Chapter 9

There is no doubt that Jenner's medical contemporaries, at least in England, failed to appreciate the magnitude of the gift their colleague had presented not merely to his own country, but to the world at large. The discovery had, of course, been led up to by several different lines of indication, but this in no way detracts from the genius of Jenner in drawing his memorable inductions from the few facts which others had known before his time. The fame of Newton is no whit diminished because Copernicus, Kepler and Galileo lived and worked before him, the credit due to Harvey is none the less because many before his time had worked on the problem of the heart and vessels, and because some of them, notably Cesalpinus, came within a very little of the discovery of the circulation; the achievements of Darwin are not to be belittled because Lamarck, Malthus or Monboddo had notions in accordance with the tenor of his great generalization of evolution among living beings. Certainly Jenner had precursors; but it was his genius and his genius alone which, putting together the various fragments of knowledge already possessed, gave us the grand but simple induction based on his own experiments that vaccinia prevents from variola. It was too simple and too new to be appreciated in all its bearings either by the medical men or the laity of his own day. Its impressiveness is not inherent in it, as it is in the mathematical demonstration of universal gravitation, as it is in the atomic theory or in that of the survival of the fittest through natural selection. The English country doctor merely said in essence--"let me give you cowpox and you will not get smallpox." Unless the fact of this immunity is regarded as possessed by all the nations of the world for ever more there is nothing particularly impressive in it; and so it failed to impress his contemporaries. It is only when we contrast the loathsomeness and danger of smallpox with the mildness and safety of vaccinia and varioloid that we grasp the greatness of the work which Jenner did for mankind. The very simplicity of vaccination detracts from its impressiveness unless its results are viewed through the vista of the centuries. We need the proper historical perspective in this as in all else. Thus viewed, however, the simplicity of the procedure and the universality of its application are most imposing. Vaccination does not, indeed, dazzle the scientific imagination like some of the other generalizations of biology, but it is one that has been gloriously vindicated by the subsequent history of the world's hygiene.

Jenner knew himself to be a benefactor of the human race; he would have been insincere if he had pretended otherwise; he finished his first paper with these words: "I shall endeavor still farther to prosecute this enquiry, an enquiry, I trust, not merely speculative, but of sufficient moment to inspire the pleasing hope of its becoming essentially useful to mankind"; and on his death-bed he said, "I do not marvel that men are not grateful to me, but I am surprised that they do not feel grateful to God for making me a medium of good."

In private life Dr. Jenner was amiable and kind-hearted. Dibden said of him: "I never knew a man of simpler mind or of warmer heart." He was particularly kind to the poor. Dr. Matthew Baillie said of him: "Jenner might have been immensely rich if he had not published his discovery."

We may in conclusion examine some of the objections to and criticisms of vaccination. The objections can be classified as those entertained (a) by medical men and (b) those by the public generally.

The objections raised by medical men are now a matter of ancient history. Each generation of medical men has refused at first to admit any new teaching promulgated in its time; physiological inertia is not at once overcome. The most enlightened of Jenner's critics did really believe that he was drawing too extensive an induction from insufficient data; this was the position of the Royal Society in 1788; but the Edinburgh reviewer of 1822 should have known better. The purely technical criticisms of Jenner's work have by this time been fully assessed and replied to. It is true that at one time it was not clear what were the relationships of chickenpox and smallpox, of vaccinia and variola, of vaccinia and varioloid, of the various forms of pox in animals--cowpox, swinepox, horsepox or grease--either inter se or to human smallpox. But I do not suppose that in this year of grace 1914 there can be found one properly trained medical man, acquainted with the history of Jennerian vaccination, familiar with the ravages of smallpox and with the protective power of vaccinia, who could be induced, by no matter how large a bribe, to say that he disapproved of vaccination or that he believed it did not protect from smallpox. There are cranks in all walks of life, but the medical crank who is also an anti-vaccinationist is happily the rarest of them all.

The lay objectors--the professed anti-vaccinators--are with us yet in spite of some very serious lessons which have been taught them. We may pass by the objectors of the class who believe that vaccinated persons cough like cows and bellow like bulls; these objections go into the limbo of old wives' fables or into the category of wilful misrepresentation. Unfortunately there is a large class of persons who can believe the absurdest nonsense about any subject which is particularly distasteful to them.[6] Another class of objection is the sentimental repugnance to the idea of being given one of the diseases of "the lower animals." Now the fact is that already we share a great many diseases with the lower animals, a few of them being tuberculosis, anthrax, rabies, tetanus, cancer, pleuro-pneumonia, certain insect-borne diseases, some parasitic worm diseases and some skin diseases like favus. As the knowledge of the lowly origin of many of our diseases is more widespread, this sort of objection will die out.

[6] Antivaccinators constantly allude to calf-lymph as "filth"; if lymph is filth, then I am able to assure them that each one of them has about three liters of it in his own body.

An objection which is worthy of more consideration is that in being vaccinated a child is apt to contract some infectious disease such as tuberculosis or syphilis which are the two most dreaded. Now so long as arm-to-arm vaccination was the routine practice, there was a remote probability that this sort of accident might occur. It appears to be true that a few accidents of this kind have occurred, just as a few arms have become septic or had erysipelas develop in them. But when the few such cases are compared with the millions and millions of uncomplicated vaccinations, their importance becomes very insignificant. Now that arm-to-arm vaccination is no longer practiced, but fresh calf-lymph used for each child, these accidental inoculations are a thing of the past. The ignorance of cause and effect is responsible for a great deal of the most childish objections to vaccination as to much else. One woman lately told me that she could not have her child vaccinated because a child in the same street was made a cripple for life by being vaccinated. Could we have a better example of the "post hoc sed non propter hoc."[7]

[7] Now and again, however, we have the sad spectacle of some one really well educated but apparently either ignorant of logic or desirous of wilfully misrepresenting facts. The Hon. Stephen Coleridge has an article in the June (1914) number of the Contemporary Review which is, to say the least of it, highly immoral in ethics and statistics.

I shall examine only that part of it bearing on vaccination. The statements are that in the last five recorded years, 58 persons died from smallpox vaccination (he means vaccination against smallpox), whereas in the same five years, 85 persons died from smallpox itself. The inference we are intended to draw from these figures is that to be vaccinated is nearly as fatal as to have smallpox itself.

Now this kind of argument is a very common one with statistically immoral persons, and is known as the suppression of the ratio. Before we can appreciate the fact that in five years 58 persons died after being vaccinated, we at least need to know the total number of persons who were vaccinated. If only 58 persons were vaccinated and they all died, then the mortality was 100 per cent., but if, as was practically the case, thousands of infants in Great Britain were vaccinated in five years, then if only 58 died after vaccination (although not necessarily in consequence of it) the mortality falls some thousands of a per cent. The suppression of the ratio, i. e., 58/many thousands is the deceit that is practiced.

Fifty-eight per year for five years, is 11.6 deaths per year of persons vaccinated: presumably these were infants: taking the birth-rate in England as 30 per 1,000 living, we may say that 900,000 infants were born; deduct 100,000 as not vaccinated, we have 800,000 infants vaccinated, of these 11.6 died after being vaccinated, which is 0.0014 per cent. This is not much of a mortality from any cause; but using Mr. Coleridge's own figures, it is a splendid demonstration of the safety of infant-vaccination, the opposite of what he pretends it shows.

Mr. Coleridge proceeds to tell us that in five years 85 persons died of smallpox in Great Britain, i. e., an average of 17 persons per year. In other words 17 persons died of smallpox in a country with 30 million inhabitants, or 0.000056 per cent. of persons living, not a high mortality. And we strongly suspect, may we hope, that those 17 were persons who had not been vaccinated.

But in Pre-Jennerian days, 17 persons died of smallpox out of every 100 persons dying from all causes.

Mr. Coleridge's figures, properly and honestly interpreted, testify loudly to conclusions exactly the opposite of what he desires to insinuate; he has no doubt taken the statistics of the Registrar-General, but he has prostituted them.

Mr. Coleridge's paper could not be a better example of the art of concealing the causes of phenomena.

He exhibits the following table:

Deaths from smallpox per annum per a million living:

1862-1870 ................................. 172.2 1871-1880 ................................. 244.6 1881-1890 ................................. 45.8 1891-1900 ................................. 13.3 1901-1910 ................................. 12.8

So that the table shows that since 1880 in Great Britain the deaths from smallpox per million per year have declined until they are only about 1/14th of their original number.

The natural inference from these figures, viewed in the light of the history of smallpox in Great Britain, is that compulsory vaccination has been steadily eradicating the disease; but this is not Mr. Coleridge's conclusion: He says it is due to the large number of persons who have refused to be vaccinated! This would be laughable if it were not really serious; it is sad and serious that a man of Mr. Coleridge's education and social position should so consistently mislead the uncritical readers of the Contemporary Review to whose pages he has unfortunately very free access. If Mr. Coleridge really believes these things he is either very stupid or very ignorant; if he knows them to be otherwise, but wilfully deceives the public, he is immoral. He suffers from the worst form of bias, the anti-scientific. {the end of long footnote}

There is still that group of persons who object to everything--anti-vivisection, anti-meat eating, anti-breakfast, anti-hats and of course also anti-vaccination. They are anti the usual and the normal that are quite good enough for the most of people. They generally also believe that the earth is flat; they are past praying for, all we can do with them is to look them, like the difficulty of Jonah and the whale, "full in the face and pass on."

Many people at the present time allow themselves to be persuaded into being anti-vaccinators because neither they nor their deluders have ever known what an epidemic of smallpox is, have never seen with their own eyes the awful spectacle of a person suffering from smallpox in any of its forms--discrete, confluent or hemorrhagic. Thanks to this very Jenner, the world has now for 100 years been almost free from epidemic, virulent smallpox and most perfectly so in the vaccinated countries, so that millions, the majority, of Englishmen, have never seen a case of smallpox at all. Not knowing the awful danger they have escaped, through Great Britain having had compulsory vaccination since 1853, they have become lax in their belief in the necessity for the continuance of that precaution. "They jest at scars that never felt a wound." Towns such as Gloucester in England, in which a large number of children have been allowed to grow up unvaccinated, have always been visited sooner or later by a serious outbreak of smallpox. It must be so; the laws of natural phenomena can not be changed to suit the taste of those persons who are mentally incapable of understanding them. They can not be evaded; ignorance of the law is no more an excuse in the realm of natural than of man-made law.

We now come to that undesirable product of present-day, grandmotherly legislation, the conscientious objector. As I am not a politician, I shall not say anything for or against the policy of inserting in a bill which makes vaccination compulsory a clause giving to the conscientious objector the power or right to refuse to have his child vaccinated, but as a medical man who knows a little of the history of medicine, I can only describe it as gratuitous folly. I am one of those who believe that the laity should have no say in the matter of whether any given procedure is or is not advantageous for the public health. The efficacy of universal inoculation of vaccinia as a prophylactic against variola is a question of scientific medicine to be decided on technical grounds and ought not to be a matter open to debate by the public at all. It is perfectly monstrous to suppose that the ordinary person, quite untrained to weigh evidence for or against the advisability of the carrying out of a particular form of national immunization against a horrid disease, is qualified to form any opinion. He might as well be consulted on the advisability of making the channel tunnel or on the safest type of aeroplane or on any other subject involving the technical training of the engineer. To permit the so-called "man in the street" to say whether he shall or shall not permit the carrying out of some important piece of civic hygiene is to introduce a principle subversive of all system and obstructive of all progress in the science of public health. It is absurd that in a case like this the pronouncements of the judges are to be submitted to the criticisms of the jury. England has already had one or two pretty severe lessons through allowing such places as Gloucester and Leicester to exercise their right of private judgment on the question of vaccination. In Gloucester where there was at one time a vigorous anti-vaccination movement, a serious epidemic overtook the city a few years ago (1896). What science pronounces to be beneficial, the layman must submit to. What we want in these days is less superstition and more faith--in science. I am informed that there are more than 2,000 unvaccinated children in the schools of this city at the present moment, and all because a piece of legislation allows any unintelligent, prejudiced or credulous parent to decide on the momentous question of the vaccination of his children.

Our quarantine regulations are extremely strict, and rightly so, on the subject of smallpox; but is it not a farce to take so much trouble about the health of our immigrants when inside the city we are all the time encouraging a high degree of receptivity towards this very disease? I should call this a very clear case of straining at the international gnat and swallowing the municipal camel. The community at present is at the mercy of its least instructed members. A most sensible suggestion is that if an outbreak of smallpox occurs in Halifax, the cost of it should be borne by the unvaccinated and by the anti-vaccinators. The fact is we have forgotten what smallpox is like. In 1796 before Jennerian vaccination, the death-rate from smallpox in England was 18.5 per cent. of deaths from all causes; in London between 1838 and 1869 it was 1.4 per cent., while in 1871--the worst year for smallpox since vaccination became compulsory--the deaths from smallpox were barely 4.5 per cent. of deaths from all causes, a proportion which was exceeded 93 times in the eighteenth century. At the present moment the deaths from smallpox in London constitute a little under 0.24 per cent. of deaths from all causes, or 77 times less than in pre-Jennerian times.

According to MacVail, in the pre-vaccination period smallpox was nine times as fatal as measles and seven and one half times as fatal as whooping cough. To-day in the vaccinated community its fatality is negligable, in the unvaccinated it is as high as it was in the Middle Ages. In the city of Berlin, where vaccination is absolutely compulsory, there is no smallpox hospital at all; the cases of smallpox in that city being only a few unvaccinated foreigners. In 1912 the deaths in New York City were as follow: 671 from measles, 614 from scarlatina, 500 from typhoid fever, 187 from whooping cough and 2 from smallpox.

In London there were in 48 years of the seventeenth century no less than 10 epidemics of smallpox; in the whole of the eighteenth, 19; and in the nineteenth no epidemic at all during which smallpox was responsible for more than one tenth of the deaths from all causes in any one year.

In Sweden, the highest death-rate before vaccination was 7.23 per 1,000 persons, the lowest 0.30; under permissive vaccination the highest was 2.57, the lowest 0.12; under compulsory vaccination the highest was 0.94, the lowest 0.0005.

It is so frequently said that the disappearance of smallpox is due not to vaccination, but to improved general hygiene, that we must look into this criticism with some care. In the first place, a large diminution in the mortality from smallpox occurred before there was any great change in the unsanitary conditions of the English towns, before there was any enforcing of the isolation of patients either in hospitals or in their own homes. Since the introduction of vaccination, measles and whooping cough still remain in the status quo ante, while smallpox has been exterminated in all fully vaccinated communities, these two diseases of children are as prevalent as ever in England even although the general sanitary conditions have been immensely improved in that country. Of course the effects of vaccination wear out in time, and that is why it is well to be revaccinated once or twice. Now there has been a remarkable progressive change in the age-incidence of smallpox "which can only be explained," says Dr. Newsholme, "on the assumption that vaccination protects children from smallpox and that the protection diminishes, though it never entirely disappears, as age advances.

The "conscience clause" should be immediately removed from the act in which it was inserted on the grounds that it is weak and reactionary in principle, not in the interests of the development of the legislative aspect of the science of public health, and that it permits in certain unintelligent communities quite a considerable number of unvaccinated children to grow up as a permanent menace to their town and district.

When the history of medicine becomes more widely known, when the principles of prophylactic inoculation are more generally understood, when respect for science is the rule rather than the exception, when great achievements in the saving rather than the destroying of life are objects of national veneration, then we may hope to see the day when it will be unhesitatingly admitted that the discovery by Dr. Edward Jenner, the Englishman, was one of the most momentous in the history of the human race, and that his life was one of the noblest, most unselfish and, in its far-reaching effects, most important that has ever been lived on this planet.

THE VALUE OF INDUSTRIAL RESEARCH

BY W. A. HAMOR

MELLON INSTITUTE OF INDUSTRIAL RESEARCH, UNIVERSITY OF PITTSBURGH

THE aim of all industrial operations is toward perfection, both in process and mechanical equipment, and every development in manufacturing creates new problems. It is only to be expected, therefore, that the industrial researcher is becoming less and less regarded as a burden unwarranted by returns. Industrialists have, in fact, learned to recognize chemistry as the intelligence department of industry, and manufacturing is accordingly becoming more and more a system of scientific processes. The accruement of technical improvements in particularly the great chemical industry is primarily dependent upon systematic industrial research, and this is being increasingly fostered by American manufacturers.

Ten thousand American chemists are at present engaged in pursuits which affect over 1,000,000 wage-earners and produce over $5,000,000,000 worth of manufactured products each year. These trained men have actively and effectively collaborated in bringing about stupendous results in American industry. There are, in fact, at least nineteen American industries in which the chemist has been of great assistance, either in founding the industry, in developing it, or in refining the methods of control or of manufacture, thus ensuring profits, lower costs and uniform outputs.

At the recent symposium on the contributions of the chemist to American industries, at the fiftieth meeting of the American Chemical Society in New Orleans, the industrial achievements of that scientific scout, the chemist, were brought out clearly.[1]

[1] In this connection, see Hesse, J. Ind. Eng. Chem., 7 (1915), 293.