Claire Litt //
“The public may reasonably look forward to the time,
when all opposition to vaccination shall cease […]”
-The Royal College of Physicians, 1806
In 1802, the British caricaturist James Gillray (1756-1815) published his print The Cow-Pock, or, the Wonderful Effects of the New Inoculation! The print features a young lady who looks on with trepidation as Dr. Edward Jenner (1749-1823), inventor of the smallpox vaccine, inoculates her using “vaccine pox hot from ye cow.” The inscription at the bottom of the print, “Vide – The publications of the anti-vaccine society” clarifies that the cartoon was intended to ridicule anti-vaxers, whose absurd beliefs Gillray hyperbolizes through the depiction of patients sprouting bovine mutations from their cowpox pustules. Yet, small details reveal that Gillray simultaneously satirized both sides of the heated debate over the safety of the new smallpox vaccine. The ‘unbelievers’ in science, whose skeptical position was evidently eroded by their susceptibility to the notion that vaccination could cause the most incredulous of metamorphoses, are juxtaposed with the scene depicted in the painting on the wall. In the painting, worshippers bow at the feet of a golden cow statue; this is Gillray’s critique of vaccine enthusiasts’ dogmatic belief in the unmitigated triumph of scientific progress. Gillray’s choice to make the cow gold is also a tantalizing allusion to the idiomatic golden goose — or cash cow, perhaps— a cynical commentary on the potential fortune to be made from a remedy to the plague of smallpox.
Throughout the 18th century, English physicians charged exorbitant fees for performing smallpox inoculation (also known as variolation). This procedure, which was first practiced in Eastern nations and in West Africa, involved inserting pustule from a person infected with smallpox under the skin of a healthy individual. The idea was that the patient would develop a relatively mild case of smallpox and become immune to future infection. The procedure was not without risks: sometimes patients died from smallpox after inoculation, and there were ethical concerns about introducing a deadly disease to otherwise healthy individuals. Despite these risks, inoculation became a marker of the privileged elite. The masses of un-inoculated commoners, many of whom could not afford physicians’ services, were shunted towards the view that inoculation was dangerous and that physicians were only out to line their own pockets.
Gillray drew Jenner’s innovative and significantly safer vaccine as a golden cash-cow only the elite could afford. But Jenner’s golden cow presented a problem. Smallpox could not be eradicated from a population for whom inoculation was prohibitively expensive. Nor could smallpox be eradicated from a population that, after decades of physicians overcharging for services, had become so cynical towards the medical establishment that it was skeptical of Jenner’s vaccine — even when it was offered to them for free. Far-fetched claims about the dangers of vaccination, such as are satirized in Gillray’s print, seem to derive not solely from the public’s residual fears about the risks of immunization associated with smallpox inoculation, but also from a deep mistrust of the rich, educated, inoculated upper-class and their fancy physicians.
Smallpox variolation was popularized amongst the English aristocracy in the early 18th century, largely through the efforts of Lady Mary Wortley Montagu (1689-1762). Once famed for her beauty at court, Lady Wortley Montagu found her charms diminished after she caught smallpox at the age of 26. In 1716, shortly after her recovery, she penned a poem about a lady-courtier named Flava whose beauty English pharmacists could not save from smallpox (Barnes, 339):
“Ye, cruel Chymists, what with-held your aid
Could no pomatums save a trembling maid?
How false and trifling is that art you boast;
No art can give me back my beauty lost”
-Saturday; The Small-Pox
Later in 1716, Lady Wortley Montagu’s husband Edward Wortley Montagu was made the English ambassador to Turkey (Stone and Stone 232). The couple relocated to Constantinople, where Lady Wortley Montagu was introduced to engrafting, a common local method of inoculating against smallpox. Evidently convinced of the efficacy of the procedure, Lady Wortley Montagu had her young son inoculated against the smallpox in Turkey in 1718 (M.Guyot 3; Riedel 22). After returning to England, an outbreak of smallpox in London in 1721 prompted Lady Wortley Montagu to have her young daughter inoculated, with members of the Royal Society of Physicians as witness (Riedel 22).
Lady Wortley Montagu’s choice to inoculate her children has been viewed by scholars to have had a significant influence on the attitudes towards smallpox inoculation in England, although almost exclusively amongst members of her elite social circle — many of whom followed suite and underwent inoculation themselves. As inoculation became the norm amongst the English aristocrats, the easy procedure was elaborated upon by physicians who wanted to charge more for their services. The transformation of inoculation into an intensive ritual requiring physicians’ supervision made it an expensive and exclusive procedure, and contributed to the popular perception that physicians cared more for money than the public good (Stone & Stone, 235).
Throughout the 18th-century, inoculation continued to gain popularity within the European aristocracy. Thomas Dimsdale (1712 – 1800), a physician practicing in Hertford, a town to the north of London, took a keen interest in smallpox variolation. Dimsdale was reportedly shocked to find the extent to which his reputation as a smallpox specialist had circulated across Europe when, in the summer of 1764, a Russian courtier turned up on his doorstep to inform him that the Empress Catherine the Great wished to be inoculated (Griffiths 14). In the fall of 1764, Dimsdale travelled to Russia to secretly perform the inoculation on the Empress. As planned, the Empress developed a mild case of smallpox and quickly recovered, after which she declared Dimsdale a Baron of Russia. In her report on the success of her inoculation to the eminent French philosopher Voltaire, the Empress concluded “Indeed, it is becoming quite the fashion” (quoted in Gorbatov, 83). Smallpox inoculation was more than a health precaution. Becoming inoculated signified individuals’ belief in the nascent field of immunology, and their subscription to such avant-garde scientific ideas was a marker of social class. Dimsdale inoculated approximately 150 members of the Russian nobility before returning to England, where he was acclaimed for his international success (Griffiths, 16).
While inoculation became the norm amongst the European elite, overseas in the British colony of Massachusetts Benjamin Franklin (1706-1790) observed,“It does not seem to make progress among the common people in America” (5). Franklin wrote in his autobiography that he regretted not inoculating his son, who died of smallpox in 1736 (Best, et al., “Making the Right Decisions” 478). Franklin’s initial decision against inoculation, however, is not surprising. Inoculation became a highly contentious issue in Boston during an outbreak of smallpox in 1721. At the time, Reverend Cotton Mather petitioned for the effectiveness of inoculation against the medical advice of prominent local medical authorities. Mather learned of inoculation from his slave, a man he called Onesimus, who explained that it was a common practice in his home in West Africa (Best et al., “Benjamin Franklin” 76; Wisecup 27). Based on Onesimus’s explanation and Mather’s petition, a Bostonian physician, Dr. Boylston, inoculated well over 200 people during the 1721 outbreak — but not without severe local opposition (Fraser-Harris 40; Best et al. “Benjamin Franklin” 76). After another outbreak of smallpox in Boston in 1753-1754, Franklin co-authored a book with a Dr. William Heberden in which he drew on data collected during the 1721 epidemic to encourage widespread inoculation amongst ‘common Americans.’ According to the numbers Franklin presented, approximately 9.3% of Bostonians who got smallpox in 1721 died, compared to 1.4% of the people who died from smallpox inoculation (4).
Franklin put considerable emphasis on the expense of inoculation as the reason for anti-inoculation sentiments, concluding that “rather than own the true motive for declining Inoculation”, by which he referred to the cost, people “join with the scrupulous in the cry against it, and influence others” (6). Franklin and Heberden sought to undercut physicians who charged hefty fees for inoculation by carefully explaining the procedure step-by-step in their book so that Americans could inoculate themselves. Franklin had a simple insight with a profound conclusion: inoculation had to be accessible in order to be accepted, and if it was not accepted by the masses, it would never be eradicated. Since inoculation was not affordable to everyone who wanted it, the resulting ‘sour grapes’ mentality amongst the masses swayed public opinion against the very idea of inoculation to the detriment of society on the whole.
Franklin’s observation anticipated the public resistance to Jenner’s introduction of a smallpox vaccine made from cow pox at the end of the 18th century. As the apocryphal story goes, Edward Jenner was working as an apprentice to a physician in the English countryside when a dairymaid candidly informed him “I cannot take the smallpox, I have had the cowpox” (Guyot 6). In 1796 Edward Jenner tested his hypothesis that cowpox provided human immunity to smallpox. He first inoculated a young boy, James Phipps, with cow-pox, causing the boy to develop symptoms in the subsequent days. After Phipp’s recovery Jenner inoculated him again with smallpox — to which the boy had no reaction (Riedel 24). Jenner’s smallpox ‘vaccine,’ a word derived from the Latin word for cow, vacca, was immensely safer than traditional smallpox inoculation. Jenner conceded that cow pox was not comfortable for patients, but countered “I have never known fatal effects arise from the Cow-pox […]” and that it “clearly appears that this disease leaves the constitution in a state of perfect security from the infection of the Small-pox” (66-67). Unlike patients inoculated with smallpox, who were infectious during their recovery period, Jenner observed that cowpox was not communicable between humans (68). Predictably, Jenner garnered immediate support from European nobility, amongst whom smallpox inoculation was already an accepted practice. Catherine the Great, eager for the Russian populace to accept vaccination, reportedly called the first child to be vaccinated in Russia “Vaccinoff” and declared that the child would be provided with a lifetime stipend and education paid for by the state (Fraser-Harris 75).
Gillray’s drawing of a golden cow implied that Jenner stood to make a fortune from his vaccine made of cow-pox. A contemporary of Jenner’s, a physician named Matthew Baillie (1761-1823), amended this supposition: “Jenner might have been immensely rich if he had not published his discovery” (Italics mind, Fraser-Harris 80). Had Jenner made his vaccine an exclusive treatment for the rich and powerful, as inoculation had been for decades, he might have made a fortune — but he would not have initiated a movement towards eradicating smallpox all together. In addition to making his research public knowledge, Jenner vaccinated people for free in the shed in the back yard of his Gloucestireshire home, which he dubbed the “Temple of Vaccinia” (Riedel, 24).
Jenner’s impecunious state was addressed by the British parliament in 1806, which rewarded him for his contribution to medicine after the Royal College of Physicians finished an inquiry into his work on the smallpox vaccine. The report concluded that vaccination “possesses material advantages over inoculation for the Small-Pox” (“On The Cow Pock, Or Vaccination”). The Royal College of Physicians, in reference to the same type of publications Gillray satirized in his cartoons, condemned reports that the vaccine was dangerous and instead expressed their optimistic opinion that, “The public may reasonable look forward to the time, when all opposition to vaccination shall cease” (Ibid). However, Franklin’s insight into vaccine hesitancy in Boston was that the cart could not come before the horse. In 1748 Lady Wortley Montagu, reflecting on the greed of English physicians, had cast doubt on the possibility that a remedy to the smallpox would ever be accessible to the broader public. “The English” she wrote, “are easier than any other nation infatuated by the prospect of universal medicines” (quoted in Stone & Stone, 235). Nearly a century later in 1840, England passed ‘The Vaccination Act’ making the smallpox vaccine free to everyone (Watson; Fraser-Harris 83).
Works Cited:
Barnes, Diana. “The Public Life of a Woman of Wit and Quality: Lady Mary Wortley Montagu and the Vogue for Smallpox Inoculation.” Feminist Studies 38, no. 2 (2012): 330–362.
Best, M, A Katamba, and D Neuhauser. “Making the Right Decision: Benjamin Franklin’s Son Dies of Smallpox in 1736.” Quality & safety in health care 16, no. 6 (2007): 478–4.
Best, Mark S. Duncan Neuhauser, Lee Slavin. Benjamin Franklin Verification & Validation of The Scientific Process in Healthcare. Victoria, Canada: Trafford Publishing, 2003.
Cerretani, Jessica. “They All Laughed: Harvard doctors have a long tradition of earning the last laugh by persevering in the face of skepticism.” Harvard Medicine: Impossible Medicine. https://hms.harvard.edu/magazine/impossible-medicine/they-all-laughed
Franklin, Benjamin, and William Heberden. Some Account of the Success of Inoculation for the Small-Pox in England and America: together with Plain instructions by which any person may be enabled to perform the operation and conduct the patient through the distemper. London: W. Strahan, 1759. Huntington Library.
Fraser-Harris, David. “Edward Jenner and Vaccination.” Reprint from The Scientific Monthly, October 1915.
Griffiths, John. “Doctor Thomas Dimsdale, and Smallpox in Russia.” Bristol Medico-Chirurgical Journal January 1984.
Gorbatov, Inna. Catherine the Great and the French Philosophers of the Enlightenment: Montesquieu, Voltaire, Rousseau, Diderot and Grim. United Kingdom: Academica Press, 2006.
Jenner, Edward. An Inquiry 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 the Cow Pox Milan: R. Lier & c., 1923.
“On The Cow Pock, Or Vaccination.” 1806. Prints and Drawings. 419 mm x 286 mm. The British Museum. William Bulmer and Co. Cleveland-Row, St.James’s. ([London], Society for the Poor:[ca.1806]). https://www.britishmuseum.org/collection/object/ P_1868-0612-1586.
Pearlson, Godfrey. “Smallpox Vaccination in the Satirical Work of James Gillray” Hektoen International: A Journal of Medical Humanities. Spring 2015. https://hekint.org/ 2017/02/01/smallpox-vaccination-in-the-satirical-work-of-james-gillray/
Riedel, Stefan. “Edward Jenner and the History of Smallpox and Vaccination.” Proc (Bayl Univ. Med. Cent.) 2005 Jan; 18(1):21-25.
Stone, A F M, and W D Stone. “Lady Mary Wortley Montagu: Medical and Religious Controversy Following Her Introduction of Smallpox Inoculation.” Journal of medical biography 10, no. 4 (2002): 232–236.
Watson. Greig. “The Anti-Vaccination Movement that Gripped Victorian England.” December 28 2019. British Broadcasting Centre (BBC). https://www.bbc.com/news/uk-england-leicestershire-50713991
Wisecup, Kelly. “African Medical Knowledge, the Plain Style, and Satire in the 1721 Boston Inoculation Controversy.” Early American literature 46, no. 1 (2011): 25–50.
