In this event report, our newsletter editor Frances Lloyd summarises the fascinating and topical talk given by Dr. Kelcey about the history of vaccination.
Colin has spent the last two years working with the Oxford AstraZeneca team. The team mutually supported each other by phone. Someone hacked a member’s phone and obtained the numbers of all the team. Team members were rung, often at very inconvenient times, haranguing them and calls were often very abusive. E-mails were also sent to the team members in a similar vein. Colin started to look into the anti-vax movement.
Blossom was a cow who has saved millions and millions of lives. Smallpox, the speckled monster, caused blister-type rashes. It has killed millions and millions of people since medieval times. People were understandably terrified of it. There was a very short time period between infection to death, with an estimate of 400,000 a year dying in Europe every year at its peak, often the biggest single killer.
Smallpox was highly contagious. It is a zoonotic disease – it transfers from animal to human like COVID. Smallpox transferred from gerbils to camels and thence to humans. There are two forms – variola major and variola minor – the former being more severe and more likely to be fatal. Variola major resulted in 30% of fatalities. Those who survived were badly scarred and it was the major cause of blindness in young adults. Females with the disease were not allowed to look in mirrors because it was feared that, as they looked so grotesque, it may result in their health declining even further or they may become suicidal (Colin showed some gruesome photos!).
Treating small pox was a big issue and there was in reality no treatment. In the 1770s, various treatments were tried such as leeches, purges and vomiting, using ‘red things’ (in the belief that red cured it) or letting out the pus. Typically, 1 in 3 of the population were infected, and 1 in 12 of those died. Fatality in under-fives was very high, about 90%.
Edward Jenner FRS FLS (1749-1823) was a gentleman doctor with private money. The Jenner Museum is in Berkeley, Gloucestershire. Jenner would often go to see his patients by horseback. He was a polymath and a dilettante. His interests included geology, horticulture and botany, hibernation, bird migration, the nesting habits of the cuckoo and hydrogen ballooning (the Air Balloon pub outside Gloucester is named in honour of him). He was a bon viveur, a musician and a poet.
Jenner was an apprentice to Daniel Ludlow, a surgeon in Chipping Sodbury, to learn medicine. He then became a pupil of John Hunter, a renowned surgeon who was surgeon to George III. He had two significant experiences of smallpox in 1757 when he was 8 and was horrified by what he saw.
Lady Mary Wortley-Montagu (1689-1762) lived for a time in Turkey where her husband was an ambassador. She discovered there was a process being used to prevent smallpox called variolation which involved collecting the scabs from a smallpox victim, grinding them up and blowing them up the nose of another person. As a result, the recipient would develop a milder case of smallpox. She brought this idea back to the UK. This was the birth of the idea of vaccination.
Jenner was variolated, horrified by the experience, and then began to wonder if giving people cowpox would prevent them contracting smallpox. There was a milkmaid in Chipping Sodbury who Jenner treated when he was still in his teens. She told him she’d had cowpox and therefore wasn’t worried about getting smallpox. This was a widespread belief amongst country folk. Later in life, Jenner started talking and speculating on the use of cowpox to protect against smallpox, and was widely scorned.
Blossom was a cow who had developed cowpox on her udder and teats. A milkmaid caught it on her hands and Jenner (aged 46 now) took the pus from the blisters and inserted it into the arm of James Phipps, an 8-year-old boy, who was the guinea pig. He had a small sore and a mild fever. Jenner variolated him and James didn’t develop smallpox; Jenner concluded the boy was immune to smallpox. Jenner wrote this up for the Royal Society who rejected it saying it was ‘too fantastical’. Sir Everard Home FRS had persuaded the Society to reject it. He was a variolator and didn’t want his income to be affected. Jenner responded by self publicising his findings in a book called The Enquiry which was like a DIY manual and became a best seller. He wanted his findings to be widely known and in the public arena. He believed in the scientific method: observation-deduction-hypothesis-experiment-verify. Then tell the world and change medical practice.
Within 5 years, Jenner’s discovery was being used world-wide. Between 1803 and 1806 the vaccine was being imported into Spain where it was tested in orphanages. The use of cowpox to immunise against smallpox was ordered by Phillip of Spain across the Spanish colonies, using 20 orphans on a ship, of whom only 10% were infected at one time – more being loaded at each port (!). Abroad generally, vaccinators were seen as saviours. Napoleon vaccinated all his troops. Jenner was awarded a medal and called ‘a prophet without honour’ in the centenary edition of the Lancet.
Opposition to vaccination in Britain was swift and savage. The grounds for opposition were sanitary considerations, religious, scientific and political. Some people disputed that disease passed from animals to humans. Others said that ‘matter from lower creatures’ shouldn’t be used in humans. Ernest McCormack said ‘extracts of cows causes cancer’. Some chose to enlist the almighty and said that Satan was the first vaccinator. Some viewed it as blasphemy and that it prevented merciful providence of culling the children of the poor. There was opposition from medical practitioners who said vaccination is dangerous, can cause bovine transformation (from child to cow!), could cause TB, madness, syphilis, blood poisoning, etc. Alternative practitioners jumped on the bandwagon. An example was D.D. Palmers, a chiropractor, who claimed smallpox could be cured by manipulation.
Luckily, many in Britain did believe in vaccination and there were 3 major Acts of Parliament:
1840 – free vaccines
1853 – fines for failure to vaccinate
1858 – imprisonment for failure to vaccinate.
There were riots in some towns, notably Leicester where the MP Peter Taylor was very anti vaccination and said it was a delusion and offered no protection. The 1898 Vaccination Act provided a conscience clause. This gave rise to the term conscientious objector. Lots of pamphlets were circulated. Poetry and song were used against vaccination. The message was that vaccination was a money-making venture. Alfred Russel Wallace said ‘it cannot be proved to have saved a single life’. Probably thousands of deaths were caused by comments like that. The working class at the time were talking about their rights. There was a sense of the upper classes taking advantage of the lower classes. Others felt that vaccination was part of a government conspiracy aimed at the working class. Compulsory vaccination had moved into people’s lives. Opponents of vaccination said there were continued outbreaks, abscesses and cross infection. Jenner was portrayed as a demon, not a saviour.
There were protest days when the copies of the Vaccination Act were burned. Alternative authorities were used to legitimise the case against vaccination. Claims were made that vaccination causes illness and doesn’t prevent smallpox, etc.
Before 1861 there was no regulation of doctors and some were quacks. A third of doctors were unqualified. In 1850 the average life expectancy was 40 years. Everyone was charged for medical services. At this point the vaccine was in its infancy and still being produced from cows. It didn’t provide lifelong immunity and had to be repeated. If given in a clumsy way there was the risk of secondary infections being transferred. If this resulted in court cases, this brought publicity for anti-vaxers.
In 1877, the medical examiner in Leicester said that cases had to be reported, and that as this worked there was no need for vaccination. There were a lot more prosecutions for non-vaccination and people wanted London to be exempt in the same way as in Leicester. This was refused. Smallpox returned to Leicester.
Long after Jenner’s death the anti-vaxers pursued him. His statue in Trafalgar Square, which had been there for 4 years, had to be moved to the Italian Garden in 1862.
In 1967, the World Health Organization (WHO) decided they could wipe out smallpox by widespread vaccination. In 1975, the last victim of variola major smallpox was found in Bangladesh. In 1977, the last victim of variola minor smallpox was found in Somalia. On 8th May 1980, the WHO said that target zero had been achieved and smallpox was finally declared eradicated.
As for Blossom, her hide is at St. George’s Medical School. One of her horns is in The Royal Society for Immunology. Though Colin said there are lots of horns which are claimed to be Blossom’s! The Latin word vaccu means cow so vaccination is a tribute to Blossom.