Pox_ An American History - Michael Willrich [21]
When Jenner published his first results in a 1798 paper, his claims bred skepticism and controversy among medical men and laypeople. An English political cartoon from the period depicts a gaggle of country bumpkins lined up to get jabbed in the arm by the bewigged Dr. Jenner. The right half of the frame is a riotous scene filled with men and women who have already taken the vaccine. Horns, hooves, and entire cows spring forth from their arms, faces, and rear ends. The cartoon is titled, “Cow Pock—or—the Wonderful Effects of the New Inoculation!” Despite opposition, vaccination spread far and wide with remarkable speed. Jenner estimated that within three years, 100,000 people had been vaccinated in England. By that time, Professor Benjamin Waterhouse of Harvard University had brought vaccination to the United States.53
More than half a century before the germ theory, then, the fundamentals of preventive immunization were in place. And yet at the turn of the twentieth century, smallpox remained full of mystery. The causative agent had not been identified, the process of human transmission was imperfectly understood, and the exact nature and biological effects of the vaccine strains in circulation were largely matters of conjecture and debate. What scientists and physicians could say for certain, based upon a century of medical experience, was that vaccination worked. Wyman’s “Précis” summed up the medical consensus: “The most efficient means for preventing the spread of smallpox is by vaccination. The protection, provided the [vaccine] virus is pure, is believed to be as complete against contagion as is that of smallpox against a second attack.” Unlike a bout with actual smallpox, the authors cautioned, vaccination conferred only a temporary immunity, perhaps five years or more. Accordingly, the “Précis” advised that communities encourage revaccination, whenever smallpox became prevalent, to “continue this protection indefinitely.”54
In the best scenario, vaccination prevented a person exposed to smallpox from getting the disease at all. Even when a previously vaccinated person did contract the disease, the vaccination accelerated the clinical course of smallpox, producing a milder form of the disease called “varioloid.” The patient remained infectious until recovered: “The most virulent form of smallpox may rise from exposure to varioloid,” the “Précis” warned. But fatalities were rare and pockmarks uncommon. Physicians found that if they vaccinated a person infected with smallpox during the first five or six days of the incubation period, the patient would normally suffer a mild case of the disease.55
Despite the power of this revolutionary scientific technology, England and America did not rush to embrace compulsion. Some European governments established compulsory vaccination of infants in the first decades of the early nineteenth century: Bavaria in 1807, Denmark in 1810, Norway in 1811, Bohemia and Russia in 1812, Sweden in 1816, and Hanover in 1821. But England, the birthplace of Jennerian vaccination, did not enact its first compulsory measure until 1853. It applied only to children.56 Until the mid-nineteenth century, the thorny legal question regarding vaccination in the United States concerned the right of local communities to use tax money to provide free vaccination for the poor. Things began to shift after England adopted compulsion. In 1855, Massachusetts became the first American state to require public schoolchildren to get vaccinated. Between the end of the Civil War and the turn of the twentieth