REAL vaccination is a rarely failing preventive of small-pox. This is a cardinal truth,of which the public always requires to be reminded; but particularly at present, when the returns of the Registrar-General proclaim that the loathsome and fatal pestilence is rife among us. There is another fact of still greater importance which ought to be impressed upon the public, and acted upon by the administrators of our sanitary affairs: it is this, that the community is served to a very large extent with a sham, in place of a real, prophylactic.
By the Public Health Act of last session, the strictly medical duties of the Board of Health— insignificant and few in number—were permanently transferred to the Privy Council. Very comprehensive powers were at the same time given to the Privy Council in respect of vaccination, and other matters of sanitary police. It was authorised to issue regulations for securing the due qualification of vaccinators contracted with by guardians, and for enforcing their efficient action. Provision was made in the same statute for punishing those who evaded or neglected the provisions of the compulsory vaccination act. The Privy Council, acting under these large powers, have just issued important and seasonable ordinances. From their publication, if they be vigorously carried out, and duly amended from time to time according to public emergencies and legislative changes, will date a new and a better era in British State Medicine. Henceforth, as we read the rules, vaccination is to be universally enforced—not the sham, but the reality.
Before we recite the substance of the new rules, it may be useful to give, in a few simple sentences, an account of what vaccination is, and of the epithets “real” and “sham” as applied to it. Real vaccination is the communication of smallpox in a modified and harmless form. The morbid poison, by passing through the system of the cow, becomes so changed as to produce an affection remarkably mitigated in severity, and quite altered in its phenomena. The disease, however, retains the character of generally exhausting in one attack the susceptibility of the constitution to receive it: and therefore the cow-pox, that is to say, the modified small-pox communicated by vaccination, equally preserves, permanently, or for a long period, from a subsequent affection either by cowpox or small-pox. This is now universally recognised as the true pathological explanation of the protective power of vaccination. The doctrine has been abundantly proved by reliable experiments performed in this and other countries. Four names are pre-eminent in this interesting inquiry; viz., Gassner, Thiele, Ceely, and Badcock.
Although Jenner used the term variolae vaccinae, or “small-pox of the cow,” there is no evidence that he comprehended the doctrine in the precise form in which it has been established by the experimenters just named. He had, however, undoubtedly arrived very nearly, if not altogether, at the exact truth; for Baron, his admirable biographer, says of him, that
“he always considered small-pox and cow-pox as modifications of the same distemper, believing that in employing vaccine lymph we only make use of means to impregnate the constitution with the disease in its mildest, instead of propagating it in its virulent and contagious form, as is done when small-pox is inoculated.”
The history of the principal researches by which the identity of small-pox and cow-pox has been placed beyond doubt, is thus succinctly and impartially given by Mr. Simon. He says: “As early as 1801, Dr. Gassner, of Gunzburg, after ten unsuccessful trials of smallpox inoculation on cows, had at last succeeded in infecting one; and with matter taken from the resulting vesicles of this animal had inoculated four children; who thereupon had developed in them the ordinary phenomena of vaccination, furnishing vesicles from the lymph of which seventeen other children had been similarly infected.
Dr. Gassner’s discovery remained for forty years almost entirely unknown or unbelieved; but at length, Dr. Thiele of Kasan repeated the experiment with equal success, and rendered it still more complete, by supplying a necessary test of the nature of the process. He showed, namely, that the lymph engendered in these experiments possessed not only the local infectiousness, but likewise the protective powers of cow-pox ; that persons recently inoculated with it might with impunity be let sleep in one bed with small-pox patients, or be inoculated with small-pox virus; that, in short, it was true protective vaccination which they had undergone.
The result of these investigations was not published before the beginning of 1839; at which time other experiments of the same kind, independent and equally conclusive, were being conducted in this country by Mr. Ceely, of Aylesbury, of whom I am glad to repeat the praise expressed by a high authority, that ho ‘has done more to advance the natural history of vaccination than any other individual since the days of Jenner.’
Soon afterwards, and also by independent experiments, Mr. Badcock, a long established druggist at Brighton, arrived at the same conclusion as to the origin of smallpox: and from 1840 to the present time, he has constantly been applying his knowledge to its important practical purpose, having within this period 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 furnished supplies of it to more than 400 medical practitioners.”
In connection with the above statement, Mr. Simon most correctly remarks: “A host of theoretical objections to vaccination might have been met, or, indeed, anticipated, if it could have been affirmed sixty years ago, as it can be affirmed now — this new process of preventing small-pox is really only carrying people through smallpox in a modified form. The vaccinated are safe against smallpox, because, in fact, tltey have had it.”
Real vaccination, therefore, is carrying one through a harmless modification of small-pox. Lord Lyttelton, when he induced the legislature to pass his compulsory vaccination, neglected to make provision for securing, in respect of those operated on, proof of their actually having passed through the disease. Consequently, since as well as before the passing of that law, multitudes have been nominally vaccinated without having been efficiently influenced. The causes of this are easily found. Public vaccinators have been so miserably paid by their union contracts, that they have in too many instances delegated the duty to untaught or careless apprentices.
In many more cases, neither principal nor assistant watches the case after the introduction of the lymph. If the mother or a neighbour report that “the arm has taken,” there is many a public vaccinator who forthwith enters the case as a “successful” one, and, for the same, receives, in due course, one shilling and sixpence of public money. The inadequacy of the pecuniary inducement to faithfulness, and the want in nearly all our medical schools of any provision for teaching vaccination, fully explain the fact that multitudes reputed to be vaccinated have been so only nominally, or in virtue of a worthless operation. It is not necessary, then, to say more about the terms “real” and ” sham,” except that it is impossible to write or speak with accuracy on the subject of vaccination without frequently employing them, or analogous expressions.
The State having made the neglect of vaccination a punishable offence, is clearly bound, in duty and in common sense, to provide the public with it in an efficient form. This, it is obvious, can only be accomplished by means of new arrangements for teaching vaccination; by the institution of examinations for the testing of the knowledge and practical skill of candidates for employment as vaccinators; by the strict supervision of vaccinators; and by the organisation of such measures as will maintain a constant supply of good lymph. It is to the first two of these points that the new rules and plans of the Privy Council refer.
Arrangements will, if possible, be made with all recognised medical schools for the public teaching of vaccination at the principal vaccination stations in their neighbourhood; and the teachers at those and also many other stations will be authorised to give certificates of proficiency to their pupils after due examination. Such certificates of proficiency will qualify their possessors to be contracted with as public vaccinators by guardians and overseers. Directions are given as to the extent and mode of instruction. The vaccinator of an educational vaccinating station is to exhibit and explain the course and characters of the vaccine vesicles to his pupils, and to teach them in a practical way the best methods of vaccinating and of taking lymph for present or future use. He is also to explain and inculcate the precautions which are necessary with regard to the health of subjects proposed for vaccination, and the selection of lymph.
Pupils are to pay a fee not exceeding one guinea, and to attend a teacher’s station for at least six weeks. Persons who have acquired their knowledge elsewhere than at a station, may, on paying one guinea, and passing an examination, receive certificates of competence. The Privy Council specifies a variety of topics upon which candidates are to be examined; and requires that they shall point out among subjects brought for inspection those from whom lymph may properly be taken, giving their reasons for the selection. When practicable, they are to see vaccination vesicles in different stages of progress, and to state in each case the date from vaccination. They are likewise to charge ivory points, or otherwise to prepare lymph for preservation.
The Privy Council, by enforcing the rules of which we have now given a summary, will be able to place national vaccination in the hands of a well trained, competent staff. This will be an immense gain; but more than this is required to render the system altogether trustworthy. The vaccinators must be placed under such inspection as will make it impossible for them to neglect their duty without detection, and then there must be an absolute certainty that the work is rightly done.
While we inculcate the necessity of an official supervision of vaccinators, we must express our earnest hope that their services are for the future to be better remunerated than in the past. The system of cheap vaccination contracts is, in all its aspects, an injustice and a mistake. As a general rule, work which is inadequately paid for, is inadequately performed.