Once a Week (magazine)/Series 1/Volume 8/Invasion of 1863: a call for volunteer defence
INVASION OF 1863:
A CALL FOR VOLUNTEER DEFENCE.
I wish I had remembered in time,—I wish a good many other citizens had remembered in time, how the 14th of May is made a festival of in Prussia and some other countries. To have made a festival of the 14th of May—or, as some people may think more appropriate, a fast, or a day of humiliation—would have been the most emphatically useful way of spending the day that we could now devise.
Prussia has reason for her rejoicing; for, by an event which occurred on the 14th of May, 1796, nearly forty thousand lives a year were saved before the century was out; and the number has since increased, of course, in proportion to the increase of population. The event thus commemorated was the brave act of Dr. Jenner—of vaccinating a child from the hand of a dairywoman who had the pock straight from the cow. In consequence of that act, there was a saving of 210,000 lives annually in Europe; and at the time of this fearful venture, as Dr. Jenner’s friends considered it, the mortality from smallpox in the known parts of the world was twenty-five millions every quarter of a century. The numbers seem scarcely credible, but they are well ascertained; and some explanation of the rapid and vast increase just before Jenner’s time is afforded by the calamitous introduction of inoculation. Much courage and excellent intention will always be attributed to Lady Mary Wortley Montagu, who introduced the practice from Turkey, and to those whom she converted: but they did not foresee, and for a long time society did not perceive, that the constant keeping alive of the disease would destroy more than inoculation could save. Year by year the disease became as terrific as it formerly was at intervals when it came as a plague, carrying off its tens of thousands in each country, and then subsiding, and passing almost out of sight for a course of years. Spain was very little troubled with smallpox (except on occasion), while it was ravaging in other countries, because in Spain inoculation was not permitted after its danger was perceived; and in France the evil became much mitigated after 1763, from the prohibition of inoculation. These facts are striking; but more so is the historical truth that Sweden, Denmark, and some German States were absolutely free from smallpox for twenty years after vaccination was properly enforced by the respective governments.
In view of these facts I need not explain why the 14th of May this year should be a day of humiliation in England. After believing for the lifetime of two generations that we had no more to dread from the most fearful of diseases—after being long accustomed to speak of it as one of the barbarisms and afflictions which the world,—or at least Europe,—or at all events England had outgrown, we find ourselves plunged back into the horror of it. Instead of hearing of a case of smallpox as a phenomenon which roused curiosity as to how it could have happened, we now read of sixty or seventy deaths per week in London alone. The Smallpox Hospital seemed, some few years since, to be going out of use; and some people began to covet it for other purposes, and reckon how soon they might propose for it; and now its directors have been advertising, day by day, that it can receive no more patients. It has been gradually filling for a considerable period; at present it is overfull: and it is continually sending away patients whose troubled friends do not know what on earth to do next for their sufferers. After being mischievously careless and thoughtless, many of the citizens are becoming mischievously alarmed; and the most rational part of the public has undeniable reason for anxiety. If the sufferers remain where they sicken, they endanger the persons about them to an unknown extent: and if they are removed, they may leave the infection in the vehicles which carry them, and wherever they go. One’s London acquaintance complain of having met men and women in the street full of the eruption, and of children sickening with it lounging on doorsteps, or, just recovering, playing in the squares.
We, in the country, hear worse things in proportion to our numbers than Londoners. The smallpox is in the village school. A. B. cannot be married next week because he is down in smallpox, and his betrothed cannot go near him because she has never been vaccinated. C. D., who was so pleased at having got an excellent place in Manchester, little supposed she was leaving our valley for ever: but her mistress writes that the doctor can give no hope, for a worse case of smallpox he never saw. The poor girl was never vaccinated. If it is shocking to hear of seven in one house all down at once, or in quick succession, it is afflicting to go from cottage to cottage in a village, and to see children in arms, fine lads and lasses, or the head of the household in the loathsome condition which our parents hoped we should escape the sight of altogether. It will be very painful, for a generation to come, to observe the effects left by the disease. Our children will see the blind led about, or groping their way; the seamed faces showing how they lost their sight. We shall hear, month after month, the consumptive cough, under which so many smallpox patients waste away sooner or later after another name is given to their ailments. Many a handsome and well-grown boy, and many a pretty and healthy girl will never look like themselves again. Henceforward they will be frail, lame, or weak-eyed, short of breath, and unfit for work, disfigured, and suffering from the change in their skin, as dogs suffer from heat, because they do not perspire. Some who never knew before what headache was will henceforth be seldom without it: and many who could not remember what it was to be feverish, will suffer that misery with every slight ailment. What a thought it is that in London, sixty or seventy people are dying week after week of this disease; and that for every one that dies there are many lying sick of it! We are told on authority that where the disease occurs “naturally” (as we call it) one in four dies. In the Smallpox Hospital the deaths have been stated to be 30 per cent. Among the vaccinated not one in 450 dies.
Here, then, is reason enough for humiliation under this scourge. We have not been vaccinated at all, or we have been vaccinated badly; multitudes have never been watched, to see whether the experiment succeeded; and the class whose business it was to see that the vaccine matter was of the proper quality have been lax about this great duty,—receiving and using any lymph which was said to have come from the cow, without ascertaining whether the cow’s case was that of the true pock; or taking lymph from the human subject from one course of years to another, without trying whether it had lost its efficacy by long transmission.
There is another reason for shame and grief which, being admitted in a general way, is not enough thought of in connection with smallpox. We all understand the mischiefs of the old method of nursing in this disease, when fresh air was excluded, and heat and crowding, and noise and confusion increased the patient’s fever: but as far as I know, it never occurred to any of us that smallpox comes of itself, like ordinary fever, when the air is vitiated in a certain manner, to a certain extent. I know of nobody who ever publicly and confidently said this before Miss Nightingale. She tells us, in her “Notes on Nursing,” that she was brought up to suppose that smallpox was a special disease which had been communicated from one person to another, from the first that had it,—(however that person may have come by it:) whereas Miss Nightingale has herself seen smallpox created by bad management. She has, moreover, seen one of these special diseases pass into another, according to the circumstances which surrounded the patient. She has seen smallpox begin where it could not possibly have been “caught:” and she has seen fever which began among people living crowded together pass into typhoid fever, if the crowding increased; and into typhus, after more crowding still.
These considerations are beyond measure important to us at this juncture, for more reasons than one.
If it is indeed the truth that the diseases which we have always considered as special, and natural to man, are actually generated by our own mismanagement, the prospects of posterity are very different from what has been supposed, and our own duty must appear to us in a very different light. We are vexed at the ignorance of our cottagers and servants who resist precautions against smallpox, because they suppose that everybody has the disease in him, and is appointed to undergo the illness; and that all endeavours to evade it will only make him suffer more in another way. Yet we are not much wiser than this if we believe that the disease must be “caught,” and that therefore we need fear nothing whatever from it if it is kept down by vaccination. We have always believed this; and now we find ourselves in the midst of such an amount of it as we never imagined would be seen again in England. We must not overlook the very significant facts that, along with smallpox, there is an alarming prevalence of typhus fever: and that this fearful spread of typhus is attributed by physicians, scientific men, and other persons of experience, to the ever-increasing condensation of the population caused by the recent improvements in several large towns, and especially in London.
In the country mischiefs of a similar kind occur wherever clearances of cottage property have been going on: and, this spring, the returns of public health have been so unfavourable that we cannot be surprised if, at the close of 1863, any possible prosperity from fine weather, and fine harvest following on three bad years, may fail to cheer us, or to look like prosperity, because epidemics have afflicted us, and typhus and smallpox have humbled our pride in our rising civilisation.
Now that the evil is upon us, what can be done?
The first idea that occurs to most people in all times of public calamity is to appeal to the Government.—Where the Government has a clearly-assigned duty to perform, it is right, of course, for the citizens to see that the duty is done. But in a country so free as ours, where the citizens have a will, a power, and an influence beyond what Government can give or take away, anything that the Administration can do is small and superficial in comparison with what municipal, social, and individual influence can effect.—Let us look a little at this.
The Lords of the Privy Council have been quite ready to attend to the appeals made to them. They have addressed their advice, with due urgency, to the thirty-six Boards of Guardians of the metropolitan parishes and unions, on the Smallpox question: and that advice consists, first, of suggestions, under five heads, for securing a more extensive vaccination, more effectively managed; and next, of a recommendation that temporary Smallpox Hospitals should be established, during the prevalence of the disease.
Such is the actual procedure of the Government.
What more is asked of them, from one quarter or another, is that vaccination should be rendered yet more compulsory by law; that law should compel a general supply of hospitals; that law should prevent public carriages being used for the conveyance of sick persons; that law should provide a due supply of good vaccine matter: that law should prevent public improvements from occasioning the over-crow ding of dwellings; that law and Orders in Council, in short, should be put in charge of the smallpox and typhus fever, so that we may be as safe as we used to be, without responsibility on our own part.
Now, these things are not the function of Government in our country; and if they were, Government could not do them half so well as we ourselves can, by a simple exercise of our powers and our influence as citizens. Where the resident citizens desire a Smallpox Hospital, there will be one. Where they do not choose to allow cabs and coaches to be infected by the removal of patients, there the hospitals or the Guardians will provide carriages for invalid use. Where they do not approve of thrusting poor people into holes and corners, to make room for new squares and fresh openings, there arrangements will be made for providing better dwellings, or for conveying the humble tenants to a new neighbourhood. Such matters as these are much better managed by the citizens in bodily presence on the spot than by the remote and intangible abstraction called Government, which falls into some mistake when it attempts to interfere in local details.
Government, that is, Parliament, has given us a Lodging-house Act: and it is for the people to see that its provisions are carried out. Government, that is, the Lords of the Privy Council, have, as I have shown, published their recommendations about temporary hospitals for smallpox while the disease prevails: and it is for the citizens to take care that the thing is done. Government has given us the Vaccination Act: and it is for us to see that it is made to work: and if there are faults which prevent its working, it is for us to point out what changes should be made, and how they may best be made. Government has sanctioned the provision of a due number of surgeons, throughout the kingdom, to vaccinate the whole population: but it is the business of the citizens, and not of the Government, to see that qualified practitioners are appointed, and that they do their duty.
It seems to me that if we put our thoughts in order a little about the duties of the case, we shall find that there are so many ways of helping, that almost every man and woman in the country may do something about putting down, and keeping down, smallpox.
First: can we help our neighbours to pure air?
A surgeon and registrar in London tells us that he has had to send six cases to the Fever Hospital from a single room of a house in his district. This was from want of air. The room is under the tiles, and the only way to enter it is by getting out upon the roof, crossing it, and slipping down into the room by “a hole about three feet square.” Even in the most airy country places we find matters almost as bad as this, in many a cottage. The family sleep all in one room; and the tiny window will not open. Thus the household are in impaired health always,—just as if they were stinted in food: and when fever or smallpox comes down upon them, it is not wonderful that seven of them are in it at once,—as has lately happened.
It is impossible to give, in a day, everybody room to move, and air enough to breathe; but it is possible any and every day to see what the state of things is in one’s neighbourhood, to put the existing law in force about the conditions of lodging-houses, about removing nuisances, &c.; and it is usually not difficult to induce respectable people to let their windows be made to open, and to take some fine breezy day at this time of the year for white-washing their houses, clearing out their dust-holes, and sunning their bedding. Not only at this, but at all times, should our influence go to discountenance the demolition of cottages and other dwellings before an ampler provision of room has been made for the tenants who are turned out: and who can say how many more good cottages and working men’s houses would be created if we all said and did what we could in furtherance of the object? It may startle some of us to hear from the Registrar General, in his last returns, that during the first quarter of this year, the additional deaths from atmospheric causes have been at the rate of 20,000 a year. Thus, if smallpox and fever are allowed to grow up of themselves in dark and close corners, they come out and sweep off, in such years as this, 20,000 more of us than die in ordinary seasons.
Next; it is everybody’s business to see that the Vaccination Act is obeyed: but how many of us do look to it? It is a case in which we should all be health-officers. Look at the facts stated in the “Times” by Mr. Clarke, the Inspector of the Norwich Board of Health. In 1861, there were 3000 or more cases of smallpox in Norwich, among high and low; and it was so virulent, that great alarm prevailed. The Inspector set to work to make out how many of the people were unvaccinated, and to get them to do what had been so long neglected. In the last half of that year, he caused 1843 children of the poor to be vaccinated, and in a little while, no more was heard of the smallpox. In the corresponding half of the next year, while there had been 1500 births, the vaccinations were only 102. This shows us what may be expected in Norwich when smallpox appears there again. Negligent and careless up to last New Year’s day, the people will be half crazy with terror when the disease is upon them; and they will again have 3000 or more of the citizens down in smallpox, and trains of funerals in their streets.
Mr. Clarke advises that the Act should be amended in this way:—that the notices issued by the registrar of births to parents that their infants must be vaccinated within three months should be required to be given in again, when the vaccination has taken place, bearing the certificate of the surgeon that the process had taken effect. The failures in the return of the notice would show the amount of neglect, and would indicate to the officers of health where the Act needed enforcing.
Meantime, we can all be health-officers in our own houses and neighbourhoods. We can at once cause every member of our own households to be vaccinated a second time, if it has not been done for a long course of years; and we must put forth our whole influence to get it done wherever our neighbours are lazy, thoughtless, or ignorant.
But much of the omission proceeds from downright disapprobation of the practice, and a conscientious objection on the part of parents. Here is a difficulty: and it is all the greater from the objections being too often well founded. We may pity and coax an ignorant mother who thinks it is cruel to make her little infant ill for a day or two, and to give it an ugly sore on its pretty arm: and we may reason with the scrupulousness which fears to meddle with “the natural course” of the diseases supposed to be appointed to all living; but what can we say to the objection that the local surgeon does not know or care whether he does the thing properly, and never inquires what comes of the experiment; or that particular diseases have followed upon vaccination; and that it has been proved to be no security against smallpox itself? These things have all been, or seemed, too true, in one place or another; and we cannot be offended at parents who had rather their children should take their chance than be thrust among these risks.
Here is a strong call upon us to look well to the character and qualifications of the surgeons charged with the vaccination of the people. It is intolerable that unfit men should hold the appointment by local favour, or because they are cheap. Which costs most—a batch of 3000 smallpox patients requiring nursing or burial, or both, or a surgeon who understands his business?
The great anxiety and difficulty of such a surgeon is about obtaining good vaccine matter. It is out of the question for ninety-nine in a hundred to get it fresh from the cow; and indeed, among the varying accounts that have been given to me, I hardly know what to think of the true matter being now ever obtained from its proper source. Meantime, the lymph is often ineffective, so that there is a wide-spread belief that its efficacy wears out by long transmission from person to person. Cannot some of us help in these difficulties? Are surgeons duly informed whenever healthy cows show an eruption which looks like the true pock? And are they told in time to make sure of their seeing the pock at the right stage? Cannot we aid the over-busy surgeon of our parish to obtain a fresh supply from proper sources? The first appearance of sympathy and appreciation on our part works wonders on the medical officers in our neighbourhood. It animates the zeal and comforts the heart of the conscientious man, and gives him weight and influence among his ignorant and reluctant clients; and, on the other hand, it is a tacit rebuke to the indolent or reckless vaccinator, making him look to his ways, and rousing him to his work. It may be safely believed that if the educated part of society were to choose and decide that society should be secured against smallpox by vaccination, the thing would be done.
We have a straight and easy course before us in regard to what to do when smallpox actually appears. A house should be ready to receive the patients, the moment the nature of their complaint is understood. We must everywhere have a house at command for a hospital, with airy rooms, proper fittings, and a sensible woman and the local surgeons in charge of it. We must have a vehicle set apart for the smallpox patients; and they must not be left to infect the people about them for a minute longer than cannot be helped. Clear as this duty is, hundreds of the sick of our great towns, in the most loathsome condition are shut in with their families or fellow-lodgers, with the worst chance for their own recovery, and the best chance of bringing down everybody about them to their own condition.
How different to the management in some places! In New England, for one. Friends of mine in Boston, a middle-aged clergyman and his wife, asked me one day what I could suppose to have been the pleasantest fortnight of their married life. I certainly should never have guessed; for it was the time when the lady had the smallpox! After a day or two of slight indisposition, she was told by her physician that a pimple on her hand looked suspicious: and the next day he pronounced it smallpox. He at once informed the authorities that there was a case of smallpox in the city; and immediately the city coach came to carry away the patient to the quarantine island in the bay. Her husband accompanied her; and much they enjoyed themselves. There was nobody in the hospital but themselves, and excellent attendants, who made them thoroughly comfortable. The patient was not at all ill when the one pustule had fairly come out. She had taken a favourite piece of fancy-work; and they carried some of their best-beloved poets, and a good novel or two; and they sat in the verandah all the lovely summer day, or strolled in the garden, and looked out on the sea. I need not say she had been vaccinated.
When we arrive at removing the first case of smallpox in our cities in this vigilant way, and when we reduce the disease to something like this one pustule, by universal vaccination, backed by good general sanitary habits, we may regard the malady as gaily as my American friends did. It makes one’s heart ache to think of the contrast between their feelings and those of the families of the sixty or seventy patients in London who are being carried to the grave week by week, leaving three or four times as many more tossing in the intolerable fever, and suffering under the horrible eruption which is more repugnant to our feelings than any other disease but leprosy. And we are conscious of a deeper disgust and humiliation under the calamity than our fathers felt, because we well know that this is no “visitation of God,” and that it has no more business among us at this day than leprosy.