The “Dangerous and Sinful Practice of Inoculation”
In 1721, London was hit with a smallpox epidemic. In response, Lady Mary Wortley Montagu, wife of the former ambassador to Turkey, had her 2 ½-year-old daughter variolated (inoculated) in front of an audience of physicians and members of the aristocracy, thus introducing the practice to British society. It had long been understood that survivors of smallpox carried life-long immunity: the practice of inoculation introduced smallpox matter directly from one person into the arm of another, generally resulting in a milder case than if one had caught the virus “wild.”
The experiments of the fashionable aside, inoculation was introduced at a time when popular understandings of the body and disease centered on divine intervention: “Diseases are sent,” preached the Reverend Edmund Massey, “if not for the Trial of our Faith, for the Punishment of our Sins” (p. 10). Therefore, to inoculate oneself or children against disease, was an arrogant refusal of God’s will, and would only lead to eternal punishment.
Massey’s opposition to the new practice of inoculation was only one of several arguments. Dr. W. Wagstaffe, of the College of Physicians, asserted that inoculation was so far proven effective for cultures who dwell in “a warm Climate, living on a spare diet, and in the lowest manner.” Englishmen, on the other hand, were “the product of the richest Diet,” and therefore an operation that originated in the near East could not be simply transplanted to Britain. Physicians, he asserted, should refrain from practicing it until they had more experience.
Charles Maitland, himself an inoculator, wrote a lengthy pamphlet in which he responded line by line to the arguments put forward by both gentlemen the same year.
The Discovery of Vaccination
From: Edward Jenner, “An inquiry into the causes and effects of the variolae vaccinae,” 1798.
In 1796, Edward Jenner began a series of experiments based on local knowledge that individuals who contracted cowpox in the course of handling livestock were not susceptible to catching smallpox. Jenner first located a number of individuals who had developed cowpox lesions previously – each case detailed in his 1798 pamphlet – and attempted to inoculate them with smallpox. In no case did the disease take. He then took cowpox matter from sores on the had of Sarah Nelmes, and introduced this into the arm of an eight-year-old boy, by making scratches into his skin. The boy was subsequently inoculated with smallpox matter, but it did not take, thus proving cowpox (or vaccinae, from the Latin, vacca, for cow) an effective preventative of smallpox.
Vaccination: a Moral Imperative
Published four years after Jenner’s discovery, Dr. Lettsom’s plea to parents to have their children vaccinated cited an increase in the mortality rate across Europe from both naturally-occurring cases of smallpox as well as from inoculation. “Parents and guardians of children!” he wrote. “If you allow them to take the Small-pox, and they should die of it, are you not accessory to their deaths? As the Vaccine Inoculation is a certain security against the Small-pox; as it introduces no constitutional disease or blemish, and is never fatal; what apology can you offer for neglecting the means of prevention and security?” Lettsom asserted that it was divine providence that the vaccine had been discovered when it was, and was a means of saving lives, as Christians had been instructed to do.
Organizing to Eradicate Smallpox
Nineteenth-century New Yorkers – and Americans generally – lived in a world with few government-sponsored social welfare programs. Nearly all services for the public welfare were provided by charitable organizations founded and funded by private, usually well-to-do citizens. One such society, the New-York Vaccine Institution, was incorporated in 1844 with the purpose “exterminating” smallpox through vaccination. The Institution provided free vaccines to anyone who visited their clinic, and also supplied the virus to individuals who worked with the public, including missionaries, sea captains, agents for receiving immigrants, and manufacturers, so that they might also vaccinate their clients and employees.
Notably, the Vaccine Institution was founded in the midst of a massive wave of immigration to the United States from Ireland and what is now Germany; approximately 7.5 million immigrants arrived on the east coast between 1820 and 1870. As stated in the organization’s charter: “a peculiar necessity exists for such an institution in this city, on account of the constant influx of emigrants, and the rapid changes of its population” (p.1). Probably it was this realization that led the Institution to establish its offices and clinic at 369 Broome Street, located in the heart of Manhattan’s densely-populated, predominantly immigrant Lower East Side.
Normal Progression of a Vaccine Vesicle
Dr. Holt’s 1171-page authoritative text on the diseases of childhood featured a substantial section on specific infectious diseases, including: scarlet fever, measles, rubella, mumps, diphtheria, typhoid fever, pertussis, tuberculosis, influenza, chicken pox, and vaccinia-vaccination (inoculation with cowpox). The image above shows examples of typical progression of the vaccination vesicle; in normal progression, the initial wound healed within 3-5 days, with sign that the vaccine took (figure A) appearing on the fifth day. Holt’s textbook includes a number of illustrations and charts and graphs, particularly when a visual would aid in diagnosis – especially useful for differentiating measles and chickenpox, as both febrile diseases cause rash or pustules on the skin. Noticeably absent from this text, however, is information on the diagnosis and treatment of smallpox. Instead, Holt rather extensively covers the process of vaccination and after-care, along with information on complications as well as common injuries (infection with tetanus, the activation of latent tuberculosis) that were known to occur. He was emphatic, however, that in the majority of cases such injuries could have been avoided if sterile lymph were used or if attention was paid to contraindications – children with active eczema rashes or syphilis were not to be vaccinated.
Holt informs his readers that: “the nature of the protection against smallpox which vaccination affords is even now but imperfectly understood. The fact, however, remains one of the best attested in medical history …It is the imperative duty of the physician to see to it that every young infant is vaccinated” (p. 998). This statement is accompanied by a chart, displaying the annual rates of death per 100,000 from smallpox from three European countries: Prussia and Holland, where vaccination became compulsory in 1874 and 1873, respectively, and Austria, where it had not been made mandatory.
Against Compulsory Vaccination
Major Boudren vigorously opposed compulsory vaccination in stark language: “The violation of the body of a healthy person and the defilement of the pure blood of a child or adult by pus inoculation as in vaccination, and without their consent, is assault and a crime in the nature of rape” (p.4). Boudren’s reasons for opposing vaccination range from an interpretation of compulsion to the procedure as a violation of individual liberty to alleging that a great many more deaths were caused by the vaccine itself than were killed by smallpox. These are supported by quotes and pieces by more eminent authors and a list of individuals injured or killed by vaccines for the years 1909 and 1910 (67 in total).
Boudren’s views on the subject can best be understood in the context of the Progressive Era, a time of rapid modernization as well as expansion of government involvement in everyday life. A number of individuals, unnerved by these rapid changes, sought to exert more direct control over government policy and to preserve their own bodily autonomy. Boudren also offers an alternative interpretation of the child welfare rhetoric that upheld compulsory vaccination for school children as necessary to their protection and to the nation’s welfare: rather than protecting children from disease, public health officials were introducing loathsome material into the body of an innocent child.
In Defense of Vaccination
According to Professor Dock, “many antivaccinationists [in 1907] are both ignorant and fanatic, but more are merely ignorant” (p. 1-2) Dock paid no mind to the arguments put forward by Boudren and others that vaccine itself resulted in injury and death; instead, he addresses the question of whether or not state governments had the authority to enforce vaccination and the benefits of a systematic approach to vaccinating the public. In detailing the various loopholes and oversights across the several states’ laws regarding vaccination, Dock builds an argument typical of the Progressive Era: the problem is not the vaccine itself, it’s how it had been administered. A system whereby vaccines were administered routinely and regularly, documented thoroughly, by well-trained officials, supplied by vaccine manufacturers whose product was overseen by the best experts, could only result in a total abatement of smallpox epidemics and would see no accidental deaths or injuries.
Smallpox defeated: Vaccination still necessary?
The last case of smallpox to occur in the United States was in 1949. By 1971, smallpox had been eradicated in North and South America. The following year, based on the advice of the American Academy of Pediatrics as well as that of the Centers for Disease Control, many states ended compulsory smallpox vaccination requirements for school children. This decision was not without attendant controversy, however. Older physicians, who remembered the severity of smallpox and its high (30 to 60 percent) mortality rate, advocated caution and recommended that compulsory vaccines be reinstated. The disease was still present in some areas of the globe, and air travel had raised the specter of an outbreak in an isolated area becoming an instantaneous global epidemic thanks to a single traveler. Additionally, skeptics of the United Nations and of global organizations hypothesized that smallpox eradication efforts could lull the United States and other western powers into a false sense of security, making them susceptible to a biological warfare attack.
In response to such concerns that had been aired in issues of the Virginia Medical Monthly, Robert Jackson, an epidemiologist for the state of Virginia, wrote the above letter to the editor of that journal. Jackson’s letter is an example of a new point in the discussion of risks and vaccines that had been taking place since the early twentieth century: when the threat of a once-dread disease is practically extinct, should the public still be expected to bear the risk of adverse side effects of vaccination?