THE GENERAL STATISTICS OF SMALL-POX MORTALITY IN RELATION TO VACCINATION
Having thus cleared away the mass of doubtful or erroneous statistics
depending on comparisons of the vaccinated and the unvaccinated in
limited areas or selected groups of patients, we turn to the only really
important evidence, those “masses of national experience” which Sir John
Simon, the great official advocate of vaccination, tells us we must now
appeal to for an authoritative decision on the question of the value of
vaccination; to which may be added certain classes of official evidence
serving as test cases or “control experiments” on a large scale. Almost
the whole of the evidence will be derived from the Reports of the recent
Royal Commission.
In determining what statistics really mean the graphic is the only
scientific method, since, except in a few very simple cases, long tables
of figures are confusing; and if divided up and averages taken, as is
often done, they can be manipulated so as to conceal their real teaching.
Diagrams, on the other hand, enable us to see the whole bearing of the
variations that occur, while for comparisons of one set of figures with
another their superiority is overwhelming. This is especially the case
with the statistics of epidemics and of general mortality, because the
variations are so irregular and often so large as to render tables of
figures very puzzling, while any just comparison of several tables with
each other becomes impossible. I shall therefore put all the statistics I
have to lay before my readers in the form of diagrams, which, I believe,
with a little explanation, will enable any one to grasp the main points
of the argument.
LONDON MORTALITY AND SMALL-POX
The first and largest of the diagrams illustrating this question is that
exhibiting the mortality of London from the year 1760 down to the present
day (see end of volume). It is divided into two portions, that from 1750
to 1834 being derived from the old “Bills of Mortality,” that from 1838
to 1896 from the Reports of the Registrar-General.
The “Bills of Mortality” are the only material available for the first
period, and they are far inferior in accuracy to the modern registration,
but they are probably of a fairly uniform character throughout, and
may therefore be as useful for purposes of comparison as if they were
more minutely accurate. It is admitted that they did not include the
whole of the deaths, and the death-rates calculated from the estimated
population will therefore be too low as compared with those of the
Registrar-General, but the _course_ of each death rate—its various
risings or fallings—will probably be nearly true.[7] The years are given
along the bottom of the diagram, and the deaths per million living
are indicated at the two ends and in the centre, the last four years
of the Bills of Mortality being omitted because they are considered to
be especially inaccurate. The upper line gives the total death-rate
from all causes, the middle line the death-rate from the chief zymotic
diseases—measles, scarlet-fever, diphtheria, whooping-cough and, fevers
generally, excluding small-pox, and the lower line small-pox only. The
same diseases, as nearly as they can be identified in the Bills of
Mortality according to Dr. Creighton, are given in the earlier portion
of the diagram from the figures given in his great work, _A History of
Epidemics in Britain_. With the exception of these zymotics the diagram
is the same as that presented to the Royal Commission (3rd Report,
diagram J.), but it is carried back to an earlier date.
Let us now examine the lowest line, showing the small-pox death-rate.
First taking the period from 1760 to 1800, we see, amid great
fluctuations and some exceptional epidemics, a well-marked steady decline
which, though obscured by its great irregularity, amounts to a difference
of 1,000 per million living. This decline continues, perhaps somewhat
more rapidly, to 1820. From that date to 1834 the decline is much less,
and is hardly perceptible. The period of Registration opens with the
great epidemic of 1838, and thenceforward to 1885 the decline is very
slow indeed; while, if we average the great epidemic of 1871 with the
preceding ten years, we shall not be able to discover any decline at
all. From 1886, however, there is a rather sudden decline to a very low
death-rate, which has continued to the present time. Now it is alleged
by advocates of vaccination, and by the Commissioners in their Report,
that the decline from 1800 onwards is due to vaccination, either wholly
or in great part, and that “the marked decline of small-pox in the first
quarter of the present century affords substantial evidence in favour
of the protective influence of vaccination.”[8] This conclusion is not
only entirely unwarranted by the evidence on any accepted methods of
scientific reasoning, but it is disproved by several important facts.
In the first place the decline in the first quarter of the century
is a clear continuation of a decline which had been going on during
the preceding forty years, and whatever causes produced that earlier
decline may very well have produced the continuation of it. Again, in
the first quarter of the century, vaccination was comparatively small
in amount and imperfectly performed. Since 1854 it has been compulsory
and almost universal; yet from 1854 to 1884 there is almost no decline
of small-pox perceptible, and the severest epidemic of the century
occurred in the midst of that period. Yet again, the one clearly marked
decline of small-pox has been in the ten years from 1886 to 1896, and it
is precisely in this period that there has been a great falling off in
vaccination in London from only 7 per cent. less than the births in 1885
to 20·6 per cent. less in 1894, the last year given in the Reports of the
Local Government Board; and the decrease of vaccinations has continued
since. But even more important, as showing that vaccination has had
nothing whatever to do with the decrease of small-pox, is the very close
general parallelism of the line showing the other zymotic diseases, the
diminution of which it is admitted has been caused by improved hygienic
conditions. The decline of this group of diseases in the first quarter
of this century, though somewhat less regular, is quite as well marked
as in the case of small-pox, as is also its decline in the last forty
years of the 18th century, strongly suggesting that both declines are
due to common causes. Let any one examine this diagram carefully and say
if it is credible that from 1760 to 1800 both declines are due to some
improved conditions of hygiene and sanitation, but that after 1800, while
the zymotics have continued to decline from the same class of causes one
zymotic—small-pox—_must_ have been influenced by a new cause—vaccination,
to produce its corresponding decline. Yet this is the astounding claim
made by the Royal Commissioners! And if we turn to the other half of the
diagram showing the period of registration, the difficulty becomes even
greater. We first have a period from 1838 to 1870, in which the zymotics
actually rose; and from 1838 to 1871, averaging the great epidemic with
the preceding ten years, we find that small-pox also rose, or at the best
remained quite stationary. From 1871 to 1875 zymotics are much lower,
but run quite parallel with small-pox; then there is a slight decline in
both, and zymotics and small-pox remain lower in the last ten years than
they have ever been before, although in this last period vaccination has
greatly diminished.
Turning to the upper line, showing the death-rate from all causes,
we again find a parallelism throughout, indicating improved general
conditions acting upon _all_ diseases. The decline of the total
death-rate from 1760 to 1810 is remarkably great, and it continues at a
somewhat less rate to 1830, just as do the zymotics and small-pox. Then
commences a period from 1840 to 1870 of hardly perceptible decline partly
due to successive epidemics of cholera, again running parallel with the
course of the zymotics and of small-pox, followed by a great decline to
the present time, corresponding in amount to that at the beginning of the
century.
The Commissioners repeatedly call attention to the fact that the
mortality from measles has not at all declined and that other zymotics
have not declined in the same proportion as small-pox, and they argue:
“If improved sanitary conditions were the cause of small-pox becoming
less, we should expect to see that they had exercised a similar influence
over almost all other diseases. Why should they not produce the same
effect in the case of measles, scarlet fever, whooping-cough, and indeed
any disease spread by contagion or infection and from which recovery
was possible?” This seems a most extraordinary position to be taken in
view of the well-known disappearance of various diseases at _different_
epochs. Why did leprosy almost disappear from England at so early a
period and plague later on? Surely to _some_ improved conditions of
health. The Commissioners do not, and we may presume cannot, tell us
why measles, of all the zymotic diseases, has rather increased than
diminished during the whole of this century. Many students of epidemics
hold that certain diseases are liable to replace each other, as suggested
by Dr. Watt, of Glasgow, in the case of measles and small-pox. Dr.
Farr, the great medical statistician, adopted this view. In his Annual
Report to the Registrar-General in 1872 (p. 224), he says: “The zymotic
diseases replace each other; and when one is rooted out it is apt to be
replaced by others which ravage the human race indifferently whenever
the conditions of healthy life are wanting. They have this property
in common with weeds and other forms of life: as one species recedes
another advances.” This last remark is very suggestive in view of the
modern germ-theory of these diseases. This substitution theory is
adopted by Dr. Creighton, who in his _History of Epidemics in England_
suggests that plague was replaced by typhus fever and small-pox; and,
later on, measles, which was insignificant before the middle of the
seventeenth century, began to replace the latter disease. In order
to show the actual state of the mortality from these diseases during
the epoch of registration, I have prepared a diagram (II.) giving the
death-rates for London of five of the chief zymotics, from the returns
of the Registrar-General, under the headings he adopted down to 1868—for
to divide fevers into three kinds for half the period, and to separate
scarlatina and diphtheria, as first done in 1859, would prevent any
useful comparison from being made.
The lowest line, as in the larger diagram, shows Small-pox. Above it is
Measles, which keeps on the whole a very level course, showing, however,
the high middle period of the zymotics and two low periods, from 1869
to 1876, and from 1848 to 1856, the first nearly corresponding to the
very high small-pox death-rate from 1870 to 1881; and the other just
following the two small-pox epidemics of 1844 and 1848, thus supporting
the view that it is in process of replacing that disease. Scarlatina and
diphtheria show the high rate of zymotics generally from 1848 to 1870,
with a large though irregular decline subsequently. Whooping-cough shows
a nearly level course to 1882 and then a well-marked decline. Fevers
(typhus, enteric, and simple) show the usual high middle period, but with
an earlier and more continuous decline than any of the other zymotic
diseases. We thus see that all these diseases exhibit common features
though in very different degrees, all indicating the action of general
causes, some of which it is by no means difficult to point out.
In 1845 began the great development of our railway system, and with it
the rapid growth of London, from a population of two millions in 1844
to one of four millions in 1884. This rapid growth of population was
at first accompanied with overcrowding, and as no adequate measures of
sanitation were then provided the conditions were prepared for that,
increase of zymotic disease which constitutes so remarkable a feature
of the London death-rates between 1848 and 1866. But at the latter date
commenced a considerable decline both in the total mortality and in that
from all the zymotic diseases, except measles and small-pox, but more
especially in fevers and diphtheria, and this decrease is equally well
explained by the completion, in 1865, of that gigantic work, the main
drainage of London. The last marked decline in small-pox, in fevers,
and to a less marked degree in whooping-cough, is coincident with a
recognition of the fact that hospitals are themselves often centres of
contagion, and the establishment of floating hospitals for London cases
of small-pox. Perhaps even more beneficial was the modern system of
excluding sewer-gas from houses.
We thus see that the increase or decrease of the chief zymotic diseases
in London during the period of registration, is clearly connected with
adverse or favourable hygienic conditions of a definite kind. During the
greater part of this period small-pox and measles alone showed no marked
increase or decrease, indicating that the special measures affecting
them had not been put in practice, till ten years back the adoption
of an effective system of isolation in the case of small-pox has been
followed by such marked results wherever it has been adopted as to show
that _this_ is the one method yet tried that has produced any large
and unmistakable effect, thus confirming the experience of the town of
Leicester, which will be referred to later on.
The Commissioners in their _Final Report_ lay the greatest stress
on the decline of small-pox at the beginning of the century, which
“followed upon the introduction of vaccination,” both in England, in
Western Europe, and in the United States. They declare that “there is no
proof that sanitary improvements were the main cause of the decline of
small-pox,” and that “no evidence is forthcoming to show that during the
first quarter of the nineteenth century these improvements differentiated
that quarter from the last quarter or half of the preceding century
in any way at all comparable to the extent of the differentiation
in respect to small-pox” (p. 19 par. 79). To the accuracy of these
statements I demur in the strongest manner. There _is_ proof that
sanitary improvements were the main cause of this decline of small-pox
early in the century, viz., that the other zymotic diseases as a whole
showed a simultaneous decline to a nearly equal amount, while the general
death-rate showed a decline to a much greater amount, both admittedly due
to improved hygienic conditions, since there is _no other known cause_
of the diminution of disease; and that the Commissioners altogether
ignore these two facts affords, to my mind, a convincing proof of their
incapacity to deal with this great statistical question. And, as to the
second point, I maintain that there _is_ ample direct evidence, for
those who look for it, of great improvements in the hygienic conditions
of London quite adequate to account for the great decline in the general
mortality, and therefore equally adequate to account for the lesser
declines in zymotic diseases and in small-pox, both of which began in the
last century, and only became somewhat intensified in the first quarter
of the present century, to be followed twenty years later by a complete
check or even a partial rise. This rise was equally marked in small-pox
as in the other diseases, and thus proved, as clearly as anything can
be proved, that its decline and fluctuations are in no way dependent on
vaccination, but are due to causes of the very same general nature as in
the case of other diseases.
To give the evidence for this improvement in London hygiene would,
however, break the continuity of the discussion as to small-pox and
vaccination; but the comparison of the general and zymotic death-rates
with that of small-pox exhibits so clearly the identity of the causes
which have acted upon them all as to render the detailed examination of
the various improved conditions that led to the diminished mortality
unnecessary. The diagram showing the death-rates from these three causes
of itself furnishes a complete refutation of the Commissioners’ argument.
The evidence as to the nature of the improved conditions will be given in
another work to be published shortly.
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.
+-------------------+-------+--------------+
| Name of Town. | Year. | Small-pox |
| | | Death-rate |
| | | per Million. |
+-------------------+-------+--------------+
| Hamburgh | 1871 | 15,440 |
| Rotterdam | 1871 | 14,280 |
| Cork | 1872 | 9,600 |
| Sunderland | 1871 | 8,650 |
| Stockholm | 1874 | 7,916 |
| Trieste | 1872 | 6,980 |
| Newcastle-on-Tyne | 1871 | 5,410 |
| Portsmouth | 1872 | 4,420 |
| Dublin | 1872 | 4,330 |
| Liverpool | 1871 | 3,890 |
| Plymouth | 1872 | 3,000 |
+-------------------+-------+--------------+
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.