Small-pox and other Diseases in Britain during the Period of Registration

We have no general statistics of mortality in England and Wales till the establishment of the Registration system in 1838, but the results make up for their limited duration by their superior accuracy. Till the year 1870 no record was kept of the amount of vaccination except as performed by the public vaccinators, but since 1872 all vaccinations are recorded, and the numbers published by the Local Government Board. My third diagram is for the purpose of showing graphically the relation of small-pox to other zymotic diseases, and to vaccination, for England and Wales. The lower line shows small-pox, the middle one zymotic diseases, and the upper the total death-rates. The relations of the three are much the same as in the London diagram, the beginning of the great decline of zymotics being in 1871, and that of small-pox in 1872, but the line of small-pox is much lower, and zymotics somewhat lower than in London, due to a larger proportion of the inhabitants living under comparatively healthy rural conditions.

But if the amount of vaccination were the main and almost exclusive factor in determining the amount of small-pox, there ought to be little or no difference between London and the country. But here, as in all other cases, the great factor of comparative density of population in compared areas is seen to have its full effect on small-pox mortality as in that of all other zymotic diseases.

This non-relation between vaccination and small-pox mortality is further proved by the thick dotted line showing the vaccinations per cent. of births for the last 22 years, as given in the “Final Report” (p. 34). The diminution of vaccination in various parts of the country began about 1884, and from 1886 has been continuous and rapid, and it is during this very period that small-pox has been continuously less in amount than has ever been known before. Both in the relation of London small-pox to that of the whole country, and in the relation of small-pox to vaccination, we find proof of the total inefficacy of that operation.

Small-pox in Scotland and in Ireland

In their Final Report the Commissioners give us Tables of the death-rates from small-pox, measles, and scarlet-fever in Scotland and Ireland; and from these Tables I have constructed my diagram (IV.), combining the two latter diseases for simplicity, and including the period of compulsory vaccination and accurate registration in both countries.

The most interesting feature of this diagram is the striking difference in the death-rates of the two countries. Scotland, the richer, more populous, and more prosperous country having a much greater mortality, both from the two zymotics and from small-pox, than poor, famine-stricken, depopulated Ireland. The maximum death-rate by the two zymotics in Scotland is considerably more than double that in Ireland, and the minimum is larger in the same proportion. In small-pox the difference is also very large in the same direction, for although the death-rate during the great epidemic in 1872 was only one-fourth greater in Scotland, yet as the epidemic there lasted three years, the total death-rate for those years was nearly twice as great as for the same period in Ireland, which, however, had a small epidemic later on in 1878. Since 1883 small-pox has been almost absent from both countries, as from England; but taking the twenty years of repeated epidemics from 1864 to 1883, we find the average small-pox death-rate of Scotland to be about 139, and that of Ireland 85 per million, or considerably more than as three to two. But even Scotland had a much lower small-pox mortality than England, the proportions being as follows for the three years which included the epidemic of 1871-3:

• Ireland, 800 per million in the three years.
• Scotland, 1,450 per million in the three years.
• England, 2,000 per million in the three years.

Now the Royal Commissioners make no remark whatever on these very suggestive facts, and they have arranged the information in tables in such a way as to render it very difficult to discover them; and this is another proof of their incapacity to deal with statistical questions. They seem to be unable to look at small-pox from any other point of view than that of the vaccinationist, and thus miss the essential features of the evidence they have before them. Every statistician knows the enormous value of the representation of tabular statistics by means of diagrammatic curves. It is the only way by which in many cases the real teaching of statistics can be detected. An enormous number of such diagrams, more or less instructive and complete, were presented to them, and, at great cost, are printed in the Reports; but I cannot find that, in their Final Report, they have made any adequate use of them, or have once referred to them, and thus it is that they have overlooked so many of the most vital teachings of the huge mass of figures with which they had to deal.

It is one of the most certain of facts relating to sanitation that comparative density of population affects disease, and especially the zymotic diseases, more than any other factor that can be ascertained. It is mainly a case of purity of the air, and consequent purification of the blood; and when we consider that breathing is the most vital and most continuous of all organic functions, that we must and do breathe every moment of our lives, that the air we breathe is taken into the lungs, one of the largest and most delicate organs of the body, and that the air so taken in acts directly upon the blood, and thus affects the whole organism, we see at once how vitally important it is that the air around us should be as free as possible from contamination, either by the breathing of other people, or by injurious gases or particles from decomposing organic matter, or by the germs of disease. Hence it happens that under our present terribly imperfect social arrangements the death-rate (other things being equal) is a function of the population per square mile, or perhaps more accurately of the proportion of town to rural populations.

In the light of this consideration let us again compare these diagrams of Irish, Scottish, and English death-rates. In Ireland only 11 per cent. of the population live in the towns of 100,000 inhabitants and upwards. In Scotland 30 per cent., and in England and Wales 54 per cent.; and we find the mortality from zymotic diseases to be roughly proportional to these figures. We see here unmistakable cause and effect. Impure air, with all else that overcrowding implies on the one hand, higher death-rate on the other. This explains the constant difference between London and rural mortality, and it also explains what seems to have puzzled the Commissioners more than anything else—the intractability of some of the zymotics to ordinary sanitation, as in the case of measles especially, and in a less degree of whooping-cough—for in their case the continual growth of urban as opposed to rural populations has neutralised the effects of such improved conditions as we have been able to introduce.

But the most important fact for our present purpose is, that small-pox is subject to this law just as are the other zymotics, while it pays no attention whatever to vaccination. The statistician to the Registrar-General for Scotland gave evidence that ever since 1864 more than 96 per cent. of the children born have been vaccinated or had had previous small-pox, and he makes no suggestion of any deficiency that can be remedied. But in the case of Ireland the medical commissioner for the Local Government Board for Ireland, Dr. MacCabe, told the Commissioners that vaccination there was very imperfect, and that a large proportion of the population was “unprotected by vaccination,” this state of things being due to various causes, which he explained (2nd Rep., QQ. 3,059-3,075). But neither Dr. MacCabe nor the Commissioners notice the suggestive, and from their point of view alarming, fact that imperfectly vaccinated Ireland had had far less small-pox mortality than thoroughly well-vaccinated Scotland, enormously less than well-vaccinated England, and overwhelmingly less than equally well-vaccinated London. Ireland—Scotland—England—London—a graduated series in density of population, and in zymotic death-rate; the small-pox death-rate increasing in the same order and to an enormous extent, quite regardless of the fact that the last three have had practically complete vaccination during the whole period of the comparison; while Ireland alone, with the lowest small-pox death-rate by far, has, on official testimony, the least amount of vaccination. And yet the majority of the Commissioners still pin their faith on vaccination, and maintain that the cumulative force of the testimony in its favour is irresistible! And further, that “sanitary improvements” cannot be asserted to afford “an adequate explanation of the diminished mortality from small-pox.”

It will now be clear to my readers that these conclusions, set forth as the final outcome of their seven years’ labours, are the very reverse of the true ones, and that they have arrived at them by neglecting altogether to consider, in their mutual relations, “those great masses of national statistics” which alone can be depended on to point out true causes, but have limited themselves to such facts as the alleged mortalities of the vaccinated and the unvaccinated, changes of age-incidence, and other matters of detail, some of which are entirely vitiated by untrustworthy evidence while others require skilled statistical treatment to arrive at true results, a subject quite beyond the powers of untrained physicians and lawyers, however eminent in their own special departments.[9]

Small-pox and Vaccination on the Continent

Before proceeding to discuss those special test-cases in our own country which still more completely show the impotence of vaccination, it will be well to notice a few Continental States which have been, and still are, quoted as affording illustrations of its benefits.

We will first take Sweden, which has had fairly complete national statistics longer than any other country, and we are now fortunately able to give the facts on the most recent official testimony—the Report furnished by the Swedish Board of Health to the Royal Commission, and published in the Appendix to their Sixth Report (pp. 751-56). Such great authorities as Sir William Gull, Dr. Seaton, and Mr. Marson, stated before the Committee of Enquiry in 1871 that Sweden was one of the best vaccinated countries, and that the Swedes were the best vaccinators. Sir John Simon’s celebrated paper, which was laid before Parliament in 1857 and was one of the chief supports of compulsory legislation, made much of Sweden, and had a special diagram to illustrate the effects of vaccination on small-pox. This paper is reproduced in the First Report of the recent Royal Commission (pp. 61-113), and we find the usual comparison of small-pox mortality in the last and present century which is held to be conclusive as to the benefits of vaccination. He says vaccination was introduced in 1801, and divides his diagram into two halves differently coloured before and after this date. It will be observed that, as in England, there was a great and sudden decrease of small-pox mortality after 1801, the date of the first vaccination in Sweden, and by 1812 the whole reduction of mortality was completed. But from that date for more than sixty years there was an almost continuous increase in frequency and severity of the epidemics. To account for this sudden and enormous decrease Sir John Simon states, in a note, and without giving his authority: “About 1810 the vaccinations were amounting to nearly a quarter of the number of births.” But these were almost certainly both adults and children of various ages, and the official returns now given show that down to 1812, when the whole reduction of small-pox mortality had been effected, only 8 per cent. of the population had been vaccinated. We are told in a note to the official tables that the first successful vaccination in Stockholm was at the end of 1810, so that the earlier vaccinations must have been mainly in the rural districts; yet the earlier Stockholm epidemics in 1807, before a single inhabitant was vaccinated, and in 1825, were less severe than the six later ones, when vaccination was far more general.

Bearing these facts in mind, and looking at diagram V., we see that it absolutely negatives the idea of vaccination having had anything to do with the great reduction of small-pox mortality, which was almost all effected before the first successful vaccination in the capital on the 17th December, 1810! And this becomes still more clear when we see that as vaccination increased among a population which, the official Report tells us, had the most “perfect confidence” in it, small-pox epidemics increased in virulence, especially in the capital (shown in the diagram by the dotted peaks) where, in 1874, there was a small-pox mortality of 7,916 per million, reaching 10,290 per million during the whole epidemic, which lasted two years. This was worse than the worst epidemic in London during the eighteenth century.[10]

But although there is no sign of a relation between vaccination and the decrease of small-pox, there is a very clear relation between it and the decrease in the general mortality. This is necessarily shown on a much smaller vertical scale to bring it into the diagram. If it were on the same scale as the small-pox line, its downward slope would be four times as rapid as it is. The decrease in the century is from about 27,000 to 15,000 per million, and, with the exception of the period of the Napoleonic wars, the improvement is nearly continuous throughout. There has evidently been a great and continuous improvement in healthy conditions of life in Sweden, as in our own country and probably in all other European nations; and this improvement, or some special portion of it, must have acted powerfully on small-pox to cause the enormous diminution of the disease down to 1812, with which, as we have seen, vaccination could have had nothing to do. The only thing that vaccination seems to have done is, to have acted as a check to this diminution, since it is otherwise impossible to explain the complete cessation of improvement as the operation became more general; and this is more especially the case in view of the fact that the general death-rate has continued to decrease at almost the same rate down to the present day!

The enormous small-pox mortality in Stockholm has been explained as the result of very deficient vaccination; but the Swedish Board of Health states that this deficiency was more apparent than real, first, because 25 per cent. of the children born in Stockholm die before completing their first year, and also because of neglect to report private vaccinations, so that “the low figures for Stockholm depend more on the cases of vaccination not having been reported than on their not having been effected.” (Sixth Report, p. 754, 1st col., 3rd par.)

The plain and obvious teaching of the facts embodied in this diagram is, that small-pox mortality is in no way influenced (except it be injuriously) by vaccination, but that here, as elsewhere, it does bear an obvious relation to density of population; and also that, when uninfluenced by vaccination, it follows the same law of decrease with improved conditions of general health as does the total death-rate.

This case of Sweden alone affords complete proof of the uselessness of vaccination; yet the Commissioners in the Final Report (par. 59) refer to the great diminution of small-pox mortality in the first twenty years of the century as being due to it. They make no comparison with the total death-rate; they say nothing of the increase of small-pox from 1824 to 1874; they omit all reference to the terrible Stockholm epidemics increasing continuously for fifty years of legally enforced vaccination and culminating in that of 1874, which was far worse than the worst known in London during the whole of the eighteenth century. Official blindness to the most obvious facts and conclusions can hardly have a more striking illustration than the appeal to the case of Sweden as being favourable to the claims of vaccination.

My next diagram (No. VI.) shows the course of small-pox in Prussia since 1816, with an indication of the epidemics in Berlin in 1864 and 1871. Dr. Seaton, in 1871, said to the Committee on Vaccination (Q. 5,608), “I know Prussia is well protected,” and the general medical opinion was expressed thus in an article in the Pall Mall Gazette (May 24, 1871): “Prussia is the country where revaccination is most generally practised, the law making the precaution obligatory on every person, and the authorities conscientiously watching over its performance. As a natural result, cases of small-pox are rare.” Never was there a more glaring untruth than this last statement. It is true that revaccination was enforced in public schools and other institutions, and most rigidly in the Army, so that a very large proportion of the adult male population must have been revaccinated; but, instead of cases of small-pox being rare, there had been for the twenty-four years preceding 1871 a much greater small-pox mortality in Prussia than in England, the annual average being 248 per million for the former and only 210 for the latter. A comparison of the two diagrams shows the difference at a glance. English small-pox only once reached 400 per million (in 1852), while in Prussia it four times exceeded that amount. And immediately after the words above quoted were written the great epidemic of 1871-72 caused a mortality in revaccinated Prussia more than double that of England! Now, after these facts have been persistently made known by the anti-vaccinators, the amount of vaccination in Prussia before 1871 is depreciated, and Dr. A. F. Hopkirk actually classes it among countries “without compulsory vaccination.” (See table and diagram opposite p. 238 in the 2nd Report.)

In the city of Berlin we have indicated two epidemics, that in 1864, with a death-rate a little under 1,000 per million, while that in 1871 rose to 6,150 per million, or considerably more than twice as much as that of London in the same year, although the city must have contained a very large male population which had passed through the army, and had therefore been revaccinated.

I give one more diagram (No. VII.) of small-pox in Bavaria, from a table laid before the Royal Commission by Dr. Hopkirk for the purpose of showing the results of long-continued compulsory vaccination. He stated to the Commission that vaccination was made compulsory in 1807, and that in 1871 there were 30,742 cases of small-pox, of which 95·7 per cent. were vaccinated. (2nd Report, Q. 1,489.) He then explains that this was because “nearly the whole population was vaccinated”; but he does not give any figures to prove that the vaccinated formed more than this proportion of the whole population; and as the vaccination age was one year, it is certain that they did not do so.[11] He calls this being “slightly attacked,” and argues that it implies “some special protection.” No doubt the small-pox mortality of Bavaria was rather low, about equal to that of Ireland; but in 1871 it rose to over 1,000 per million, while Ireland had only 600, besides which the epidemic lasted for two years, and was therefore very nearly equal to that of England. But we have the explanation when we look at the line showing the other zymotics, for these are decidedly lower than those of England, showing better general sanitary conditions. In Bavaria, as in all the other countries we have examined, the behaviour of small-pox shows no relation to vaccination, but the very closest relation to the other zymotics and to density of population. The fact of 95·7 per cent. of the small-pox patients having been vaccinated agrees with that of our Highgate hospital, but is even more remarkable as applying to the population of a whole country, and is alone sufficient to condemn vaccination as useless. And as there were 5,070 deaths to these cases, the fatality was 16·5 per cent., or almost the same as that of the last century; so that here again, and on a gigantic scale, the theory that the disease is “mitigated” by vaccination, even where not prevented, is shown to be utterly baseless. Yet this case of Bavaria was chosen by a strong vaccinist as affording a striking proof of the value of vaccination when thoroughly carried out, and I cannot find that the Commissioners took the trouble to make the comparisons here given, which would at once have shown them that what the case of Bavaria really proves is the complete uselessness of vaccination.

This most misleading, unscientific, and unfair proceeding, of giving certain figures of small-pox mortality among the well vaccinated, and then, without any adequate comparison, asserting that they afford a proof of the value of vaccination, may be here illustrated by another example. In the original paper by Sir John Simon on the History and Practice of Vaccination, presented to Parliament in 1857, there is, in the Appendix, a statement by Dr. T. Graham Balfour, surgeon to the Royal Military Asylum for Orphans at Chelsea, as to the effects of vaccination in that institution—that since the opening of the Asylum in 1803 the Vaccination Register has been accurately kept, and that every one who entered was vaccinated unless he had been vaccinated before or had had small-pox; and he adds: “Satisfactory evidence can therefore, in this instance, be obtained that they were all protected.” Then he gives the statistics, showing that during forty-eight years, from 1803 to 1851, among 31,705 boys there were thirty-nine cases and four deaths, giving a mortality at the rate of 126 per million on the average number in the Asylum, and concludes by saying: “The preceding facts appear to offer most conclusive proofs of the value of vaccination.” But he gives no comparison with other boys of about the same age and living under equally healthy conditions, but who had not been so uniformly or so recently vaccinated; for it must be remembered that, as this was long before the epoch of compulsory vaccination, a large proportion of the boys would be unvaccinated at their entrance, and would therefore have the alleged benefit of a recent vaccination. But when we make the comparison, which both Dr. Balfour and Sir John Simon failed to make, we find that these well vaccinated and protected boys had a greater small-pox mortality than the imperfectly protected outsiders. For in the First Report of the Commission (p. 114, Table B) we find it stated that in the period of optional vaccination (1847-53) the death-rate from small-pox of persons from ten to fifteen years[12] was 94 per million! Instead of offering “most conclusive proofs of the value of vaccination,” his own facts and figures, if they prove anything at all, prove not only the uselessness but the evil of vaccination, and that it really tends to increase small-pox mortality. And this conclusion is also reached by Professor Adolf Vogt, who, in the elaborate statistical paper sent by him to the Royal Commission, and printed in their Sixth Report, but not otherwise noticed by them, shows by abundant statistics from various countries that the small-pox death-rate and fatality have been increased during epidemics occurring in the epoch of vaccination.

One more point deserves notice before leaving this part of the inquiry, which is the specially high small-pox mortality of great commercial seaports. The following table, compiled from Dr. Pierce’s Vital Statistics for the Continental towns and from the Reports of the Royal Commission for those of our own country, is very remarkable and instructive.

The small-pox death-rate in the case of the lowest of these towns is very much higher than in London during the same epidemic, and it is quite clear that vaccination can have had nothing to do with this difference. For if it be alleged that vaccination was neglected in Hamburgh and Rotterdam, of which we find no particulars, this cannot be said of Cork, Sunderland, and Newcastle. Again, if the very limited and imperfect vaccination of the first quarter of the century is to have the credit of the striking reduction of small-pox mortality that then occurred, as the Royal Commissioners claim, a small deficiency in the very much more extensive and better vaccination that generally prevailed in 1871, cannot be the explanation of a small-pox mortality greater than in the worst years of London when there was no vaccination. Partial vaccination cannot be claimed as producing marvellous effects at one time and less than nothing at all at another time, yet this is what the advocates of vaccination constantly do. But on the sanitation theory the explanation is simple. Mercantile seaports have grown up along the banks of harbours or tidal rivers whose waters and shores have been polluted by sewage for centuries. They are always densely crowded owing to the value of situations as near as possible to the shipping. Hence there is always a large population living under the worst sanitary conditions, with bad drainage, bad ventilation, abundance of filth and decaying organic matter, and all the conditions favourable to the spread of zymotic diseases and their exceptional fatality. Such populations have maintained to our day the insanitary conditions of the last century, and thus present us with a similarly great small-pox mortality, without any regard to the amount of vaccination that may be practised. In this case they illustrate the same principle which so well explains the very different amounts of small-pox mortality in Ireland, Scotland, England, and London, with hardly any difference in the quantity of vaccination.

The Royal Commissioners, with all these facts before them or at their command, have made none of these comparisons. They give the figures of small-pox mortality, and either explain them by alleged increase or decrease of vaccination, or argue that, as some other disease—such as measles—did not decrease at the same time or to the same amount, therefore sanitation cannot have influenced small-pox. They never once compare small-pox mortality with general mortality, or with the rest of the group of zymotics, and thus fail to see their wonderfully close agreement—their simultaneous rise and fall, which so clearly shows their subjection to the same influences and proves that no special additional influence can have operated in the case of small-pox.

CHAPTER IV
TWO GREAT EXPERIMENTS WHICH ARE CONCLUSIVE AGAINST VACCINATION

Those who disbelieve in the efficacy of vaccination to protect against small-pox are under the disadvantage that, owing to the practice having been so rapidly adopted by all civilized people, there are no communities who have rejected it while adopting methods of general sanitation, and who have also kept satisfactory records of mortality from various causes. Any such country would have afforded what is termed a “control” or test experiment, the absence of which vitiates all the evidence of the so-called “variolous test” in Jenner’s time, as was so carefully pointed out before the Commission by Dr. Creighton and Professor Crookshank. We do, however, now possess two such tests on a limited, but still a sufficient, scale. The first is that of the town of Leicester, which for the last twenty years has rejected vaccination till it has now almost vanished altogether. The second is that of our Army and Navy, in which, for a quarter of a century, every recruit has been revaccinated, unless he has recently been vaccinated or has had small-pox. In the first we have an almost wholly “unprotected” population of nearly 200,000, which, on the theory of the vaccinators, should have suffered exceptionally from small-pox; in the other we have a picked body of 220,000 men, who, on the evidence of the medical authorities, are as well protected as they know how to make them, and among whom, therefore, small-pox should be almost or quite absent, and small-pox deaths quite unknown. Let us see, then, what has happened in these two cases.

Perhaps the most remarkable and the most complete body of statistical evidence presented to the Commission was that of Mr. Thomas Biggs, a sanitary engineer and a town councillor of Leicester. It consists of fifty-one tables exhibiting the condition of the population in relation to health and disease from almost every conceivable point of view. The subject is further illustrated by sixteen diagrams, many of them in colours, calculated to exhibit to the eye in the most clear and simple manner the relations of vaccination and sanitation to small-pox and to the general health of the people, and especially of the children, in whose behalf it is always alleged vaccination is enforced. From this wealth of material I can give only two diagrams exhibiting the main facts of the case, as shown by Mr. Biggs’ statistics in the Fourth Report of the Royal Commission, all obtained from official sources.

The first diagram (No. VIII.) shows in the upper part, by a dotted line, the total vaccinations, public and private, since 1850.[13] The middle line shows the mortality per million living from the chief zymotic diseases—fevers, measles, whooping-cough, and diphtheria—while the lower line gives the small-pox mortality. We notice here a high mortality from zymotics and from small-pox epidemics, during the whole period of nearly complete vaccination from 1854 to 1870. Then commenced the movement against vaccination, owing to its proved uselessness in the great epidemic when Leicester had a very much higher small-pox mortality than London, which has resulted in a continuous decline, especially rapid for the last fifteen years, till it is now reduced to almost nothing. For that period not only has small-pox mortality been continuously very low, but the zymotic diseases have also regularly declined to a lower amount than has ever been known before.

The second diagram (No. IX.) is even more important, as showing the influence of vaccination in increasing both the infantile and the total death-rates to an extent which even the strongest opponents of that operation had not thought possible. There are four solid lines on the diagram showing respectively, in five-year averages from 1838-42 to 1890-95, (1) the total death-rate per 1,000 living, (2) the infant death-rate under five years, (3) the same under one year, and (4), lowest of all, the small-pox death-rate under five years. The dotted line shows the percentage of total vaccinations to births.

The first thing to be noted is the remarkable simultaneous rise of all four death-rates to a maximum in 1868-72, at the same that the vaccination rate attained its maximum. The decline in the death-rates from 1852 to 1860 was due to sanitary improvements which had then commenced; but the rigid enforcement of vaccination checked the decline owing to its producing a great increase of mortality in children, an increase which ceased as soon as vaccination diminished. This clearly shows that the deaths which have only recently been acknowledged as due to vaccination, directly or indirectly, are really so numerous as largely to affect the total death-rate; but they were formerly wholly concealed, and still are partially concealed, by being registered under such headings as erysipelas, syphilis, diarrhœa, bronchitis, convulsions, or other proximate cause of death.

Here, then, we have indications of a very terrible fact, the deaths by various painful and often lingering diseases of thousands of children as the result of that useless and dangerous operation termed vaccination. It is difficult to explain the coincidences exhibited by this diagram in any other way, and it is strikingly corroborated by a diagram of infant mortality in London and in England which I laid before the Royal Commission, and which I here reproduce (No. X.). The early part of this diagram is from a table calculated by Dr. Farr from all the materials available in the Bills of Mortality, and it shows for each twenty years the marvellous diminution in infant mortality during the hundred years from 1730 to 1830, proving that there was some continuous beneficial change in the conditions of life. The materials for a continuation of the diagram are not given by the Registrar-General in the case of London, and I have had to calculate them for England. But from 1840 to 1890 we find a very slight fall, both in the death-rate under five years and under one year for England, and under one year for London, although both are still far too high, as indicated by the fact that in St. Saviour’s it is 213, and in Hampstead only 123 per 1,000 births. There appear to have been some causes which checked the diminution in London after 1840, then produced an actual rise from 1860 to 1870, followed by a slight but continuous fall since. The check to the diminution of the infant death-rate is sufficiently accounted for by that extremely rapid growth of London by immigration which followed the introduction of railways and which would appreciably increase the child-population (by immigration of families) in proportion to the births. The rise from 1860 to 1870 exactly corresponds to the rise in Leicester, and to the strict enforcement of infant vaccination, which was continuously high during this period; while the steady fall since corresponds also to that continuous fall in the vaccination rate due to a growing conviction of its uselessness and its danger. These facts strongly support the contention that vaccination, instead of saving thousands of infant lives, as has been claimed, really destroys them by thousands, entirely neutralising that great reduction which was in progress from the last century, and which the general improvement in health would certainly have favoured. It may be admitted that the increasing employment of women in factories is also a contributory cause of infant mortality, but there is no proof that a less proportion of women have been thus employed during the last twenty years, while it is certain that there has been a great diminution of vaccination, which is now admitted to be a vera causa of infant mortality.

Before leaving the case of Leicester it will be instructive to compare it with some other towns of which statistics are available. And first as to the great epidemic of 1871-2 in Leicester and in Birmingham. Both towns were then well vaccinated, and both suffered severely by the epidemic. Thus:

But since then Leicester has rejected vaccination to such an extent that in 1894 it had only seven vaccinations to ten thousand population, while Birmingham had 240, or more than thirty times as much, and the proportion of its inhabitants who have been vaccinated is probably less than half those of Birmingham. The Commissioners themselves state that the disease was brought into the town of Leicester on twelve separate occasions during the recent epidemic, yet the following is the result:

Here we see that Leicester had less than one-third the cases of small-pox, and less than one-fourth the deaths in proportion to population than well-vaccinated Birmingham; so that both the alleged protection from attacks of the disease, and mitigation of its severity when it does attack, are shown, not only to be absolutely untrue, but to apply really, in this case, to the absence of vaccination!

But we have yet another example of an extremely well-vaccinated town in this epidemic—Warrington, an official report on which has just been issued. It is stated that 99·2 per cent. of the population had been vaccinated, yet the comparison with unvaccinated Leicester stands as follows:

Here then we see that in the thoroughly vaccinated town the cases are more than six times, and the deaths more than eight times, that of the almost unvaccinated town, again proving that the most efficient vaccination does not diminish the number of attacks, and does not mitigate the severity of the disease, but that both these results follow from sanitation and isolation.

Now let us see how the Commissioners, in their Final Report deal with the above facts, which are surely most vital to the very essence of the enquiry, and the statistics relating to which have been laid before them with a wealth of detail not equalled in any other case. Practically they ignore it altogether. Of course I am referring to the Majority Report, to which alone the Government and the unenlightened public are likely to pay any attention. Even the figures above quoted as to Leicester and Warrington are to be found only in the Report of the Minority, who also give the case of another town, Dewsbury, which has partially rejected vaccination, but not nearly to so large an extent as Leicester, and in the same epidemic it stood almost exactly between unvaccinated Leicester and well-vaccinated Warrington, thus:

Here again we see that it is the unvaccinated towns that suffer least, not the most vaccinated. The public of course have been terrorised by the case of Gloucester, where a large default in vaccination was followed by a very severe epidemic of small-pox. The Majority Report refers to this in par. 373, intending to hold it up as a warning, but strangely enough in so important a document, say the reverse of what they mean to say, giving to it “very little,” instead of “very much” small-pox. This case, however, has really nothing whatever to do with the question at issue, because, although anti-vaccinators maintain that vaccination has not the least effect in preventing or mitigating small-pox, they do not maintain that the absence of vaccination prevents it. What they urge is, that sanitation and isolation are the effective and only preventives, and it was because Leicester attended thoroughly to these matters, and Gloucester wholly neglected them that the one suffered so little and the other so much in the recent epidemic. On this subject every enquirer should read the summary of the facts given in the Minority Report, paragraph 261.

To return to the Majority Report. Its references to Leicester are scattered over 80 pages, referring separately to the hospital staff, and the relations of vaccinated and unvaccinated to small-pox; while in only a few paragraphs (par. 480-486) do they deal with the main question and the results of the system of isolation adopted. These results they endeavour to minimise by declaring that the disease was remarkably “slight in its fatality,” yet they end by admitting that “the experience of Leicester affords cogent evidence that the vigilant and prompt application of isolation ... is a most powerful agent in limiting the spread of small-pox.” A little further on (par. 500) they say, when discussing this very point—how far sanitation may be relied on in place of vaccination—“The experiment has never been tried.” Surely a town of 180,000 inhabitants which has neglected vaccination for twenty years, is an experiment. But a little further on we see the reason of this refusal to consider Leicester a test experiment. Par. 502 begins thus: “The question we are now discussing must, of course, be argued on the hypothesis that vaccination affords protection against small-pox.” What an amazing basis of argument for a Commission supposed to be enquiring into this very point! They then continue: “Who can possibly say that if the disease once entered a town the population of which was entirely or almost entirely unprotected, it would not spread with a rapidity of which we have in recent times had no experience?” But Leicester is such a town. Its infants—the class which always suffers in the largest numbers—are almost wholly unvaccinated, and the great majority of its adults have, according to the bulk of the medical supporters of vaccination, long outgrown the benefits, if any, of infant-vaccination. The disease has been introduced into the town twenty times before 1884, and twelve times during the last epidemic (Final Report, par. 482 and 483). The doctors have been asserting for years that once small-pox comes to Leicester it will run through the town like wild-fire. But instead of that it has been quelled with far less loss than in any of the best vaccinated towns in England. But the Commissioners ignore this actual experiment, and soar into the regions of conjecture with, “Who can possibly say?”—concluding the paragraph with—“A priori reasoning on such a question is of little or no value.” Very true. But a posteriori reasoning, from the cases of Leicester, Birmingham, Warrington, Dewsbury, and Gloucester, is of value; but it is of value as showing the utter uselessness of vaccination, and it is therefore, perhaps, wise for the professional upholders of vaccination to ignore it. But surely it is not wise for a presumably impartial Commission to ignore it as it is ignored in this Report.[14]

The Army and Navy as a Conclusive Test

In the Report of the Medical Officer of the Local Government Board for 1884, it is alleged that when an adult is revaccinated “he will receive the full measure of protection that vaccination is capable of giving him.” In the same year the Medical Officer of the General Post Office stated in a circular, “It is desirable, in order to obtain full security, that the operation (vaccination) should be repeated at a later period of life”; and the circular of the National Health Society already referred to states that “soldiers who have been revaccinated can live in cities intensely affected by small-pox without themselves suffering to any appreciable degree from the disease.” Let us then see how far these official statements are true or false.

In their Final Report the Commissioners give the statistics of small-pox mortality in the Army and Navy from 1860 to 1894, and, although the latest order for the vaccination of the whole force in the Navy was only made in 1871, there can be no doubt that, practically, the whole of the men had been revaccinated long before that period;[15] but certainly since 1873 all without exception, both English and foreign, were revaccinated; and in the Army every recruit has been revaccinated since 1860 (see 2nd Report, Q. 3,453, 3,455; and for the Navy, Q. 2,645, 6, 3,212-13, and 3,226-3,229). Brigade-Surgeon William Nash, M.D., informed the Commission that the vaccination and revaccination of the Army was “as perfect as endeavours can make it,” and that he can make no suggestion to increase its thoroughness (Q. 3,559, 3,560).

Turning now to the diagram (No. XI.) which represents the official statistics, the two lower solid lines show the small-pox death-rate per 100,000 of the force of the Army and Navy for each year, from 1860 to 1894. The lower thick line shows the Army mortality, the thin line that of the Navy. The two higher lines show the total death-rate from disease of the Navy, and of the Home force of the Army, as the tables supplied do not separate the deaths by disease of that portion of the Army stationed abroad.

Looking first at these upper lines, we notice two interesting facts. The first is, the large and steady improvement of both forces as regards health-conditions during the thirty-five years; and the second is the considerable and constant difference in the disease mortality of the two services, the soldiers having throughout the whole period a much higher mortality than the sailors. The decrease of the general mortality is clearly due to the great improvements that have been effected in diet, in ventilation, and in general health-conditions; while the difference in health between the two forces is almost certainly due to two causes, the most important being that the sailors spend the greater part of every day in the open-air, and in air of the maximum purity and health-giving properties, that of the open sea; while soldiers live mostly in camps or barracks, often in the vicinity of large towns, and in a more or less impure atmosphere. The other difference is that soldiers are constantly subject to temptations and resulting disease, from which sailors while afloat are wholly free.

Turning now to the lower lines, we see that, as regards small-pox mortality, the Navy suffered most down to 1880, but that since that period the Army has had rather the higher mortality. This has been held to be due to the less perfect vaccination of the Navy in the earlier period, but of that there is no proof, while there is evidence as to the causes of the improvement in general health. Staff-Surgeon T. J. Preston, R.N., stated them thus: “Shorter sea-voyages; greater care not to overcrowd; plentiful and frequent supplies of fresh food; the introduction of condensed water; and the care that is now taken in the general economy and hygiene of the vessels” (Q. 3,253). These seem sufficient to have produced also the comparative improvement in small-pox mortality, especially as the shorter voyages would enable the patients to be soon isolated on shore. The question we now have to consider is, whether the amount of small-pox here shown to exist in both Army and Navy demonstrates the “full security” that revaccination is alleged to give; whether as a matter of fact our soldiers and sailors, when exposed to the contagion of intense small-pox, do suffer to “any appreciable degree”; and lastly, whether they show any immunity whatever when compared with similar populations who have been either very partially or not at all revaccinated. It is not easy to find a fairly comparable population, but after due consideration it seems to me that Ireland will be the best available, as the statistics are given in the Commissioners’ Reports, and it can hardly be contended that it has any special advantages over our soldiers and sailors,—rather the other way. I have therefore given a diagram, XII., in which a dotted line shows the small-pox mortality of the Irish people of the ages 15 to 45 in comparison with the Army and the Navy mortality for the same years. (The figures for this diagram, as regards Ireland, have been calculated from the table at p. 37 of the Final Report, corrected for the ages 15 to 45 by means of Table J. at p. 274 of the Second Report.)

This dotted line shows us that, with the exception of the great epidemic of 1871, when for the bulk of the Irish patients there was neither isolation nor proper treatment, the small-pox mortality of the Irish population of similar ages has been on the average below that of either the Army or the Navy; while if we take the mean mortality of the three for the same period (1864-1894) inclusive, the result is as follows:

If we combine the Army and Navy death-rates in the proportion of their mean strength so as to get the true average of the two forces, the death-rate is 64·3 per million, or almost exactly the same as that of Ireland.

Now if there were no other evidence which gave similar results, this great test case of large populations compared over a long series of years, is alone almost conclusive; and we ask with amazement,—Why did not the Commissioners make some such comparison as this, and not allow the public to be deceived by the grossly misleading statements of the medical witnesses and official apologists for a huge imposture? For here we have on one side a population which the official witnesses declare to be as well vaccinated and revaccinated as it is possible to make it, and which has all the protection that can be given by vaccination. It is a population which, we are officially assured, can live in the midst of the contagion of severe small-pox and not suffer from the disease “in any appreciable degree.” And on comparing this population of over 200,000 men, thus thoroughly protected and medically cared for, with the poorest and least cared for portion of our country—a portion which the official witness regarding it declared to be badly vaccinated, while no amount of revaccination was even referred to—we find the less vaccinated and less cared for community to have actually a much lower small-pox mortality than the Navy, and the same as that of the two forces combined. The only possible objections that can be taken, or that were suggested during the examination of the witnesses are, that during the early portion of the period, the Navy was not wholly and absolutely revaccinated; and secondly, that troops abroad, and especially in India and Egypt, are more frequently subjected to infection. As to the first objection, even if revaccination were not absolutely universal in the Navy prior to 1873, it was certainly very largely practised, and should have produced a great difference when compared with Ireland. And the second objection is simply childish. For what are vaccination and revaccination for, except to protect from infection? And under exposure to the most intense infection they have been officially declared “not appreciably to suffer”!

But let us make one more comparison comprising the period since the great epidemic of 1871-2, during which the Navy as well as the Army are admitted to have been completely revaccinated, both English and foreign. We will compare this (supposed) completely protected force with Leicester, an English manufacturing town of nearly the same population, by no means especially healthy, and which has so neglected vaccination that it may now claim to be the least vaccinated town in the kingdom. The average annual small-pox death-rate of this town for the twenty-two years 1873-94 inclusive is thirteen per million (see 4th Report, p. 440); but in order to compare with our Army and Navy we must add one-ninth for the mortality at ages 15-45 as compared with total mortality, according to the table at p. 155 of the Final Report, bringing it to 14·4 per million, when the comparison will stand as follows:

It is thus completely demonstrated that all the statements by which the public has been gulled for so many years, as to the almost complete immunity of the revaccinated Army and Navy, are absolutely false. It is all what Americans call “bluff.” There is no immunity. They have no protection. When exposed to infection, they do suffer just as much as other populations, or even more. In the whole of the nineteen years 1878-1896 inclusive, unvaccinated Leicester had so few small-pox deaths that the Registrar-General represents the average by the decimal 0·01 per thousand population, equal to ten per million, while for the twelve years 1878-1889 there was less than one death per annum! Here we have real immunity, real protection; and it is obtained by attending to sanitation and isolation, coupled with the almost total neglect of vaccination. Neither Army nor Navy can show any such results as this. In the whole twenty-nine years tabulated in the Second Report the Army had not one year without a small-pox death, while the Navy never had more than three consecutive years without a death, and only six years in the whole period.

Now if ever there exists such a thing as a crucial test, this of the Army and Navy, as compared with Ireland, and especially with Leicester, affords such a test. The populations concerned are hundreds of thousands; the time extends to a generation; the statistical facts are clear and indisputable; while the case of the Army has been falsely alleged again and again to afford indisputable proof of the value of vaccination when performed on adults. It is important, therefore, to see how the Commissioners deal with these conclusive test-cases. They were appointed to discover the truth and to enlighten the public and the legislature, not merely to bring together huge masses of undigested facts.

What they do is, to make no comparison whatever with any other fairly comparable populations, to show no perception of the crucial test they have to deal with, but to give the Army and Navy statistics separately, and as regards the Army piecemeal, and to make a few incredibly weak and unenlightening remarks. Thus, in par. 333, they say that, during the later years, as the whole force became more completely revaccinated, small-pox mortality declined. But they knew well that during the same period it declined over all England, Scotland, and Ireland, with no special revaccination, and most of all in unvaccinated Leicester! Then with regard to the heavy small-pox mortality of the wholly revaccinated and protected troops in Egypt, they say, “We are not aware what is the explanation of this.” And this is absolutely all they say about it! But they give a long paragraph to the Post Office officials, and make a great deal of their alleged immunity. But in this case the numbers are smaller, the periods are less, and no statistics whatever are furnished except for the last four years! All the rest is an extract from a parliamentary speech by Sir Charles Dilke in 1883, stating some facts, furnished of course by the medical officers of the Post Office, and therefore not to be accepted as evidence.[18] This slurring over the damning evidence of the absolute inutility of the most thorough vaccination possible, afforded by the Army and Navy, is sufficient of itself to condemn the whole Final Report of the majority of the Commissioners. It proves that they were either unable or unwilling to analyse carefully the vast mass of evidence brought before them, to separate mere beliefs and opinions from facts, and to discriminate between the statistics which represented those great “masses of national experience” to which Sir John Simon himself has appealed for a final verdict, and those of a more partial kind, which may be vitiated by the prepossessions of those who registered the facts. That they have not done this, but without any careful examination or comparison have declared that revaccinated communities have “exceptional advantages” which, as a matter of fact, the Report itself show they have not, utterly discredits all their conclusions, and renders this Final Report not only valueless but misleading.

CHAPTER V
CRITICAL REMARKS ON THE “FINAL REPORT”

Before proceeding to sum up the broad statistical case against vaccination, it may be well here to point out some of the misconceptions, erroneous statements, vague opinions, and conclusions which are opposed to the evidence, which abound in this feeble Report.

And first, we have the repetition of an oft-corrected and obviously erroneous statement as to the absolute identity of the vaccinated and the unvaccinated, except on the one point of vaccination. The Commissioners say: “Those, therefore, who are selected as being vaccinated persons might just as well be so many persons chosen at random out of the total number attacked. So far as any connection with the incidence of, or the mortality from, small-pox is concerned, the choice of persons might as well have been made according to the colour of the clothes they wore” (Final Report, par. 213). But there are tables in the Reports showing that about one-seventh of all small-pox deaths occur in the first six months of life, and by far the larger part of this mortality occurs in the first three months. The age of vaccination varies actually from three to twelve months, and many children have their vaccination specially delayed on account of ill-health, so that the “unvaccinated” always include a large proportion of those who, merely because they are infants, supply a much larger proportion of deaths from small-pox than at any other age. Yet the Commissioners say the unvaccinated might as well be chosen at random, or by the colour of their clothes so far as any liability to small-pox is concerned. One stands amazed at the hardihood of a responsible body of presumably sensible and truth-seeking men who can deliberately record as a fact what is so obviously untrue.

Hardly less important is it that the bulk of the unvaccinated, those who escape the vaccination officers, are the very poor, and the nomad population of the country—tramps, beggars and criminals, the occupants of the tenement houses and slums of our great cities, who, being all weekly tenants, are continually changing their residence. Such were referred to, in the Report of the Local Government Board for 1882 (p. 309), as constituting the bulk of the thirty-five thousand of default, under the heading—“Removed, not to be traced, or otherwise accounted for.”

One of the Commission’s official witnesses, Dr. MacCabe, Medical Commissioner for Ireland, distinctly affirms this. He says (2nd Report, Q. 3,073) that he formerly had charge of the Dublin district, and that “out of a population of a quarter of a million, 100,000 live in tenement-houses, that is to say, houses that are let out in single rooms for the accommodation of a family. It is amongst that class, to a very great extent, that the defaulters exist. The relieving officer, when he goes to the tenement-dwelling where the birth occurred, finds that the parents have gone to some other tenement-dwelling and there is no trace of them.... A great number of these defaulters occur in this way.”

Now weekly tenants do not live in the best and most sanitary parts of towns, and the records of every epidemic show that such insanitary districts have an enormously greater proportion of the small-pox deaths than the healthier districts. Yet the Commissioners declare that there is “absolutely no difference between the vaccinated and the unvaccinated” except in respect of vaccination. Again we stand amazed at a statement so contrary to the fact. But the Commissioners must of course have believed it to be true, or they would not put it in their Final Report, upon which legislation may be founded affecting the liberties and the lives of their fellow countrymen.

I submit to my readers with confidence that this statement, so directly opposed to the clearest and simplest facts and to the evidence of official witnesses, proves the incapacity of the Commissioners for the important inquiry they have undertaken. By their treatment of this part of the subject they exhibit themselves as either ignorant or careless, in either case as thoroughly incompetent.

The next passage that calls for special notice here is par. 342, where they say, “We find that particular classes within the community, amongst whom revaccination has prevailed to an exceptional degree, have exhibited a position of quite exceptional advantage in relation to small-pox, although these classes have in many cases been subject to exceptional risk of contagion.” It seems almost incredible that such a statement as this could be made as a conclusion from the official evidence before the Commissioners, and it can only be explained by the fact that they never made the simplest and most obvious comparisons, and that they laid more stress on bad statistics than on good ones. They trust, for example, to the cases of nurses in hospitals,[19] as to which there are absolutely no statistics in the proper sense of the term, only verbal statements by various medical men, and they overlook or forget the largest and only trustworthy body of statistics existing as to revaccination—that of the Army and Navy! “A position of quite exceptional advantage!!” When the small-pox mortality of more than 200,000 men, all revaccinated to the completest extent possible by the medical officials, shows no advantage whatever over the whole comparable population of Ireland, and a quite exceptional disadvantage in comparison with almost unvaccinated Leicester![20] There is only one charitable explanation of such a “finding” as this—namely, that the Commissioners were by education and experience wholly incompetent to deal intelligently with those great masses of national statistics which alone can furnish conclusive evidence on this question.

At the end of the main inquiry, as to the effect of vaccination on small-pox (pp. 98, 99) the Commissioners adopt a very hesitating tone. They say that—“where vaccination has been most thorough the protection appears to have been greatest,” and that “the revaccination of adults appears to place them in so favourable a condition as compared with the unvaccinated.” But why say “appears” in both these cases? It is a question of fact, founded on ample statistics, which show us clearly and unmistakably—as in comparing Leicester with other towns—that vaccination gives no protection whatever, and that the best and most thorough revaccination, as in the Army and Navy, does not protect at all! It is no question of “appearing” to protect. As a fact, it does not protect, and does not appear to do so. The only explanation of the use of this word “appears” is that the Commissioners have founded their conclusions, not upon the statistical evidence at all, but upon the impressions and beliefs of the various medical officials they examined, who almost all assumed the protection as an already established fact. Such was the case of the army-surgeon who declared that the deaths were much fewer than they would have been without revaccination; and who, on being asked why he believed so, answered that it was from reading of the small-pox mortality in pre-vaccination times! He had made no comparisons, and had no figures to adduce. It was his opinion, and that of the other medical officers, that it was so. And the Commissioners apparently had always held the same opinions, which, being confirmed by the opinions of other official witnesses, they concluded that comparisons of the revaccinated Army and Navy with ordinary death-rates were as unnecessary as they would certainly have been puzzling to them. Hence “appears” in place of “is” or “does”; and their seven conclusions as to the value and protectiveness of vaccination all under the heading—“We think,” not “We are convinced,” or “It has been proved to us,” or “The statistics of the Army and Navy, of Ireland, of Leicester and of many other places, demonstrate the (”protectiveness” or “inutility”—as the case may be) of vaccination.” I trust that I have now convinced my readers that the best evidence—the evidence to which Sir John Simon and Dr. Guy have appealed—DEMONSTRATES complete INUTILITY, as against what “appears” to the Commissioners and what they “think.”

One other matter must be referred to before taking leave of the Commissioners. I have already shown how completely they ignore the elaborate and valuable evidence, statistical tables and diagrams, furnished by those who oppose vaccination, such as were brought before them by Mr. Biggs of Leicester, Mr. A. Wheeler, and Mr. William Tebb, who, though all were examined and cross-examined on the minutest details, might as well never have appeared so far as any notice in the Final Report is concerned. But there is also a very elaborate paper contributed by Dr. Adolf Vogt, Professor of Hygiene and Sanitary Statistics in the University of Berne, who offered to come to London and submit to cross-examination upon it, which, however, the Commission did not consider necessary. This paper, a translation of which is printed in the Appendix to the 6th Report, p. 689, is especially valuable as the work of a thorough statistician, who, from his position, has access to the whole body of European official statistics, and his discussion goes to the very root of the whole question. The treatise is divided into nine chapters, and occupies thirty-four closely printed pages of the Blue Book; but, being an elaborate argument founded mainly on a scientific treatment of statistics, there was probably no member of the Commission capable of adequately dealing with it. Yet it is of more value than fully nine-tenths of the remainder of the voluminous reports, with their 31,398 questions and answers. Professor Vogt’s treatise covers almost the whole ground, medical and statistical, and enforces many of the facts and arguments I have myself adduced. But there are two points which must be especially mentioned. His first chapter is headed—“A Previous Attack of Small-pox does not Confer Immunity.” I have long been of opinion that this was the case, and have by me a brief statement, written six years since, to show that the rarity of second attacks may in all probability be fully explained by the doctrine of chances. But I had not statistics sufficient to prove this. Professor Vogt, however, having the statistical tables of all Europe at his command, is able to show not only that the calculus of probabilities itself explains the rarity of a second attack of small-pox, but that second attacks occur more frequently than they should do on the doctrine of chances alone, indicating that, instead of there being any immunity, there is really a somewhat increased susceptibility to a second attack![21] This being the case, it becomes really ludicrous to read the questions and answers and the serious discussions as to whether a “good vaccination” protects more or less than a previous attack of small-pox. Some think the protection is the same, but the greater number think it is not quite so much. Even the most ardent vaccinists do not claim a greater protection. But none of them ever doubt the fact of the protection gained by having had the disease, and yet none of them, nor any of the Commissioners, thought that any evidence, much less proof, of the fact itself was needed. They took it for granted. “Everybody knows it.” “Very few people have small-pox a second time.” No doubt. But very few people suffer from any special accident twice—a shipwreck, or railway or coach accident, or a house on fire; yet one of these accidents does not confer immunity against its happening a second time. The taking it for granted that second attacks of small-pox, or of any other zymotic disease, are of that degree of rarity as to prove some immunity or protection indicates the incapacity of the medical mind for dealing with what is a purely statistical and mathematical question.