DR. CREIGHTON AND PROF. CROOKSHANK (Chapter 4, The Vaccination Problem by Joseph Swain, 1936)

DR. CREIGHTON AND PROF. CROOKSHANK (Chapter 4, The Vaccination Problem by Joseph Swan, 1936)

HAVING

regard to the highly important character of the views of Dr. Charles Creighton and Prof. E. M. Crookshank, as set forth in their various publications and in their evidence before the Royal Commission, it has always been a matter of astonishment to anti-vaccinists that they did not exercise a greater influence on the conclusions of the Royal Commission and the subsequent decisions of Parliament.

Dr. Creighton’s Conversion

The Royal Commission was moved for on the 5th April, 1889, and appointed on the 23rd May, 1889. Two years prior to its appointment Dr. Creighton had published a small professional work entitled Natural History of Cowpox and Vaccinal Syphilis (Cassell & Co., 16o pp., 1887), in which he traversed the contentions of Jenner and his followers as to the alleged identity of cowpox and smallpox, and advanced the startling view that "the real affinity of cowpox was not to the smallpox but to the great pox" (p. 155). Shortly afterwards (towards the close of the year 1888), he created a further sensation in medical circles by the publication of anti-vaccinist opinions in the article on "Vaccination," which the Editors of the Encyclopedia Britannica commissioned him to write for the ninth edition of that leading work of reference; and in 1889 he published his views in a more popular form in a work entitled Jenner and Vaccination (Cassell & Co., 36o pp.).

> The circumstances in which Dr. Creighton was led to change his belief in vaccination were set forth by himself in a letter to the Press in 1895 as follows:—

> "Having written medical articles in The Encyclopedia Britannica regularly from the year 1880, I was engaged in the ordinary course to write on vaccination, as well as on several other subjects within the range of my studies, which came into the same part of the work. I had hardly begun upon vaccination in 1886 when I found myself immersed in an original inquiry into the nature and circumstances of the historical cowpox of Jenner and others. That inquiry brought to light so many unexpected things that I published the results of it, for medical readers, in a small volume of 6o pages in the autumn of 1887 (Cassell & Co.). One result of the historical and pathological research was that I began to suspect the value of cowpox as a protective from smallpox. As soon as I had reached that point, I took the precaution of writing to the Editor of the Encydopedia to ask whether he wished the article to be apologetic, like the one in the eighth edition. His reply, written on a post card, was, in so many words: ‘We do not want an apologetic article’; and that, of course, was in keeping with the principle of editing applied to other subjects in science and history. The article was sent in soon after, and was in due course put into type. It received, perhaps, more than the usual editorial scrutiny of articles in hand, and was even submitted to several medical authorities in succession (I do not know their names) for an opinion. They expressed a somewhat vague dissatisfaction with it; but, on being asked to point out in particular wherein the article was erroneous, they severally dedined to take that responsibility. Thereupon the Editor decided, as he afterwards told me, that the article should go in. Having had my doubts about its fate, I took the opportunity of putting the question to him on an occasion when I met him casually in London. I had not been consulted in the matter at all; it was wholly in the Editor’s hands; he knew very well what he was about; and he had sufficient time to get another article written, if he so desired, even at the last moment, as ‘Vaccination’ just missed coming into the twenty-third volume, for which it was prepared, and had to wait some eight months longer for the last volume. The Editor’s deliberate judgment requires no defence from me; but I venture to say that another article, substituted for mine, but written on the same plan of giving as full a summary as possible of the pathological and statistical facts from authentic sources, would not have been materially different. The real alternative would have been to occupy the assigned space with excuses for the failure of vaccination, as had been clone in the preceding edition; but that was not consistent with the editorial design in general, nor with my explicit instructions."

Dr. Creighton also informed the Royal Commission (Q5584) that up to 1886, when the article on vaccination in the Encyclopedia Britannica was written, he had no doubt about the value of vaccination, that it never occurred to him to question the thing at all, and that he took it as one of the things he had been taught as a student. He left the Commission in no doubt as to the result of his studies. "In my opinion," he said (Q-5430) "vaccination affords no protection against smallpox."

Dr. Creighton died on the 18th July, 1927, in his eightieth year. The following brief extracts from an obituary notice which appeared in the Lancet on the 3oth July, 1927, from the pen of Prof. William Bulloch, F.R.S., afford generous, though belated, testimony to his capacity to form a judgment on the vaccination question, and his courage in maintaining his views despite the professional ostracism which they entailed:—

"By the death of Charles Creighton, England has lost her most learned medical scholar of the nineteenth century, although it cannot be forgotten that some of his opinions were the subject of such criticism that he ceased to be felt as a power in the medical world. . . . I was his only intimate friend for years before he died, for he was a most lonely forsaken man. To the end he was a scholar and a philosopher and the most learned man I ever knew. He spoke and read nearly all the European languages and had an extraordinary knowledge not only of medicine but of the classics and the Bible. His knowledge of English literature and history was also profound. Although he frequently spoke as if he wished to be considered and remembered as a pathologist, it is by his Historj of Epidemics in Great Britain that he earned a permanent place beside the great masters of medical history like Daremberg, Haeser, Freind, and Hirsch. In my judgment Creighton’s History of Epidemics is the greatest work of medical learning published in the nineteenth century by an Englishman. .
"The real tragedy of Creighton’s life was connected with his views on cowpox and vaccination. . . . His article on ‘Vaccination’ in the ninth edition of the Engclopedia Britannica, published in 1888, literally sealed Creighton’s fate. Based on an extended study of the original data, he came to the conclusion that Jenner’s work was incorrect, and that cowpox was not, as Jenner stated, ‘Variola Vaccinse.’ In Creighton’s view cowpox had nothing to do with variola and was not a protective against variola. .
"The issue between Creighton and general professional opinion on vaccination was not thrashed out there and then as it ought to have been. It was deemed more expedient to drop Creighton into oblivion, and if he was ever referred to at all it was only as ‘Creighton the Anti-Vaccinator.’ All his other work was forgotten in the debacle, and he was a doomed man. . . . In the opinion of many he was harshly treated by the world for holding views that did not conform to standard. Perhaps this very world has become more tolerant than it was in Creighton’s time, because even in his own subject there are epidemiologists who express with impunity to-day views as heterodox as those for which Creighton was pilloried and ostracised 40 years ago."

Professor Crookshank’s Conversion

It appears that Sir James Paget mentioned Dr. Creighton’s book on Cowpox and Vaccinal Syphilis to Dr. E. M. Crookshank, Professor of Comparative Pathology in King’s College, London, who was just then investigating an outbreak of cowpox in Wiltshire on behalf of the Agricultural Department of the Privy Council. Sir James no doubt expected that Prof. Crookshank would be able to rebut Dr. Creighton’s contentions. Oddly enough, Prof. Crookshank’s investigation of the subject led him to reject vaccination, and in 1889 he published a voluminous and critical enquiry, in two volumes, entitled History and Pathology of Vaccination (London: H. K. Lewis, 36S.); the first volume containing a statement of Professor Crookshank’s views and researches, and the second a reprint of Jenner’s Inquiry, and numerous other early pamphlets on the subject.
In his preface (from which this account of the book’s origin is derived), Prof. Crookshank says:—

"I had devoted myself for some time to pathological researches in connection with the communicable diseases of man and the lower animals, when the discovery of an outbreak of cowpox, in 88, led me to investigate the history and pathology of that affection. At that time I accepted and taught the doctrines, in reference to this disease, which are commonly held by the profession, and are described in the text-books of medicine.
"In endeavouring to discover the origin of this outbreak, it was proved beyond question that the cows had not been affected by milkers suffering from smallpox.
"While attending at the National Vaccine Establishment of the Local Government Board I was unable to obtain any exact details, clinical or pathological, of the source of the lymph which was employed there. From my experience of this and other vaccination stations, I found that both official and unofficial vaccinators were completely occupied with the technique of vaccination, to the exclusion of any precise knowledge of the history and pathology of the diseases from which their lymph stocks had been obtained.
"I gradually became so deeply impressed with the small amount of knowledge possessed by practitioners, concerning cowpox and other sources of vaccine lymph, and with the conflicting teachings and opinions of leading authorities, in both the medical and veterinary professions, that I determined to investigate the subject for myself."

Professor Crookshank’s investigation finally compelled him to conclude that the orthodox teaching on the subject was entirely erroneous. At pages 465 and 466 of Vol. I of his book he says:—

"Unfortunately, a belief in the efficacy of vaccination has been so enforced in the education of the medical practitioner, that it is hardly probable that the futility of the practice will be generally acknowledged in our generation, though nothing would more redound to the credit of the profession and give evidence of the advance made in pathology and sanitary science. It is more probable that when, by means of notification and isolation, smallpox is kept under control, vaccination will disappear from practice, and will retain only an historical interest."

Both Dr. Creighton and Prof. Crookshank gave evidence before the Royal Commission and their views withstood the critical examination of the medical members of the Commission.

Why did not the Criticisms of Drs. Creighton and Crookshank secure the Downfall of Vaccination?

Having regard to the acknowledged authority of Drs. Creighton and Crookshank, and to the circumstances under which they were led to abandon their belief in vaccination, it is astonishing that the practice survived their authoritative attack. A few probable reasons why this sequel did not ensue may be briefly indicated:—

(1) They were or had been college professors and not in general practice, and they therefore had against them the enormous dead weight of the professional interests of the Government medical officials and the general practitioners. Some idea of the strength of these interests may be gathered from the following brief extracts from leading articles in the Lance! and British Medical Journal in April, 1889, on the decision of the Government to appoint the Royal Commission, which were penned, be it remembered, after the publication of Dr. Creighton’s first book and the appearance of his article in The Encyclopezdia Britannica. The Lancet said (13th April, 1889): "It is about as rational to investigate the merits and value of vaccination as a security against smallpox as it would be to question the utility of life-boats, or Davy lamps, or fire brigades." The British Medical Journal of the same date said: "We cordially agree with Sir Lyon Playfair ‘that if it were not for popular prejudices it would not be necessary to have an inquiry,’ but, under existing circumstances, we wholly approve of the step taken."

(2) Dr. Creighton’s views as to the essential relationship between cowpox and syphilis were somewhat speculative, and both his criticisms and those of Prof. Crookshank dealt so largely with the theoretical and medical aspects of the vaccination question, that the Royal Commission adroitly discounted their influence by suggesting that actual experience of vaccination as a protection against smallpox ought to be regarded as of more importance. Any theories inconsistent with this experience, they airily said, might safely and wisely be disregarded (see pars. 362-4). The long-drawn-out character of the Commission’s inquiry also helped to weaken the influence which it was at first thought must follow the scientific attacks on Jennerism delivered by Drs. Creighton and Crook-shank.

(3) Another contributory cause was the concurrent rise into fame of the investigations of Pasteur, and the introduction of the method of treating diseases by sera, vaccines and antitoxins. The vaccinists astutely utilised these developments to bolster up their tottering idol. A new school of bacteriologists began to reign, and Drs. Creighton and Crookshank were sneered at as exponents of a bygone phase of medical research.
And yet it is safe to say that some day their teaching will receive as full recognition from the ranks of the profession, and from the general public, as it now receives at the hands of anti-vaccinists.
Both Dr. Creighton and Prof. Crookshank quite realised that the conversion of the medical profession and the general public to the anti-vaccinist position would be a slow process. In his book on Jenner and Vaccination (published in 5889), Dr. Creighton said:—

"The public at large cannot believe that a great profession should have been so perseveringly in the wrong. . . . The profession as a whole has been committed before now to erroneous doctrines and injurious practices, which have been upheld by its solid authority for generations. . . . It is difficult to conceive what will be the excuse made for a century of cowpoxing; but it cannot be doubted that the practice will appear in as absurd a light to the common sense of the twentieth century as bloodletting now does to us. Vaccination differs, however, from all previous errors of the faculty, in being maintained as the law of the land on the warrant of medical authority. That is the reason why the blow to professional credit can hardly help being severe, and why the efforts to ward it off have been, and will continue to be so ingenious" (pp. 352-3-4).

It may be mentioned that Prof. Crookshank resented the efforts made by anti-vaccinists to secure his sympathy with their political aspirations. This was especially noticeable when in later life, after he had left the sphere of medicine to take up the life of a country gentleman, he stood as a Conservative candidate for Parliament at East Grinstead, in the General Election of 1906. On that occasion, owing to the unsatisfactory nature of his replies to queries put to him by anti-vaccinists in regard to the repeal of the compulsory clauses of the Vaccination Acts, he did not receive their support. His Liberal opponent (C. H. Corbett) gave satisfactory answers and was returned by a majority of 262.
Dr. Creighton, on the other hand, rendered Trojan service to the anti-vaccination movement for many years, both by voice and pen. The following opening and closing extracts from an obituary notice which appeared in the columns of The Vaccination Inquirer on the 1st September, 1927, eloquently express the great respect and regard of anti-vaccinists for Dr. Creighton, and their deep appreciation of his services to the cause of health and liberty:—

"Anti-vaccinists will not learn unmoved of the death of our great leader, Dr. Chas. Creighton. He died in his 8oth year, poor, lonely, neglected, almost obscure. Others, with a more pliant knee in the House of Rimmon, went past him to wealth and titles and public ofilce. Posthumous honour and respect may come his way, but while he lived he paid the penalty of affronting the solidarity of the profession and patronising a despised and hated cult which threatened to undermine a whole system of vested and cherished professional interests. He suffered as Semmclweiss and Hahnemann and &champ and a long list of medical heretics and martyrs suffered before him. But he accepted his fate with Roman fortitude and magnanimity, and his austere integrity of intellect and character was never tempted to a politic compliance.

"He did not seek, and would not have valued the huzzas of the multitude. He would not have liked the title of this article [‘A Dead Hero’]. Nevertheless he was of the heroic quality, the type that makes a nation great and which only can keep it from corruption and decay.

"With profound respect and unavailing regrets we lay our wreath upon his grave. It is for us yet to vindicate his memory and avenge his fate in the only way he would have valued."

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