Drs Hoggan on Smallpox Vaccination

[Smallpox]

From DRS GEORGE AND F. E. HOGGAN, 7, Trevor-terrace, Rutland-gate, September 7, 1883.(Vaccination Inquirer, Vol 5)

Dear Sir---We regret very much that it will not be in our power to be present at the Congress relative to Compulsory Vaccination, which is to be held next month in the city of Berne. You are aware, no doubt, that our objections are not so much to vaccination per Se, as to compulsory vaccination, to which we are prepared to offer uncompromising opposition. We are not prepared to say that vaccination can have no effect in ameliorating a subsequent attack of small-pox, or even in preventing occasionally attacks that might otherwise have developed; we must, how ever, frankly admit that we have no scientific evidence before us tending to prove that it does so, the mere moral effect of having been vaccinated being excluded. On the other hand, we have the certainty that, in innumerable cases, vaccination has absolutely failed to have any beneficent effect, moral or physical, and, in our own professional capacity, we have known vaccination to have been the means by which a loathsome disease was conveyed to patients in whom, otherwise, it had no chance of being developed. These two latter considerations are, we submit, quite sufficient to justify uncompromising hostility to compulsory vaccination, even apart from any ideas of ours as to the virtues of personal liberty.

Besides those we have already brought forward, we have several other grave objections to make to the supposed efficacy of vaccination. In the first place, the principle, as now accepted, has no scientific basis, so that it can be debated quite as well by laymen as by scientific men, The vast majority of medical men cannot, indeed, claim to come under the latter head; and a layman of such clear common sense as Mr. Peter Taylor may, we consider, if he only gives his mind to the question, form an opinion worth the opinions of any hundred medical men who have only accepted the teachings of the medical schools on the subject, without independent inquiry. To the scientific aspect we shall hereafter refer; but leaving that aside, there only remains the statistical evidence, which any intelligent layman is as capable as any medical man to discuss. Such evidence, to be of any weight, must be obtained from unbiased witnesses. In the present state of things, however, it is the vaccinator specially interested in proving vaccination to be of value who, so to speak, manufactures the evidence wherewith to prove his case; and one has only to observe the extreme anxiety to prove that persons who have died of small-pox did not show scars very distinctly or sufficient in number, in order to reject the whole of the statistics offered, as thoroughly unreliable.

Supposing, however, the statistics, proving that the deaths resulting from small-pox have greatly decreased in ratio since vaccination was established, stood unchallenged, we should not even then be prepared to admit that the improvement was due to vaccination, or that post hoc, ergo propter hoc. The history, past and contemporaneous, of many other diseases shows how little dependence is to be placed in such an argument. Take leprosy, for example, a disease to which we have given special study, and one on which our researches, published in the "Archives de Physiologie, 1883," and "Pathological Transactions, 1880," give us a valid right to speak. Well, 300 years ago leprosy was rampant in Great Britain, as it how is in Norway and India. Leper-houses or hospitals existed all over the country, and their foundation funds are still applied to the maintenance of many of the general hospitals; During the last hundred years no case of leprosy has developed de novo in this country, and yet there is no medical cure for the disease; and, as shown by its startling progress at the present day in the Sandwich Islands, we have no specific means of controlling its ravages. We emphasise the above statement on account of the mendacious statements to the contrary continually appearing from interested sources. To what, then, is the decrease of leprosy in these islands due? We know not, but we are certain that if mere blowing in the eyes of leprous patients had been practised, between one and two hundred years ago, the decrease of the disease might just as fairly be put down to that operation as the diminution of small-pox mortality, did it truly exist, may be put down to the operation of vaccination. That the statistics are, unfortunately, still very unsatisfactory, is admitted by every candid supporter of the principle of vaccination, and, as long as they are so, to make vaccination compulsory is a great wrong.

We have asserted that vaccination has no scientific basis, and this assertion applies equally to its alleged good effects, and to our power of averting its possible evil effects. As regards the latter, it is continually stated that if care be exercised in procuring the vaccine only from pure sources, there is no danger of communicating other disease. From personal experience, however, as before referred to, we assert that such a provision is illusory, and impossible to be carried out. Moreover, the frequent announcement of lymph having been microscopically tested and proved to be pure, we, as specialists in microscopical pathological investigation, stigmatise unhesitatingly as an impudent fraud on a credulous public. There is no indication for knowing vaccine lymph to be pure, or only what it is represented to be, by means of the microscope. We readily admit, with profound admiration, the scientific basis of Pasteur’s inoculations. He proceeds upon a clear knowledge of what he is doing with the inoculation of attenuated virus of different diseases. He is a true scientific homeopath; (we are not homeopaths, and consider infinitesimal doses irrational) ; and if in a large practice the results are not so invariably favourable as in carefully-conducted experiments, the merit of the investigator is not lessened thereby. But even if found to be correct, the nation would reject with horror the principle of compulsory inoculation of all inoculable diseases, with its known attendant dangers, by way of guarding against problematical infection in the future yet, to be consistent, every upholder of compulsory vaccination ought to be equally ready to make universal inoculation with the attenuated virus of known diseases compulsory. Strangely enough, however, the only scientific process analogous to those of Pasteur in relation to small-pox, viz., the inoculation of the virus of small-pox itself, has been made a penal offence in this country!

Vaccination as at present practised is nonscientific, because we do not know what we are inoculating, or why it should act beneficially. "What is cow-pox?" is rather a difficult question to answer. At the conferences on this subject, a few years ago, instituted by the British Medical Association, it was asserted roundly (and we happen to know that the assertion was accepted by more than one supposed authority, who thereupon changed his views in consequence of it, after the whole truth on the question of vaccination was supposed to have been told), that cow-pox was only modified small-pox, due to contagion from an infected milkmaid. "Who ever heard of bull-pox ? "was received with great laughter, and the querist aptly remarked that the man who said be had heard of it would be hooted. If, however, cow-pox were modified small-pox, there would be a. scientific reason for inoculating this attenuated virus; but then improvement in small-pox statistics of mortality would find its explanation, not in vaccinat.ion, but in improved sanitary conditions, which no longer permit an infected milkmaid to sow broadcast the seeds of small-pox in the most sensitive soil. It is not yet clear that Pasteur’s investigations will prove a great practical and. unmixed blessing, but that they have a great scientific interest is undeniable. This being granted, we must, however, equally allow that they carry unqualified condemnation of the statement that there is any scientific basis for vaccination as at present practised. They form, on the contrary, a strong argument in support of the abolition of compulsory vaccination.

Pasteur’s experiments are of additional interest both to the public and to scientific pathologists when viewed in their relation to the history of vaccination. The upholders of compulsory vaccination are being driven from pillar to post in the most ignominious fashion. They have to abandon their infallible nostrurns or practices one after the other, a new one being substituted for each old one as fast as that old one is exposed and rendered untenable, after having been sworn to as infallible. The craze for animal vaccine is the last manifestation, and the next will doubtless be a demand for compulsory inoculation of attenuated smallpox virus on Pasteur’s principle. Thus the wheel goes round. The inoculation of small-pox, now penal, will be revived as a benefit to be compulsorily accepted by all, and just as possibly the vaccination of to-day will take its place amongst the wrongs provided against by penal enactments in the future. At all events, we shall have attained at last to a. scientific basis for our inoculations, when Pasteur’s methods are introduced, but shall we be in any way benefited thereby? Nous verrons.

It is continually alleged by supposed authorities that, when vaccination has proved inefficacious, it was because one mark only had been made, and that had there been three marks all would have been well, although latterly even three marks have been pronounced insufficient. Oh! the pitiful ignorance and charlatanism which underlie such allegations! As far as the scientific knowledge of the day warrants us in giving an opinion, we are justified in maintaining that if a single living cell receives the impression which we call disease, it is able to pass it on through the whole organism. Now, the living cells involved in a single vaccine pock amount to many thousands in number, any one of which is capable of passing on the disease to the organism, and it can make no difference whatsoever whether or not the number of primarily infected cells be tripled or centupled.

The theories promulgated as to the danger or benefit; of drawing or not drawing blood in making the inoculation, are just as baseless and void of any foundation in fact, while the statement that diseases foreign to small-pox can be conveyed only if blood has been mixed with the lymph, meets with nothing but derision from the scientific pathologist.

We sat down to pen a short reply to your invitation to attend the Congress; but our thoughts on this question being for the first time committed to paper, this note has lengthened out into an essay, which might become five times as long did we allow ourselves to state fully all the objections we have to vaccination when made compulsory. We will, however, draw this letter to a close with one more reference to the present state of things. It seems to us that people look not so much to the facts as to the reputation of the men who discuss them, and that the names of Dr. Lyon Playfair, Dr. Carpenter, and others, carry more weight than the facts themselves. Dr. Lyon Playfair is a man of great scientific eminence as a chemist, but as a pathologist he has no claims which entitle him to be considered as a leader. His very title of "Dr." is misleading, for he is not; a medical man; and if it is borne in mind that, as the member for the University of Edinburgh, he is bound to represent the opinion of his medical constituents, little importance need be attached to his advocacy of medical interests. Of Dr. Carpenter it must also be remembered that he is a book-maker, and not an investigator. It is only to the scientific worker, to the man who is engaged studying the biological elements from morn till night in all their various phases, that we have to look for scientific opinions, and, unfortunately for truth, such workers prefer the laboratory to the platform and the public press. To M. Pasteur, although he is not a medical man, all ought to listen with respect, for he has vindicated his right to speak by years of patient, painstaking biological investigation. We believe ha would agree with us in all our scientific objections to vaccination, and if he did, our legislators ought to require no further scientific authority to warrant them in abolishing at once and for ever compulsory vaccination.—We are, dear air, yours faithfu.lly,

> > GE0RGE HOGGAN, M.B.

> > Frances Elizabeth Hoggan, MD.