506 Journal of the Royal Society of Medicine Volume 77 June 1984 Rider Haggard and smallpox' William A R Thomson MD FRCPEd I am no Rider Haggard addict. Until last year the only one of his novels I had read was 'King Solomon's Mines' - more or less a stock item in the recommended reading of schoolboys of my generation. My memones of it are vague, which, combined with the fact that I did not read its sequel, 'She', suggests I was not unduly impressed by it. But before recounting my reintroduction to this prolific writer of fiction, perhaps I might be allowed to remind you of the salient features of one of the most fascinating episodes in the history of medicine, culminating in the consignment of one of the major killers all down the ages to the limbo of the past. At least, such is the hope that we all share with the World Health Organization. Smallpox, of course, as every medical student used to know in the good days when medical students were educated, not merely trained, is the small pox to distinguish it from syphilis, the great pox. One of the great killers from time almost immemorial, the procedure of protective inoculation, or variolation as it came to be known, probably goes back as far; though why it should have been introduced and, what is more important, practised, in those ancient days is one of the unsolved problems of medical history. The first recorded evidence of variolation dates back to the end of the sixth century AD - and, almost needless to say, China. Variolation was popularized, if not actually introduced, in this country by Lady Mary Wortley Montagu (1689-1762) (Figure 1), who had learned of the technique when her husband was our ambassador in what was then known as Constantinople. Though not without risk, Lady Mary was obviously a good saleswoman, and, after two carefully controlled clinical trials - one on six condemned criminals in Newgate Prison (offered their freedom if they survived, which they did), and another on six orphans - George I allowed two of his grandchildren to be inoculated a' la Turk. Variolation, however, was not without its hazards, and the whole outlook was changed by the publication in 1798 of Edward Jenner's classical 75-page report: 'An Enquiry into the Causes and Effects of the Variolae Vaccinae, a Disease discovered in some of the Western Counties of England, particularly Gloucestershire, and known by the Name of Cow Pox'. In this model clinical trial he demonstrated that cowpox could be transmitted artificially from one person to another, and that such vaccination, as it came to be known, provided effective protection against smallpox. Outside the United Kingdom Jenner's work was rapidly recognized and hailed as one of the outstanding contributions to the health of mankind, as admirably documented by Paul Saunders (1982) in 'Edward Jenner. The Cheltenham Years 1795-1823.' In Russia the first child to be vaccinated was christened Vaccinof and given a life pension by the dowager Empress. At home, however, Jenner was treated with despicable disdain by the medical establishment and the State. He never received a knighthood and he was refused a State funeral in Westminster Abbey. The only medical corporations that contributed to the memorial fund for a statue in Gloucester Cathedral were - to their lasting honour - the Edinburgh Colleges of Physicians and of Surgeons. Primary vaccination of infants was made compulsory, under penalty of 20 shillings, in 1853. In view of the persisting vocal criticism of it by a minority of the population, the 'Based on paper read to the Section of the History of Medicine, 2 February 1983. Accepted 24 March 1983. Dr Thomson died on 19 November 1983 0141-0768/84/060506-07/$01.00/0 0 1984 The Royal Society of Medicine Journal of the Royal Society of Medicine Volume 77 June 1984 507 Figure 1. Lady Mary Wortley Montagu (1689-1762) Figure 2. Henry Rider Haggard (1856-1925) Government set up a Royal Commission in 1889. This finally reported in 1896, its main conclusion being that vaccination 'diminishes the liability to be attacked by the disease ... modifies the character of the disease and renders it (a) less fatal, and (b) of a milder or less severe type'. During the passage through Parliament of the subsequent Vaccination Acts Amendment Act 1898, the howls of rage of the strident minority of antivaccinationists, the absurdity of whose claims was in inverse ratio to the proven value of vaccination, caused the Government to panic, and at the last minute include a 'conscience clause' whereby objectors could escape the provisions of the 1853 Act by making a declaration of conscience before a magistrate. This, as Parish (1965) has noted, was 'the first relaxation of compulsion, and was a retrograde step'. And this is where Rider Haggard came in but, before switching over, perhaps I may be permitted to complete the story of vaccination. The 1898 Act was followed by a drop in the number of infants vaccinated annually, from around 80% to 71% in 1901. The Vaccination Act of 1907 allowed parents to make a statutory declaration that they were opposed to vaccination on conscientious grounds, without all the rigmarole of satisfying a magistrate as to the validity of their conscientious objections. And this is where I come into the picture temporarily. My father, a Scottish minister, held no very strong views on the subject, and therefore my elder brother and I were duly vaccinated in infancy. When the 1907 Act came into force, however, he took advantage of the relaxation, made the statutory declaration, and so ensured that none of the younger members of the family was vaccinated. Following the 1907 Act the vaccination rate crashed. By 1914 it was down to below 50%, falling to 34% by 1939. With the advent of the National Health Service in 1948, compulsory vaccination of infants came to an end, and in 1971 the Secretary of State for Health and Social Security decreed that vaccination against smallpox need no longer be recommended as a routine procedure in early childhood. Henry Rider Haggard (Figure 2) was born on 22 June 1856 at Wood Farm on the estate of Bradenham Hall which had been the family seat for three generations, 'the impecunious younger son of an obscure, flamboyant, irascible squire'. In 1880, at the age of 24, he married Louisa Margitson, the owner of Ditchingham House, an 18th century mansion close to the main Bungay-Norwich road, with a garden running down to the River Waveney, and known as 'The Mustard Pot' because of its unusually shaped chimneys. Here 508 Journal of the Royal Society of Medicine Volume 77 June 1984 he was to spend much of his married life and write many of his novels. He was knighted in 1912, and died on 14 May 1925, four days after what his surgeons described as an 'entirely successful operation'. He wrote 68 books, including 58 novels. The first appeared in 1882 and the last in 1924. Of his success as a novelist there can be little doubt, as exemplified by the fact that in his autobiography, written in 1912, but not published at his own request until after his death, he records: "'King Solomon's Mines" which was produced as a 5-shilling book, proved an instant success. Published on September 30, 1885, on December 9, Messrs Cassells wrote to me that they had already sold 5000 copies more or less, a large sale for a boy's book by a practically unknown man. I wonder how many copies they have sold up to Xmas 1911! In one form or another the total must run to hundreds of thousands' (Haggard 1926). But he was not merely a successful novelist. As the publisher ofmost ofhis books and editor of his autobiography, C J Longman, points out in his introduction to the autobiography, he journeyed through twenty-seven counties examining the condition of agriculture and published his results in 'Rural England' (1902). He travelled through USA and Canada as a Commissioner appointed by the Colonial Office to report to the Secretary of State on the Labour Colonies instituted by the Salvation Army. In addition he served on the Royal Commission on Coastal Erosion and Afforestation (1906), and the Dominion Royal Commission of 1912. As a Norfolk laird he took a tremendous interest, not only in the development of his estate, but also the social welfare of all who toiled on his land. He therefore accepted enthusiastically the invitation of Charles Longman, his publisher, to keep throughout 1898 a daily diary in which he would record the events of what would be published as 'A Farmer's Year'. This, one of the most fascinating books it has been my lot to read, duly appeared in 1899. In it is brilliantly brought out his duties and activities as a landlord, farmer and magistrate, interested in all the goings-on of the farmers and agricultural labourers with whom he came in contact. In his own words: 'My object in compiling that record.. was that in its pages future generations might see a picture of the conditions under which agriculture was practised in England at the end of the 19th century'. As I have already indicated, I am no Rider Haggard addict, and it was through D S Higgin's biography, 'Rider Haggard: The Great Storyteller', published in 1981, that my attention was drawn to 'A Farmer's Year'. In this, in due course, I read the entry for 20 July. 'I see in the papers today that the Government has given way suddenly on the Vaccination Bill, and that henceforth 'conscientious objection' on the part of parents is to entitle them to disregard the law and neglect their children'.