some statistics adverse to vaccination by saying that statistics could be made to prove anything; and presently went on to relate that when his mother was a girl every third person she met was pock-marked. She had told him so repeatedly, and there was no doubt about her accuracy. Thus statistics in general were untrustworthy, but his mother's statistic was unquestionable.

We need not hesitate to allow that when smallpox was common and cultivated pock-marked faces were more numerous : but we must not forget that whether a patient is marked or not marked is very much a matter of treatment. Many at this day pass through smallpox, and severe smallpox, and escape unmarked, simply because those who have care of them observe certain precautions. It was different in former times. The treatment of smallpox was atrocious. The sick-room was made pestiferous by the exclusion of air and the maintenance of high temperature. The patient sweltered under bed-clothes. He was neither allowed to wash nor change his linen. He was drenched with physic and stimulants. In hospitals, patients were stuck two or three in a bed, and stewed together. If, under such circumstances, the sick were restored to life pock-marked, what wonder! Patients who were fortunate enough to be sufficiently let alone, stood the best chance of recovery.

Besides smallpox was not equally diffused. In some places it was endemic ; in others it appeared at intervals; and in others it was hardly known. The smallpox death-rate of Glasgow was double that of London; and we may therefore infer that pock-marked faces were twice as numerous in Glasgow as in London. Hence when recollections are, appealed to, they should be localised. What might be true of one population might be grossly untrue of another.

It has been observed that smallpox was falling off toward the close of last century, and the decline accelerated in the present century, irrespective of vaccination. An excellent illustration of this reduction of smallpox is furnished by the reports of the National Vaccine Establishment for 1822, 1825, and 1837, where the disappearance of pock-marked faces from London is triumphantly recorded and claimed as a result of vaccination. In 1831 Dr. Epps, director of the Royal Jennerian Society, made the like observation and the like claim, saying, " Seldom are persons now seen blind from smallpox. Seldom is the pitted and disfigured face now beheld” ; adding, " but seldom do mankind inquire for the cause. It is vaccination. It is vaccination which preserves the soft and rounded cheek of innocence, and the still more captivating form of female loveliness." Inasmuch as not ten per cent. of the population were vaccinated in 1831, the claim made for vaccination was absurd, whilst the disappearance of pock-marked faces was sufficiently explicable by the reduced prevalence of smallpox.

Where then is the argument for vaccination from the disappearance of pock-marked faces ? When anyone under seventy proceeds to recite the legend, " There is no use in arguing against vaccination, for when I was young every third or fourth person was pock-marked," etc., etc., the effect is droll. It shows how prone we are to fancy we have seen what we think we ought to have noon. Droller still it is when striplings of five-and-twenty and thirty profess the same experience—" When " I was a lad," and so forth and so forth. There is matter for reflection as well as for laughter in the hallucination.

Nevertheless, if pock-marked faces are not so common as they must have been a century ago, they are by no means rare; and if the argument for vaccination were valid, the pock-marked would be unvaccinated. But are they ? Those who will take pains to inquire will find that almost invariably they have been vaccinated, and some of them repeatedly, the vaccination having as it were induced the smallpox.

VACCINIA A REAL DISEASE.

Thus far we have chiefly dealt with vaccination as if its fault were limited to failure to prevent smallpox; but vaccination is more than an ineffective incantation. It is the induction of an acute specific disease. The prime note of vaccination is erysipelas. " The cowpox inflammation," said Jenner, " is always of the erysipelatous " kind." He held that cowpox unattended with erysipelas was " incapable of producing any specific effect on the human constitution." If it is supposed that Jenner is antiquated, we may refer to a distinguished contemporary. Mr. John Simon replying to the question, Whether properly performed vaccination is an absolutely inoffensive proceeding?" answers decisively, "Not at all; nor does it pretend to be so." The rationale of vaccination is that it communicates a mild variety of smallpox, and that with a little of the devil we buy off the entire devil. Dr. Ballard, Medical Officer to the Local Government Board, in his treatise, Vaccination : its Value and Alleged Dangers, says, " Vaccination is not a thing to be trifled with, or to be made light of; it is not to be undertaken thoughtlessly, or without due consideration of the patient, his mode of life, and the circumstances of season and of place. Surgeon and patient should both carry in their minds the regulating, thought, that the one is engaged in communicating, the other in receiving into his system, a real disease—as truly a disease as smallpox or measles; a disease which, mild and gentle as its progress may usually be, yet, nevertheless, now and then, like every other exanthematous malady, asserts its character by an unusual exhibition of virulence."

VACCINAL FATALITIES.

Here we have Vaccinia defined as disease with precautions for its safe reception; yet withal it is allowed it may assert itself with virulence. But where do we find any precautions exercised in the vaccination of the, poor ? —that is to say, of the vast majority. Precautions are not only disregarded, they are unknown, they are impracticable. Infants of all sorts and conditions are operated on as recklessly as sheep are marked. Whether they live or die is matter of official indifference, whilst each is warrant for an official fee. Sir Joseph Pease, speaking in the House of Commons, said, " The President of the Local Government Board cannot deny that children die under the operation of the Vaccination Acts in a wholesale way." Vaccination conveys an acute specific disease (having a definite course to run like smallpox or other fever) which, whether by careless treatment, or superinduced, or latent disease, is frequently attended with serious and fatal issues. Hence it is that vaccination is dreaded and detested by the poor on whom it is inflicted without parley or mitigation; in itself a bearer of illness, it is likewise a cruel aggravation of weakness and illness. When the poor complain that their children are injured or slain by vaccination, they are officially informed they are mistaken. Dr. Stevens, a well-known familiar of the vaccination office, says he has seen more vaccination than any man, and has yet to witness the least injury from the practice. Variolators used to say the same of their practice until vaccinators arose and convicted them of lying. Coroner Lankester held that vaccination was not a cause of death " recognised by law," and was therefore an impossible cause. Such prevarication is mockery. True it is that, if a child dies of vaccination, it dies of erysipelas, or pyoemia, or diarrhoea, and it is easy enough to ignore the primary cause and assert the secondary; but I would ask, How else can death ensue from vaccination than by erysipelas, pyoemia, diarrhoea, or similar sequelae ? If vaccination kills a child, how otherwise could it kill? Even should death occur directly from surgical shock, it would be said, the child did not die of vaccination, but from lack of vigour to sustain a trivial operation. The Sangrado of the Stevens pattern is never without a shuffle.

VACCINIA MODIFIED IN ITS RECIPIENTS.

It is usual at coroners' inquests on vaccination fatalities to produce children vaccinated at the same time from the same vaccinifer, and to assert that inasmuch as they have made good recoveries, it is impossible that the virus was at fault, and that something else than vaccination must have been the cause of death. The argument often impresses a jury, but it is grossly fallacious. Suppose a mad dog bit six men, and that five escaped injury beyond their wounds and fright, and that one died of rabies, would the escape of the five prove that the death of the sixth was unconnected with the dog ? Or suppose an equal potion of gin were administered to six infants, one of whom died and five recovered, would the recovery of the five prove that gin did not kill the sixth? Mr. Stoker writes to the newspapers that he vaccinated twelve other persons with the virus he used for Miss Ellen Terry, and that as no untoward symptoms appeared in the twelve, therefore Miss Terry's whitlow had no connection with her vaccination—and this in spite of the untoward symptoms falling due at the very time that vaccination accounted for them ! Any reasons are good for those disposed to be convinced, and who have settled it in their minds that vaccination is invariably harmless.

No doubt there is virus used for vaccination that is virulent beyond other virus, as there is virus that is comparatively innocuous; but, as Dr. Mead observed more than a century ago, " It is more material into what kind of body smallpox is infused than out of what it is taken." The same virus that one constitution may throw off with little effort, may induce disease and death in another. Dr. Joseph Jones, president of the Louisiana Board of Health, relates that " In many cases occurring in the Confederate Army, the deleterious effects of vaccination were clearly referable to the condition of the forces, and the constitution of the blood of the patients; for it was observed in a number of instances that the same lymph from a healthy infant inoculated upon different individuals produced different results corresponding to the state of the system ; in those who were well fed and robust, producing no ill-effects, whilst ; in the soldiers who had been subjected to incessant fatigue, exposure, and poor diet, the gravest results followed."

Some constitutions are peculiarly liable to injury from vaccine virus, just as some constitutions cannot endure drugs that others receive without inconvenience. Thus it is that fatalities from vaccination are frequent in certain families. Of these, neither the law nor medical men condescend to take account. Parents often plead in vain for exemption from the rite on the ground that they have already had children injured or slain by its performance; the brutal and unscientific argument running, "How can vaccination hurt your children when it does not hurt other people's children ?"

VACCINIA PLUS OTHER DISEASE.

Nor is the case against vaccination yet complete. The virus used is not only Vaccinia, but more than Vaccinia; for it is impossible to propagate virus from child to child without taking up other qualities. This was clearly foreseen by the variolators when vaccination was introduced—they making it a point to take smallpox for inoculation from known and sound subjects. They maintained that cowpox transferred indiscriminately from arm to arm must acquire and convey constitutional taints; and their prognostication was speedily and grievously fulfilled in the item of syphilis. Notwithstanding, the fact was furiously contested. It was said that parents used vaccination as a screen for their own wickedness ; and assertion alternated with denial even to our own day. At last the conflict is at an end. The evidence has grown too multitudinous and deadly for evasion. The invaccination of syphilis is admitted, and any question is reserved for the degree of frequency. Some are pleased to describe the risk as infinitesimal, but their pleasure stands for nothing but itself. Deeds are expressive beyond words. The wide resort to animal vaccination on the Continent and in the United States has but one interpretation. Doctors and patients do not abandon what is easy for what is troublesome, nor incur the risk of the communication of bovine disorders unless under the influence of over-mastering terror.

STATISTICAL EVIDENCE OF EXTRA DISEASE.

Relations of individual experience may be disregarded as untrustworthy, but the broad evidence of national statistics conveys authoritative lessons. Vaccination in England was made compulsory in 1853, stringently so in 1867, and systematically extended to the entire population. If therefore it were true that vaccination often communicates more than Vaccinia, and that it aggravates existent and excites latent disease, the proof must be manifest in the statistics of the Registrar-General. Thus argued Mr. C. H. Hopwood, and accordingly he moved in the Souse of Commons successively for three Returns, published as follows—VACCINATION, MORTALITY, No. 433,1877; MORTALITY (GENERAL AND INFANT), No. 76, 1880; and DEATHS (ENGLAND AND WALES), No. 392, 1880.

These Returns, charged with curious and authentic information, are little known, and have been treated with significant silence by the press. Obscurantism is not confined to ecclesiastics. Our valiant journalists who mock at the Index Expurgatorius, and abhor the Russian censorship, are in their little way as ready to act the same part in favour of established prejudice. If facts adverse to the public confidence in vaccination are revealed, it is considered no more than decent to keep them out of sight.

What then is the evidence of Mr. Hopwood's Returns ? Briefly this : they clearly illustrate that vaccination does produce, intensify, excite and inoculate disease whose issue is death. The record of infant mortality from fifteen specified diseases related to vaccination stands thus—

Thus, while the population of England and Wales had increased from 18 to 23 millions, the deaths of infants from fifteen diseases had risen from 63,000 to 106,000. Had the mortality kept pace with the population, the deaths in 1875 would only have been 80,000; that is to say, in 1875 there perished in England 26,000 infants who would have lived had vaccination remained as little in vogue as in 1847! The result though startling in the gross is precisely what might have been predicted. The infancy of a country cannot be systematically diseased, that is vaccinated, without exciting and aggravating other maladies, and thereby enlarging the harvest of death.

VACCINIA AGGRAVATES DISEASE.

The asserted connection of vaccination with other ailments, such as bronchitis, sometimes gives occasion to ignorant ridicule. "Bronchitis," says Sir Lyon Playfair, " has about the same relation to vaccination as “the Goodwin Sands have to Tenterden Steeple." The answer is that the debility produced by vaccination pre-disposes to affections of the respiratory organs. The human body does not consist of isolated compartments, but is an organised whole, sympathetic in all its parts and functions. Erysipelas, as we have seen, is the primary symptom of inoculated Vaccinia, and diarrhoea is its commonest sequence ; and given erysipelas and diarrhoea, what vigour may remain to assist and throw off other ailments? It is not said that certain maladies are communicated by vaccination, but that vaccination contributes to their fatality. An infant that would have survived bronchitis dies of bronchitis and vaccination; dies of teething and vaccination; dies of convulsions and vaccination; dies of whooping-cough and vaccination ; and so on. Again disease kindles disease, and many a child might outgrow congenital scrofula or phthisis if the latent disorder were not roused by vaccination. For these reasons no doubt need be entertained that were vaccination abolished, the event would be immediately signalised by an extraordinary fall in infant mortality.

ORIGIN OF COMPULSORY VACCINATION.

If vaccination were a voluntary superstition, its prevalence would be sufficiently deplorable; but when we think of it as inflicted on the nation, and pressed on those who know it for an injurious imposture, language is apt to arise which it is expedient to repress. It may be asked how it came to pass that legislation was ever compromised with a medical prescription, and the answer is not a reassuring one. The initial error was the endowment in 1808 of the National Vaccine Establishment, and the provision of vaccination fees in 1840 out of the poor rate. For the enforcement of vaccination, there never was any popular demand—never the slightest. The public had, however, learnt from sanitarians that a large part of the sickness from which they suffered did not come of fate, but was preventable; and under this novel persuasion the vast expenditure on sanitary works during the past fifty years has been cheerfully incurred. Availing themselves of this favourable disposition in the public mind toward projects in the name of health, certain medical place-hunters operating as the Epidemiological Society contrived to gain the ear of Government and to pass a compulsory Vaccination Act in 1853. The politicians who lent themselves to this transaction disowned any knowledge of vaccination. They acted, they said, under medical advice, and ran the bill through Parliament with little resistance. The Act did not personally concern M.P.'s. If they happened to believe in vaccination, their children received the rite with all recognised precautions. Its enforced application by contract at 1s. or 1s. 6d. per head was reserved for the unenfranchised and unconsulted multitude; whilst the administration of the Act provided place and pay for its ingenious promoters.

RESISTANCE, INFLEXIBLE RESISTANCE.

When an oppressive law is enacted, by whatever strategy or however corruptly, its repeal is no easy matter. The oppressors have won the nine points of possession. The antagonists of the Vaccination Acts nevertheless possess a certain advantage. Some bad laws can only be denounced as it were from a distance; but vaccination touches every household, and can be fought wherever a child is claimed as a victim for the rite.

We abhor the rite. We detest it as an imposture. We dread it as a danger. We refuse it on any terms. We encourage, we justify, we insist on the duty of rejection. Our contention extends and prospers. In various parts of the country resistance has been rewarded with success. The evil law has been broken down. Freedom has been recovered and freedom is enjoyed. In other parts the struggle for liberty proceeds, and as it proceeds, light is diffused and courage evoked for enlarged resistance. Elsewhere there are vindictive and cruel prosecutions, chiefly of humble folk. "Respected ratepayers," to whom the law is objectionable and its penalties trivial annoyances, are discreetly passed over. Hard, however, is the lot of poor men, who for love of their children affront the dull animosity and ignorance of English Philistines whether as guardians or as magistrates on the bench of Injustice. Shortly co-operation for defence and insurance against fines will enable the feeblest and most fearful to maintain his integrity and encounter his pursuers with undaunted front. Parliament, as our statesmen allow, is deaf to the aggrieved until they make themselves intolerable, and to raise ourselves to that pitch must be our end and aim.

COMPULSORY EDUCATION AND VACCINATION.

Many good people are distressed over the operation of this extraordinary law, and sometimes in their perplexity adventure for excuse, " Surely since we compel parents to educate their children, it cannot be wrong to compel them to have their children vaccinated."

We answer, education is compulsory so far as it is outside conscience. Compulsion is designed to overcome parental indifference and selfishness : where it confronts serious convictions it is arrested. By general consent the most important part of education is religion; and religion is precisely that part of education which is exempted from compulsion. The law does not even enforce some form of religion, so that parents who regard religion as superfluous may not be aggrieved. What therefore the opponents of vaccination demand is, that the respect thus accorded to the religious conscience be extended to the scientific conscience—to those who are convinced that vaccination does not prevent smallpox or is an injurious practice. Even allowing it to be a harmless ceremony, resistance would be justifiable. It would be in vain to console a Baptist, forced to convey his child to the parish font, with the assurance that a few drops of water could do no harm. It is not in human nature to submit to the indignity of imposture; and to thousands of Englishmen vaccination is a cruel and degrading imposture, and to punish them for their loyalty to what they think right is every whit as tyrannical as it was for Catholics to persecute Protestants, and Protestants Catholics, and Catholics and Protestants Jews. There is no difference in the terms of intolerance; and there is no difference in the spirit with which this latter-day tyranny is confronted, and that spirit with which religious liberty was vindicated and won.

CONDITIONS OF THE CONFLICT.

To some eyes the conflict is not only arduous; it is hopeless; but we are of a different mind. The conflict may prove even less arduous than it appears; and for these reasons. The law as it stands is perfunctorily defended. No politician answers for it without reluctance. Many allow that a serious mistake was made when legislation was enacted for medical advantage at medical dictation. The Gladstone government proposed to abolish repeated penalties. The central authorities at the Local Government Board make no secret of the insuperable difficulties which attend the administration of the law. They advise concession to its resolute adversaries. They do not reinstate the law where it has broken down. Legislation thus discredited is sure to collapse under broader pressure. The medical support is still weaker; and is chiefly confined to those who represent the trade element of the profession—men who would defend any abuse however flagrant if established and lucrative. It is the custom to laud the immortal Jenner and the salvation he wrought, but these are words of an old song. Those who have penetrated to the in-inception of the Jennerian rite; who know the absolute promise by which it prevailed and its absolute failure; who have followed its successive transformations and varieties with their respective injuries and fatalities who are aware of the Babel of confusion and contradiction in which its venal practitioners are involved—these we say recognise how impossible it is for vaccination to be brought under discussion and survive. It is this consciousness which accounts for the reserve of the more prudent order of medical men. They excuse their acquiescence in the delusion (after the manner of ecclesiastics) by the exigencies of professional loyalty; and by the supposition that the harm of the practice is exaggerated, whilst it serves for the consolation of the vulgar. It is for such reasons that we consider the conflict less arduous than it appears. The fortifications are undermined; the bulwarks are rotten through and through. Over all, we place our confidence in the omnipotent favour of the truth. Goliath, mighty and vaunting, is evermore laid low by a smooth stone shapen in the waters of verity.

A WORD FOR THE AUTHOR.

The Story of this Great Delusion, I have tried to tell concisely, keeping close to matter-of-fact, and with some exceptions adhering to English experience. When we venture abroad, we are apt to fall into inaccuracies and draw unwarrantable conclusions. I am told my animus is too pronounced, and that I should have done better had I adopted a more judicial tone. Ah well! we should always have done differently had we done differently. It seems to me a man does best when he is most truly himself; and I question whether I should have improved my case had I tried to conceal my real mind in order to make a more startling show of it at the close.

L’ENVOI.

Lastly, a word to those who are accustomed to dismiss opponents of vaccination as fools and fanatics. It is related of Sydney Smith that calling on Lord Melbourne one morning, he found his lordship in an evil temper and cursing at large. Smith, urgent about his own affairs, at last observed that they should take everything for damned and proceed to business. For like reason I would suggest that the familiar tirade of fool and fanatic be taken as spoken, and that we proceed to discuss vaccination and compulsory vaccination on their merits.

Q, When other diseases in the course of time have become mild or died out, what is that due to ?

SANCHO PANZA.—I beg of your Worship that you would let your wound be dressed, for a great deal of blood comes from that ear: and I have some lint, and a little white ointment, here in my wallet.

DON QUIXOTE.—All this would have been needless had I recollected to make a vial of the balsam of Fierebras; for with one single drop of that, we might have saved both time and medicine.

DON QUIXOTE.—It is a balsam, the receipt of which I hold in memory ; and having it, there is no fear of death, nor that any wound will be fatal: therefore, when I shall have made it, and given it to thee, all thou wilt have to do, when thou seest me in some battle cleft asunder (as it frequently happens) is, to take up fair and softly that part of my body

which shall fall to the ground, and with the greatest nicety, before the blood is congealed, place it upon the other half that shall remain in the

saddle, taking especial care to make them tally exactly and justly. Then shalt thou give me two draughts only of the balsam aforesaid, and instantly wilt thou see me become sounder than an apple.

SANCHO PANZA.—If this be so, I renounce from henceforward the government of the promised island ; and only desire, in payment of my many and good services, that your Worship will give me the receipt of this extraordinary liquor; for I daresay it will anywhere fetch more than two reals an ounce; and I want no more to pass this life with credit and comfort. But first, I should be glad to know whether the making of it will cost much?

SANCHO PANZA,—Sinner that I am ! Why does your Worship delay making and showing it to me ?

DON QUIXOTE.—Peace, friend, for I intend to teach thee greater secrets, and to do thee greater kindnesses: but at present, let us set about the cure ; for my ear pains me more than I could wish.

PART 1.---VARIOLOUS INOCULATION.

CHAPTER I.

COTTON MATHER AND ZABDIEL BOYLSTON.

To the Turks we owe little, and in the little is included the practice of inducing smallpox artificially. The practice was first brought under English attention by Emanuel Timoni in a letter, dated Constantinople, December, 1713, communicated to the Royal Society by Dr. Woodward,

and published in the Society's Transactions for 1714.¹ About the same time, Pylarini, Venetian consul at Smyrna, described the practice in a Latin pamphlet printed at Venice, 1715,² and reproduced in the Philosophical Transactions for 1716. Mr. Kennedy, an English surgeon, who had visited Turkey, also reported the practice under the designation of "Engrafting the Smallpox."³

Timoni was a Greek physician, who had studied at Oxford and Padua, and then established himself in Constantinople. He described "smallpox by incision" as having been practised in Constantinople for forty years, and that it had been found uniformly successful in warding off smallpox as naturally developed. The variolous matter was usually taken from healthy boys suffering from the spontaneous disease, and was applied to persons of all ages and temperaments, causing them no more than temporary and trifling inconvenience. The only preparation requisite for incision was abstinence from flesh and broth for twenty or twenty-five days.

1. Philosophical Transactions, No. 338, 1714.

2. Nova et Tata Variolas Excitandi per Transplantationem Methodus. Jacob Pylarinum. Venet. 1715. Reprinted in Philosophical Transactions, No. 347, 1716.

3. An Essay on External Remedies. By P. Kennedy. London, 1715.

It so happened that when Woodward read Timoni's letter to the Royal Society, he at the same time produced a selection from the correspondence of Cotton Mather of Boston, Massachusetts—a curious jumble of facts and fancies. Mather had been elected a Fellow of the Society, and the selections from his correspondence, and Timoni's letter appeared in the same number of the Transactions, No. 338, 1714.

Cotton Mather is one of the marvels of biography—a choice specimen of Puritanism developed without check. He was a man of boundless energy and incessant industry, of intense piety and unlimited self-confidence; and thus, without hesitation, he set himself to extirpate witchcraft, shrinking from no atrocity, until the frightful Salem tragedy of 1692 shocked the colony into mercy and common-sense.

Mather was just the sort of character to be impressed with Timoni's description of the short and easy way with smallpox; and he who had hanged warlocks and witches with sublime assurance, was not likely to have scruples about inoculating the community when inwardly satisfied it was for the public good. The audacity and tyranny of conscientious conceit are proverbial. He had, however, to exercise patience in awaiting an opportunity to test the Turkish remedy, for there had been no smallpox in Boston for nineteen years—a fact worth noting by those who imagine smallpox was an omnipresent ailment -until the advent of Edward Jenner. In 1721 a serious outbreak occurred, the deaths rising in October to 100 a week in a population of 15,000. Mather convoked a meeting of physicians, and laid before them the new prescription, but they would not listen to it. Dr. Boylston, however, was persuaded, and inoculated two of his slaves, and then his sons, aged five and six; whereon he was summoned before the justices and severely reprimanded. Undeterred by the State, and supported by the Church, he persevered, and by the end of September had inoculated 80, and by the middle of December, 250.

His custom was to make a couple of incisions in the arms, into which bits of lint dipped in pox-matter were inserted. At the end of twenty-four hours the lint was withdrawn, and the wounds dressed with warm cabbage leaves. On the seventh day the patient sickened and pustules appeared, sometimes few, sometimes hundreds. Mather and Boylston maintained it was a most whole-some operation, for after it "feeble, crazy, consumptive people, grew hearty, and got rid of their former maladies." ¹

To be poxed was to be rejuvenated.

1. Philosophical Transactions, Vol. xxxii. p. 35.

Cotton Mather's own account of the Boston experience is worth reading. He wrote—

March 10th, 172½ .

The distemper hath lately visited and ransacked the City of Boston; and in little more than half a year, of more than 5000 persons that have undergone it, near 900 have died. But how many lives might have been saved if our unhappy physicians had not poisoned and bewitched our people with a blind rage that it has appeared very like a Satanick Possession against the method of relief and safety in the way of the smallpox inoculated !

I have prevailed with one physician (and for it I have had bloody attempts made upon my life by some of our Energumens) to introduce the practice ; and the experiment has been made upon almost 300 Objects in our neighbourhood, young and old (from one year seventy), weak and strong, male and female, white and black, in midsummer, autumn, and winter, and it succeeds to admiration !

I cannot learn that one has died of it; though the experiment has been made under various and marvellous disadvantages. Five or six have died upon it, or after it, but from other diseases or accidents ; chiefly from having taken infection in the common way by inspiration before it could be given in this way by transplantation.

Dr. Leigh, in his Natural History of Lancashire, counts it an occurrence worth relating, that there were some catts known to catch the smallpox, and pass regularly through the state of it, and then to die. We have had among us the very same occurrence.

It was generally observed and complained that the pigeon-houses of the City continued unfruitful, and the pigeons did not hatch or lay as they used to do all the while that the smallpox was in its epidemical progress: and it is very strongly affirmed that our dunghill fowl felt much of the like effect upon them.

We have many among us who have been visited with the Plague in other countries many years ago, who have never been arrested with smallpox after it, though they have been exposed as much as any other people to it; whence the belief now begins to prevail among us, that they who have had the Plague will never have the smallpox after it.

Considering the developed evidence that awaits us as to the character and results of inoculation, it would be superfluous to discuss this singular report, but we may remark the consummate audacity with which Mather assumes and maintains his position. What a masterly touch of the quack have we in these words—

I cannot learn that one has died of it. Five or six have died upon it, or after it, but from other diseases or accidents; chiefly from having taken infection in the common way by inspiration before it could be given in the way of transplantation.

We can readily understand how the hand that could give so adroit a turn to awkward disasters could in other days frame irresistible indictments for witchcraft.

The precise truth as to the extent of the Boston epidemic is far from easy to ascertain : it was the temptation of the inoculators to magnify the numbers of the afflicted and of their antagonists to minimise. Thus we read—

At a meeting by public authority in the Town House of Boston, before His Majesty's Justices of the Peace and the Select Men; the practitioners of physic and surgery being called before them, concerning Inoculation, agreed to the following conclusion:—

A Resolve upon a debate held by the physicians of Boston concerning inoculating the Smallpox on the 21st day of July, 1721.

It appears by numerous instances, that it has proved the death of many persons soon after the operation, and brought distempers upon many others which have in the end proved deadly to 'em.

That the natural tendency of infusing such malignant filth in the mass of blood is to corrupt and putrefy it, and if there be not a sufficient discharge of that malignity by the place of incision, or elsewhere, it lays a foundation for many dangerous diseases.

That the operation tends to spread and continue the infection in a place longer than it might otherwise be.

That the continuing the operation among us is likely to prove of most dangerous consequence.

The number of persons, men, women, and children, that have died of smallpox at Boston from the middle of April last (being brought here then by the Saltertuda's Fleet) to the 23rd of this instant July (being the hottest and worst season of the year to have any distemper in) are, viz.—2 men, strangers, 3 men, 3 young men, 2 women, 4 children, 1 negro man, and 1 Indian woman, 17 in all; and those that have had it, some are well recovered, and others in a hopeful and fair way of recovery.

BY THE SELECT MEN OF THE TOWN OF BOSTON.

Dr. Fleuart of Boston wrote to London that of 70 inoculated, 14 or 15 had died; and that at Roxbury, where there was no smallpox, 5 inoculated had died.¹

Conflicting as are the testimonies, we must allow much to the natural aversion from an operation, not only novel, but disgusting; but taking the best that could be claimed for the new practice by an enthusiastic advocate, the benefit was trifling when seriously scrutinised. Dr. Boylston visited London after the Boston epidemic, and finding inoculation in high vogue he published an Account of the Smallpox inoculated in New England.² George I. and the Prince and Princess of Wales had taken Inoculation under their august patronage, and Boylston with loyal fervour burst forth—

Shall not physicians and surgeons recommend and bring it into greater esteem and practice, and save (under God) thousands and of thousands by it; and make further improvements in it; set more vigorously about it when they consider their great Pattern and Example for it, namely, the greatest and wisest of Kings, their royal highnesses the Prince and Princess at the head ; and that it has been used upon their Royal Issue with great success?

Boylston in his Account recites his cases with, we think, general veracity. He performed 244 inoculations, in and says, " there were in the towns near Boston about 36 persons more inoculated, which all did well; namely, by Dr. Roby about 11, and by Dr. Thomson about 25, which, together with my 244, make up the number of 280; out of which number died only 6 persons, notwithstanding all the difficulties the practice laboured under."

1. Letter to Dr. Jurin by Isaac Massey. London, 1723

2. An Historical Account of the Smallpox inoculated in New England upon all sorts of persons, Whites, Blacks, and of all Ages and Constituions. By Zabdiel Boylston. London, 1726.

Beyond measure extraordinary was the bland assurance wherewith Boylston, in common with Mather and others, assumed and argued that the 280 inoculated had been thereby delivered from the plague of smallpox and death. Accepting the improbable supposition that the 280 were a fair average of 15,000 Bostonians, of whom one-third took smallpox, we have to abstract two-thirds of the 280, or 186 as superfluously inoculated, leaving 93 saved from smallpox. If we then inquire how many of these were saved from death, and resort to Boylston's statistics, who says,—

In 1721 and beginning of 1722 there were in Boston 5,759 persons who had smallpox in the natural way, out of which number died 844; so that the proportion that die of natural smallpox appears to be one in six, or between that of six and seven—¹

We find the number no more than 15, from which, if we deduct the 6 who died under his hand, his trophies are reduced to 9, to save whom he put 280 into serious sickness and jeopardy—so serious indeed in some instances (as appears from his own notes) that there was slight reason to prefer inoculated to spontaneous smallpox. Viewed thus in his own light—a light most favourable, how vain, not to say impudent, was such boasting as this—

Now, if there be any one that can find a faithful account or history of any other method or practice that has carried such a number of all ages, sexes, constitutions, and colours, and in the worst seasons of the year, through the smallpox; or indeed through any other acute distemper with better success, then I will alter my opinion of this; and until then, I shall value and esteem this method of inoculating the smallpox as the most beneficial; and successful that ever was discovered to, and practised by mankind in this world.²

And, gaining courage through his own noise, he went yet farther, and proclaimed that smallpox was tamed and subdued—

It is, and shall be acknowledged, to the praise and glory of God, that whereas a most wild, cruel, fierce and violent distemper, and which has destroyed millions of lives, is now (by that happy discovery made of its transplantation) become tractable, safe and gentle. ³

1. An Historical Account, p. 39. 2. Ibid. p. 38. 3. Ibid. p. 40.

In the knowledge of the emptiness of this bounce, it nay seem malicious to withdraw it from forgetfulness; but it serves to point the truth that human nature in 1726 was much the same as human nature at this day, and that the same arts of audacious assertion and rowdy rhetoric were in practice then as now. Indeed, whoever is sufficiently wicked to presume on the natural trustfulness of mankind, and will lie loud enough and long enough, may attain an appalling success—as our story, alas! will prove.

One thing goes to Boylston's credit: he did not propose to make poxing universal—to poison and sicken everybody, and inflict certain injury to avert future and uncertain danger from a few. He proposed to reserve inoculation for emergencies—

When the smallpox left Boston, inoculation ceased; and when it shall please Providence to send and spread that distemper among us again, may inoculation revive, be better received, and continued a blessing in preserving many from misery, corruption and death.

The narratives of Mather and Boylston are of special importance because we have in them the true lineage of inoculation as introduced from the eastern to the western world. Boylston tells us that when smallpox appeared in Boston—

Dr. Mather, in compassion to the lives of the people, transcribed from the Philosophical Transactions of the Royal Society the accounts sent them by Dr. Timonius and Pylarinus of inoculating the smallpox in the Levant, and sent them to the practitioners of the town for their consideration thereon.¹

For some inscrutable reason the true position of Cotton Mather in the history of inoculation is continually overlooked or mis-stated. For instance, in Mather's biography In the excellent English Cyclopœdia, it is said that he derived his information and impulse from the letters of Lady Mary Wortley Montagu; a statement repeated in the memoirs of that lady, which is entirely fabulous.

1. An Historical Account, p. 1.

CHAPTER 2. LADY MARY WORTLEY MONTAGU.

As for History “said the Duke of Marlborough, "I know that it is false;” and whoever has occasion to enter minutely into any historical question will be apt to concur with the Duke. Happening to refer to Walter Bagehot's essay on Lady Mary Wortley Montagu, I found this passage—

She brought from Turkey the notion of inoculation. Like most improvers, she was roughly spoken to. Medical men were angry because the practice was not in their books, and conservative men were cross at the agony of a new idea. Religious people considered it wicked to have a disease which Providence did not think fit to send you; and simple people " did not like to make themselves ill of their own accord." She triumphed, however, over all obstacles: inoculation, being really found to lengthen life and save complexions, before long became general.¹

1. Literary Studies, Vol. i. p. 248.

Now Bagehot loved accuracy and abhorred credulity and yet in these lines, delivered with as much confidence as a column of the multiplication table, there are exhibited about as much inaccuracy and credulity as could be packed into the space. Let us see what Lady Mary really did in the matter of inoculation.

Mr. Wortley Montagu was appointed ambassador to the Porte, and set out for Constantinople in the autumn of 1716 accompanied by his wife, then in her twenty-seventh year. The Ottoman Empire was in those days powerful and proud, disdaining to send representatives to Christian Courts, and receiving ambassadors as commercial agents, or as bearers of homage from their respective sovereigns. The English ambassador reached his destination early in 1717, and ere a month had passed, and ere Lady Mary had time to look around and appreciate the strange world into which she had entered, with sprightly audacity she wrote as follows to her friend Miss Sarah Chiswell—

I am going to tell you a thing that I am sure will make you wish yourself here. The smallpox, so fatal, and so general amongst us, is entirely harmless by the invention of ingrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the smallpox: they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nut-shell full of the matter of the best sort of smallpox, and asks which veins you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch), and puts into the vein as much venom as can lie upon the head of her needle, and after binds the little wound with a hollow bit of shell; and in this manner opens four or five veins. The Grecians have commonly the superstition of opening one in the middle of the forehead, in each arm, and on the breast, to mark the sign of the cross; but this has a very ill effect, all these wounds leaving little scars, and is not done by those that are not superstitious, who choose to have them in their legs, or that part of the arm that is concealed. The children or young patients play together all the rest of the day, and are in perfect health to the eighth. Then the fever begins to seize them, and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty [pustules] in their faces, which never mark; and in eight days' time they are as well as before their illness. Where they are wounded, there remain running sores during the distemper, which I don't doubt is a great relief to it. Every year thousands undergo this operation; and the French ambassador says pleasantly that they take the smallpox by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it; and you may believe I am very well satisfied of the safety of the 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 should 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 considerable 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 your friend.

In this letter there was material for a smallpox idyl—nothing easier, nothing surer, "smallpox made entirely harmless." But idyls are deceptive; their paradisiacal effects are obtained by the sedulous exclusion of whatever is otherwise. About the time that Lady Mary romancing so triumphantly to Miss Sarah Chiswell she despatched this note to her husband—

Sunday, 23rd March, 1717-18.

The boy¹ was engrafted last Tuesday, and is at this time singing and playing, and very impatient for his supper. I pray God my next may give as good an account of him. ... I cannot engraft the girl; her nurse has not had the smallpox.

1.* Born in Yorkshire, 1713.

Why should the engrafting of the infant have been hindered because the nurse had not had smallpox ? The answer to the question reveals a peril concealed from Miss Sarah Chiswell. Because the engrafted child would probably have communicated unmitigated smallpox to the nurse. Why not then engraft nurse and child ? Because they would have sickened together, and mother Mary did not care to incur the risk. There was no danger, she said; none whatever, only a pleasant diversion; nevertheless she preferred discretion to her own voluble assurance.

In History we have always to suspect the picturesque, for mankind have a fatal preference for handsome error over uncomely fact; and Lady Mary Wortley Montagu as mother of English inoculation, and derivatively of vaccination, is ever so much more graceful than dull Timoni and Pylarini in the Philosophical Transactions or Cotton Mather in New England. Few condescend to inquire whether Lady Mary, as primary inoculator, was acting independently, or whether she had advisers and prompters. "All of her self and by her self " is the heroic; representation—" a woman's wit against the world;" and judgment surrenders to fancy, as is the way with myths ancient and modern.

But it so happens that what in itself ought to be incredible—that a young Englishwoman should suddenly adopt the strange practice of a strange people—is demonstrably incredible. Lady Mary did not act alone. She had for counsellor and director, Charles Maitland, the physician to the embassy, who, familiar with the fame of inoculation, was glad to observe its practice experimentally. Maitland writes—

In the year 1717, when I had the honour to attend the English Ambassador and his family at Constantinople, I had a fair opportunity fully to inform myself of what I had long before heard, namely, the famous practice of transplanting, or raising the smallpox by inoculation.”¹

Here we may note, too, that Maitland was aware that inoculation did not originate in Turkey. He says—

Whilst universally practised all over Turkey for three-score years it has been known in other parts of the East, a hundred, or, aught we know, some hundreds of years before.²

1. Account of Inoculating for Smallpox. London, 1722.
2. A Short Account of Inoculation. London, 1723.

It was Maitland who managed the inoculation of young Montagu, and he thus described the operation—

About this time, the Ambassador's ingenious lady resolved to submit her only son to it, a very hopeful boy of about six years of age. She first of all ordered me to find out a fit subject to take the matter from, and then sent for an old Greek woman who had practiced this way a great many years. After a good deal of trouble and pains, I found a proper subject, and then the good woman went to work; but so awkwardly by the shaking of her hand, and put the child to so much torture with her blunt and rusty needle, that I pitied his cries, who had ever been of such spirit and courage that hardly anything of pain could make him cry before; and therefore, inoculated the other arm with my own instrument, and with so little pain to him that he did not in the least complain of it. The operation took in both arms, and succeeded perfectly well….He had about an hundred pox all upon his body. This operation was performed at Pera in the mouth of March, 1717.

That is to say, almost simultaneously with the Ambassador's arrival in Turkey.

The embassy returned to England in 1718, after a residence of little over a year in Constantinople. The dates are worth observation; for whilst it appears that the doctor and the lady were in common resolved to recommend the practice of inoculation to their countrymen, the dates prove with what inexperience and levity they assumed the grave responsibility. If quackery be assertion in absence of knowledge or of evidence, then we may accurately stigmatise Maitland and Montagu a couple of quacks. But so far as concerns Maitland we may go farther, for he expressly tells us—

I was assured and saw with my eyes that the smallpox is rather more malignant and epidemic in the Turkish dominions than with us; insomuch that, as some have affirmed, one-half, or at least one-third part of the diseased, at certain times, do die of it; and they that escape are terribly disfigured by it.¹

1. Account of Inoculating for Smallpox p4

Yet this same Maitland, who thus testified of the impotence of inoculation to mitigate and restrain smallpox in Turkey, came to England ready to assert its power to, mitigate and restrain! It is difficult to find words of due severity for such impudent inconsistency. We shall see, however, in the course of this wonderful story, how every rule of evidence may be defied in the matter of smallpox, and how it is possible to shut one's eyes and prophesy in the name of science, and have noise and hardihood accepted for veracity.

CHAPTER 3. MAITLAND'S EXPERIMENTS.

LADY MARY WORTLEY MONTAGU returned to England in 1718, but not until 1721 did she fulfil her intention of making war on the doctors, and incurring their resentment for the good of mankind. In the spring of 1721 she commenced action in earnest by the inoculation of her daughter—the infant that it was considered unsafe to "engraft" when at Pera in 1718. In Maitland's words—

The noble Lady sent for me last April, and when I came, she told me she was now resolved to have her daughter inoculated, and desired me forthwith to find out matter for the purpose. I pleaded for a delay of a week or two, the weather being then cold and wet. I also prayed, that any two physicians whom she thought fit, might be called, not only to consult the health and safety of the child, but likewise to be eye witnesses of the practice, and contribute to the credit and reputation of it. This was at first denied me, it might be out of a design to keep it secret, or lest it should come to nothing.

In the meantime having found proper matter, I engrafted the child in both arms, after the usual manner. She continued easy and well till the tenth night, when she was observed to be a little hot and feverish. An ancient apothecary in the neighbourhood being then called, prudently advised not to give the child medicine, assuring the parents there was no danger, and that the heat would quickly abate, which accordingly it did, and the smallpox began next morning to appear. Three learned physicians of the college were admitted, one after another, to visit the young lady; they are all gentlemen of honour, and will on all occasions declare, as they have done hitherto, that they saw Miss Wortley playing about the room, cheerful and well, with the smallpox raised upon her; and that in a few days after she perfectly recovered of them. Several ladies, and other persons of distinction, also visited this young patient, and can attest the truth of this fact.

One of the learned physicians who had visited Miss Wortley, having some years since fully informed himself of this method of practice, and being thoroughly satisfied of the safety and reasonableness of it, at length resolved to try it in his own family; he had formerly lost some children in a very malignant kind of the smallpox, therefore advised me to lose no time to engraft the only son he had left. The boy (who was not quite six years of age) being of a pretty warm and sanguine complexion, the Doctor ordered about five ounces of blood to be taken from him; and then, in ten days, having found matter which he liked, I inoculated him in both arms. This was performed the 11th of May, 1721.

The learned physician here referred to was Dr. Keith, and the facility wherewith he adopted the novel practice supplies an instructive commentary on Lady Mary's anticipation of the resentment of "the profession"—her imitator coming from the ranks of the dreaded self-seeking obstructives. Furthermore, we have to observe how different is Maitland's account from the heroic myth current of " the one woman confronting the prejudice and ill-will of the world." Even Lady Louisa Stuart, who made it her business to correct many misconceptions as to her grandmother's career, writes—

Only the higher motive of hoping to save numberless lives could have given Lady Mary courage to resolve upon bringing home the discovery. For what an arduous, what a fearful, and, we may add, what a thankless enterprise it was, nobody is now in the least aware. Those who have heard her applauded for it ever since they were born, and have also seen how joyfully vaccination was welcomed in their own days, may naturally conclude that when once the experiment had been made, and had been proved successful, she could have nothing to do but to sit down triumphant, and receive the thanks and blessings of her countrymen. But it was far otherwise. . . Lady Mary protested that in four or five years immediately succeeding her arrival at home, she seldom passed a day without repenting of her patriotic undertaking; and she vowed that she never would have attempted it, if she had foreseen the vexation, the persecution, and even the obloquy it brought upon her. The clamours raised against the practice, and of course against her, were beyond belief. The faculty rose in arms to a man, foretelling failure and the most disastrous consequences; the clergy descanted from their pulpits on the impiety of thus seeking to take events out of the hand of Providence; the common people were taught to look at her as an unnatural mother, who had risked the lives of her own children. . . We now read in grave medical biography that the discovery was instantly hailed, and the method adopted, by the principal members of the profession. . . But what said Lady Mary of the actual fact and actual time ? Why, that the four great physicians deputed by Government to watch the -progress of her daughter's inoculation, betrayed not only such incredulity as to its success, but such an unwillingness to have it succeed, such an evident spirit of rancour and malignity, that she never cared to leave the child alone with them one second, lest it should in some secret way suffer from their interference.¹

1. Letters and Works of Lady Mary Wortley Montagu. Vol. i. pp. 88-90. Ed. 1861.

Thus is History written! An apothecary and three doctors, selected by the Wortleys at discretion, and admitted singly to view a private experiment, are converted into " four great physicians deputed by Government," rancorous and dangerous ! Thus are myths generated !

Lady Mary was a woman of mark in society, fashionable and literary, and her exploit was naturally the talk of the town. Among her friends was Caroline, Princess of Wales, a lady of more than ordinary strength of mind and intelligence, with a taste for theology and philosophy, the patron of Butler, and his sympathetic student. It has been said, " There never was a clever woman that was not a quack ;" and Princess Caroline was an illustration of its truth. The new remedy for smallpox caught her fancy, and she determined to put it to the test. She begged of George I. that six felons should be pardoned on condition of their submission to inoculation, and the King was pleased to comply with the extraordinary request. Maitland was then called upon to exhibit his skill, but he hesitated to act as hangman's substitute ; whereon Sir Hans Sloane, the court physician, was appealed to. Sir Hans held counsel with Dr. Terry of Enfield, who had practised physic in Constantinople, and knew something of inoculation; and fortified with Terry's assurance, he was enabled to overcome Maitland's scruples, real or affected. Accordingly, on the 9th of August, 1721, writes Maitland—

I performed the operation of inoculating the smallpox on six condemned criminals at Newgate in presence of several eminent physicians, surgeons, and others. The names of the criminals were—

1. MARY NOETH, . . . Aged 36 years.

2. ANNE TOMPION, 25 years

3. ELIZABETH HARRISON, 19 years

4. JOHN CAWTHERY, 25 years

5. JOHN ALCOCK, 20 years

6. EICHARD EVANS, 19 years

On Wednesday morning, 9th August, he made incisions in both arms and the right legs of the six. Thursday passed and Friday passed without any indications of constitutional disturbance, and, despairing of success, he obtained fresh pox on Saturday from Christ's Hospital, and repeated the inoculation in new incisions in the arms of five of them. He had no matter left for Evans, who, it appeared, had had smallpox in September, 1720, and who therefore escaped hanging unwarrantably. The disease now " took," and progressed satisfactorily. Says Maitland—

One day Mr. Cook, an eminent Turkey merchant, having seen the persons engrafted in Newgate, and having fully considered their incisions and eruptions, he openly declared they were the very same as he had observed in Turkey, having seen a great many instances; and that we might be assured they would never again be infected with smallpox.

Dr. Mead suggested another experiment—that cotton dipped in pox should be inserted in the nostrils; and a young woman sentenced to death received her life on condition of submitting to the operation. Here we have Mead's own account of the transaction—

A learned author has given an account of the practice of sowing smallpox, as they call it, known to the Chinese above three hundred years, which is this. They take the skins of some of the dried pustules, which are fallen from the body, and put them into a porcelain bottle, stopping the mouth of it very close with wax. When they have a mind to infect any one, they make up three or four of these skins, putting between them with one grain of musk into a tent with cotton, which they put up the nostrils.

I myself have had an opportunity of making an experiment to this purpose. For, when in the year 1721, by order of his Sacred Majesty, both for the sake of his own family, and of his subjects, a trial was to be made upon seven condemned malefactors, whether or not the smallpox could safely be communicated by inoculation ; I easily obtained leave to make the Chinese experiment in one of them. There was among those who were chosen out to undergo the operation, a young girl of eighteen years of age. I put into her nostrils a tent, wetted with matter taken out of ripe pustules. The event answered: for she, in like manner with the others, who were infected by incisions made in the skin, fell sick, and recovered;. but suffered much more than they did, being, immediately after the poison was received into the nose, miserably tormented with sharp pains in her head, and a fever, which never left her till the eruption of the pustules.¹

Finally, says Maitland—

On the 6th of September they were all dismissed to their several counties and habitations. The thing has been successful on all the-five, far beyond my expectation, considering their age, habit of body, and circumstances; and it has perfectly answered Dr. Timoni's account of the practice, and also the experience of all who have seen it in Turkey.²

1. On Smallpox and Measles. By Dr. Mead. London, 1747.

2. Mr. Maitland's Account of Inoculating the Smallpox. 2nd. ed. London, 1723.

So Maitland asserted, but others were of a different opinion. Dr. Wagstaffe, who visited the patients in Newgate regularly, maintained in a letter addressed to Dr. Freind—

Upon the whole, Sir, in the cases mentioned, there was nothing like the smallpox, either in symptoms, appearances, advance of the pustules, or the course of the distemper. And it would puzzle any one to conceive how it is possible that smallpox can ever be prevented by inoculation. With the exception of one of the men, the girl who had cotton dipped in matter thrust up her nostrils, had as fair a smallpox as any in the place. ¹

Sir Hans Sloane and Dr. Steigertahl, physician to the King, to test the matter farther, "joined purses," and had one of the women inoculated in Newgate sent to Hertford, where smallpox of a severe form was prevalent, to lie in bed with smallpox patients. This she did with impunity ; but it was reasonably objected that many who were not inoculated did so likewise and escaped without harm.

The Newgate experiment, of course, caused great excitement, and induced many repetitions in town and country. The Princess of Wales was especially alive to the importance of " the great discovery;" and for her additional satisfaction, six charity children, belonging to the parish of St. James, were inoculated ; and all but one " took" and did well; the exception being due to the craft of the child, who, for the sake of the reward, concealed the fact of having had smallpox.

1. A Letter to Dr. Freind showing the Danger and Uncertainty of Inoculating the Smallpox. By W. Wagstaffe, M.D. London, 1722.

Upon these trials, and several others in private families [wrote Sir Hans Sloane], the Princess of Wales sent for me to ask my opinion of the inoculation of the Princesses. I told Her Royal Highness, that by what appeared in the several essays, it seemed to be a method to secure people from the great dangers attending smallpox in the natural way. That preparations by diet and necessary precautions being taken, made the practice very desirable ; but that not being certain of the consequences which might happen, I would not persuade nor advise the making trials upon patients of such importance to the public. The Princess then asked me if I would dissuade her from it: to which I made answer that I would not, in a matter so likely to be of such advantage. Her reply was, that she was then resolved to have it done, and ordered me to go to the King, who commanded me to wait upon him on the occasion. I told his Majesty my opinion, that it was impossible to be certain, but that raising such a commotion in the blood there might happen dangerous accidents not foreseen : but he replied that such might and had happened to persons who had lost their lives by bleeding in a pleurisy, and taking physic in any distemper, let never so much care be taken. I told his Majesty that I thought this to be the same case, and the matter was concluded upon, and succeeded as usual, without any danger during the operation, or the least ill symptom or disorder since.¹

The Princess Amelia, aged eleven, and Caroline, aged nine, were therefore inoculated on the 19th of April, 1722.

Let us return to Maitland, whose triumph for the moment appeared complete, and with it his assurance. To his detractors he professed boldly—

I could bring a great many cases of persons inoculated in Turkey to prove the constant and certain success of the practice; in all which I have never seen any miscarriage, except in one, which was wholly due to the rashness and inadvertence of a surgeon at Constantinople.

Is it not a matter of the greatest importance for us to know how to prevent the mighty contagion of the smallpox, and how to preserve our children from the violent attacks and fatal effects of it ?

To divine Maitland's character—to determine how far he was deceiver or deceived is not easy. He obviously made professions in vast excess of his knowledge. One of his contemporaries writes—

I remember Mr. Maitland at Child's Coffee House, when the experiment was just begun at Newgate, was as confident and positive of the success and security proposed by inoculation as if he had had twenty years experience without any miscarriage, which made those who heard him justly suspect he was more concerned for the employ than for the success of it. ²

1. An Account of Inoculation by Sir Hans Sloane, Bart., given to Mr. Ranby to be published, 1736. Philosophical Transactions, Vol. xlix. p. 516.

2. Isaac Massey to Sir Hans Sloane, 1722.

He had not the proper craft of the conscious rogue, for alongside his assertions of absolute competence and safety, he set forth such confessions of ignorance and disaster, that one is impelled to pronounce him a purblind enthusiast. For example, take this case, which he published without apparently any sense of its scope—

2nd October, 1721.—After due preparation of the body, I engrafted Mary Batt, an infant of two years and a half old, daughter of Thomas Batt, a Quaker, living at Temple, within three miles of Hertford. The red spots and flushings appeared on her face and neck the fourth day; and she kept playing about well till the seventh or eighth, when she became a little heavy and thirsty, with a fuller and quicker pulse ; then the pustules came out fresh and full, and the incisions discharged a thick and well digested matter. She had not above twenty in all upon her; they continued about three or four days, then dried away and fell off, and the child recovered perfectly.

Thus far all was well; but what happened afterwards was, I must own, not a little surprising to me, not having seen or observed anything like it before. The case was in short this. Six of Mr. Batt's domestic servants, namely, four men and two maids, who all in their turns were wont to hug and caress this child whilst under the operation, and the pustules were out upon her, never suspected them to he catching, nor indeed did I, were all seized with the right natural smallpox, of several and very different kinds; for some had the round distinct sort, some the small continued, and others the confluent; all of 'em had a great many, but especially the last, with the usual bad symptoms, and very narrowly escaped. But they all (God be thanked) did well (except one maid, that would not be governed under the distemper, who died of it,) and now enjoy a perfect state of health.¹

Thus at the outset, smallpox and death were the products of inoculation—the peril to be averted was incurred and multiplied. Yet the man who thus records his own infamous ignorance, had the impudence in the same pages to assert—

The practice prudently managed, is always safe and useful, and the issue ever certain and salutary.²

1. Maitland's Account, p. 27.

2. Ibid. p. 33.

Words are wasted on such reckless folly : we perceive how true is Carlyle's observation, " Stupidity intellectual always means stupidity moral, as you will, with surprise or not, discover if you look."

Before leaving Maitland, we may take another leaf from his experience. He writes—

12th October, 1721.—I inoculated Joseph and Benjamin, sons of William Heath, of Hertford; the first of about seven, and the second three years of age ; both with the same matter and at the same time : the last had a gentle and favourable kind; but the first, namely, Joseph, being a fat, foul, gluttonous boy, who would not be confined to the rules and directions I had strictly charged his mother withal, as to diet and keeping warm, was taken very ill before the eruption, and after it had a great load of the continued small kind, but at last recovered and did well.

What a mighty difference is here to be observed between those two boys! The reason of it seems to be plainly this: the younger, who had the favourable kind, was of a clean habit, moderate appetite, and easily governed during the whole process. The elder was not only of a gross foul constitution, but likewise had a voracious appetite, always eating and filling his belly with the coarsest food —as cheese, fat country pudding, cold boiled beef, and the like, which I saw myself as I came in by chance the third day after the operation; nor was there any care taken to restrain or keep him within doors in cold, windy, frosty weather; he once wet his feet in water—insomuch that had he taken the smallpox by infection, the world could not have saved his life. Hence it appears how necessary it is to cleanse thoroughly foul habits before the operation, and, withal, to keep patients to a very strict regimen under it.¹

1. Maitland's Account, p. 27.

Verily, as Cobbett said, quackery is never without a shuffle. As we shall see, inoculation came to require a preparatory course of very strict regimen—so strict as to be impracticable for the rank and file of the world; but the practice was at first commended without any such conditions. What said Maitland's patron, Lady Mary, in her famous letter from Adrianople ?—

The smallpox, so fatal and so general amongst us, is here entirely harmless by the invention of ingrafting…….. Every year thousands undergo its operation; and the French ambassador says pleasantly that they take the smallpox here by way of diversion, as they take waters in other countries. There is no example of anyone that has died in it.

It was under cover of such seductive assurances that inoculation was introduced to England, and established in perversity and quackery.

CHAPTER 4. THE FIRST OPPONENTS OF INOCULATION.

As we have seen, it is part of the legend that the introduction of inoculation was fanatically resisted by physicians, clergy, and mob; but the resistance was neither fanatical nor extensive, and is chiefly the invention of the romancing biographers who represent Lady Mary Wortley Montagu as a heroine and martyr of science. To do that shrewd and brilliant woman justice, she made no pretence to the character imputed to her, and in her copious correspondence, there is not a hint of annoyance on the score of her patronage of the Turkish modification of smallpox. On the contrary, it would appear that inoculation brought her a large share of that veiled notoriety in which she had sincere pleasure. Writing to the Countess of Mar in 1723, she says—

Lady Byng has inoculated both her children, and since that experiment has not had any ill effect, the whole town are doing the same thing; and I am so much pulled about, and solicited to visit people, that I am forced to run into the country to hide myself.¹

Lady Mary understood her countrymen thoroughly, and, thirty years after her exploits in inoculation, she wrote to Mr. Wortley Montagu as follows—

BRESCIA, 24th April, 1748.

I find Tar Water succeeded to Ward's Drop. ’Tis possible, by this time, that some other quackery has taken place of that. The English are easier than any other nation infatuated by the prospect of universal medicines, nor is there any country in the world where the doctors raise such immense fortunes. I attribute it to the fund of credulity which is in all mankind. We have no longer faith in miracles and relics, and therefore with the same fury run after recipes and physicians. The same money which three hundred years ago was given for the health of the soul is now given for the health of the body, and by the same sort of people-women and half-witted men. ²

1. Letters and Works of Lady M. W. Montagu, Vol. i. p. 468, edition 1861.

2. Ibid. Vol. ii. p. 161.

Those who fancy there could be any wide or effective resistance to inoculation in 1721 misapprehend the conditions of the time. There was no scientific knowledge of the laws of health; diseases were generally regarded as mysterious dispensations of Providence over which the sufferers had little control; and a great part of medicine was a combination of absurdity with nastiness. It would not be difficult to compile a series of recipes from the pharmacopoeia of that day which would alternately excite amusement, surprise, and disgust, and to describe medical practice from which it is marvellous that ever patient escaped alive; but so much must pass without saying. Suffice it to assert, that to inoculation there was little material for opposition, rational or irrational; and that what we might think the natural horror of transfusing the filth of smallpox into the blood of health, was neutralised by the currency of a multitude of popular remedies which seemed to owe their fascination to their ; outrageous and loathsome characteristics.

Moreover, as the dates prove, the interval was brief between the introduction of inoculation and its authoritative acceptance. The girl Montagu was privately inoculated in April, 1721, Dr. Keith's boy on the 11th of May, the Newgate experiment took place on the 9th of August, a variety of experiments followed, and lastly the Princesses Amelia and Caroline were inoculated on the 19th of April, 1722—sharp work for one year. There was not time for opposition. The citadel of social approval was carried with a rush. As a contemporary observed—

I could not but take notice with what united force and zeal the practice was pushed on upon the life and reputation it received from its admission to the Royal Palace ; all pens and weekly papers at work to recommend and publish it; and it was rightly judged, then or never was the time ; and had it not been for some unlucky miscarriages, the inoculators would have had the best chance for full practice and full pockets that ever fell into the hands of so small a set of men.¹

1. A Short and Plain Account of Inoculation. By Isaac Massey. London, 1724.

The royal approval was assiduously worked, and there were not wanting hints that to question the goodness of inoculation was equivalent to disloyalty; and thus we find the Rev. E. Massey protesting in a letter to Mr. Maitland—

I wish the Doctor more candour toward those who differ from him than to insinuate that they are guilty of high treason, and a hotter argument for this practice than the cry, Inoculation! and King George for ever! ¹

Bad reasons are often advanced against bad policy, and whilst it is probable that some silly things were uttered against inoculation, yet I think every candid mind would be impressed with the moderation of Maitland's chief adversaries. There was Isaac Massey, for instance, apothecary to Christ's Hospital, who published several pamphlets in opposition, wherein candour and good sense are throughout conspicuous. He defined—

Inoculation as an art of giving the smallpox to persons in health, who might otherwise have lived many years, and perhaps to a very old age without it, whereby some unhappily come to an untimely death.²

He objected to the exaggerated dangers of smallpox wherewith the Inoculators operated on the public fears, and appealed to his own experience in Christ's Hospital—

Where there are generally near 600 children, the nurseries at Ware and Hertford constantly filling the places of those who go off. It hath sometimes happened that great numbers have been down of the smallpox, and 'tis but seldom that the House is free, or not long so: yet I daresay, and Sir Hans Sloane, I presume, will say so too, that in twenty years there have not died above five or six at most of the distemper, and in the last eight years there died but one. ³

1. Letter to Mr. Maitland. By Edmund Massey. London, 1722,
2. A Short and Plain Account of Inoculation, p. 1.
3. Ibid. p. 21.

So lightly did he regard the peril of smallpox to the young that he delivered this challenge—

Suppose that twenty-five Bluecoat Hospital boys at a medium, one year with another, taken ill of the smallpox.

Suppose we likewise, that the Inoculators take out of the several wards, yearly, as they find them, twenty-five boys, which are inoculated.

Quere, What the difference of success ? I solemnly protest that if this could be put in practice, I would lay two to one against the inoculated.

For, as I have said before, we have lost but one smallpox patient these nine years [writing in 1723] although 1800 children have been in the House during that time, and I declare to have met with no unequal success in other families amongst children about the same ages (that is between 8 and 15) where I have been concerned, and I doubt not but many of the Learned Faculty, as well as some others of my profession, can say as much from their own experience and observation. ¹

1. Letter to Dr. Jurin. By Isaac Massey. London, 1723.
2. Letter to Dr. Freind. By W. Wagstaffe, M.D., P.R.S., one of the physicians of St. Bartholomew's Hospital. London, 1722.

To appreciate Massey's contention on this point, we have to remember that smallpox is the designation of a disease of many degrees of intensity; a consideration which Dr. Wagstaffe, another opponent of inoculation, thus enforced—

There is scarcely, I believe, so great a difference between any two distempers in the world, as between the best and worse sort of smallpox, in respect to the dangers which attend them. ... So true is that common observation, that there is one sort in which a nurse cannot kill, and another which even a physician can never cure.²

Of course the Bills of Mortality were appealed to in evidence of the extent and fatality of smallpox; and as it is matter of common belief that prior to inoculation and Jenner (there is always a haze about the date) people were mown down with smallpox, it may be worth while reviving the table of relative mortality in London during the first twenty-two years of the 18th century.

Burials from all Diseases.	From Smallpox.
1701	20,471	1,095
1702	19,481	311
1703	20,720	898
1704	22,684	1,501
1705	22,097	1,095
1706	19,847	721
1707	21,600	1,078
1708	21,291	1,687
1709	21,800	1,024
1710	24,620	3,138
1711	19,833	915
1712	21,198	1,943
1713	21,057	1,614
1714	26,569	2,810
1715	22,232	1,057
1716	24,436	2,427
1717	23,446	2,211
1718	26,523	1,884
1719	28,347	3,229
1720	25,454	1,440
1721	26,142	2,375
1722	25,750	2,167
	505,598	36,620

By these tables [wrote Dr. Jurin] it appears that upwards of 7 per cent., or somewhat more than, a fourteenth part of mankind, die of the smallpox; and consequently the hazard of dying of that distemper, to every individual born into the world, is at least that 1 in 14.¹

1. A Letter to Caleb Cotsworth, M.D. By James Jiirin, M.D. London, 1723.

This large induction from London to universal mankind is noteworthy, because, as we shall see, it came to be often made, and involved a serious fallacy; for unless universal mankind dwelt in conditions similar to Londoners, it was idle to infer a common rate of disease and mortality. The population of London in 1701 was estimated at about 500,000 (there was no exact census), rising to about 600,000 in 1720. It was closely packed and lodged over cess-pools; the water supply was insufficient, and there was no effective drainage. The vast multitude was disposed, as if by design, for the generation and propagation of zymotic disease, and specially smallpox. Little attention was paid to personal cleanliness, and still less to ventilation, to light, to exercise. The condition of a large urban community a century ago is almost inconceivable at the present day.

Londoners were then only slowly and blindly rising out of those modes of existence which made the Plague of 1665, and other plagues, possible. Hence we need not be astonished that smallpox was a common and persistent affliction; but it was less prevalent and less deadly than it is the custom to assert; and had the disease not been attended with injury to feminine beauty, there might have been no more fuss made about it than about any other form of eruptive fever.

It has also to be observed, that smallpox as a cause of death was probably much exaggerated in the Bills of Mortality; for as Isaac Massey pointed out—

These Bills are founded on the ignorance or skill of old women, who are the searchers in every parish, and their reports (very often what they are bid to say) must necessarily be very erroneous. Many distempers which prove mortal, are mistaken for the smallpox, namely, scarlet and malignant fevers with eruptions, swine-pox, measles, St. Anthony's fire, and such like appearances, which if they destroy in three or four days (as frequently happeneth) the distemper can only be guessed at, yet is generally put down by the searchers as smallpox, especially if they are told the deceased never had them.¹

Massey, in the same spirit of good sense, objected to generalisations about smallpox from the Bills of Mortality, as if all who died were slain by the disease and by nothing else.

There ought to be no comparison [he said] between sick people, well regimented with diet and medicine, and those who have no assistance, or scarcely the necessaries of life.

The miserable poor and parish children make up a great part, at least one-half of the Bills of Mortality; to confirm this I have examined several yearly bills, and I find that the out-parishes generally bury more than the ninety-seven parishes within the walls, and the parish of Stepney singly, very near as many as the City of London yearly; this sufficiently shows what little help and care are taken of the poor sick, which so much abound in all those places.²

1. Letter to Dr. Jurin. London, 1723.

2. Ibid.

Of course there lurks a fallacy in all statistics of disease wherein conditions of life are not discriminated. Whether patients survive or die from any zymotic ailment depends upon their breed, their circumstances, their habits, and their medical treatment and nursing— all essential particulars, yet difficult to define and register on a large scale. It would appear that in sound constitutions, and with fair treatment, smallpox in 1721 was by no means deadly, whilst in bad constitutions, and with exposure and neglect, it was extensively fatal. Yet of these differences, little account was taken by the Inoculators, and the malady was measured and discussed as though it were something uniform like water or gold. Massey in one year had 49 cases of smallpox and one death; in Stepney an equal number of cases might have shown a, mortality of 20 or 30 per cent.; whilst Dr. Nettleton reported that of 1245 cases in Halifax and adjacent towns in Yorkshire, there died 270, or about 22 per cent.¹ One of Massey's fears in relation to inoculation was the risk of poisoning the blood with more than smallpox. He was not disinclined to experiment with " duly prepared children infected with smallpox by inspiration," for then—

They will run no hazard of being infected by a leprous, venereal, or scrofulous taint that may, for aught we know, be transplanted by inoculation.²

1. Mr. Maitland's Account of Inoculating the Smallpox Vindicated. London, 1722, p. 20.
2. Letter to Dr. Jurin, p. 12.

Massey's prescience has been woefully verified; is indeed under perpetual verification in the pollution and destruction of multitudes of infants. The notion that virus with a complex of qualities can be transferred from one body to another, and operate with the single quality the operator is pleased to favour, is a notion that might pass muster in a manual of magic or folk-lore, but which never can have any warrant in human physiology.

Of course the chief strength of the opponents of inoculation (ere experience gave them stronger ground) lay in the assertion of the folly of incurring a certain injury for an uncertain advantage. Whatever the risk of smallpox to those who have it, yet large numbers, it was argued, pass through life untouched; and why should they make themselves sick, and risk their lives in order to obtain a superfluous security ! ¹

The frequent assertion that the clergy thundered against inoculation is untrue and invented for effect. The Rev. Edmund Massey, Lecturer of St. Alban, Wood Street, did preach a sermon against the new practice, and a fair sermon it was, according to the standard of sermons. Maitland published some remarks on the sermon, to which Massey rejoined; and if I select a passage from the rejoinder it will prove, better than any description, that the divine was more than a match for the surgeon. Said Massey to Maitland—

Inoculation, in your sense, is an engraftment of a corrupted body into a sound one; an attempt to give a man a disease, who is in perfect health, which disease may prove mortal.

This I said was tempting Providence.

To which you reply, It resembles that of a person who leaps out of a window for fear of fire; and surely that can never be reckoned a mistrust of Providence.

No, certainly, Sir, if his house be really on fire, and the stairs burnt. 'Tis the only probable way of safety left; and if the leap should kill him, the action could neither be called sinful or imprudent. But what should we say to a man, who jumped out of the window when his house was not a-fire, only to try what he might perhaps be forced to do hereafter ? This mad action exactly hits the case between us. For if my house be not on fire, that is, if I am in no apparent danger, what need I jump out at the window ? What occasion is there to inoculate me ?
To carry on your own allegory, I would ask you, Sir, what human or divine authority you have to set a man's house on fire, that is, put a man who is in perfect health in danger of his life by a fit of illness ? His own consent is not sufficient, because he has no more lawful power over his own life or health than you have, to put either of them in hazard.²

1. Jurin's Yearly Account of Inoculation, p. 13.
2. Letter to Mr. Maitland in Vindication of the Sermon against Inoculation, London, 1722.

In short, nothing can be more unfounded than the assumption in literature, popular and professional, that Maitland and Montagu were confronted by a crowd of howling fanatics over whom they triumphed as light over darkness. Marvellous is the imbecility wherewith biographers and historians reproduce the fables of any inventive predecessor.

I shall now proceed to show that the practice of inoculation introduced by Cotton Mather to New England, and by Maitland to England, collapsed in a few years under stress of the mischiefs and fatalities which attended it; that it was revived in a subsequent generation; that it proved a curse wherever practised; and that finally it was abandoned with execration in the Western world.

CHAPTER 5. COLLAPSE OF INOCULATION.

WE sometimes fetch from afar what is to be found at our own doors; and thus it was with inoculation. No sooner was the great Eastern preventive advertised than it was said—Why, it is nothing more than a practice common in Wales and the Highlands of Scotland! Perrot Williams, M.D., and Richard Wright, surgeon, of Haverfordwest, communicated to the Royal Society¹ that the people in Pembrokeshire had practised inoculation "time out of mind." They either scraped the skin thin or pricked it with pins, and then rubbed in pus from a smallpox patient. This they called " buying the smallpox," as it was customary to pay something for what was fancied to be " good matter." The Welshmen gave the same account of the practice as the Turks—there was no danger, no mishaps, and certain security from smallpox. In Scotland it did not appear that the skin was scraped, but worsted threads saturated with pus were tied round the wrists of children to whom it was desired to communicate the disease.²

1. Philosophical Transactions, No. 375, 1723.
2. An Account of Inoculation in Scotland. By A. Monro. Edin., 1765.

Dr. Thomas Nettleton, of Halifax, Yorkshire, was an early and energetic inoculator. He prepared his patients by vomiting, purging, and bleeding. He disliked Maitland's small punctures, and made gashes an inch long— one in the arm and one in the opposite leg, and inserted bits of cotton steeped in pus, and covered them up with plaster and rollers. It was his design to produce large wounds with copious discharges, so that peccant matter might be freely evacuated. He was well satisfied with his heroic practice, and a record of his cases was sent to the Royal Society¹—a record from which any reader will be apt to conclude that there was little to choose between Nettleton's inoculations and smallpox itself. He made no pretence that inoculation induced a trifling-ailment, but only one less serious than the spontaneous disease, congratulating himself on having conveyed some sixty inoculated patients through grave peril; whilst, he wrote—

In Halifax, since the beginning of last winter, 276 have had the smallpox, and out of that number 43 have died. In Bochdale, a small neighbouring market town, 177 have had the distemper, and 88 have died. It is to be noted that in this town [Halifax] the smallpox have been more favourable this season than usual, and in Leeds they have been more than usually mortal; but upon a medium there have died nearly 22 out of every 100 in these three towns, which is about a fifth part of all that have been infected in the natural way.²

1. Philosophical Transactions, No. 370, 1722.
2. Letter from Dr. Nettleton to Dr. Jurin, dated Halifax, 16th June, 1722.

English experience quickly made an end of the fiction under cover of which inoculation had been introduced— that it was attended with no risk, and might be performed by any old woman. Dr. Jurin, secretary of the Royal Society, and a steady advocate of the practice, thus laid down the conditions considered essential to success— conditions arrived at through stress of suffering and disaster—

Great care ought to be taken to inoculate none but persons of a good habit of body, and free, not only from any apparent, but, as far as can be judged, from any latent disease.

The body, especially if plethoric, ought to be prepared by proper evacuations—as bleeding, purging, vomiting, etc.—though in many cases there will be occasion for very little or none of these, it being sufficient to enjoin a temperate diet and proper regimen. But this must be left to the judgment of the physician.

The utmost caution ought to be used in the choice of proper matter to communicate the infection. It should be taken from a young subject, otherwise perfectly sound and healthful, who has the smallpox in the most favourable manner. When the pustules are properly maturated, and just upon the turn, or soon after, two in three of them should be ripped with a glover's needle or small lancet, and a couple of small pledgets of lint or cotton are to be well moistened with the matter, and immediately put into a little vial or box, and carried in the warm hand or bosom of the operator to the house of the person to be inoculated.¹

The publication of these conditions was little short of a practical surrender, and the opponents of inoculation wore not slow to avail themselves of the advantage. What had been proclaimed the easy and universal defence against smallpox proved hedged about with precautions and preparations for which only health with wealth was equal. Where was the profit, argued Francis Howgrave, of a practice which leaves the feeble and delicate and poor to their fate, which makes the well sick, and wounds those that are whole, whilst smallpox in the natural way very rarely affects life where the habit of body and constitution are good.²

1. An Account of the Success of Inoculating the Smallpox in Great Britain. By James Jurin, M.D.
2. Reasons Against the Inoculation of the Smallpox. By Francis How-grave, Apothecary. London, 1724.

Isaac Massey was especially indignant over Jurin's comparison of the mortality of smallpox with the mortality of inoculation. Jurin reckoned that out of every 100 who took smallpox, 20 died, whilst only 2 in 100 died from the effects of inoculation. "He forgets," said Massey, "that the inoculated are picked lives. If this be fair, Hang fair !" Massey was right. It was absurd to institute a comparison between the common smallpox, comprising that of the poor and neglected, and the well-fed and carefully tended subjects of inoculation. Massey, too, was strong in his own experience, saying—

I have a list of the names of 32 children, who are all that have had the smallpox during the last two years [1727] in Christ's Hospital, and every one recovered. I have had, besides, 17 or 18 more in my private business, of whom only one died. Here, then, we have 49 cases of natural smallpox and but 1 death.¹

Emphatic likewise was his protest against the exaggeration of the inoculators.

A natural simple smallpox seldom kills, unless under very ill management, or when some lurking evil that was quiet before is roused in the fluids and confederated with the pocky ferment.²

At this point we may see the judgment and the fears of the English people had gone against inoculation, and the practice appeared destined to gradual extinction. According to the inoculators, their work was thus summarised—

182 inoculations in 1721 and '22, with 3 deaths.

292 „ in 1723, with 6 deaths.

40 „ in 1724, with 1 death.

Prince Frederick and Prince William were among the inoculated of 1724.

256 inoculations in 1725 and '26, with 4 deaths.
124 „ in 1727 and '28, with 3 deaths.

Dr. Scheuchzer, in 1729 tabulated ³ the cases and results of these years, 1721-28, as follows—

Age	No. operated upon	Successfully inoculated.	Had imperfect Smallpox.	Did not take.	Died .

Under 1 year	24	24	0	0	2
1 to 2	34	33	0	1	4
2 to 3	65	65	0	0	1
3 to 4	91	88	0	3	1
4 to 5	65	63	0	2	1
5 to 10	257	249	3	5	3
10 to 15	140	131	1	8	1
15 to 20	104	95	3	6	2
20 and upwards	110	91	6	13	2
Unknown,	7	6	0	1	0
	897	845	13	39	17

1. Remarks on Dr. Jurins Last Yearly Account of the Success of Inoculation. By Isaac Massey. London, 1727.
2. Ibid. p. 5.

3. An Account of the Success of Inoculating the Smallpox in Great Britain. By John Gasper Scheuchzer, M.D. London, 1729.

Thus stood the account by the inoculators' own showing, and it was by no means a satisfactory balance-sheet. What strikes one painfully in looking over it, is the vast preponderance of the young and defenceless (780 out of 897) upon whom the abominable experiment was tried. " Helplessness which commands the protection of the brave is the opportunity of the investigating sneak." Whilst the inoculators argued laboriously that if some danger attended artificial smallpox, it was trifling to that attached to the spontaneous disease (among other obvious replies), it was maintained that only after much wider experience could it be known what were the precise effects of inoculation. Inoculation, as introduced by Maitland in 1721, had proved vastly different after acquaintance, and there was no telling what remained to be revealed.

As Dr. Wagstaffe observed---

Had it always been slight, gentle, safe, and useful, with all those alluring epithets bestowed on it ; had none had above a hundred or two hundred pustules, and no one died of it in the space of several years ; and had there been no instance of any one's being over again infected with smallpox who had any pustules at all, how few soever, raised by inoculation, nobody would sooner have subscribed to the practice than myself.¹

1. Danger and Uncertainly of Inoculating the Smallpox, p. 64.

The primal promise that the inoculated were thereafter proof against smallpox was speedily belied, but that difficulty was disposed of by the assertion that inoculation in such cases must have been imperfect, for it was impossible for any one to have smallpox twice. The admission of fatalities from inoculation was very tardily made; and they were generally referred to some cause perversely concealed from the inoculator, which, had he known, would have prevented his operation. Then, the manifest fatalities were naturally suspected to stand for a larger number sedulously kept out of sight. As Massey put it —

The ill success of inoculation is very partially and sparingly given to the world. The operator will not tell it, who lives by the practice; nor will the relations, to whose authority the mischief is owing, be fond of revealing that to the public, which is grief to them in private."¹

Fortunately for the public, several of the mishaps occurred in "good society," and were too conspicuous to be hushed up or denied. Miss Rigby died eight weeks after inoculation." miserably disordered by the operation." A son of the Duke of Bridgewater and a son of the Earl of Sunderland likewise perished; and a servant of Lord Bathurst died of confluent smallpox " consequent on engraftment." Such incidents struck terror everywhere, and caused wise and timid alike to face the ills they knew rather than risk certain peril for uncertain advantage.

Maitland returned to Scotland, his native country, in 1726, and, going among his relations in Aberdeenshire, showed off his skill by inoculating six children. One of them, Adam, son of William Urquhart of Meldrum, aged 18 months, sickened on the seventh, and died on the eighth day. There was a great outcry, and Maitiand; tried to excuse himself by asserting that Adam was afflicted with hydrocephalus, which had been improperly concealed from him. Anyhow, the Aberdeenshire folk were satisfied with their experience, and recommended "Charlie Maitland to keep his new-fangled remedy for the English in future." He was more fortunate in the west of Scotland, where he "inoculated four children of a noble family," who escaped alive. The Scots, however, were deaf to his persuasions, and he made no headway among them. At a later date, 1733, inoculation began to be practised in and about Dumfries, and occasionally elsewhere.

In Ireland little more was effected than in Scotland. It was said that 25 inoculations took place between 1723 and 1728 with 3 fatalities. Dr. Bryan Kobinson inoculated five children in Dublin in 1725, and was the death of two of them.²

1. Massey's Remarks, p. 18.
2. Scheuchzer and Massey.

Inoculation met with faint acceptance on the Continent. Maitland went over to Hanover in 1724 and inoculated Prince Frederick and eight children of Baron de Schulenberg. In France the practice had been discussed by Dr. Boyer so far back as 1717 : and in 1723 the English experiments were recounted in Paris with much enthusiasm by Dr. de la Coste, evoking a declaration from the College of Physicians, " that for the benefit of the public, it was lawful to make trials of inoculation." A commencement was about to be made in the hospitals under the sanction of the Regent, the Duke of Orleans, when his death put a stop to the design. Soon after Dr. Hecquet published Raisons de Doute contre l'Inoculation, which, coupled with bad reports from England, made an end of the project.

If a London journalist had been called upon in 1728 to report upon Inoculation, he might have written as follows—

Seven years ago the practice was introduced to this country under powerful auspices. It was confidently averred that anyone might have his blood infected with the virus of smallpox, that a trifling ailment would ensue, and that thenceforward he would be secure from smallpox in the natural form. Experience rapidly belied these promises. The trifling ailment proved, in many cases, a serious ailment—so serious that physicians tried to anticipate and mitigate its severity by a preliminary regimen of bleeding, purging and vomiting. So exhausting and hazardous is the whole operation, that only sound and vigorous constitutions are considered fit for it; and the delicate and feeble, who require protection most, are advised to submit themselves as of old to the ordinary course of nature. Moreover, the induced smallpox is occasionally as severe as the spontaneous; the pustules are multitudinous, and sometimes confluent, with death for the issue. Fear may exaggerate the risks of inoculation, but more are believed to have perished than the inoculators are willing to confess. Again, many are not susceptible of inoculation, and though the infection fails to operate in their blood as desired, they do not always escape injury: they find their health disordered—are rendered sickly and uncomfortable. Worst of all, what none at first reckoned on, the artificial smallpox turns out to be infectious, and begets natural smallpox in those who are with the inoculated. Thus, the very means taken to limit the disease become a cause of its extension. Smallpox was more than usually prevalent in Hertford in 1721, and in London in 1724, and there was fair reason to conjecture that it was extensively disseminated by inoculation. Lastly, it is doubtful whether even successful inoculation protects from subsequent smallpox; for it is maintained that some of the inoculated have already fallen victims to the natural disorder. In short, the preventive appears to have so many drawbacks that it is questionable whether it is not worse than the malady; and it is probable that in a year or two it will pass into forgetfulness in common with many other remedies as highly extolled on early and imperfect acquaintance.

So much might have been stated and prognosticated in 1728: how the prognostic failed to be verified remains to be told.

CHAPTER 6. REVIVAL OF INOCULATION.

THE practice of inoculation, thus discredited, revived, and not only revived, but prevailed. The revival was gradual, and may be said to have acquired definition about 1748, under the powerful approval of Dr. Mead. In the score of years from 1728 to 1748, it is not to be imagined that the practice was abandoned: there were always a few repeating the attempt to have smallpox without the penalties of smallpox, but success was not conspicuous or encouraging. Inoculation was introduced to a generation specially disposed to receive it; and it was only allowed to slip for a time under the compulsion of manifest disaster. Perhaps there never was a people with such a taste for dodges in favour of health as the English of last century: the common intelligence was invested in quackery. Even Wesley found time to dabble in medicine, and to compile a volume of prescriptions for his followers, entitled Primitive Physic— a piquant mixture of sense with absurdity and credulity. Our forefathers had no clear conception of the connection of physical well-being with physical well-doing, and many of the essential conditions of health were unknown to them. Their physical afflictions were regarded as mysterious dispensations to be endured with resignation or frustrated with medicines. The same attitude of mind is far from uncommon at the present day, and many will recollect how, ere sanitary science attained repute, it was considered profane to assert that typhus was subject to control, and that cholera might be suppressed; whilst a drug to subdue either would be heard of with gratitude. Superstition has rarely had any objection to the apothecary.

An incident passed over in histories, although far more inwardly characteristic of the mind of the 18th century than a multitude of the superficialities wherewith their pages are cumbered, is that of Joanna Stephens and her remedies for the stone. Her cures were so remarkable and (on evidence) so indisputable, that a general demand arose for the revelation of her secret for the public benefit. This revelation Mrs. Stephens agreed to make on receipt of £5,000 as compensation; and a subscription was started, to which Fellows of the Royal Society, physicians, noblemen, bishops, ladies, and kindly folk of all orders set their names. Such, however, was the unanimity and anxiety to possess the Stephens secret, that it was pronounced a national concern, and Parliament was invoked to supply the requisite funds; whereon an Act was passed " for providing a reward to Joanna Stephens upon a proper discovery to be made by her of the medicines prepared by her for the cure of the stone." The discovery was duly disclosed to appointed trustees, one of whom was Archbishop of Canterbury, and the £5,000 was paid over in 1739; and here we have the heads of the precious revelation—

My medicines are a Powder, a Decoction, and a Pill.

The Powder consists of egg-shells and snails, both calcined.

The Decoction is made by boiling camomile, fennel, parsley, and burdock leaves (together with a ball, which consists of soap, swine's cresses burnt to a blackness, and honey) in water.

The Pills consist of snails calcined, wild carrot seeds, burdock seeds, ashen keys, hips and hawes, all burnt to a blackness, soap and honey.

JOANNA STEPHENS.

16th June, 1739.

The public were apparently satisfied with the purchase, but with the usual levity of credulity forgot Mrs. Stephens and her marvellous cures in the pursuit of fresh nostrums. Fashions in medicine are on a par with fashions in dress, and have only occasional reference to the permanence and veracity of nature.

The revival of inoculation in England was stimulated by reports from abroad. For instance, in the Gentleman's Magazine it was stated that in 1737 there were inoculated in Philadelphia—

Men and Women,..... 32

Children under twelve,......64

Negroes, . ....... 32

and that out of the 128 only one Negro died. Again, in the same magazine for 1738 we read—

In Barbados in March last there were upwards of 3,000 persons down in the smallpox, where inoculation is practised with great success.

Such reports, whilst secure from examination, were none the less effective over the public imagination. There was a report published by Dr. Mead in 1747, which derived great credit from his endorsement, and which continues to be cited to the present day as proof for inoculation, but which is a model of convenient and circumstantial vagueness worthy of Defoe. Thus Mead's story runs—

The following relation was communicated to me by a gentleman of great credit. He was a merchant at St. Christopher's in the West Indies, and in the making of sugar employed a great number of slaves. In one year, when the smallpox raged with more than ordinary violence in the neighbouring islands, with his own hands he inoculated three hundred of them, from five to sixty years of age, with such success, that not one of them died, though most of them were negroes. And whereas all the Americans suffer this distemper in a most terrible manner, yet experience shows, that it is much more dangerous when it attacks the natives of Africa.¹

Mead held positions which later and more exact inquiry rendered untenable. He would not allow that the pus of smallpox could communicate any disease but smallpox, if taken from a proper subject—a condition that required supernatural assistance to fulfil. He maintained that inoculation generated true smallpox, and that as no one could have smallpox twice, therefore no one could have smallpox after inoculation, and that reports to the contrary were not credible. It now goes without saying that in this contention Mead was at fault, but at the time his confidence was not inexcusable; and whilst defending and recommending inoculation, he made admissions which fully justified those who resisted and condemned his counsels. Let us not forget that the following passage was published in 1747, and was the fruit of six-and-twenty years of experience in the best London practice. Thus Mead wrote—

It ought not to be omitted, that boils and swellings under the ears and in the arm-pits arise more frequently after the distemper procured by art than after that which comes of its own accord ; for this reason, as I suppose, that the venomous matter is pushed forward with less force, which disadvantages Nature makes amends for in this way.

Therefore all possible means are to be used to ripen such tumours of whatever kind they are: if this cannot be done, they must be opened by incision; and when all the matter is drawn out, the body must be purged by proper medicines, which are to be oftener repeated in this than in the natural disease. ²

1. Medical Works of Dr. Mead, Vol. ii. p. 146. Edinburgh ed., 1765.
2. Ibid, p. 149.

How just are the judgments of Divine Order! These boils, swellings, and tumours, were the sequences of the violated harmony of the body—of the faithless anticipation, the meddling and muddling with its processes.

An extensive series of inoculations took place in 1742-45 in the south of England. Smallpox was prevalent in Winchester and adjacent towns, and Dr. Langrish operated freely on whoever resorted to him. In Portsmouth, Chichester, Guildford, Petersfield, and Winchester, it was said that at least 2,000 were poxed, and that only two pregnant women perished, who, as usual, " were inoculated contrary to the advice of their physician." The ill results, wrote Bishop Maddox, "were only such as might reasonably be supposed to have been worse had those operated on had smallpox in the natural way"—such being the euphemism wherewith boils, tumours, and other sequelae were accounted for.

The reviving favour for inoculation was indicated in this paragraph from the newspapers of 13th April, in 1744—

Fourteen children, three years old, having been inoculated for the smallpox in the Foundling Hospital, Hatton Garden, all with good success, the Governors have resolved to have all their children inoculated at the same age.

An important movement was made in 1746 with the opening of a Smallpox Hospital in Cold Bath Fields at which " the benefit of inoculation" was offered to the poor. At first those who applied were taken into the house, and nursed through their self-inflicted illness, but the proximity of the veritable smallpox, the regimen, and the seclusion were sufficient to deter applicants : those, however, who have a hobby to ride grow reckless in presence of obstacles, and by-and-by inoculation was offered to all comers, who were dismissed to recover and diffuse infection in their own homes.

With the revival of inoculation there was a revival of the controversy as to its lawfulness theologically. Dr. Isaac Maddox, Bishop of Worcester, preached a sermon on behalf of the Smallpox Hospital in St. Andrew's, Holborn, on 5th March, 1752,¹ which excited considerable attention.

1. A Sermon before the Governors of the Smallpox Hospital. Isaiah 1viii. 7. London, 1752; second ed., 1753.

He showed the necessity for such an hospital for the poor and forsaken of the great city—a necessity incontestable. He mentioned (and the remark supplies a curious note on the hygiene of the time) that ventilators were to be introduced, and it was expected that the access of fresh air might benefit the patients. The return of the Hospital for 1752 showed 344 admissions, with 262 recoveries, and 82 deaths—a proportion that does not contrast disadvantageously with 19th century hospitals, fortified with sanitary appliances. During the same year 112 inoculations were effected at the Hospital. The Bishop had been assured by three eminent surgeons that they had inoculated 1500 persons with only 3 fatalities, one of them (Sergeant Ranby) having accomplished one thousand without a mishap. The practice was without doubt lawful, for it averted a dangerous disease, and some risk was inseparable from all methods of cure. The practice had already done much to lessen smallpox, and, as it became commoner, it would do more. The result of the sermon was a subscription of £809 for the charity at the subsequent dinner in the Drapers' Hall.

The Bishop was singularly at fault in his ascription of diminished mortality to inoculation, for, in 1752, smallpox was more than unusually rife in the Metropolis, and its prevalence was not unreasonably attributed to infection, from the inoculated. In 1751 the deaths from smallpox in London were 998; they rose to 3,588 in 1752; declined to 774 in 1753; and rose to 2,359 in 1754.

Dr. Doddridge lent his powerful influence in favour of inoculation; and, considering the unqualified assertions of medical men as to its benefits and harmlessness, it cannot be said he was blameworthy. The audacious assurance with which many of them bore down opposition overcame the simple-minded, who argued as if the world were constituted after the pattern of their own innocent hearts. That smallpox frequently followed inoculation is now known beyond dispute, and yet Dr. Kirkpatrick wrote—

I have heard myself a great many rumours of the inoculated being naturally infected afterwards, which upon examination proved just as many lies.¹

1. An Analysis of Inoculation, 2nd ed. 1761, p. 145.

How could women and divines resist such evidence ?

A voluble antagonist of inoculation was the Rev. Theodore Delafaye of Canterbury. He preached a sermon in that city on the 3rd of June, 1753, from the text, " Let us do evil that good may come " (Rom. iii. 8), and published it under the title of Inoculation an Indefensible Practice. He was in turn attacked by the inoculators, and in 1754 issued A Vindication of 200 pages, in which he returned more than he received with vigour rather than discretion. His conclusion was—

Inoculation I maintain to be, in a religious and moral view, a, self-destructive, inhuman, and impious machination, and in a physical one an unreasonable, unnatural, unlawful, most hazardous, ineffectual, fruitless, uncertain, unnecessary device; in a word, a practice which nature recoils at, which reason opposes, and which religion condemns.

We sometimes read that inoculation was denounced as Atheism, and we are expected to reprobate or to smile at the bigotry; and, whilst we may not approve of the stigma, we may at the same time recognise the honest sense in which it might be affixed. Some who spoke of inoculation as Atheistic felt more vividly than they could otherwise describe, that it was an infraction of the deeper sanctity of Nature, where man's hand cannot enter and prosper, and that those who made the attempt could have no proper sense of Him in whom they lived, and moved, and had their being. Moreover, if we are to admit that they who thus expressed themselves are blameable for excessive vehemence, what are we to say of the more numerous party who did not hesitate to pronounce inoculation a discovery effected in the human mind by God himself ? If it was reasonable to speak of the practice as Theistic, why should it be fanatical to assert the contrary, and maintain that it involved a negation of Divine Providence ? Dr. Kirkpatrick., with the sycophancy which was the custom of his age, praised George II. for "the benevolent, and even celestial disposition," which induced him to patronise " the wonderful and probably Heaven-descended practice of inoculation;" and extolled " its equal simplicity and success" as demonstrating "to a reflective mind the goodness of Providence in making what may be so often necessary, so easily accomplished." ¹ It would not be difficult to cite scores of confessions of gratitude to God for inoculation, but to what purpose ?

1. Analysis of Inoculation, p. 348.

What we think good we necessarily ascribe to God; and we do well; but much that we think good is otherwise, or is only partially good; and what then ? Why, we are undeceived and corrected by experience. We put our notion of what is good to the test of practice, and God answers us in the event—justifies, amends, or confounds us. Thus with inoculation. It was fair that those who thought it good should refer it to God, and thank him for it; and it was equally fair that those who thought it bad should say it was none of his—that it was at variance with his order, and a discredit to the intelligence of those who imputed it to Him. How was the issue to be determined ? Only by God himself. And how would He speak ? In the results of experience wherein his will would become manifest beyond equivocation.

In 1754 inoculation obtained full recognition from the London College of Physicians. It was declared "that experience had refuted the arguments urged against the practice; that it was now more extensively employed in England than ever; and that it was highly beneficial to mankind. " The fence of hesitation was thrown down, and to be inoculated became the distinction of all who wished to be numbered with the enlightened and prudent. That the Circassians were famous for their beauty, and that they practised inoculation, was a staple argument, and an irresistible, with a multitude of Englishwomen. Opposition was chiefly confined to the lower orders, who objected to have the inoculated at large among them, and in some places threatened to demolish the houses where inoculation was performed.¹ Occasionally a medical practitioner acquired reputation as an inoculator, and was resorted to by patients from a distance, and his operations were not regarded with much favour by his neighbours. Thus the physicians and surgeons of Newbury, Berks, were compelled by their townsmen to promise to inoculate no one who had not resided in Newbury at least two years.

The new practice created much business, and its distribution excited some jealousy. Physicians complained that surgeons inoculated without their assistance, and surgeons that apothecaries did so likewise. Dr. Kirkpatrick laid clown the rule that every rightly conducted inoculation involved the employment of physician, surgeon, and apothecary—the physician to prepare and prescribe for the patient, the surgeon to cut, infuse, and dress, and the apothecary to make up the medicines. Some, however, dispensed with all three, and effected their own inoculations. A boy poxed fourteen of his schoolfellows in sport, and amateur inoculators, male and female, multiplied. As an example of amateur procedure, Dr. Kirkpatrick relates that a gentleman of Kent sent his servant, Silvanus, a young man, to Mrs. Chapman, at Heathfield, to be inoculated. He had to ride thirteen miles, and arrived hot and fatigued at the house of the inoculatrix. As he had taken his preparatory physic at his master's, Mrs. Chapman desired him to get ready at once for the operation, which he begged her to defer as he was in such a heat. She replied that he must be inoculated that very day, Tuesday, or remain until the following week, for Tuesday was her lucky day. The poor fellow allowed himself to be persuaded, and was then and there inoculated : severe smallpox ensued, and he died. ²

Thus was inoculation revived and established, and smallpox with it—established and diffused.

1. Gentleman's Magazine, March, 1753.

2. Kirkpatrick's Analysis of Inoculation, p. 359.

CHAPTER 7. TRIUMPH OF INOCULATION.

IT having come to pass, according to the boast of Dr. K irkpatrick, that inoculation was regarded as " the most salutary practice ever discovered for restraining a very loathsome and destroying disorder, which it had nearly expunged from the catalogue of mortal diseases," it was the aim of physicians and patients to reduce the trouble and hazard of the operation to the lowest terms possible. In the words of Dr. Jenner, " There was bleeding till the blod was thin, purging till the body was wasted, to a skeleton, and starving on vegetable diet to keep it so;" and practitioners who promised to mitigate these rigours, placed themselves in the line of popularity and prosperity. Among distinguished easy inoculators was a family named Sutton—"the Suttons" being a familiar name a century ago. Dr. Robert Sutton practised surgery and pharmacy at Debenham, in Suffolk, and went into inoculation with such energy that between 1757 and 1767 lie operated on 2,514 patients. His son, Robert, set up as inoculator at Bury St. Edmunds, where he did a large business, but a second son, Daniel, was the genius of the household. He had been acting as assistant to Mr. Bumstead at Oxford, and returned to his father in 1763 enthusiastic over a new plan of inoculation whereby the time of preparation was to be shortened, whilst the patients were to live in the open air. Old Sutton showed no favour for the projected innovation, whereon Daniel opened an inoculating house on his own account at Ingatestone, in Essex, advertising himself as inoculator on a new, safe, and sure method. The speculation answered. In 1764 he took 2,000 guineas, and in 1765 his receipts were £6,300. His fame spread throughout the country, and so many resorted to him that lodgings were scarcely to be had in and around Ingatestone. His practice in Kent was also extensive, and he was obliged to employ assistants. To crown his enterprise, he kept a parson—the Rev. Robert Houlton, to puff his skill and success. According to Houlton, the business of Daniel Sutton during three years was as follows—

Inoculated in 1764,     .        .        .    1,029
      „              1765,     .        .        .     4,347
                      1766,     .        .        .     7,816
                                                          13,792

to which number was added ,6000 inoculated by Sutton's assistants, making a total of 20,000, without, said Houlton, a single death.¹

1. Sermon preached at Ingatestone, 12th October, 1766, in defence of Inoculation, with App. on the present state of Inoculation, Lond., 1767.

Sutton was denounced as a quack, and if to reserve as one's own, and to traffic in what is proclaimed to be for the common advantage of mankind, constitutes a quack, Sutton was one. Nevertheless, he was successful, and his success begot so much jealousy that he was indicted at the Chelmsford quarter sessions, but acquitted with the thanks of the grand jury for the lesson he had taught the Faculty.

Much ingenuity was exercised in ferreting out Sutton's secret. His secret, so far as it was anything, was an open one; and supposing it necessary to infect men's blood with variolous pus, and then to operate for their recovery, there would be much to say for Sutton's procedure. His patients were obliged to go through a strict preparatory regimen for a fortnight, during which every kind of animal food, with the exception of milk, and all fermented liquors and spices were forbidden. Fruit of all sorts was allowed, unless on days when purges were taken. In the course of a fortnight a powder was thrice administered at bed-time, and a dose of salts on the succeeding morning. When the days of preparation were accomplished, the patient was taken to the inoculating house, where in the public room was found an array of people in various stages of smallpox. From one of these sufferers, the operator selected a pustule to his mind, opened it with his lancet, and, turning to the patient to be poxed, raised the cuticle on the outer part of his arm with the moist lancet, and pressed it down with his finger. This was the entire operation: no plaster or bandage was applied: and from that moment the patient was pronounced proof against smallpox, even if he should lie in bed with one suffering from the disease. Of course there remained the variolous affection to be dealt with. The regimen of preparation was continued unchanged, and a pill was taken nightly until the fever came on. None were allowed to rest in bed, except for sleep, but had to walk abroad and enjoy fresh air, even in winter weather. If a patient was too sick to go alone, he was supported by attendants; and when the fever was at its height, he was encouraged to drink copiously of cold water.

Much more was attributed to Sutton's pills and powders than to his regimen, and these were no more than preparations of antimony and mercury, with which practitioners of all orders were only too familiar. Sutton, however, contrived to maintain his mystery until he had no longer occasion for it, and lived to recognise a successor in Jenner. He removed to London in 1767 in hope of enlarging his income, but like many other provincial celebrities, discovered that he had better have remained where he shone without rivals and detractors.

The Sutton regimen, so far as it might be described as " cool," came into general favour, whilst what was called the hot regimen of warm rooms, bed, and cordials was correspondingly discredited. Contrasting the two methods, Sir George Baker, writing in 1771, observed—

I found that in the counties of Norfolk, Suffolk, and Essex, many thousands of people of all ages and constitutions, and some of them with every apparent disadvantage, had been inoculated with general good success; whereas at Blandford, in Dorset, out of 384 who were inoculated, 13 actually died, and many others narrowly escaped with their lives from confluent smallpox.¹.

1. Medical Transactions, vol. ii. art. xix.

A famous inoculator was Dr. Thomas Dimsdale of Hertford, a Quaker of easy principles. He published in 1766 a treatise entitled The Present Method of Inoculating for the Smallpox—an exposition of the most approved practice of the time, which, by one of those curious felicities of circumstance, conferred on him a European reputation; and in 1781, Tracts on Inoculation—a record of his opinions and adventures at home and abroad.

Dimsdale desired to universalise inoculation, but with circumspection. He recommended that the inhabitants of a suitable district should be dealt with as a whole and at once. That the names of all should be taken, and on a certain day that everyone, who had not had smallpox, should be inoculated. That the district should then continue in quarantine for about three weeks, at the end of which the danger and the fear of smallpox would cease, until an unpolluted generation should afresh accumulate. The project was not mere dreaming. Dimsdale was a man of influence and energy, and effected several complete inoculations of villages and parishes in Hertfordshire according to his plan. In later years, he combined banking with medicine, and the firm of Dimsdale, Fowler, and Co. of Cornhill originated with him and perpetuates his name.

Dimsdale's practice lay chiefly among the upper classes, to whom he made matters very comfortable. As he wrote—

I do not enjoin any restriction in respect to diet, nor direct any medicines to be taken before the time of operation by such as appear to be in a proper state of health.¹

He was satisfied with administering a powder on the evening of the day on which a patient was inoculated, consisting of calomel, tartar emetic, and crabs' claws.

Whilst labouring to popularise inoculation, Dirnsdalc was strongly opposed to the trade therein passing to xm-authorised hands—simple, safe, and salutary though he asserted it to be. Thus he averred—

The mischiefs arising from the practice of inoculation by the illiterate and ignorant are beyond conception.²

1. Tracts on Inoculation, p. 126.

2. Ibid. p. 107

How illiteracy should affect inoculation, he left to conjecture. He apparently forgot that the practice was derived from people who made no pretence to literature, and whose efficiency and success were, moreover, set forth as warrant and encouragement for English imitation.

In 1775 a Society was formed for General Inoculation, and an hospital was opened for the purpose at Battle Bridge, on the site of what is now the Great Northern Railway station, King's Cross. Dr. Lettsom, a popular Quaker physician, issued an appeal on behalf of the enterprise, and having invoked Dr. Dimsdale's approval, a lively controversy ensued between the brethren—personal rather than profitable. Dimsdale disapproved of indiscriminate inoculation: he was ready to inoculate the whole world, but systematically, and under strict safeguards. He pointed out that whatever might be the advantage to the individual, unless the inoculated patient was rigorously secluded, he would diffuse the disease from which he sought to be delivered, and that the price of his life might be the destruction of many. Dimsdale's warnings were, however, slightly regarded, and inoculation was pursued with criminal recklessness. As Pascal observes, of all the faculties given to man, the most awful in its consequences is the power of standing amid a number of facts, and seeing such as we please to see, and being blind to the rest.

Specially remarkable in connection with the smallpox of last century was the exaggerated terror expressed for it by professional inoculators, and the little real terror manifested by the multitude. It was by no means the most fatal of diseases, nor was it a large factor in the common mortality. Wherever we test the matter by unbiased contemporary evidence, we find the outcry factitious: the dreadful and desolating malady from which Jenner delivered his country is merely a fiction continued by the vaccinators from the inoculators. For proof let us turn to the evidence of Dr. Alexander Monro, Professor of Medicine and Anatomy in the University of Edinburgh. The Faculty of Medicine in Paris had appointed a commission to inquire into the advantages of inoculation, which in the course of duty applied to Monro, who in response produced and published in 1765 An Account of the Inoculation of Smallpox in Scotland. He reported that from the introduction of the practice by Maitland in 1726, there had been 5,554 inoculations effected in Scotland with 72 fatalities; that is to say about 140 annually with deaths 1 in 78, according to the confession of the inoculators themselves. Monro further stated that the practice was disliked in Scotland as " a tempting of Providence," an unwarrantable risk of life for an uncertain advantage. Our present interest, however, is in the statistics of deaths from smallpox in Edinburgh for a series of twenty years thus adduced by Monro.

	Burials from all Diseases	From Small pox.		Burials from all Diseases	From Small pox.
1744	1345	167	1754	1215	104
1745	1463	141	1755	1187	89
1746	1712¹	128	1756	1,316	126
1747	1200	71	1757	1,267	113
1748	1286	167	1758	1,001	52
1749	1132	192	1759.	1,136	232
1750	1038	64	1760	1,128	66
1751	1241	109	1761	903	6
1752.	1187	147	1762.	1,305	274
1753	1105	70	1763.	1,160	123
	12,709	1,256		11,613	1,185

1. Monro accounts for the excessive mortality of this year by the presence of regiments in Edinburgh after the suppression of the rebellion of 1745.

Here we have a piece of valid experience with every advantage to the smallpox terrorist: for Edinburgh last century was a city contrived as if for the generation and perpetuation of smallpox. The population of 55,000 was lodged thickly in flats, in houses of many storeys, closely built in lanes and courts—a population densely compacted as any in Europe, with arrangements for cleanliness indescribable, at this day perhaps incredible. Yet in conditions so propitious to smallpox, we see before us the total outcome during a series of twenty years; and reprehensible as the result may appear to contemporary sanitarians, who hold, and rightly hold, that all zymotic diseases are preventible, yet it affected Monro with no anxiety or dismay: nor does the rate of mortality of old Edinburgh contrast unfavourably with that of the modern city. The case of Edinburgh, however, serves to show that in all cases when we hear of the ravages of smallpox before Jenner appeared as deliverer, our policy is to insist firmly upon the production of special and adequate evidence : it is monstrous that the assertions of common quacks, whether inoculators or vaccinators, should pass into tradition and be accepted as unquestionable verity.

We have, moreover, to observe that the mortality from smallpox in Edinburgh was infantile mortality: for as Monro testified—

The inhabitants of Scotland generally have the smallpox in their infancy or childhood; very few adults being seen in this disease. Whether this is owing to any particular constitution of the air, or of the people, or to the disease not being so much dreaded as to cause any to fly from the place where it is, or to the great intercourse which must be among the inhabitants of the towns, of which several, nay, many families enter to their houses by one common stair, while in the villages the peasants are generally assistant to their neighbours of whose family any is sick, it is not now necessary to inquire.

Not only were the habits of the people contributory to the diffusion of eruptive disorders, but likewise their food, of which oatmeal was the staple, whilst vegetables were few, fruit rare, and tea unknown. Hence many maladies had free course; and as Dean Ramsay relates, a girl on her arrival at Mrs. Betty Muirheid's boarding-school in the Trongate, Glasgow, when asked whether she had had smallpox, replied, " Yes, mem, I've had the sma'pox, the nirls [measles], the blabs [nettle-rash], the scaw [itch], the kink-host [whooping-cough], the fever, the branks [mumps], and the worm [toothache]."

A last word as to Lady Mary Wortley Montagu. After a residence of twenty years in Italy, she returned to England to die, 21st August, 1762. On the west side of the north door in Lichfield Cathedral, there is a female figure, in marble, leaning on an urn inscribed M. W. M. The inscription runs—

SACRED    TO   THE    MEMORY
OF THE   RIGHT HONOURABLE
LADY MARY WORTLEY MONTAGU,
WHO HAPPILY INTRODUCED,   FROM TURKEY,

INTO THIS COUNTRY,
THE SALUTARY ART OF INOCULATING THE SMALLPOX.

CONVINCED OF ITS EFFICACY,
SHE FIRST TRIED IT WITH SUCCESS

ON HER OWN CHILDREN,
AND THEN RECOMMENDED THE PRACTICE OF IT TO

HER FELLOW-CITIZENS.
THUS, BY HER EXAMPLE AND ADVICE,

WE HAVE SOFTENED THE VIRULENCE, AND
ESCAPED THE DANGER, OF THIS MALIGNANT DISEASE.
TO PERPETUATE THE MEMORY OF SUCH BENEVOLENCE,

AND TO EXPRESS HER GRATITUDE
FOR THE BENEFIT SHE HERSELF RECEIVED FROM

THIS ALLEVIATING ART,
THIS MONUMENT IS ERECTED BY

HENRIETTA INGE,

RELICT OF THEODORE WILLIAM INGE, ESQ.,

AND DAUGHTER OF SIR JOHN WROTTESLEY, BART.,

IN THE YEAR OF OUR LORD,

MDCCLXXXIX.

Whilst we do not resort to epitaphs for truth, we may discover in them what was taken for truth, or what was wished to be taken for truth. We have in the foregoing epitaph the legend which has caught the popular fancy, and which is likely to survive corrections innumerable. It is the custom of mankind to identify a common movement with some prominent or picturesque figure in the movement, and to suppress the rest. The practice is convenient, but it taints all history with fable.

It may be said that the practice of inoculation met with no active resistance in England during the last thirty years of last century. How widely and deeply it extended it would be difficult to determine. The probability is, that the mass of the population was untouched, and that inoculation was limited to the upper and middle classes, and to the lower so far as they came under the immediate influence of those above them. We have, perhaps, an index to the condition of affairs in Dr. Wm. Buchan's Domestic Medicine, first published in 1769, which ran through eighteen editions, amounting to 80,000 copies, in the author's life-time. It is not uncommon to refer contemptuously to Buchan, but his work was the production of a man of vigorous good sense with faith in the good sense of his readers—a book creditable to the author and to the people who appreciated him.

Buchan was an inoculator, a zealous advocate of inoculation, and earnestly laboured to universalise the practice. In the Domestic Medicine, ed. 1797, he wrote—

No discovery can be of general utility while the practice of it is kept in the hands of a few. Had Inoculation been practised by the same kind of operators in our country as in the countries from which we derived it, it had long ago been universal. The fears, the jealousies, the prejudices, and the opposite interests of the Faculty are, and ever will be, the most effectual obstacles to the progress of any salutary discovery. Hence it is that Inoculation never became in any manner general in England till taken up by men not bred to physic.

Consistently with this opinion, Buchan strongly advocated domestic practice, saying—

They know very little of the matter, who impute the success of modern inoculators to any superior skill, either in preparing the patient or communicating the disease. Some of them, indeed, from a sordid desire of engrossing the whole practice to themselves, pretend to have extraordinary secrets or nostrums for preparing persons for inoculation, which never fail of success. But this is only a pretence calculated to blind the ignorant and inattentive. Common-sense and prudence alone are sufficient both in the choice of the subject and management of the operation. Whoever is possessed of these may perform this office for his children whenever he finds it convenient, provided they be in a good state of health.

This statement is not the result of theory, but of observation. Though few physicians have had more opportunities of trying inoculation in all its different forms, so little appears to me to depend on those generally reckoned important circumstances, of preparing the body, communicating the infection by this or the other method, etc., that, for several years past, I have persuaded parents and nurses to perform the entire operation themselves.

I have known many instances of mothers inoculating their children, and never so much as heard of one bad consequence. Common mechanics often, to my knowledge, perform the operation with as good success as physicians.

Having described the ordinary method of inoculation by incision with a lancet dipped in pus, he goes on to say—

If fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread, about half an inch long, wet with the matter, be immediately applied to the arm, midway between the shoulder and the elbow, and covered with a piece of common sticking-plaster, and kept on for eight or ten days. This will seldom fail to communicate the disease.

Instead of multiplying arguments to recommend this practice, I shall beg leave to mention the ease of my own son, at the time an only child. After giving him two gentle purges, I ordered the nurse to take a bit of thread which had been previously wet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, until it was rubbed off by accident. At the usual time smallpox made their appearance, and were exceedingly favourable. Surely this, which is all that is generally necessary, may be done without any skill in medicine.

Thus was smallpox made easy! Buchan appealed to the clergy for co-operation as inoculators—

The persons to whom we would chiefly recommend the performance of this operation are the clergy. Most of them know something of medicine. Almost all of them bleed, and can order a purge, which are all the qualifications necessary for the practice of inoculation.

And as propagandists—

No set of men have it so much in their power to render the practice of inoculation general as the clergy, the greatest opposition to it still arising from some scruples of conscience, which they alone can remove. I would recommend them not only to endeavour to remove the religious objections which weak minds have to this salutary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make use of a means which Providence has put in our power for saving the lives of our offspring. Surely such parents as wilfully neglect the means of saving their children's lives are as guilty as those who put them to death.

How familiar have vaccinators rendered this line of adjuration! If you do not comply with our prescription, and your children catch smallpox, then are you their murderers.

Here is another passage from Buchan, which with equal accuracy might apply to Vaccination—is indeed what is perpetually asserted to be the truth concerning Vaccination—

As the Smallpox is now become an epidemical disease in most parts of the known world, no other choice remains but to render the malady as mild as possible. This is the only manner of extirpation now left in our power; and though it may seem paradoxical, the artificial method of communicating the disease, could it be rendered universal, would amount to nearly the same thing as rooting it out. It is a matter of small consequence whether a disease be entirely extirpated, or rendered so mild as neither to destroy life nor hurt the constitution; but that this may be done by Inoculation, does not now admit of a doubt. The numbers who die under Inoculation hardly deserve to be named. In the natural way, one in four or five generally dies; but by Inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient.

In this deliverance, Buchan did not lie, nor did he speak for himself alone, but expressed the medical opinion of his time, precisely as a physician of to-day testifies concerning Vaccination. Yet we all know that Buchan was completely at fault, and substituted what he wished to be true for what was true.

I cannot leave Buchan without a few words in his favour, for, according to his lights, he was a worthy fellow, and the words shall be his own. He wrote—

I am old enough to remember the time when the success of Inoculation was supposed to be entirely owing to the preparation of the body, as it was called; but I am convinced that such preparation always has done, and still does, more harm than good. The body cannot be better prepared to meet a disease, than by being in good health. Medicine may cure a disease, but it cannot mend good health. When a person enjoys the blessing of health, he ought never to meddle with medicine on any account whatever.

No: nor with half an inch of thread dipped in pox.

CHAPTER 8. INOCULATION ABROAD.

BEFORE proceeding to relate how Inoculation was superseded and ultimately suppressed in England, it may be expedient to make some notes on the prevalence of the practice in other lands.

And first in New England where, as we have seen, Cotton Mather had precedence in subjecting the reports of eastern inoculation to the test of western practice. Mather and his coadjutor, Boylston, did not propose to make inoculation habitual, but to reserve it for use in epidemics. Sometimes years elapsed in New England without smallpox: there were no dense urban populations to constitute seats of zymotic disease: and to provide perpetually against what was occasional was obviously unnecessary. Nevertheless the colonists shared the common disposition of the time for pottering in remedies, and their slaves afforded convenient opportunities for experiments in which temerity had the sanction of beneficence. With the Whites, cleanliness, ventilation, drainage, and pure water, were conditions of accident rather than of providence, but with the Blacks life was that of the stye, and the consequences in smallpox were thought to be sufficiently accounted for by the assertion that Negroes were constitutionally pre-disposed to that disorder. Wherefore the Blacks from Boston to the Spanish Main were from time to time remorselessly inoculated, and all of them who afterwards escaped smallpox had their immunity ascribed to their inoculation.

Jonathan Edwards, the prince of Calvinistic divines, was killed by inoculation. There was an epidemic of smallpox in New Jersey, and, for security, Edwards was inoculated. The result was the generation of smallpox in a severe form, of which he died, 22nd March, 1758, in his 54th year. In search of a superfluous safety was he slain. A man of the age of Edwards had little to fear from smallpox; for the disease, in the vast majority, was an affection of the young, concerning which, as having attained middle life, Edwards might have maintained comparative indifference.

The colonists usually ascribed any outbreak of smallpox to importation by shipping from Europe, if not manifestly, then covertly; for, it was held that smallpox could never be evolved spontaneously. Great pains were therefore taken to isolate patients, and Boston and other sea-ports had hospitals erected on sites remote from habitation, from which a flag was displayed whenever occupied by the sick. A physician who visited an hospital was required to take off his wig, to change his shoes, and to put on a gown which hung from his neck to his ankles; and, when he came out, to wash his hands, and be fumigated with frankincense. In setting forth these precautions, Professor Waterhouse of Cambridge, Massachusetts, observed in a letter to Dr. Haygarth of Chester—

I cannot believe them altogether unnecessary. Our towns are small, our houses scattered, most of them having a garden between them, so that we have been able to trace the action of contagion. We have tried many experiments with smallpox in New England, and persuade ourselves that we have some pretensions of knowing more of that disease than you in Europe.

During the war with England, smallpox broke out in the American army, and inoculation was so freely resorted to that scarcely a man escaped the lancet. Washington had his New England soldiers inoculated at Cambridge in 1776, and it was difficult to find men to keep guard over the sick; that is to say, men who had passed through smallpox and were not considered liable to infection, a curious evidence of the rarity of the natural disease in the communities from which the army had been recruited.¹

1. Humphries's Life of General Putnam, p. 151.

Cotton Mather's triumph over Boston was complete— complete beyond his intention; for it came to be as thoroughly inoculated as any town in these days is vaccinated. Dr. Waterhouse, writing on 28th October,

1788, said-

We find that in 1752 there were but 170 persons liable to smallpox in Boston, and in 1754, when there was a general inoculation in the town, I question whether there was a quarter of that number that did not receive the infection via naturœ vel artis. In the years 1776, '77, and '78 they inoculated pretty freely throughout the State. Two days ago, I was at the review of part of the militia of the county of Suffolk, and of 520 men, I scarcely think there were a hundred above twenty-five years of age that had not passed through smallpox by means of inoculation ; and of 2,000 reviewed a week or two before, in the county of Middlesex, there was not a greater proportion of the same age liable to take the disease. Since 1764 the dread of smallpox has lessened considerably; and since 1778 we meet the disorder with as little fear as any people you can mention.

In another letter, dated 15th October, 1787, the Doctor said—

I do not believe there is at present a single person infected by smallpox in all the four New England Governments, that is, not one in a million of people.¹

1. These letters of Benjamin Waterhouse, M.D., Professor of Physic at Cambridge, Mass., appear in Haygarth's Plan to Exterminate Smallpox. London, 1793.

However it may have been elsewhere, inoculation was conducted in Boston with a formality and deliberation that might have satisfied Dimsdale himself. There was an inoculation hospital erected on Sewell's Point, which juts into Charles River, remote by a mile and a half from the common road, and situated in pleasant grounds with trees and walks. Three weeks were devoted to inoculation and the subsequent sickness, and before dismissal, wrote Dr. Waterhouse—

The patients are washed all over in soap suds, then rubbed with brandy, and lastly washed in vinegar; they put on fresh clothes, and bury those they wore during their stay in the hospital. But even then they are smoked and fumigated with sulphur in the smoke-house, which is about twice the size of a common sentry-box. This smoke-house has a hole in its side for the patient to put his head out of during the operation. Although this seems formidable on paper, yet patients submit cheerfully, and with no slight merriment.

There are perhaps 150 under inoculation at present at Sewell's Point, not one of them paupers. They are principally children, perhaps thirty or forty of them of the first people in the commonwealth. The charge for the whole process is 8 dollars, or 36s. sterling, including every expense from incision to dismission. In some places they inoculate for half that sum. You must conceive the whole business conducted with a good deal of gaiety, where a patient, when ill, is as apt to be pitied as if sea-sick with a sailing party. The established system of mirth and good humour contributes not a little to the welfare of the patients.

It is a curious story, and stands in broad contrast to the rough and ready practice of Turkey, and of many inoculators in England and elsewhere. Dr. Waterhouse adds—

There were a considerable number of persons in Boston to whom smallpox could not be communicated by inoculation. In some the operation was repeated two, three, and four times with fresh matter. Several of these have had the disease severely since in the natural way, and some have died of it.

France was slow to accept inoculation. After its introduction in 1723, about thirty years elapsed without any serious movement in its favour, when Voltaire, Diderot, and their set began to recommend the practice, which had the merit of being English and disliked by those who held change and improvement in aversion. La Condamine read an eloquent paper on the advantages of inoculation before the Academy of Sciences; and Turgot, the ardent and sagacious lover of his kind, procured the inoculation of a child in Paris, 1st April, 1755; which was followed on 14th May by a young man, named Chastellux, submitting himself to the operation in the interest of the common welfare. Then Dr. Hosty was sent to London to investigate and report, and on his return issued these statements—

1. That out of 463 cases inoculated in the London Hospital, only one had been unsuccessful; whereas in the Smallpox Hospital nearly one in four had died.

2. That Mr. Ranby, principal surgeon to his majesty, had inoculated 1600 persons, and Mr. Bell 903, without the loss of one.

3. That to form a just comparison between the fatality of natural and artificial smallpox, it is only necessary to visit the London Smallpox Hospital and then the Inoculation Hospital: the difference between the two is so remarkable that the most incredulous must be convinced.

4. Lastly, with respect to the asserted insemination of other diseases with inoculated smallpox: no instance of the kind has ever been produced. Persons have been inoculated with variolous matter taken from patients afflicted with venereal disease, yet they have received no infection save that of smallpox only.

It would be superfluous to deal with the fallacies involved in these statements: they served to satisfy those who were disposed to be satisfied, and inoculation became the fashion among the scientific and enlightened. Dr. Tronchin, a well-known inoculator, was summoned from Geneva to Paris in 1756 to operate upon the children of the Duke of Orleans, and his success was pronounced decisive. Nevertheless inoculation did not extend beyond people of leisure and culture, and in 1763 an outbreak of smallpox in Paris made an end of the practice. An inquiry was instituted by the authorities, and the evidence left no doubt that the epidemic had been diffused, if it did not originate, with the artificially poxed; and inoculation was thenceforth prohibited in Paris. Any citizen who was resolved to have the induced disease had to retire to country quarters.

Here we may observe that the confidence of the inoculator was grounded on the assumption that whoever had once passed through smallpox, whether natural or artificial, could never again contract the disease. Nevertheless the inoculated did contract the disease, and the disaster was uniformly accounted for as due to some imperfection in the inoculation. There were also instances of smallpox after smallpox, but these, too, were discredited; the first smallpox could not have been smallpox, but chickenpox, measles, or some other eruptive disorder. There was a conspicuous confutation of these evasions in the case of Louis XV. He had smallpox unquestionably in his 14th year, and of unquestionable smallpox he died in 1774 in his 64th year. Notwithstanding, the assertion was perpetuated that there was no possibility of smallpox after smallpox, and it was only when it became necessary to maintain the credit of vaccination that the facts were admitted; and in this form—Smallpox after vaccination is no more common or extraordinary than smallpox after smallpox—a falsehood on the back of a former falsehood.

We have seen under what safeguards inoculation was practised in Boston, and now we shall turn to Geneva and discover how all the American precautions were set at naught in that city with apparent impunity. The details are from a letter of the Council of Geneva, dated 24th December, 1791, addressed to Dr. Haygarth in answer to his inquiries and suggestions. Des Gouttes, secretary to the Geneva Syndic, wrote—

1.—The Republic of Geneva contains about 35,000 inhabitants, of whom 20,000 dwell in the city, and 9,000 in the adjacent country.

2.—The city is of small extent, and ill adapted to so large a population; and its extension is not easy on account of the fortifications wherewith it is surrounded. There are little more than 1,200 houses in the city, which are built in many storeys of many apartments like the ancient part of Edinburgh, each house sheltering on an average twenty-one inhabitants.

3.—A great part of the population consists of strangers, not only because most of our servants and labourers are natives of other countries, but because Geneva being a frontier city, girt about by Savoy, Switzerland, and France, and situated on the highways of intercourse between these states, travellers are always coming and going.

4.—Notwithstanding this continual resort of strangers within our walls, an epidemic of smallpox is of almost regular occurrence every five years; and between the epidemics it frequently happens that we have no natural smallpox whatever, either in the city or its vicinity,

5.—Inoculation began to be practised here in 1751, since which date we have inoculated a very large number of children annually, and with such marked success that the deaths have but slightly exceeded 1 in 300. Although we have often had to inoculate with pus brought from a distance at times when there was no smallpox to be found in the city, and although children so inoculated have gone freely into the streets, walks, and other public places, before, during, and after the eruption, we have never observed that they were sources of contagion, nor that they produced any intermediate epidemic, nor that they accelerated the return of the periodical epidemic.

6.—Lastly, our citizens enjoy a republican constitution which requires us to pay most scrupulous regard to the liberty of every individual. No coercive measures to hinder the introduction or communication of smallpox are here practicable; and we believe we ought to limit our action to advice, and to simple precautions of police, which must not, nor even seem to be, oppressive to the citizens.

This glimpse into old Geneva is not only instructive as concerns inoculation, but it is another exposure of the monstrous fable that represents European cities as decimated with smallpox until Jenner's advent as saviour—a fable that vanishes like smoke whenever brought into contact with matter-of-fact.

Inoculation was introduced to Rome and Florence during a severe epidemic in 1754; and attention being drawn to the remedy, it was discovered that the Italian peasantry had long practised voluntary smallpox just as did the peasantry of Wales and the Highlands of Scot-. land. In Spain inoculation made little headway: in the words of Moore—

Some inoculations were effected in a few trading cities, which held communication with England; but these efforts were of short duration, and from the distinguished inaction of the Spaniards, inoculation was soon relinquished; and no other country in Europe has suffered so little from smallpox.¹

1. The History of the Smallpox. By James Moore. London, 1815. P.288.

In Holland and Denmark inoculation acquired a certain vogue among the upper classes, and in Germany the like was true to a less extent. In Sweden inoculation was encouraged by the Court, and Dr. Schultz was deputed to visit the London Hospital. His report was so favourable that in 1755 inoculation houses were opened in several parts of the kingdom, and the benefits of the practice were commemorated by a medal in 1757—a curious trophy of illusion under prepossession.

Perhaps the most notable event in the story of inoculation was its introduction into Russia: how it was brought about is thus described by Mr. Morley—

As soon as Catharine came into power (1762), she at once applied herself to make friends in this powerful region [French letters and philosophy]. It was a matter of course that she should begin with the omnipotent monarch at Ferney. Graceful verses from Voltaire were as indispensable an ornament to a crowned head as a diadem, and Catharine answered with compliments that were perhaps more sincere than his verses. She wonders how she can repay him for a bundle of books that he had sent to her, and at last bethinks herself that nothing will please the lover of mankind so much as the introduction of inoculation into the great Empire ; so she sends for Dr. Dimsdale from England, and submits to the unfamiliar rite in her own sacred person.¹

1. Diderot and the Encyclopœdists. By John Morley. Vol. ii. p. 114.

One day in the summer of 1768, at his house in Hertford, Dimsdale received an unexpected message from Pouschin, the Russian minister in London, to wait upon him ; and in his presence he learnt that he was required to proceed at once to St. Petersburg to inoculate the Empress. There was of course some hesitation about undertaking so long a journey, but Pouschin had been authorised to overcome all obstacles. What would the doctor require in the way of expenses ? The Doctor discreetly answered that he would leave that to her Imperial Majesty, whereon Pouschin handed him £1000 to pay his way to St. Petersburg. Dimsdale summoned his son from his medical studies in Edinburgh, and the two set off for the North on the 28th of July.

At St. Petersburg Dimsdale was received with every mark of respect and liberal hospitality. He was introduced to the Empress, who was charming and gracious; and he was instructed to make the requisite preparations for the serious duty before him. He had to find pus, and to obtain pus he had to lay hands on a suitable sufferer from smallpox—a task which proved by no means easy. Having discovered a case to his mind, he had then had to overcome an obstinate objection to the abstraction of virus. He had, at the same time, to find a couple of healthy young men, who had not had smallpox, on whom to raise secondary virus, for the Empress could not be expected to run the risk of smallpox without mitigation. His first attempt was a complete failure, and he had to report accordingly to his expectant patient. Catharine heard his report with philosophical equanimity, and left him to try again. At last he was successful, and at the palace of Czarscoe Selo on Saturday, 11th October, 1768, the Empress swallowed five grains of mercurial powder, and late on Sunday evening Dimsdale inoculated her with fluid matter by one puncture in each arm. She did well. From the time of the inoculation to the commencement of the eruption, she walked every day for two or three hours in the open air, and, on the 1st November, she returned to St. Petersburg in perfect good health, to the great joy of the whole city.”¹ The Grand Duke was inoculated on the 30th October, and by the 22nd November had perfectly recovered."

1. Dimsdale: Tracts on Inoculation.

The Empress having played, the nobility had to follow suit, and Dimsdale was requested to proceed to Moscow to take them in hand; but at this time there was a new difficulty. There was said to be no smallpox in Moscow, and as Dimsdale could not inoculate without fresh virus, he had to inoculate two girls in St. Petersburg, designing so to time their disorder that he should arrive with them in Moscow in prime condition for business. One girl was a failure, and mishaps and delays on the sledge journey almost made a failure of the other. He did, however, reach Moscow in time enough to communicate the requisite infection to fifty patients, and in Moscow he remained for two months operating and playing the lion. Then he set off for home, and on his route through St. Petersburg found Catharine suffering from pleurisy, for which he bled her, drawing eight ounces of imperial blood. Then came the reckoning. In substantiate he had—

£10,000 down;

£2,000 for travelling expenses;

£500 a year for life, to be paid in net English cash, and

A superb gold snuff-box set with diamonds for Mr, Dimsdale.

In honours he had the appointments of—

Counsellor of State;

Physician to her Imperial Majesty; and Baron of the Russian Empire with descent of title to his eldest son.

It was a barbarian's style of recompense, paid under the eye of Europe. It cost Catharine nothing, for it is subjects who suffer for the extravagance of despots.

Dimsdale had plans for the systematic inoculation of Russia, but they resulted in little. Catharine's purpose was sufficiently served in the display she had made ; and possibly she came to consider Dimsdale an appendage of that deceiver Voltaire, whose busts, that had adorned her saloons and corridors, were by her orders thrown into the cellars when the French revolution opened her eyes to the consequences of French philosophy.

In perusing the literature of inoculation, nothing impresses a reader, enlightened by sanitary science, so much as the manner in which smallpox was regarded as something like hail or lightning that might be averted, but could not be prevented. So far, I have not met with even a hint in that literature that smallpox was either induced by unwholesome modes of life, or that it could be avoided by wholesome modes. In conjunction with this blindness was the amazing assumption of the inoculators, that every one inoculated was to be placed to their credit as saved from smallpox ; as if (granting inoculation to be prophylactic) smallpox was ever a universal epidemic, and as if multitudes did not pass through life without smallpox before inoculation was heard of. The true problem to be set and solved in all epidemics, whether of influenza or smallpox, is why some are susceptible and some insusceptible, and whether it is not practicable so to modify conditions as to carry over the susceptible to the ranks of the insusceptible.

CHAPTER 9. INOCULATION SUPERSEDED AND SUPPRESSED.

THE illusory character of human testimony is graphically illustrated in the case of inoculation. Suppose an inquirer wished to ascertain the ratio of deaths to inoculations, he would be completely bewildered. We have seen what Dr. Buchan wrote—

In the natural way, one in four or five generally dies of smallpox ; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient.

John Birch, an eminent London surgeon, said—

Not one in three hundred dies of inoculation in the general irregular mode of proceeding, and not one in a thousand among observant practitioners; and if the inoculated patient die, he dies of smallpox and of nothing but smallpox.¹

1. Serious Reasons for Uniformly Objecting to the Practice of Vaccination. By John Birch. London, 1806.

In the Edinburgh Review, October, 1806, we read—

Of those -who have smallpox naturally, one is found to die in six. Of inoculated patients, only one dies in two hundred and fifty. This at least is Dr. Willan's calculation; and we are persuaded that it is very near the truth. In London, where it ought to he best ascertained, some eminent practitioners have stated the proportion to be so high as one in the hundred. The zealous anti-vaccinists have denied it to be greater, under judicious treatment, that one in a thousand. It cannot be denied, however, that besides the risk to life, the disease, even under the mitigated form, has frequently proved an exciting cause of scrofula and other dreadful distempers, and has often been attended with blindness and deformity.

In Reynolds's System of Medicine, it is stated by Marson that—

The Smallpox and Inoculation Hospital was founded in London in 1746, and inoculation was continued there until 1822. Dr. Gregory went carefully over the records of the Hospital for that period of seventy-six years, and found that only three in a thousand died of inoculation. The inoculated disease was usually very mild, but not invariably so.

Scores of such testimonies might be adduced, twitching the reader from conclusion to conclusion; and in the conflict of authorities what is to be said ? It is true that if we select what evidence we like, and call it sound, and reject what we dislike, and call it unsound, we may prove anything; but it is also true, that if we are to be fettered by evidence we shall stand paralysed amid contradictions. When men who are competent, and obviously honest, deliver varying testimony, we are driven to seek some method of reconciliation; and in this matter of Inoculation wherein our resort is to books, and about which we can have no immediate experience, we may derive much light from the corresponding practice of Vaccination. Thus, what is commoner than for vaccinators to assert, that never within their sphere of observation have they witnessed a single case of injury resulting from Vaccination—not one! Subject any dozen ordinary practitioners to judicial examination, and they would thus testify with scarcely a note of variation. On the other hand, take any dozen mothers of families, especially from among the poor, and they would tell of illness, disease, and death following the vaccinators' lancets. The men are more or less competent and honest, and the women likewise, and how shall we account for their variance ? In the first place, the men have been drilled from the outset of their profession into the conviction that Vaccination is absolutely harmless, and if any disaster follows, it is coincidence, not consequence. Occasionally a practitioner of more vigorous intelligence than the average, like Mr. Henry May of Birmingham, sees what the mothers see, but does he report accordingly ? Not at all. In Mr. May's own words—

A death from Vaccination occurred not long ago in my practice, and although I had not vaccinated the child, yet in my desire to preserve Vaccination from reproach, I omitted all mention of it from my certificate of death.¹

1. Birmingham Medical Review, January, 1874.

Mr. May recognised the fact and concealed it: a duller man would have ascribed the death mechanically to erysipelas or pyœ mia. Indeed, it is a commonplace with medical men, that no child dies of Vaccination; and hence Vaccination is not an admitted cause of death; and when the fact is insisted upon, there is no limit to the hardihood wherewith the truth is crushed down and covered up. Coroners refuse to hold inquests on children slain by Vaccination, and Dr. Lankester, as coroner for Middlesex, did not hesitate to authorise a false certificate of death in order, like Mr. May, "to preserve Vaccination from reproach." ¹ As for mothers, poor creatures, few of them have minds of their own, and if only they were adequately assured that it was for the good of their offspring that their noses should be slit, they would believe, weep, and submit.

1. The facts are set forth in Vaccination Tracts, No. 14, p. 7.

But it will be pointed out that inoculators of the more reasonable sort admitted a certain mortality from the practice. It is so; but the admission was unavoidable. Inoculation communicated smallpox, and there was no evasion of the fact that occasionally the malady assumed a severe form, and the patient died. For such mishaps, however, there were always excuses. The patient was not in a suitable condition of body; he had been eating improperly; he had caught cold; and so on. There remained, nevertheless, the sequelae of Inoculation, which were just as persistently denied as are those of Vaccination, although there were always clear-sighted observers who maintained that it was impossible to infect the blood with a complex organic virus, and that it should exhaust its effects in a single and definite issue. We all remember how we used to be assured with contemptuous emphasis that it was utterly impossible to communicate Syphilis by Vaccination, and that assertions to the contrary were the fables of ignorance and malice; yet, we see that what was fabulous a few years ago, is now accepted as medical matter-of-fact. Nowhere is scepticism so useful as among physicians; for whenever they protest most, suspect most.

With the close of the 18th Century, Inoculation with smallpox to avert smallpox was accepted as sound practice throughout England. Its safety and efficiency were extolled by medical writers in terms curiously identical with those applied to Vaccination. The objectors were few, and for pious rather than physiological reasons; and the question that exercised practical and benevolent minds was how to universalise the remedy, which, on account of its troublesome accompaniments, was chiefly confined to the upper and middle classes. On this point it may be well to cite the words of Dr. Haygarth of Chester, who, in a letter to the Council of Health of Geneva, dated 10th February. 1792, thus sets forth the position of affairs—

In Chester, and, I believe, in most of the large towns of England, the casual smallpox is almost constantly present. All the children of the middle and higher ranks of our citizens are inoculated in early infancy. The populace, very generally regarding the distemper as inevitable, neither fear nor shun it; but much more frequently by voluntary and intentional intercourse, endeavour to catch the casual infection. All the difficulties of our Smallpox Society in Chester proceeded from this strange delusion and perversity of disposition. With us the smallpox is seldom or never heard of except in the Bills of Mortality ; but there its devastation appears dreadful indeed.

The strong objection to Inoculation was, that it diffused the disease generally which it was supposed to avert individually. Inoculators tried to minimise and deny the danger, but in vain; and nothing so contributed to the supersession of the practice by Vaccination as the expectation of escape from the artificially propagated disease. How extensive was that propagation, we leave the writer in the Edinburgh Review of 1806 to describe—

The inoculated smallpox is an infectious disease, and those who take it naturally from an inoculated patient have it as violently as if they had been infected from a case of spontaneous disease ; it is to all intents and purposes the natural smallpox again in them. Now, if it be considered that several hundred thousand persons have been annually inoculated in these Kingdoms for the last fifty years, it will be easy to calculate the immense addition that must have been made in that period to the cases of actual disease, and the increase of natural smallpox that may be supposed to have arisen from this constant multiplication of the sources and centres of infection.

Unless this culture and this traffic in smallpox throughout the United Kingdom be realised, the potent cause of the immediate and extravagant success of Vaccination will be left out of reckoning. When we are harassed, anxious and impatient under some course of conduct, our ears are open to any promise of relief; and it was to a generation so afflicted and so receptive that Jenner in 1798 made his revelation of the virtue of cowpox. No more need, said he, to inoculate with smallpox. Substitute cowpox; and whilst it will protect as effectually, it will inflict no injury and diffuse no infection. The revelation was received with acclamation, and within eighteen months of its delivery (without due experience, and without any warrant that could pass muster in the severe realm of science) the leading physicians and surgeons of London subscribed and published the following manifesto in the newspapers of 1800—

We, the undersigned physicians and surgeons, think it our duty to declare our opinion, that those persons who have had the Cow-pox are perfectly secure from the infection of the Smallpox, provided this infection has not been previously communicated.

I do not wish to anticipate the wondrous tale of Jenner—my present purpose is to show how Inoculation was set aside; and it suffices to state that cowpox rapidly made an end of inoculation with smallpox. Indeed, I question whether a revolution in practice was ever effected with similar facility. Within eight years of the delivery of Jenner's revelation, the writer in the Edinburgh Review of 1806, already cited, was able to testify—

The bitterest enemies of Vaccination will not deny, that more than nine-tenths of the medical world are decidedly and zealously in favour of it, and that all their demonstrations of its dangers and terrors have been insufficient to convert a single one of their brethren from so damnable and dangerous a heresy. Testimonies, it may be said, should be weighed, and not numbered; and in this respect the vaccinators, we are afraid, will have a splendid and indisputable triumph. We give the anti-vaccinists all the advantage in our power when we assign to them a few members of the profession in London; for in the country at large, we believe, they have not one respectable practitioner on their side in five hundred. In this great city and school of medicine [Edinburgh] we are assured, they are without a single public adherent.

The resistance to Vaccination was almost entirely confined to the resistance of inoculators, who were too deeply compromised by their own disloyalty to Nature, to make effective resistance. They were steadily borne down by the vaccinators, many of whom had been energetic inoculators, and displayed the usual ardour of apostates in condemning what they had formerly approved. Indeed, when we consider how Inoculation was commended for its efficiency and harmlessness by the same medical authorities who, within a year or two after Jenner's appearance, denounced the practice for its difficulties and dangers, their tergiversation appears little short of shameless. Dr. Lettsom had been an inoculator, yet on 2nd July, 1805, he felt warranted in writing—

What have not the abettors of Variolous Inoculation to answer for ? To shoot a dozen or two innocent people in the public streets of London would not be half so injurious as allowing the murderers to kill the rising generation, the future hope of the State. Nothing can show the supineness and ignorance of the Government more than legalising these Variolous Murders.

How far the conquest of the inoculators by the vaccinators had advanced, appeared in a debate in the House of Commons in 1806, when Wilberforce urged that Inoculation should be suppressed, or at least that those who insisted on Inoculation should be compelled to place their patients in quarantine. Mr. Windham admitted the scandal of wretched and miserable subjects of Inoculation being carried about in the streets, but he hesitated to recommend coercive legislation until persuasion had been fully tried and had failed. Dr. Matthews, M.P. for Hereford, took occasion at the same time to run with the hounds. Inoculation, he said, was a frequent cause of disfigurement and of death in its most awful form; it was a magazine of the most dreadful evils; a magnifier of mortality; and a means of introducing scrofula, a more dangerous and pernicious disorder than smallpox itself—facts which it would have been more creditable to have proclaimed when Inoculation was in fashion. It is so easy to kick when a foe has fallen, and where all are kicking. Human nature is never so despicable as when thus engaged.

The question of restraining Inoculation came again before the House of Commons in 1807, when the practice of inoculating out-patients at the London dispensaries and hospitals was energetically condemned. " I think that the legislature," said Mr. Sturges Bourne, " would be as much justified in taking a measure to prevent this evil by restraint, as a man would be in snatching a firebrand out of the hands of a maniac just as he was going to set fire to a city."

No one was more eager to suppress Inoculation by force than Jenner himself, and in July 1807, he sought an interview with the Premier for the purpose. In a letter to Dr. Lettsom he thus describes his mortification—

You will be sorry to hear the result of my interview with the Minister, Mr. Perceval. I solicited this honour with the sole view of inquiring whether it was the intention of Government to give a check to the licentious manner in which Smallpox Inoculation is at this time conducted in the metropolis. I instanced the mortality it occasioned in language as forcible as I could utter, and showed him clearly that it was the great source from which the pest of smallpox was disseminated through the country as well as through the town. But, alas! all I said availed nothing, and the speckled monster is still to have the liberty that the Smallpox Hospital, the delusions of Moseley, and the caprices and prejudices of the misguided poor, can possibly give him. I cannot express to you the chagrin and disappointment I felt at this interview.

We are not accustomed to regard politicians of Pereceval's order as favourable to liberty; and yet it is refreshing to remark in even the Tories of the Georgian age a jealous regard for the personal freedom of Englishmen and a hearty contempt for the plausible quacks who were always contriving to circumscribe it. Perceval was not opposed to Vaccination, but he would not consent to give it an illicit advantage over Inoculation. If it were the good thing it was asserted to be, it might be left to prevail by reason of its own quality.

Under medical and social pressure, the practice of Inoculation at public institutions was gradually abandoned. On 5th May, 1808, the inoculation of out-patients was discontinued at the London Smallpox Hospital, but not until 20th of June, 1822, did the inoculation of in-patients cease. In 1816 the Colleges of Surgeons of London and Dublin pledged themselves against the practice. A formal attempt at coercive legislation, often called for, was at last made by the directors of the National Vaccine Establishment. They framed and promoted a bill, which was introduced to the House of Lords in 1813 by Lord Boringdon, but it was ignominiously withdrawn in 1814—a choice example of grandmotherly legislation. Among its provisions was the enactment that whenever an inoculation took place, the clergyman of the parish should receive notice, and that rod flags should be displayed from the house where the patient lay! As Earl Stanhope observed, instead of being a measure of humanity, it would, if passed into law, be one of the most troublesome, inconvenient, and mischievous ever enacted.

In the discussion on this foolish project, Lord Eldon pointed out that the common law was already sufficient to arrest the exposure of sufferers from infectious disease ; and acting on the hint the Vaccine Establishment prosecuted a woman, 27th April, 1815, for carrying her inoculated child covered with pustules through the streets of her neighbourhood. Evidence was adduced that she had thus infected eleven persons with smallpox of whom eight had died. The Court of King's Bench pronounced her conduct illegal and criminal, but as it was the first prosecution for such an offence, she was let off with a sentence of three months' imprisonment.

A practice thus banned could not long survive in England, and by and by a medical man who would consent to inoculate became a rarity, or was accounted disreputable. Yet there remained old-fashioned folk who would have nothing to do with cowpox, and insisted on having genuine human pox for their children and grandchildren. Hence Dr. Epps writing in 1881 had to say—

There is a class of medical practitioners who inoculate for the smallpox. Society should utter its voice of moral indignation against such individuals, who glory in anything by which they can claim singularity, or by which they can increase their pecuniary means. Let not society be deceived into any parley with such practices upon the plea, that parents will have their children inoculated with the smallpox.¹

Gradually the inoculating practitioner ceased, and the practice remained in the hands of " ignorant and unqualified persons, old women, and itinerant quacks;" ² and then the end came. An Act of Parliament was passed in 1840 wherein it was enacted that—

Any person who shall produce or attempt to produce in any person by inoculation with variolous matter, or by wilful exposure to variolous matter, or to any matter, article, or thing impregnated with variolous matter, or wilfully by any other means whatsoever produce the disease of smallpox in any person in England, Wales, or Ireland, shall be liable to be proceeded against and convicted summarily before any two or more justices of the peace in petty sessions assembled, and for every such offence shall, upon conviction, be imprisoned in the common gaol or house of correction for any term not exceeding one month.

1. Life of John Walker, M.D. London, 1831, p. 326.

2. Letter of Poor Law Commissioners, 20th August, 1840.

The Government did not at first intend to make the prohibition absolute, but Mr. Wakley insisted that the time had arrived to suppress the nuisance summarily, and that not a voice would be raised in opposition. Nor was there any opposition. Mr. Goulburn expressed some hesitation, but the House was practically unanimous.

Outside the House few regrets were expressed. Dr. George Gregory, physician of the Smallpox Hospital at St. Pancras, was, however, a man of philosophic turn, and he did not see the old idol cast down unmoved.

On 23rd July, 1840 [he wrote], the practice of inoculation, the introduction of which has conferred immortality on the name of Lady Mary Wortley Montagu, which had been sanctioned by the College of Physicians, which had saved the lives of many kings, queens, and princes, and of thousands of their subjects, during the greater part of the preceding century, was declared illegal by the English Parliament, and all offenders were to be sent to prison, with a good chance of the tread-mill. Such are the reverses of fortune to which all sublunary things are doomed.¹

Gregory was not blind to the extravagant claims made for Vaccination, and evidently had a lurking conviction that all was not gain in the substitution of the new practice for the old, saying —

Had not the discovery of Jenner interfered to interrupt its extension and improvement, Inoculation would have continued to this day increasing yearly in popularity.2

1. Lectures on Eruptive Fevers. London, 1843, p. 39.
2. Ib., p. 93.

Yet was not Inoculation abolished. Sometimes when we get the devil out at the door, he presently re-enters by the window ; and thus while Parliament was making an end of Inoculation in one form, it was reviving in another.

It is to be understood that Jenner's cowpox, whatever it might be, was an uncommon and erratic disease, and its discovery and maintenance difficult. To provide a substitute, cows were from time to time inoculated with smallpox, and the resulting virus was used instead of the Jennerian specific. Lest one should be accused of questionable witness, let us refer to Dr. Seaton's Handbook of Vaccination. There we read —

Mr. Ceely of Aylesbury in February, 1839, succeeded in inducing vaccine vesicles on two sturks by inoculation with variolous lymph, and in thus establishing lymph-stocks, which passed at once into extensive use, so that, in a few months, more than 2,000 children had been vaccinated from them. In December, 1840, Mr. Badcock succeeded in variolating a cow at Brighton, and deriving therefrom a stock of genuine vaccine lymph. In this manner he has raised stocks of vaccine lymph for use on no fewer than thirty-seven separate occasions. The lymph thus obtained by him is now largely employed ; it has been supplied to many hundreds of practitioners, and very many thousands of children have been vaccinated with it. Mr. Ceely's experiments were repeated in America in 1852 by Dr. Adams of Waltham, and Dr. Putnam of Boston, who were able, it is said, to furnish the city and neighbourhood of Boston with all the vaccine matter used there since that period.

Again, Sir John Cordy Burrows, a surgeon, speaking as a magistrate, at Brighton on 5th February, 1876, observed—

The public seem scarcely to understand what Vaccination means. The vaccine lymph taken from a child is nothing more than what has passed from a smallpox patient through a cow. In 1856-58 I took an active part in inoculating seventeen cows with smallpox, producing in three cases vaccine lymph, and from these the world has been supplied.

Thus, as asserted, has Inoculation been revived, and Jenner's specific set aside. When Dimsdale had Russian nobles to operate upon, he tried to mollify the smallpox by passing it through healthy children. Cows have now taken the place of children, and the virus in its passage from arm to arm may still further be reduced in virulence, when it does not take up fresh malignities such as syphilis; but it is inoculation with smallpox all the same.

CHAPTER 10. AS TO THE PREVALENCE OP SMALLPOX IN THE 18TH CENTURY.

THE exact truth as to the prevalence of smallpox in the 18th Century is not attainable; vital statistics were undeveloped; and in the absence of precision the imaginative revel. M.D.'s and M.P.'s shut their eyes, tilt their noses skyward, and prophesy concerning the frightful ravages, and the salvation wrought by the revered and immortal Jenner. Any extravagance, as to the ravages, or as to the salvation, is accepted as laudable zeal for humanity. " Decimation " is a favourite word in this connection without any sense of its definite meaning. " What family before 1800 ever escaped decimation from smallpox?" asks Dr. Granville. "Smallpox decimated the country in olden times," says Dr. Chavasse; "it ravaged like a plague, whilst Inoculation caused the disease to spread like wild-fire;" adding as a sequence, " Vaccination is an important cause of our Increasing population." In the same temper, Lord Chief Justice Cockburn described an unvaccinated infant as "a centre of contagion;" and as the folly of the great is intensified in the little, Mr. Bompas, Q.C., informed the electors of Marylebone, that "a person not vaccinated is like a flaming fire-brand among the people." Thus the infants of last century were "centres of contagion ;" the adults were "flaming fire-brands;" whilst England was "decimated" with smallpox diffused like wild-fire by inoculation. What a picture of 18th Century England painted by Rant and illuminated by Delirium !

The tendency of excess on one side is to provoke to excess on the other, but the extravagance of these popular Tables ought to put us in love with homely matter-of-fact—wherein indeed is the true extreme of these frantic inventions. What was the extent of smallpox in England last century is the question. With accuracy, we do not know. The common estimates (when not evolved from inner consciousness) are based on the London Bills of Mortality, and when these Bills are scrutinised we find nothing to justify the opinion that the community was harassed and devastated by smallpox over other ailments. In the first place, we have to remark that the exact population of the metropolis was unknown. Some say it was 500,000 in 1701, and others 700,000. In 1751 it was generally reckoned at 750,000, and in 1801 it was said to be 958,863. Then we have to consider that the increase, whatever it might be, lay only partially within the Bills of Mortality, for several rising quarters were outside the boundaries, and there were extensive exemptions within. Thus, so late as 1818, we find Dr. Burrows writing—

The parishes of Marylebone, Pancras, Chelsea, Kensington, and Paddington, now forming an integral part of the metropolis, and containing a population of 160,000 are not within the Bills of Mortality, and make no returns. Neither are there any returns from St. Paul's Cathedral, Westminster Abbey, the Temple Church, the Rolls and Lincoln's Inn Chapels, the Chapter House, the Towel Church, and various other places of worship of the Established Church. Besides, neither Dissenters, Papists or Jews who have burying places of their own, are included in the Bills. Many of the wealthier classes when they die are removed for interment into the country; nor do they appear in the Bills.

With omissions so serious, the Bills are obviously worth little as registers of the number of deaths in any year in London ; and when we inquire how far they may be trusted as indicating the relative prevalence of certain forms of disease, we find them equally questionable. Dr Burrows thus describes the method by which the cause of death were ascertained—

Diseases as specified in the Bills are a disgrace to the medical science and civilisation in which as a nation we are acknowledged pre-eminent; nor can any effective reform take place while the sources of information are so ignorant and venal as at present. The information as to the disease of which any person dies is collected and verified in the following way.—The Churchwardens of each parish within the Bills of Mortality appoint two old women to the office of Searchers. These women as soon as they hear the knell for the dead, repair to the sexton of the parish to learn the residence of the deceased. They demand admittance into the house to examine the body in order that they may see that there is nothing suspicious about it, and judge of what disease the person died ; and they report to the parish clerk. The regular charge for the performance of this office is 4d. to each Searcher; but if an extra gratuity be tendered, they seldom pass the threshold or hall of the house, and are content with whatever account is given; or should they actually view the corpse, it is easy to imagine what credit due to the judgment they pronounce.¹

1. "On the Uses and Defects of Parish Registers." By G. M. Burrow M.D. In London Medical Repository, No. 58, October, 1818.

In presence of defects so grave as to the number of the dead, and of diagnosis so grotesque as to the causes of death, it would be unwise to argue with any confidence from the data of these Bills; yet, such as they are, we have nothing else to appeal to. The variations of mortality from year to year were of wide irregularity; and whatever influence smallpox might have had, it does not appear to have had much in magnifying the annual totals. Let us take a dozen years when smallpox was heaviest from the last seventy years of the century, and observe its relation to the entire mortality, and to that from fevers—

Year.	Burials from all Diseases.	From Smallpox.	From Fevers.
1736	27,581	3014	3361
1740	30,811	2725	4003
1746	28,157	3236	4187
1749	25,536	2625	4458
1752	20,485	3538	2070
1757	21,313	3296	2564
1762	26,326	2743	3742
1763	26,143	3582	3414
1768	23,639	3028	3596
1772	26,053	3992	3207
1781	20,709	3500	2249
1796	19,288	3548	1547
	296,021	38,827	38,398

Again, let us take twelve years when the death-rate from smallpox was at its lowest. Here they are-

Year	Burials from all Diseases	From Smallpox	From Fevers
1745	21,296	1,206	2,690
1750	23,727	1,229	4,294
1751	21,028	998	3,219
1753	19,276	774	2,292
1773	21,656	1,039	3,608
1780	20,517	871	2,316
1782	17,918	636	2,552
1786	20,454	1,210	2,981
1788	19,697	1,101	2,769
1795	21,179	1,040	1,947
1797	17,014	522	1,526
1799	18,134	1,111	1,784
	241,896	11,737	31,978

We thus see that in twelve years when the death-rate from smallpox was highest, as many died of fevers as of smallpox; and in twelve years when the death-rate from smallpox was lowest, there died thrice as many of fevers as of smallpox. Again, we have to remark, that, on an average of all the years, smallpox was accountable for something less than a tenth of the total mortality. Also we have to note, that the mortality from smallpox was in great part infant mortality, and that there is reason to believe measles was extensively confounded with smallpox. The infant mortality was prodigious. Rarely a year passed in which a fourth of the deaths was not set down to Convulsions—that is, to babes killed by improper feeding. In 1772 (the worst smallpox year of the century when 3,992 died) there were, 6,605 ascribed to Convulsions, the total mortality being 26,053.

Now I have no wish to minimise the London smallpox of last century, nor even to set 1797, when 522 died, against 1796, when 3,548 died. I yield to none in detestation of smallpox as a preventable and therefore disgraceful affliction. Let so much pass for granted; but do not let us in any access of sanitary fury lose alike eyes and reason and rave like maniacs. If smallpox was bad, fevers were worse, and as both had a common origin, why should we make a wanton and unscientific distinction between them ?

That smallpox should have been constantly present in London throughout last century was in nowise surprising. The citizens lived in a manner to invite and maintain fevers. I shall refer to their food and drink presently, and would now call attention to the fact that they were a stay-at-home generation almost beyond present-day belief. Cowper did not violate credibility when he sang—

John Gilpin's spouse said to her dear,

" Though wedded we have been
These twice ten tedious years, yet we
No holiday have seen."

They had no ready means of locomotion, and indeed did not think of fresh air and exercise. An apprentice or maid from the country entered London and was immured as in a prison. We know how the lower orders in our own time huddle together like pigs, unless so far as restrained by lodging-house law, but middle-class Londoners a century ago utilised their apartments, with more decency perhaps, but with equal ignorance of the virtue of oxygen. The Londoners were a densely compacted community, and at night the streets and lanes of the city were almost as thickly tenanted as a man-of-war, but without benefit of sea-air. A Quaker told me that he served his apprenticeship to a grocer in Cheapside between 1786 and 1793, that the shop was opened at seven in the morning and closed at ten at night, that he slept under the counter, that his ablutions were limited to his countenance, and that he never went out except to meeting on First Days; adding, that he had no sense of being hardly dealt with; it was the custom of the time, and he was as his fellows. Memoirs of the 18th century prove that he spoke the simple truth. Bishop Wilson of Calcutta records that he served in the house of a silk merchant in Milk Street from 1792 to 1797, that he was occupied from six or seven in the morning till eight at night; that there was supper at 8.30, followed by prayers, and that all went to bed at ten. An apprentice in the same house said that he never put on his hat for weeks together, and that more than three years elapsed before his first holiday was granted. William Cobbett in 1783 got into a lawyer's office in Gray's Inn where, he relates, " I worked like a galley slave from five in the morning till eight or nine at night, and sometimes all night long. I never quitted this gloomy recess except on Sundays when I usually took a walk to St. James's Park." Such instances might be multiplied to any extent; and in short it comes to this, that the Londoners of last century lived from year to year in their houses, and had no outdoor exercise. If they were careless about air, they were equally careless about light, and, but for the cost of candles, might have disregarded it altogether. Water was chiefly brought from wells or conduits, and was used sparingly; and it is needless to add, there were no water-closets. Even in well-ordered households, stenches were dreadful; and where there were slatterns, the condition of affairs may be faintly imagined. Horrible cesspools lay behind or beneath most of the houses, evolving pestiferous effluvia. Out of doors, the streets were scarcely less noisome. Rain was the chief scavenger. Swift, in his description of a City Shower, sets before us as graphically as Hogarth, the offices of the rain—

Now in contiguous drops the flood comes down

Threatening with deluge this devoted town.

Now from all parts the swelling kennels flow,

And bear their trophies -with them as they go:

Filths of all hues and odours seem to tell

What street they sailed from by their sight and smell.

They, as each torrent drives with rapid force,

From Smithfield or St. 'Pulchre's shape their course,

And in huge confluence joined at Snowhill ridge,

Fall from the conduit prone to Holborn Bridge.

Sweepings from butchers' stalls, dung, guts, and blood,

Drowned puppies, stinking sprats, all drenched in mud,

Dead cats, and turnip-tops, come tumbling down the flood.

Nor in estimating the sanitary condition of 18th Century London is the influence of the dead on the living to be forgotten. The twenty thousand who died annually remained to poison the survivors. The city grave-yards were places of decomposition, rather than of interment, and an odour of corpses pervaded many neighbourhoods. Mr. Samuel Gale wrote in 1736—

In the church-yard of St. Paul, Covent Garden, the burials are so frequent that the place is not capacious enough to contain decently the crowds of dead, some of whom are not laid above a foot under the loose earth. The cemetery is surrounded every way with close buildings; and an acquaintance of mine, whose apartments look into the churchyard, hath averred to me that the family have often rose in the night-time and been forced to burn frankincense and other perfumes to dissipate and break the contagious vapour. This is an instance of the danger of infection proceeding from the corrupt effluvia of dead bodies.¹

1. Nichols's Illustrations of Literary History, vol. iv. p. 499.

Church-goers were subjected to cadaverous influences from the dead in the yard without and from the dead in the vaults below; and pious thoughts acquired an indescribable savour of the sepulchre. Many illnesses originated in church; and families who led wholesome lives at home were brought into deadly peril when they turned out on Sundays to public worship.

It is necessary to enter into these details if we would know what manner of people the Londoners were who suffered from smallpox, and what sort of place London was wherein they suffered. Londoners have been taken for the standard of 18th century smallpox, in forgetfulness of the fact that there did not then exist in England a town of a hundred thousand inhabitants—perhaps only two or three of fifty thousand; whilst the rural population bore a far larger proportion to the urban than is the case at this day. In so far as the sanitary conditions of Bristol, Norwich, or York resembled those of London, the analogy between them held good; but to convert the London rate of smallpox into the common rate of England, of Europe, and of the world, and to use the appalling result as a whip of terror wherewith to enforce universal inoculation, and afterwards vaccination, was sheer absurdity, if not something worse.

Whilst smallpox was always present in London, its appearance in the country was irregular and usually epidemic. The Bills of Mortality of towns as large as Northampton wore sometimes clear of smallpox for years. Sir Gilbert Blane, in his advocacy of Vaccination versus inoculation, said, that previous to the practice of inoculation there were many parts of the country where smallpox was unknown for periods of twenty, thirty, and even forty years. Mr. Connah, a surgeon of Seaford, Sussex, with a population of 700, informed Dr. Haygarth in 1782, that one person had died of smallpox in Seaford about eleven years before, and he could not ascertain that any other death from the disease had occurred subsequently; and that there was reason to believe that a like immunity prevailed throughout the smaller towns and villages of southern counties. Wherever we inquire, we are driven to the conclusion that the prevalence and fatality of smallpox in the 18th century were grossly exaggerated by quacks and panicmongers. Nor should we forget in this connection how Professor Waterhouse, of Boston, an ardent inoculator, had to write in 1787—

I do not believe there is at present a single person infected by smallpox in all the four New England Governments; that is, not one in a million of people.

What we have to say of London smallpox during last century is, that prevalent as it was, our wonder is that; it was not more prevalent; that the disease was bred in the circumstances and habits of the citizens; and that if it were possible to reproduce the same conditions, we; should reproduce the same smallpox. On the contrary, say our valiant vaccinators, the same conditions might be reproduced, but if the citizens were universally and efficiently vaccinated and re-vaccinated, there would be no smallpox. Thus we are taught that people may eat and drink as they like, live in darkness, neglect personal cleanliness, take little exercise, breathe air polluted by respiration, filth, and putrefaction, and that whatever disease overtakes them, they will be proof against smallpox. The promise is deceptive, but it was the promise of the inoculator, and it is the promise of the vaccinator; and Dr. Drysdale, describes the practice which warrants the promise as " the greatest triumph of hygienic science —I repeat, by far the greatest triumph of positive hygienic science ever made."¹

1. The Times, 23rd Oct. and 4th Dec., 1879.

Some share in the fatality of 18th century smallpox must be charged to the treatment of the disease. What was described as the cool regimen was no secret, yet its practice appears to have been limited to few; whilst with the multitude, patients were confined to close and heated rooms, under heavy bed-clothes, plied with hot drinks, cordials, and alcohol, and kept in foul linen until killed or cured. Frequently, when symptoms of smallpox appeared, bleeding, blistering, and purging were energetically resorted to. If a family of children were affected, they were commonly stowed away in one bed, and their skins would stick together with pus and sweat. It was much the same in hospitals and workhouses. "I have seen above forty children," says Dr. Buchan, "cooped up in one apartment, all the while they had this disease, without any of them being admitted to breathe the fresh air." The same course was pursued with other fevers, and the effluvia of the sick-room was overpowering. Take this instance from Jenner's own household. His nephew, Henry, and a maid-servant, were seized with typhus, and Jenner wrote—

The stench from the poor girl is so great as to fill the house -with putrid vapour; and I shall remove Henry this morning, by means of a sedan chair, to an adjacent cottage.¹

Indeed, the cleanliness and ventilation we consider so salutary were sedulously avoided. Cold air was accounted specially pernicious, and occasionally when the poor, afflicted with smallpox, were exposed to the weather, astonishment was expressed that recovery instead of death was the issue. It is related in Hutchins's History of Dorset that Blandford was burnt down in 1731, and several patients in smallpox were laid under the arches of the bridge as a place of refuge, and, to the general surprise, all got well, although many had died in their beds before the fire. John Birch a London surgeon of high repute, writing in 1814, sums up the case for us on this head in saying—

I consider the natural smallpox a mild disease, and only rendered malignant by mistakes in nursing, in diet, and in medicine, and by want of cleanliness, which last is the fomes of hospital fevers, and all camp and contagious disorders.

It would hardly be too bold to say, that the fatal treatment of this disease, for two centuries, by warming the chamber, and by stimulating and heating cordials, was the cause of two-thirds of the mortality which ensued.2

1. Baron's Life of Jenner, vol. i. p. 107.

2. An Appeal to the Public on Vaccination. By John Birch.

We now come to an interesting question. If the reader refers to the list of twelve years of greatest smallpox, and to the list of twelve years of least smallpox in London, it will be observed that the years of least smallpox predominate in the last quarter of the century, and this in spite of the diffusion of the disease by Inoculation. The inoculators when charged with increasing smallpox appealed to the London Bills of Mortality. "Let us," they said, "take the last ninety years of the century, and we shall find that there died in London of smallpox in the thirty years—

From 1711 to 1740 inclusive            65,383
          1741 to 1770                           63,308
          1771 to 1800                           57,268

Here we see, that the number of deaths was greater in the first thirty years by 2,075 than in the second thirty years during which Inoculation had acquired some stability, and greater by 8,115 than in the last thirty years during which Inoculation was the established practice of most prudent families.¹ We are therefore unjustly accused. These figures leave no doubt that smallpox decreasing, and we claim that the decrease is due to our practice."

1. Dr. Adams in Medical Journal, 1810, p. 31. Dr. Gregory in treatise on Eruptive Fevers, 1843, cites and endorses this argument.

The decrease was certain, but I cannot allow that was due to Inoculation; on the contrary I assume the decrease would have been greater but for the culture of the disease by the inoculators. The fact is extremely distressing to the more rabid vaccinators, and Dr. Corfield tries to curse it out of existence as "the falsest of falsehoods;" but there it abides. It is hard for those who represent Jenner as the saviour of mankind from smallpox to have it shown that Londoners, at least, were in process of salvation before his intervention ; but facts are cruelly unkind to theorists, sentimentalists, quacks of all sorts. In the words of Dr. Farr—

Smallpox attained its maximum mortality after Inoculation was introduced. The annual deaths from smallpox from 1760 to 1779 were on an average 2,323. In the next twenty years, 1780 to 1799 they declined to 1,740. The disease, therefore, began to grow less fatal before Vaccination was discovered ; indicating, together with the diminution of fevers, the general improvement of health then taking place." ¹

1. Article, "Vital Statistics: Epidemics," in M'Culloch's Statistical Account of the British Empire.

The decrease of smallpox towards the close of the century, says Dr. Farr, was due to "the general improvement of health then taking place;" but to what was that improvement due ? No marked improvement had been effected in the sanitary arrangements of London— why then this change for the better ? My answer is, that a great alteration was in progress in the popular diet.

Dr. George Cheyne, in his famous Essay of Health and Long Life, published in 1724, says—

There is no chronical distemper whatsoever more universal, more obstinate, and more fatal in Britain, than the Scurvy taken in its general extent.

And more than fifty years afterwards, in 1783, we have Dr. Buchan bearing similar testimony—

The disease most common to this country is the Scurvy. One finds a dash of it in almost every family, and in some the taint is very deep.

It is scarcely necessary to cite authority for what was so generally known and confessed; but in this question of smallpox and its prevention we have to deal with many who appear to be destitute of any historic sense; who argue as if what Englishmen are today, they always were; and who contend that as there was more smallpox in London before Jenner than since Jenner, therefore Jenner must be the cause of the diminution. It is necessary to condescend to such feeble folk.

The cause of the general scorbutic habit of the people was widely recognised by medical men, and Buchan merely repeated their common opinion in saying—

A disease so general must have a general cause, and there is none so obvious as the great quantity of animal food devoured by the natives of this island. As a proof that Scurvy arises from this cause, we are in possession of no remedy for that disease equal to the free use of vegetables.1

1. Domestic Medicine. Chap. 1vi. Concerning the Diet of the Common People.

Cheyne said much the same at the earlier date. He complained that the upper classes gorged themselves with animal food, and slaked their thirst with wine, "which is now [1724] become common as water, and the better sort scarce ever dilute their food with any other liquor." Beer had the place of wine among the middle and lower orders. In the words of Buchan—

The English labourer lives chiefly on bread, which being accompanied with other dry, and often salt food, fires his blood and excites an unquenchable thirst, so that his perpetual cry is for drink.

He adds—

If men will live on dry bread, poor cheese, salt butter, broiled bacon, and such like parching food, they will find their way to the alehouse—the bane of the lower orders, and the source of half the beggary in the nation.

Were we to say that the diet of the English for the greater part of last century consisted of Bread, Beef, and Beer, we should not go far wrong. The London bread was then, as now, poor stuff; "spoiled," says Buchan,"to please the eye, artificially whitened, yet what most prefer, and the poorer sort will eat no other." Whenever it could he obtained, beer was the beverage that went with bread, and was drank by young and old. Salt beef and mutton, bacon, salt fish, and butchers' offal completed the dietary of the multitude. The feeding of the poor in hard seasons exercised the beneficent severely, for the baker's bill often went far to exhaust the working-man earnings.

It was easy to recommend the rich to get rid of their scurvy by a resort to vegetable food, but to the poor with their obstinate prejudices, shiftlessness, and ignorance, such a recommendation was a sort of mockery. Deliverance, however, came in a form recommended by pleasantness and economy, namely, in the potato. It is true the tuber had been known long before, but not as an article of free and ordinary consumption. Toward the middle of the century it was discovered that potatoes could be grown cheaply in large quantities, and supply and demand developed together. Women and children especially rejoiced in the new food, whilst the benevolent exulted in the liberal accession to the poor man's fare. It became a point of duty with Lord and Lady Bountiful to recommend the culture and consumption of potatoes everywhere; and to see how far the substitution of potatoes for bread had extended early in the nineteenth century, we need only refer to the pages of Cobbett, who denounced the change with unwearied virulence as a degradation of humanity. Certainly potatoes are inferior to bread in nutritive value, but in food we have to look for more than mere nutriment; and the general use of the potato went far to purify and ameliorate the blood of the English people.

The appearance of the potato as a cheap constituent of common fare, was an argument wherewith Jenner endeavoured to allay apprehensions, that, having stopped smallpox, there would soon be more mouths than food to fill them. To Dunning he wrote, 10th February, 1805—

I have often urged the following argument when too numerous a population has been thrown in my teeth, as one of the ill effects likely to attend vaccination. Who would have thought a century ago, that providence had in store for us that nutritious and excellent vegetable, the potato—that ready made loaf, as it were, which is prepared in higher perfection in the garden of the cottager than in the highly manured soil of the man of opulence.

And again to Worthington, 25th April. 1810—

What a gift from Heaven was this extraordinary vegetable—a ready made loaf; reserved, too, till the hour when population, in these realms at least, began first to increase; and then coming we scarcely know how. Away with Malthus and his dreary speculations ! The skies are filled with benevolence, and let population increase how it may, let us not distrust and suppose that men will ever pick the bones of each other.¹

1. Baron's Life of Jenner, vol. ii. pp. 348 and 410.

Nor was the change in the people's diet limited to the introduction of the potato; with it came tea. Of course we know that tea was drank in England long ere George III. was King, but it was in his days that tea came into popular use. Here again we may refer to Buchan, who was strongly opposed to the innovation. He wrote—

It is said the inhabitants of Great Britain consume more tea than all the other nations of Europe together. The higher ranks use tea as a luxury, while the lower orders make a diet of it. The lowest woman in England must have her tea, and the children generally share it with her. The mischiefs occasioned by tea arise chiefly from its being substituted for solid food, and had I time to spare, I think it could not be better employed than in writing against the destructive drug. Its use will induce a total change in the constitutions of the people of this country. Indeed, it has gone a great way towards effecting that evil already.

What Buchan had not time to do, Cobbett subsequently did, and some of his most racy patches of vituperation were applied to tea and tea-drinkers. In Bacon, Bread and Beer, according to Cobbett, consisted the strength of the English working-man, whilst tea and potatoes he held in abomination.

To this partial substitution of potatoes and tea for salted animal food and malt liquor, we may justly attribute the reduction of the scorbutic habit of the people, and that improvement of health which were coincident with the close of last century and were continued into the present. What every student of vital statistics has to remember is, that conditions have to be identical to yield identical results. The lives of the majority of the English people last century, and notably so in London, were hard and sordid to a degree which in these times is difficult to realise. Their sanitary conditions have been indicated, and I would now enforce the observation, that they were ill fed and insufficiently fed; consequently their diseases were malignant, and smallpox not un-frequently scarred deeply its scorbutic victims. Wherefore to run a parallel between the Londoners of the 18th century and the English of the 19th in the matter of smallpox, and to ascribe any difference between them to Jenner's specific, is to display ignorance that is inexcusable, or craft unscrupulous.

PART 2.-VACCINATION.

CHAPTER I.

JENNER'S EARLIER YEARS.

THE competent biographer, it is said, must be an admirer of his subject, for only so far as he sympathises can he understand. Tout comprendre c'est tout pardonner. But I neither propose to write a Life of Jenner, nor do I believe it essential to insight to sympathise where compelled to reprobate. In Jenner's case we have to deal with an accident rather than with a vigorous personification of evil. It was his fate to have a happy (or unhappy) thought, adapted to the humour and practice of his time, which was immediately caught up and carried to world-wide issues. In himself, he was as ordinary a character as was ever thrust into greatness. For the mischief of his thought, some of his contemporaries were as responsible as himself—some, indeed, more blameworthy. With Bishop Butler I may ask, "Why may not whole communities be seized with fits of insanity, as well as individuals ?" and with him aver, "Nothing else can account for a great part of what we read in history." The common mind passes at times into unwholesome conditions, wherein the words of Paul are exemplified, "For this cause shall God send them a strong delusion, that they should believe a lie."

Edward Jenner, the son of a clergyman, was born at Berkeley, Gloucestershire, on 17th May, 1749. After the usual education of a youth of his class, he was apprenticed to Mr. Ludlow, surgeon and apothecary, of Sodbury, near Bristol; and on the completion of his time (1770) was sent to London, where he resided for two years with Dr. John Hunter, who increased his means for scientific inquiry by the reception of pupils, caring much more for his menagerie at Brompton than for patients, and utilising his pupils as assistants in his researches. Captain Cook returned from his first voyage of discovery in 1771, and his collection of specimens of natural history was assigned to Hunter for arrangement, who set Jenner to work upon them; and, it is said, he did his duty so well that he was offered the appointment of naturalist in Cook's next expedition. Jenner was, however, eager to commence business as country surgeon, and in 1772, at the age of 23, he returned to his native vale, legally qualified by his experience at