By Bliss Baird
***Since this is a public website, I feel responsible for clarifying immediately that this page is explaining a historical relationship between syphilis and vaccines, i.e., the method used in the 19th century carried a risk of syphilis, not the act of vaccination in general. ***
On May 14, 1796, Edward Jenner initiated the vaccine era with the inoculation of an 8-year-boy (Dudgeon 1367). That success, however, was not final: Jenner’s technique—scraping lymph from the vesicle of a vaccinated individual (the vaccinifer) and introducing it into the arm of a new individual—would need modifications as vaccinations became large-scale. The London Medical Officer of Health (MOH) Reports reveal that public concern over contracting syphilis during vaccination eventually convinced the reluctant British medical community of the merits of calf lymph.
European Innovation and Motivation
Although vaccination originated in England, much of its innovation occurred on the European continent. In 1805, three years after Jenner stated that cultivating calf lymph would be impractical, Italians succeeded in harvesting lymph from the flanks of inoculated cows (Benedek 109, Dudgeon 1370). The Kingdom of Bavaria became the first government to mandate smallpox vaccination in 1807 (and one of the few to offer it without cost); England would not enact compulsory vaccination until 1853 (Benedek 94, Mortimer 1112). The Academy of Medicine in Paris spent the years 1861-1864 debating the mechanism by which syphilis was transferred during vaccinations, stoked by concern over the Georg Hübner malpractice case which, in the words of a contemporary, “elevated vaccination syphilis to the hottest question of the day” (Mortimer 1112, Benedek 96 qtd. from Bohn 98). Dr. Alexandre Viennois of Lyon proposed “vaccinia by lymph, syphilis by blood,” implying that patients were safe so long as the lymph was free of the vaccinifer’s blood (Mortimer 1112). Britain, preferring the method that had originated on her shores, stuck with Viennois’ slogan even as mainland Europe, Russia, the US, and India converted to calf inoculation (1112).
Loyalty to Jenner’s method was not the only reason Britain fell behind. Whereas as late as 1857, the British surgeon-pathologist Sir James Paget could write that he had never heard of syphilis arising from vaccination, vaccine-syphilis was well-documented on the mainland (Benedek 99-100). Giovanni Baptista Monteggia, a Milanese professor of surgery, had listed syphilis as a complication of vaccination as early as 1802 (95). In 1849, 19 people in Coblenz, Germany, experienced syphilitic symptoms after their vaccinifer died of congenital syphilis a mere week after being cleared for the procedure (95). Litigation ensued (95). The largest documented vaccine-syphilis outbreak occurred in 1861 in Piedmont, Italy: 39 of 46 infants became infected after their vaccinifer had been nursed by a syphilitic woman (105). Since the symptoms appeared, on average, 20 days after the vaccination, one of those infants had already served as a vaccinifer for 17 others, infecting seven. Members of the infected infants’ families also contracted the disease (105). Nine infants died (105).
Britain Blame and Change
Even those British doctors willing to admit the possibility of vaccine-syphilis siphoned the blame away from Jenner’s method. In 1856, Sir John Simon, Medical Officer of the British General Board of Health, sent a survey to physicians inquiring whether lymph from a true Jennerian vesicle could transmit syphilis (Benedek 104). Out of 539 respondents (509 from Britain), only 5% had seen vaccine-syphilis or even believed that it occurred (105). Simon appended his own answer: “I believe it to be utterly impossible, except under circumstances of gross and punishable misconduct, for any other infection than that of cow-pox, to be communicated” (105 qtd. from Simon lxiii). Instead, he condemned colleagues in his comments on two cases of vaccine-syphilis in the Bavarian Army, writing, “syphilis was unmistakingly present in the children from whom lymph was taken. The inoculation of syphilis can at all times be avoided by an observant surgeon, who uses due circumspection in choosing the subject.” (Benedek p. 93, qtd. from Simon 169-70). The MOH for Whitechapel harnessed a different scapegoat in his 1859 quarterly report (reiterated in 1870): “when it happens that a child, whose constitution from birth is tainted with syphilis, has been vaccinated, the parents, although they themselves are alone to blame for the diseased condition of their offspring, take the opportunity of casting the blame on vaccination” (https://wellcomelibrary.org/moh/report/b19883456/85#?m=0&cv=85&c=0&s=0.)
British opinion shifted in the 1870s thanks to reports by its own scientists. In 1871, the syphilis expert Jonathan Hutchinson published two cases concerning vaccine-syphilis, one in which 11 of the 13 vaccinated were infected, and one in which at least nine of 26 (some lost to contact) manifested symptoms (Benedek 106-107). A more dramatic presentation ensued when, from 1877 to 1881, Dr. Robert Cory tempted fate four times by vaccinating himself with blood-free lymph collected from syphilitic infants (Mortimer 1113). Cory’s exact expectations are unclear. In 1878 and 1879 letters to The Times, he promoted a view consistent with that of the British medical consensus: animal lymph would be unnecessary because syphilis could be transmitted only by blood (1113). However, Hutchinson asserted in 1886 that Cory was fully aware of the risks, and Cory was already securing calf lymph from Europe (1115). Whatever his reasoning, his first three experiments were uneventful, but on July 26, 1881, twenty days after the fourth trial, red papule appeared at two of the three inoculation sites. Hutchinson and another surgeon decreed that the resulting ulcer and lesions were syphilitic. His case proved virulent enough to demand full anti-syphilitic treatment by the fall (Cory would survive and go on to champion calf-lymph vaccinations) (1113). In 1887, Dr. John C. McVail reported 28 cases where syphilis had been contracted from a vaccine in Britain in the span of 16 years (1113-1114). By 1897, doctors recommended to the Local Government Board that all vaccinations be from calf lymph except when comparing its efficacy to the calf-to-arm method (Dudgeon 1371). The highly influential Vaccination Act of 1898 incorporated their suggestion (1369).
The MOHs’ Approaches
MOHs responded to the shift in protocol with varying degrees of acceptance. Early analyses echoed the pre-1870s sentiment even as they introduced the new data. In 1885, Hackney’s MOH admitted, “In the case of human lymph, the danger of transfering syphilis, although extremely slight, cannot be entirely excluded” (https://wellcomelibrary.org/moh/report/b19885386/10#?m=0&cv=10&c=0&s=0). Kensington’s MOH continued to consider vaccine-syphilis a vanishingly slight risk, citing a rate of less than one per million, but supported appeasing the public in order to encourage vaccinations (https://wellcomelibrary.org/moh/report/b19824294/156#?m=0&cv=156&c=0&s=0&z=-0.5953%2C0.9397%2C2.1009%2C0.8201).
The prime year for dissention among MOH reports proved to be 1896. The Westminster MOH recited that the inoculation of syphilis must be exceedingly rare if it happened at all (https://wellcomelibrary.org/moh/report/b18038207/35#?m=0&cv=35&c=0&s=0). St. Olave’s MOH employed a more conciliatory tone, urging “careful examination of the facts,” in light of dangers “undoubtedly real and not inconsiderable in gross amount” (although, the report assured, relatively insignificant) and explained, “We put the use of calf-lymph in the forefront because, as we have said, this would afford an absolute security against the communication of syphilis. Though we believe the risk of such communication to be extremely small where humanized lymph is employed, we cannot but recognize the fact that however slight the risk the idea of encountering even such a risk is naturally regarded by a parent with abhorrence” (https://wellcomelibrary.org/moh/report/b18038268/33#?m=0&cv=33&c=0&s=0). The report out of Battersea exemplified the most wholesale acceptance of the new official position. “Nothing has produced so deep an impression hostile to vaccination as an apprehension that syphilis may be communicated by it,” the MOH noted (https://wellcomelibrary.org/moh/report/b17996983/166#?m=0&cv=166&c=0&s=0). The report exposed the previous official position as “mistaken” and stated that, considering the new evidence, “no doubt can have been entertained by any that it is possible to convey syphilis in the act of vaccination,” (https://wellcomelibrary.org/moh/report/b17996983/167#?m=0&cv=159&c=0&s=0). Nevertheless, the report emphasizes vaccine-syphilis’s rarity, dismantling most of the few supposed cases as either non-syphilitic or not attributable to the vaccine (https://wellcomelibrary.org/moh/report/b17996983/167#?m=0&cv=159&c=0&s=0 and subsequent pages). The ultimate conclusion is that “absolute freedom from risk of Syphilis can be had only when calf-lymph is used, though where the antecedents of the vaccinifer are fully ascertained, and due care is used, the risk may be for practical purposes regarded as absent” (https://wellcomelibrary.org/moh/report/b17996983/167#?m=0&cv=165&c=0&s=0). Not all dissension resolved in 1896; the following year, the City of London MOH argued, “The modern innovation of substituting calf for human lymph has been forced upon the Legislature chiefly by platform agitators, and is purely and simply a question of political exigency. I am, however, convinced that it has in no way modified the predilection of experienced medical practitioners in favour of arm-to-arm vaccination, and, personally, I much prefer that method” (https://wellcomelibrary.org/moh/report/b17999054/16#?m=0&cv=16&c=0&s=0&z=-1.5429%2C-0.4939%2C4.1218%2C2.5248). However, unfortunately for that MOH, the shift in professional opinion was already irreversible.
By the turn of the century, the controversy had quieted. The 1901 Woolwich report mentioned the subject only in the context of characterizing as immoral the suggestion that the original policy intended to spread syphilis (https://wellcomelibrary.org/moh/report/b19823265/115#?m=0&cv=115&c=0&s=0). The 1902 Kensington report pushed for calf lymph to be provided to all medical practitioners, not only public vaccinators, since arm-to-arm vaccination “is now discouraged, and has indeed become impracticable” (https://wellcomelibrary.org/moh/report/b18045224/71#?m=0&cv=71&c=0&s=0).
The brief but intense debate surrounding vaccine-syphilis spawned innovation in vaccination procedures, first on the European continent—where vaccine-syphilis was sooner and better noted—and later in Britain, the home and staunchest supporter of Jenner’s arm-to-arm method. Although the medical community recognized transmission of erysipelas before that of syphilis, and although leprosy, tuberculosis, scarlatina, and measles were also attributed to vaccination, syphilis proved to be the primary impetus for change, most likely because it was more dreaded than the former condition and more clearly linked to vaccinations than the latter ones (Mortimer 1115, Benedek 108). Medical Officer of Health reports reveal that members of London’s medical community differed in their opinion of the calf-lymph protocol, but legislation and public concern dictated an abrupt end to arm-to-arm vaccination. In this way, fear of syphilis forged the future of vaccination.
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