LONDON MORTALITY AND SMALL-POX   
SMALL-POX AND OTHER DISEASES IN BRITAIN DURING THE PERIOD DURING REGISTRATION 
SMALL-POX IN SCOTLAND AND IN IRELAND  
SMALL-POX AND VACCINATION ON THE CONTINENT

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 failings—will probably be nearly true.

[It is always stated that only the deaths of those persons belonging to the Church of England, or who were buried in the churchyards, are recorded in the "Bills." This seems very improbable, because the "searchers" must have visited the house and recorded the death before the burial; and as they were of course paid a fee for each death certified by them, they would not enquire very closely as to the religious opinions of the family, or where the deceased was to be buried. A friend of mine who lived in London before the epoch of registration informs me that he remembers the "searchers’ "visit on the occasion of the death of his grandmother. They were two women dressed in black; the family were strict dissenters, and the burial was at the Bunhill Fields cemetery for Nonconformists. This case proves that in all probability the "Bills" did include the deaths of many, perhaps most, Nonconformists.]

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." (Final Report of Roy. Comm., p. 20 (85).)

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—smallpox--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 smallpox, 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 l872(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 smallpox; 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 over-crowding, 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 smallpox," 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 DURING 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 smallpox 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 smallpox 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 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 zymotio 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. [As an example of the commissioners’ statistical fallacies in treating the subject of changed age-incidence, see Mr. Alexander Paul’s A Royal Commission’s Arithmetic (King & Son, 1897), and, especially, Mr. A. Mimes’ Statistics of Small-pox and Vaccination in the Journal of the Royal Statistical Society, September, 1897.]

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. [The highest small-pox mortality in London was in 1772, when 3,992 deaths were recorded in an estimated population of 727,000, or a death-rate of not quite 5,500 per million. (See Second Report, p. 290.]

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 be-came 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. [The small-pox deaths under one year in England have varied during the last fifty years from 8.6 to 27 per cent. of the whole. (See .Final Report, p. 154.)] 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 smallpox shows no relation to vaccination, but the very closest relation to the other zymotics and to density of populaftion. The fact of 95.7 per cent of the smallpox 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 be 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 [This almost exactly agrees with the ages of the boys who are admitted between nine and eleven, and leave at fourteen. (See Low’s Handbook of London Charities.)] was 94 per million! Instead of offering "most conclusive proofs of the value of vaccination," his own f acts 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 smallpox 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, Sunder-land, 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 smallpox 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.

Index Chapter 4