BRMISH MAY 25, 1963 DEVELOPMENT OF SMALLPOX VACCINE MEDICAL JOURNAL 1367 Papers and Originals DEVELOPMENT OF SMALLPOX VACCINE IN ENGLAND IN THE EIGHTEENTH AND NINETEENTH CENTURIES BY J. A. DUDGEON, M.C., M.D. The Hospital for Sick Children, Great Ormond Street, London 3 and 4 Victoria XXIX. 23rd July, 1840. the fact that some of the details do not appear to be Whereas it is expedient to extend the Practice of Vaccination well known, others are incomplete, and many unfor- " Be it therefore enacted by the Queen's Most Excellent tunately are missing altogether. In these notes an Majesty by and with the Advice and Consent of the Lords attempt has been made to put some of these facts on Spiritual and Temporal, and Commons, in this present record before they drift for ever into obscurity. Parliament assembled and by the Authority of the same, That from and after the passing of this Act it shall be Vaccination: Development and Legislation lawful for the Guardians of every Parish and Union. to contract with the Medical Officer of their several Union Edward Jenner was born in 1749 at Berkeley, in or Parish respectively . for the vaccination of all Gloucestershire. It was a common belief in the West Persons resident in such Unions or Parishes respectively . Country that those who had had cowpox, an endemic "And Be it further enacted, That any person who shall infection of milch cows, were resistant to smallpox. from and after the passing of this Act produce or cause to While in practice in Berkeley, Jenner put these theories produce in any Person, by Inoculating with Variolous to the test and proved to his own satisfaction that there Matter, or by wilful exposure to Variolous Matter, or wilfully by any other Means whatsoever produce was some substance to this belief. On May 14, 1796, the Disease of Smallpox in any person shall be liable to be Jenner " selected a healthy boy (James Phipps, Case proceeded against . and shall, upon Conviction, be XVII) about 8 years old for the purpose of inoculation imprisoned in the Common gaol, or House of Correction for for the cow-pox. The matter was taken from a sore a Time not exceeding one Month." on the hand of a dairymaid (Sarah Nelmes, Case XVI)." With this traditional preamble to English legislation When the lesion on the arm had healed Jenner proceeded the First Vaccination Act was passed by Parliament and to test the effect by inoculating the boy with variolous received the Royal Assent on July 23, 1840. Thus 17 material. This was done on July 1, 1796, and repeated years after Edward Jenner's death in 1823 the country several months later. The boy remained well on both in which vaccination had first been developed gave occasions, as did three other patients similarly treated belated recognition to its success, and was one of the (Jenner, 1798). last European countries to do so. The development of Jenner first communicated his observations to the smallpox vaccination in England took just on 100 years Royal Society in London in 1797, but, according to from the time of Jenner's first observations in 1798 until Baron, the President returned the manuscript, suggesting 1898, when the comprehensive Vaccination Act came " that he be more cautious and prudent." In June, 1798, into force. The Act of 1840 is an important milestone Jenner's monograph was published in London entitled in this period of development. Until this time, "'vario- An Inquiry into the Causes and Effects of the Variolae lation," or inoculation smallpox, introduced into this Vaccinae, A Disease discovered in some of the Western country in 1721 as a result of the influence of Lady Mary Countries of England particularly Gloucestershire and Wortley Montagu, wife of the British Ambassador in known by the name of Cow Pox (Jenner, 1798).* Turkey, was still being practised on quite a wide scale The immediate reaction in London was not enthusiastic, in England. This undoubtedly held back the early but one or two leading doctors took notice of Jenner's acceptance of the new method of "cowpoxing," or work. Mr. Henry Cline, surgeon to St. Thomas's vaccination. Hospital, vaccinated a young boy (Richard Weller) with After the 1840 Act, which made variolation illegal, the lymph supplied by Jenner and later inoculated the boy country gradually came to accept vaccination, but with with variolous matter in three places. The boy remained no great enthusiasm. At this time human lymph was well (Jenner, 1799). As a result Cline became a supporter virtually the only source of vaccine, and as the practice of Jenner and a great advocate of vaccination. In 1799 of vaccination grew the disadvantages of human beings Dr. Woodville, physician to the Smallpox and Inocula- as vaccinifers became increasingly apparent. By the end tion Hospital in London, and Dr. Pearson, also physician of the century these difficulties had largely been resolved to St. George's Hospital, started a series of public by the development of animal vaccine lymph, and under vaccinations at the Smallpox Hospital. Their enthusiasm the Vaccination Act of 1898 glycerinated calf lymph was was not entirely helpful to the cause of vaccination. introduced into England as the standard vaccine. This Many of their patients developed severe reactions, and Act marked the end of the beginning of the development this led to a bitter controversy with Jenner and also to of smallpox vaccine. But it did more than this; it doubt in the public mind as to the value of this new recognized the need for an all-round improvement in form of prophylaxis. In January, 1800, Dr. Pearson vaccination procedure, and in doing so paved the way started the first vaccination station in Warwick Street for a new era of research and development in the and later in Golden Square, where he practised twentieth century. vaccination for a number of years. The literature on smallpox vaccine is already *Jenner considered cowpox to be smallpox of the cow, hence and the reason the name variolae (smallpox) vaccinae (Latin vacca, a cow; voluminous, only for adding to it is Latin deriv. vaccinus, hence also to " vaccinate "). BRITISH 1368 MAY 25, 1963 DEVELOPMENT OF SMALLPOX VACCiNEVACCINE MEDICAL JOURNAL In 1802 a Select Committee of the House of The Vaccination Acts Commons* heard evidence from Jenner and many others, as a result of which Parliament voted Jenner Jenner's discovery aroused great interest in Europe the sum of £10,000, a motion to increase the grant to and in the New World. Numerous requests for lymph £20,000 being lost by only three votes (Jenner, 1805). were made, and many countries, such as Sweden, The same year the Royal Jennerian Institution was Denmark, and the German States, introduced legislation inaugurated in London with Jenner as president, and 13 at an early date making vaccination compulsory. In vaccination stations were started in London to provide Sweden, following the introduction of vaccination in information and teach the method of vaccination, but 1801, there was a dramatic fall in the incidence of small- trouble soon arose between Jenner and his assistant, pox, and for a time the disease virtually disappeared. Dr. Walker, who then proceeded to set up a rival But in England the change was less spectacular. Indeed, Vaccine Institution in London. it was largely due to the stimulus to public opinion made by a report of the Provincial Medical and Surgical In July, 1806, the Chancellor of the Exchequer moved Association: in 1839 that the first Vaccination Act was that a humble address be presented to the King introduced the following year. The action taken by " praying that he be pleased to direct the Royal College Parliament was prompt. Two days after the Associa- of Physicians to enquire into the state of vaccine tion's Petition was presented in the House of Lords in inoculation in the Kingdom, and to report their opinion March, 1840, a Bill was introduced which became law as to the progress which has been made...." The in July (3 & 4 Vict. 1840). The 1840 Act did not work motion was passed without dissent. The College of well in practice, and after a few years apathy on the Physicians acted with extraordinary promptitude. part of the population was again evident. Having corresponded with the Colleges of Physicians in Dublin and Edinburgh and with the Colleges of During the ensuing years several further inquiries Surgeons of London, Dublin, and Edinburgh, and with were held which in turn led to further legislation. In other societies established for vaccination, they published 1853 the Epidemiological Society, after an extensive their report nine months later, in April, 1807: ". the inquiry, came to the conclusion that the risk from small- College of Physicians feel it their duty strongly to recom- pox resulted from public apathy, which could only be mend the practice of vaccination...." On June 9, 1808, remedied by compulsory vaccination. On August 20, a central institution, the National Vaccine Establishment 1853, an " Act to Extend the Process of Vaccination " (see Appendix), was set up in London by Royal Warrant was passed which made vaccination compulsory (16 under the Privy Council, from which it received an & 17 Vict. 100). Objections and propaganda against annual grant for the collection, supervision, and distri- compulsory vaccination followed, and, as was to be bution of vaccine lymph, and " for the purpose of expected, many of the facts relating to the ill effects rendering vaccine inoculation generally beneficial to of vaccination were distorted, as can be seen from Fig. 1. His Majesty's subjects" (Hansard, 1808). Possibly influenced by this reaction, the General Board of Health, which had been created in 1848, conducted The N.V.E.