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.
Quite in accordance with this influence of small-pox in rendering the
patient somewhat more liable to catch the disease during any future
epidemic, is the body of evidence adduced by Professor Vogt, showing that
vaccination, especially when repeated once or several times, renders
the persons so vaccinated _more_ liable to take the disease, and thus
actually increases the virulence of epidemics. This has been suspected
by some anti-vaccinators; but it is, I believe, now for the first time
supported by a considerable body of statistics.
The other important feature in Professor Vogt’s memoir is the strong
support he gives to the view that small-pox mortality is really—other
things being approximately equal—a function of density of population. All
the evidence I have adduced goes to show this, especially the enormously
high small-pox death-rate in crowded cities in approximate proportion to
the amount of crowding. Professor Vogt adds some remarkable statistics
illustrating this point, especially a table in which the 627 registration
districts of England and Wales are grouped according to their density
of population, from one district having only sixty-four persons to a
square mile to six which have 20,698 per square mile, another column
showing in how many of the years during the period 1859-1882 there
were any small-pox deaths in the districts. The result shown is very
remarkable. In the most thinly populated district no small-pox death
occurred in _any one_ of the twenty-four years; in the most densely
peopled districts small-pox deaths occurred in _every one_ of the
twenty-four years. And the frequency of the occurrence of small-pox in
all the intervening groups of districts followed exactly the density of
the population. Taking two groups with nearly the same population, the
fourth group of 107 districts, with a total population of 1,840,581,
had small-pox deaths in only five or six out of the twenty-four years
in any of them; while the thirteenth group of thirteen districts, with
a population of 1,908,888, had small-pox deaths in twenty-three out of
the twenty-four years. But the first group had a density of 160 to the
square mile, and the last had 8,350 to the square mile. The Commissioners
dwell upon the alleged fact that neither water-supply, nor drainage,
nor contaminated food produce small-pox, and urge that what is commonly
understood by sanitation has little effect upon it (par. 153). But what
may be termed the fundamental principle of sanitation is the avoidance
of _overcrowding_; and this is shown by an overwhelming body of evidence
invariably to influence small-pox mortality quite irrespective of
vaccination.[22] Yet the remarkable contribution to the mass of evidence
in the “Reports” which brings out this fact most clearly, receives no
notice whatever in the _Final Report_.