Small pox, breakthrough doctors and the anti-Vaxxers

Giacomo Lorandi wrote of the pro-inoculation career of Theodore Tronchin in France and the anti-Tronchin response, to be followed by the anti-vaccination movement in Britain and the USA.

Swiss physician Théodore Tronchin's (1709–1781) clinic att­racted patients from everywhere and his reputation, esp­ecially for ground-breaking research on the prevention of smallpox through inoculation, grew. The Duke of Orleans, Louis-Philippe I (1725-85), summoned him to Paris to treat his children. His success in saving the children sparked interest in inoculation among the Parisian ar­istocracy and his rise to fame meant inocul­ation became wide­spread.

Tronchin’s work involved a tiny amounts of the smallpox virus taken from the pustule of a person afflicted with the dis­ease; it was injected into the superficial layers of the skin to induce immunity. Tronchin was a major advocate of a healthy lifestyle and phys­ical well being. He devoted time to the sick, listening to their symptoms; he sugg­ested an active lifestyle, good hygiene, outdoor activities and diet so that the body could react fully to diseases and to inocul­at­ion. He earned great popul­ar­ity in aristocratic circles, among Paris’ intellectual-artistic salons and at the royal court.

Tronchin’s access to elite groups allowed him to meet a constant stream of new patients to whom he recommended a more sober lifestyle. He renewed the air in a sick room; didn’t condemn pregnant women to a poor diet; gave children a healthier education and banned the bindings that deformed women's size.

Dr Théodore Tronchin 

Vaccination, as developed by the English physician Edward Jenner (1749–1823) in the 1790s, came later. It was an inject­ion of a sam­ple taken from a cow suffering from cowpox. It was con­sidered safer than inocul­at­ion and was the most common method used to fight against smallpox, polio, measles and tetanus. 

During the late 1800s, the mortality rate from small pox in non-inoculated infants approached 80% in London and 98% in Berlin. Inoculated children had up to a 2% mortality rate.

Dr Edward Jenner

Anti Vaxxers are not just a modern phenomenon. Tronchin’s success inevitably led to a campaign of hatred against him. Ammunition in­c­luded his contribution towards making inoculation popular, his being a foreigner, a Calvinist and his successes. His colleagues expressed doubts about the scientific basis of his inoculat­ions. Similar attacks came from the Church and from the University of Paris’ medical faculty.

So Paris’ medical est­ablishment revolted against him, especially his inoculation. He was labelled a medical pirate, who pract­ised for money alone, treated only those he believed capable of recovery and whose fame came from his rejection of both tradit­ional remedies (opium, emet­ics, quinine) and com­mon treat­ments (purgat­ives, blood lettings). His most vocal crit­ics were eminent doct­ors who criticised Tronchin’s empiricism and the simp­licity of his remedies. As did other opponents eg Prof Jean Astruc.

Widespread smallpox vaccination in Britain began in the early 1800s, following Edward Jenner’s cowpox experiments, in which he showed that he could protect children from smallpox if he infected them with lymph from a cowpox blister. But Jenner’s ideas were novel for Britain and were met with immediate public criticism. The rationale for criticisms of Jenner’s vaccinations included sanitary, religious, scientific and political objections.

Critics of vaccination opposed the smallpox vaccine in England in the mid to late 1800s. Anti-vaccination leagues emerged, as well as more recent vaccination controversies eg surr­ounding the efficacy of the diphtheria and tetanus immunisation and the MMR (measles/mumps/rubella).

The Vaccination Act of 1853 ordered mandatory vaccination for British infants up to 3 months old, and the Act of 1867 extended this age requirement to 14 years, adding penalties for vaccine refusal. The laws were met with immediate resistance from citizens who demanded the right to control their bodies and those of their child­ren. The British Anti Vaccination Leagues formed in response to mandatory laws, and numerous anti-vaccination journals sprang up.

Mass demonstrations and general vaccine opposition across Britain led to a commission designed to study vaccination. In 1896 the commission ruled that vaccination protected against smallpox, but suggested removing penalties for failure to vaccinate. The Vac­cination Act of 1898 removed penalties and included a conscientious objector clause, so that parents who feared vaccinat­ion’s safety or efficacy could be exempted.

Smallpox outbreaks in the USA led to pro-vaccine campaigns and anti-vaccine activity. The Anti Vaccination Society of America was founded in 1879, following a visit to America by leading British anti-vaccinationists. Other Anti-Vaccination Leagues followed in the 1880s.

The pustule-covered hand of a baby with a mild case of smallpox.
Centre for Disease Control and Prevention

In 1998, British doctor Andrew Wakefield recommended in­vest­igation of the relationship between bowel disease, autism and the MMR vac­cine. He alleged the vaccine was not properly tested before being put into use. The General Medical Council found that Dr Wakefield had a fatal conflict of interest; he’d been paid by a law board if he could support a litigation case brought by parents who believed that the vaccine had harmed their children. Dr Wakefield was struck off from the medical register in Great Britain. Since 2011, a large number of research studies assessed the safety of the MMR vaccine, none of which found a link between the vaccine and autism.

The next blog post will examine another difficult medical history.