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CHAPTER XXXI.

SWEDEN, DENMARK AND ICELAND.

Jenner was in the habit of pointing to Sweden and Ceylon as proofs of what vaccination might accomplish. We have seen how badly Ceylon answered to his reference; and I now proceed to inquire whether Sweden served his purpose any better.

The decline of smallpox in some communities, contemporaneously with the introduction of vaccination, might be ascribed to the cessation of inoculation with smallpox—virtually the culture of that disease; but in Sweden little had to be accounted for in that way. Spite of strong recommendations, variolation was rarely practised, and never became popular. The very year that vaccination was introduced, Dr. Acksell, of Kalmer, stated in an official report, dated 30th March, 1801, “that it is impossible to convince the lower classes of the advantages of inoculation. Dr. Colliander and I have had it announced to the people from the pulpit, that, we were ready to give our services, gratis, in inoculating their children, but not a single person applied.” And such undoubtedly was the state of things throughout the kingdom.

Sweden last century was sorely afflicted with smallpox, and, considering the repute of variolation in other lands, it is surprising how the people refrained from its vaunted protection. It is thought dreadful that in London one death in ten should have been due to this disease, but in Sweden the ratio stood as high as one in seven. To give some idea of the extent of the mischief at its highest and its lowest, let us look at eighteen years in the latter half of the century—

In these figures we see how wide were the variations in smallpox mortality prior to the introduction of vaccination; and also how indifferent was its influence on the general mortality, much smallpox not raising the death-rate, nor little smallpox lowering it.

Among the factors of mortality in Sweden were scarcity and famine. At this day, when the ends of the earth are drawn together, we are apt to forget the struggle, the misery, and the sickness that prevailed when a deficient harvest in one country, or parts of the same country, could not be made good from the sufficiency of others. Population in Northern Europe did little more than maintain existence through several centuries against the severity of Nature, with food scant and bad, and raiment and shelter inadequate. Of the latter fifty years of last century, at least fifteen were years of dearth in Sweden, and consequently of increased mortality.

The chief sufferers from deficient and unsuitable food are the young, their suffering having form in various ailments, and among them smallpox. I have repeatedly had to point out how smallpox is especially an affection of childhood, and how in Scotland, for instance, it used to be almost exclusively confined to the young, like measles and whooping-cough. The like was true of Sweden; for of the deaths from smallpox from 1774 to 1798—

a total of 85·60 per cent, being mere children. Or, to put it otherwise—

and so on.

Now, whilst I have no wish to minimise the sadness and culpability of the mortality of the young, I have yet to maintain that its consequences are by no means so serious to the State as when the heads of families and bread-winners are stricken down; and that it is a gross exaggeration to compare the fatality of smallpox with that of men slain in battle. Again, we have to recollect how many of the young die from smallpox, so to say, needlessly, from inattention and malpractice. This was clearly recognised in a Royal Letter issued from Stockholm in 1763, recommending variolation, in which the Medical Board was directed “to instruct the common people how children should be treated when suffering from natural smallpox,” assigning the cogent reason, “because many more children die from want of care than from the disease.” The assertion may be taken as indisputable; and, being true, it stands for the fact that the mortality from smallpox might have been largely reduced if parents had had the knowledge and the means to nurse their offspring through their illness. They died less of smallpox than of ignorant and defective treatment whilst under smallpox.

I have also to observe that smallpox in Sweden was steadily declining toward the close of the century, and that the decline continued into the present century. Taking the years in decades from 1749 to 1868, and casting the average, we have these results—

With these details before us, we are in a position to appreciate the claim made for vaccination, that it exterminated Smallpox in Sweden.

Vaccination began to be practised in Sweden in the year 1801. It was at first viewed with distrust by some of the leading medical authorities, but grew so rapidly in favour, that the medical board in 1803 ventured to make proposals for its general introduction. By Royal Letters in 1804 and 1805 measures were decreed for the encouragement of Vaccination; and in the almanacs for 1806, information and advice were inserted concerning “the new and certain means for the prevention and extirpation of Smallpox.” Nevertheless, the practice made way but slowly into the confidence of the common people, and not until 1812 did a committee of the Diet go so far as to recommend its compulsory adoption. The principle of compulsion was affirmed by the Diet in 1815, leading to a Royal Decree of 6th March, 1816, whereby Vaccination was made obligatory under penalty of fine and imprisonment.

Subsequently, the law was modified, but never relaxed. Whilst the rite was obligatory, it was offered gratuitously, and public vaccinators, usually parish clerks and midwives, were appointed throughout the land, and stimulated to exertion by special rewards. Vaccination was made a condition of admission to school, and was placed by the clergy on a level with baptism and confirmation. Wherefore, in course of time, it has come to pass that Sweden is described as “the best vaccinated country in the world.”

To this result the recognised interest of the Swedish clergy in medical practice largely contributed. They were not slow to perceive a fresh line of business in vaccination. Archbishop Lindblom, among others, was extremely zealous in promoting the practice in his diocese, and from a correspondence between the Consistory of Upsala and the Medical Board, it appears that the competition between the physicians and the parsons was severe. The Consistory complained that the rewards for vaccination energy were more liberally bestowed on medical men than on the deserving clergy, and that it was unfair to insist on the clergy taking out a license to vaccinate, ending with the reproach that the mishaps of some medical men had so alarmed the people in certain districts, that very few were willing to avail themselves of the wonderful prophylactic. The Board replied, that they were aware that mistakes had occurred through the use of spurious cowpox, as proved by the outbreak of smallpox afterwards; but, at the same time, what better check could be devised on incompetent practitioners than a medical license? The right of the clergy to vaccinate was not contested, but only that they should possess some recognised qualification. The extent of the ecclesiastical operations in cowpox appears from the return of the Archbishopric of Upsala, which showed that from 1804 to the end of 1810 there were 33,298 persons vaccinated, of whom 7,025 were inoculated by clergy, 20,000 by church officers, and 6,273 by medical men and others. It was by the clergy and the doctors that the project of compulsion was initiated. In a letter from the Medical Board to the King in 1810, complaint was made that “the public in Sweden do not in all places manifest the care and zeal which might be expected from sensible and tender parents in applying for, or allowing to be applied, the precious means of salvation provided for their children’s good looks and future health.” In 1814, the same Board wrote that “several of the Bishops who take the deepest interest in the spread of vaccination, have expressed their conviction that certain well-devised penalties have become as necessary as regards the ignorant masses as encouragements are useful”; and as late as 1815, the Board had to testify against the “sluggishness and indifference prevalent among the less enlightened classes.”

Compulsion was, therefore, enacted in 1816 to overcome the inertia of the lower orders, the mass of the people who at all times yield the largest crop of smallpox.

“Smallpox was exterminated in Sweden by vaccination,” is a common saying. Moore, in his History of Vaccination, published in 1817, after describing the various measures taken, observed—

Ere proceeding to inquire whether smallpox was thus suppressed, I would call attention to the hands by which vaccination was administered in Sweden. It is the custom at this day to describe vaccination as a delicate operation, and to attribute subsequent smallpox to some irregularity or defect in its performance; and yet here we are asked to contemplate a whole nation delivered from smallpox, the vaccinators being chiefly priests, clerks, and midwives. What does it mean? Is it that any sort of vaccination is good when smallpox does not follow, and that any sort is bad when smallpox does follow? If smallpox had not ceased out of the land, would it then have been said, “What wonder, considering the character of the vaccinators”?

To the assertion that smallpox in Sweden was exterminated by vaccination, the answer is an unqualified contradiction. It is not true; it is demonstrably untrue. Smallpox was declining in Sweden before vaccination was heard of, and the fall continued irrespective of its influence. Look at the figures. Here we have the returns of smallpox mortality in Sweden during the last sixteen years of the past, and the first sixteen years of the current century, up to the time when vaccination was made compulsory—

Thus we see the process of subsidence, with alternations from year to year, with the reduction of two-thirds, from 66,866 in the former to 23,376 in the latter series of years.

It will be said, of course, that vaccination was introduced into Sweden in 1801. True, but the introduction of vaccination was one thing, and its diffusion over the nation another. It was a section of the people least likely to be affected with smallpox who welcomed and practised vaccination; and however energetic and successful they might be in their promotion of the new rite, their efforts were limited to thousands among millions. All the while smallpox was declining, and they took the decline for encouragement, and began to cry out, “See! see what we are doing!” The enactment of compulsory and gratuitous vaccination in 1816 was an open confession that the lower classes remained to be dealt with, that is to say, the very people among whom smallpox had its stronghold. There are tribes whose priests profess to bring rain, and drive away sickness with their enchantments; but if showers had begun to descend, and the sick to recover, ere their assistance was invoked, it would be hard to convince even the credulous that the desired relief was due to their subsequent magic. But it is precisely in the subsequent magic of the vaccinators that we are asked to believe when told that vaccination drove smallpox out of Sweden. It was going out before vaccination was called in, and kept going out all the same when the vaccinators plied their enchantments. Happily, patient Nature holds her way unprovoked by human quackeries. Not even to confute impostors does she reverse for an instant her impartial operations.

But, although deaths from smallpox fell off so rapidly, there was no correspondent improvement in the public health. Smallpox was merely replaced by other forms of disease. Thus, the death-rate of Sweden per 1,000 for seventy years, stands as follows—

Moreover, smallpox mortality, whilst rapidly decreasing before the enactment of compulsory vaccination, has since been slowly increasing. Thus—

We therefore see that while Jenner and his friends were boasting of their achievements in Sweden, they had to account for the fall in smallpox before their intervention, and for its continued decline ere their intervention was operative; and, moreover, to answer the question, What is the profit of salvation from smallpox if death ensue from other causes? It is, however, to be observed that such large considerations were outside the scope of Jenner’s intelligence. There was smallpox, and there was vaccination, his invention, the infallible preventive of smallpox, and he saw nothing beyond. His self-love was implicated in the defence of vaccination, and any story in its favour was accepted as true, and proclaimed abroad, whilst anything to its discredit was resented as a personal affront, or denounced as wilful and diabolic falsehood. As for statistics, he had no capacity. Baron says, “Neither Dr. Jenner’s previous education nor his habits gave him a relish for any of the branches of pure science; and he seemed to have a peculiar horror of arithmetical questions, and was often jocular on this defect in his nature.”[263] This inability to calculate goes far to account for the absurdity of many of his statements concerning the miraculous effects of vaccination among populations where only two or three per cent. had been operated upon; and who, therefore, must have vicariously delivered the remainder from smallpox. To an intellect thus defective, the introduction of vaccination to Sweden was the vaccination of the Swedes; the decline of smallpox was its suppression; and its suppression was the consequence of vaccination. But the excuse that is available for Jenner does not serve those who cannot plead his congenital defect, and are satisfied to repeat his preposterous assertions.

Smallpox kept declining in Sweden until the decade (1841-50) when the annual average of deaths per million fell to 212. The variations in the mortality in single years are remarkable. Here are thirteen years when the deaths were under a hundred—

On the other hand, here are eighteen years when the deaths were over a thousand—

The death-rate from smallpox, which fell to 212 per million in 1841-50, rose to 862 per million in 1851-60, to 867 per million in 1861-70, and, owing to the epidemic of 1873-74, the worst in Sweden since 1801, the last decade, 1871-80, will exhibit a higher average.

In presence of these statistics, it is fair to repeat the inquiry, “Why was smallpox declining before vaccination was introduced; and why has smallpox revived and increased in ‘the best vaccinated country in Europe’?”

Again, too, I must call attention afresh to the fact of the irrelevant influence of smallpox upon the national mortality. Mr. P. A. Siljeström has published a diagram of the course of mortality in Sweden from 1774 to 1878, with the part smallpox has played in that mortality, from which it is manifest (to all who choose to use their own eyes) that the action of smallpox as a destroyer of life has been wildly exaggerated.[264] Bad years of smallpox are not years of a high death-rate, nor are years with little smallpox years of a low death-rate. When smallpox is prevalent it appears to replace other forms of disease, and when not prevalent, to be replaced by diseases of greater fatality. Wherefore, argues Mr. Siljeström—

Sweden is a large country, and its diseases must be subject to many local variations; but Stockholm, representing a compact population, exhibits much the same phenomena. In some years of last century the city was severely afflicted with smallpox, as the deaths in these years show—

These years were the worst; there were variations such as these—

As in Sweden at large, so in Stockholm, a fall in smallpox had set in, and was continued into the new century, until years appeared without a single death; for which vaccination had the credit, and the disease was proclaimed “stamped out,” none dreaming of reverse ahead. By and by it began to revive, and deaths were thus registered—

And then came the dreadful epidemic of 1874, when 1,191 perished, and 317 in 1875.

Thus, in two years, 1,382 perished in a population of 150,000—a death-rate of 7,916 per million—against 2,430 per million in London during the memorable epidemic of 1871; the severest outbreak of smallpox in the century in “the best and most vaccinated population in Europe!”

Under examination, the case for vaccination in Sweden altogether disappears. By Mr. P. A. Siljeström the examination has been conducted with a precision, a thoroughness, and a judicial temper that leave nothing to desire. His treatise was translated into English by Miss Frederica Rowan, and published in 1875, under the title of “The Vaccination Question: an Essay towards determining the Boundaries within which a Scientific Theory may rightfully claim to have effect given it by Legislation;” and a skilful abridgment was produced by Prof. F. W. Newman; but the original, which extends to no more than 104 pages, should be studied by whoever is seriously interested in the vaccination question. Sweden, through the possession of a long series of vital statistics, offers special facilities for a comprehensive study of the phenomena of smallpox; and in Mr. Siljeström’s treatise, we have veracity with good sense, and science with philosophy, instead of the inadequate and catchpenny stuff current in this country as “truth about vaccination.”

In Finland, the story of vaccination is much the same as in Sweden, with the difference that there was no natural subsidence of smallpox to be placed to its credit. Wherefore, as concerns Finland, it is the habit of vaccinators to preserve a discreet silence, the facts not tending to edification in the Jennerian faith.

A curious evidence of the simple trust with which the cowpox revelation was received in certain countries, is found in an ordinance issued in Finland constituting smallpox after vaccination a proof of imposture on the part of the vaccinator. The ordinance ran thus—

Under such a law (no severer than many which enact punishment where the buyer does not obtain from the seller what he gives his money for) how would it fare with the legion who now practise vaccination? But I am reminded that vaccinators no longer undertake to preserve their patients from smallpox, but only to keep it off until it comes, and then to make it milder.

Vaccination was introduced to Denmark at the same time as Sweden, and was made compulsory in 1810. As in Sweden, smallpox was falling off, and, as in Sweden, the vaccinators were loud in their outcry over their success; but their claim was absurd. The population of Denmark in 1801 was 925,680, and up to 1810 no more than 118,782 persons had been vaccinated, whilst the births during the same period were 283,905. It was, therefore, assumed that the vaccination of less than a tenth of the population in eight years had reduced and extinguished smallpox among the unvaccinated nine-tenths! Where there is a disposition to believe, anything may pass for credible.

Subsequently to 1801 there was little smallpox in Copenhagen, and from 1811 to 1823 not a death from the disease was recorded; but in 1824 smallpox reappeared; and in 1835 there were 434 deaths in the city; when it began to be admitted that vaccination did not prevent smallpox, and that revaccination was necessary for complete protection; but, if requisite, how was the miraculous extinction of the disease by the primary vaccination of less than a tenth of the population in the early years of the century to be accounted for?

Here we have the record of Copenhagen smallpox for seventy-five years, 1801-75—

Thus the number of deaths in the five years, 1871-75, was nearly equal to the deaths in the preceding thirty years, 1841-70; whilst at the same time the more or less smallpox had no apparent influence in raising or lowering the general mortality.

Iceland, as a dependency of Denmark, is often cited as evidence for the virtue of vaccination. Speaking in the House of Commons recently, Mr. T. W. Evans proclaimed, “Vaccination has extinguished smallpox in Iceland! There has not been a case in the island for thirty years.” Could aught be more conclusive? and the assertion is re-asserted with triumph: yet, under examination, we shall see the statement and the inference vanish like smoke.

First, the absence of smallpox from Iceland for series of years was nothing uncommon. Iceland’s history is singularly copious and accurate; and from Schleisner’s Iceland from the point of view of Medical Science, Copenhagen, 1849, we have the following list of smallpox epidemics during five hundred years—

1347—A great epidemic.
1380—Ditto.
1430—Terrible epidemic—8000 deaths.
1511—A great epidemic.
1555—Ditto.
1574—Ditto.
1580—A kind of variolous disease.
1590—Smallpox epidemic.
1616-17—Ditto by importation.
1632—Smallpox epidemic.
1636—Ditto.
1655—Ditto.
1658—Ditto.
1670-1—Varioloid and Smallpox.
1707-9—A dreadful epidemic by importation—18,000 died.
1742—A small epidemic from case brought in Dutch vessel.
1762-3—A mild epidemic.
1785—A small epidemic—73 deaths.
1786—Epidemic—1237 deaths.
1787—Epidemic—113 deaths.
1839-40—Smallpox again brought to Iceland, but prevented from spreading by strict quarantine.

From this list it will be seen that for centuries Iceland has had long terms of immunity from smallpox. Thus—

Inasmuch then as vaccination could have nothing to do with the years of immunity in former times, on what ground of reason can vaccination be set forth as the cause of immunity at this day? Schleisner observes—

Very good; but in 1785-87, vaccination was unknown; and as the epidemics of 1742 and 1762 are recorded by Schleisner as “small” and “mild” respectively, while so early as 1580 one is described as “a kind of variolous disease,” it is evident that vaccination could have as little to do with making “smallpox milder” as with the long terms of immunity which Iceland has enjoyed.

In an appeal by Mr. William Morris on behalf of the Icelanders, threatened with famine in 1882 he observed—

Measles absent from Iceland for thirty-six years! Supposing there were some dodge against measles corresponding to vaccination against smallpox, would not the exemption in every year up to the thirty-sixth have been ascribed to its efficacy?

Dr. Garth Wilkinson relates that in 1866 when standing on the Lawrock, where the Althing was held, Dr. Hjaltalin, Medical Inspector of Iceland, told him—

Whilst thus the Icelandic Vaccination Bubble is burst, it remains to be observed that if vaccination had saved the Icelanders from smallpox it could only have been vicariously—as in so many instances of similar salvation; for during the first half of the present century no more than 17,072 vaccinations were effected in a population of between fifty and sixty thousand in the flux of birth and death. The vaccinations are thus recorded—

There is much of the like order of “facts in favour of vaccination” current concerning other European populations, which only pass muster because they are rarely subjected to criticism; because vaccination is considered such a benign invention that to question its credentials is wicked; and because it is held that if even some of the claims made for it are touched with fable, yet their effect on the popular mind is so clearly for good in inspiring confidence and overwhelming occasional mishaps, that it is inexpedient to be over-scrupulous. But, however instructive and wholesome may be the exposure of such sophistications, it is necessary to restrain ourselves, and for the remainder of my Story we shall keep to English ground.

From the preceding details we see how far vaccination in Sweden, Denmark and Iceland fell short of the claims made for it by Jenner and his successors. Jenner, it is true, died in 1823, before the more pronounced refutations of his assertions had been evolved, but, as said, it is questionable whether he ever realised that the names of countries stood for millions of men, women and children whose vaccination could only be overtaken by organised exertion in the process of years. His various boasts, therefore, of vaccinated nations and exterminated smallpox are to be taken as proofs of defective arithmetical capacity and of that scientific imagination which runs with possibility and matter-of-fact.