CHAPTER V
CRITICAL REMARKS ON THE "FINAL REPORT"
BEFORE proceeding to sum up the broad statistical case against vaccination, it may be well here to point out some of the misconceptions, erroneous statements, vague opinions, and conclusions which are opposed to the evidence, which abound in this feeble Report.
And first, we have the repetition of an oft-corrected and obviously erroneous statement as to the absolute identity of the vaccinated and the unvaccinated, except on the one point of vaccination. The Commissioners say: "Those, therefore, who are selected as being vaccinated persons might just as well be so many persons chosen at random out of the total number attacked. So far as any connection with the incidence of, or the mortality from, small-pox is concerned, the choice of persons might as well have been made according to the colour of the clothes they wore (Final Report, par. 213). But there are tables in the Reports showing that about one-seventh of all small-pox deaths occur in the first six months of life, and by far the larger part of this mortality occurs in the first three months. The age of vaccination varies actually from three to twelve months, and many children have their vaccination specially delayed on account of ill-health, so that the "unvaccinated" always include a large proportion of those who, merely because they are infants, supply a much larger proportion of deaths from small-pox than at any other age. Yet the Commissioners say the unvaccinated might as well be chosen at random or by the colour of their clothes so far as any liability to small-pox is concerned. One stands amazed at the hardihood of a responsible body of presumably sensible and truth-seeking men who can deliberately record as a fact what is so obviously untrue.
Hardly less important is it that the bulk of the unvaccinated, those who escape the vaccination officers, are the very poor, and the nomad population of the country—tramps, beggars and criminals, the occupants of the tenement houses and slums of our great cities, who, being all weekly tenants, are continually changing their residence. Such were referred to, in the Report of the Local Government Board for 1882 (p. 809), 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 afirms this. He says (2nd Report, Q. 8,073) 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 goner 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,
[As regards the case of the nurses in small-pox
hospitals, about which so much has been said, I brought before the Commission some
evidence from a medical work, which sufficiently disposes of this part of the question. In
Buck’s Treatise on Hygiene and the Public Health, Vol. II., we find an article
by Drs. Hamilton and Emmett on "Small-pox and other Contagious Diseases," and on
page 321 thereof we read: "It is a fact fully appreciated by medical men, that
persons constantly exposed to small-pox very rarely contract the disease. In the case of
phyicians, health-inspectors, nurses, sisters of charity, hospital orderlies, and some
others, this is the rule; and of over 100 persons who have been to my knowledge constantly
exposed, some of them seeing as many as 1,000 cases, I have never personally known of more
than one who has contracted the disease; but there are many writers who believe perfect
immunity to be extremely rare. In this connection attention may be called to the exemption
of certain persons who occupy the same room, and perhaps bed, with the patients, and
though sometimes never vaccinated, altogether escape infection."
And Mr. Wheeler shows that at Sheffield the hospital staff did suffer from
small-pox in a higher degree than other comarable populations (see 6th Report, Q.
19,907).]
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!
[It is a common practice of vaccinists to quote the German Army as a striking proof of the good effects of revaccination; but as our own Army is as well vaccinated as the Army surgeons with unlimited power can make it, it is unlikely that the Germans can do so very much better. And there is some reason to think that their statistics are less reliable than our own. Lieut.-Col. A. T. Wintle, (late) R.A, has published in the Vaccination Inquirer extracts from a letter from Germany stating, on the authority of a German officer, that the Army statistics of small-pox are utterly unreliable. It is said to be the rule for Army surgeons to enter small-pox cases as skin-disease or some other "appropriate illness," while large numbers of small-pox deaths are entered as "sent away elsewhere." We had better therefore be content with our own Army and Navy statistics, though even here there is some concealment. In 1860 Mr Duncombe, M.P., moved for a return of the disaster at Shorncliffe Camp, where, it was alleged, 30 recruits were vaccinated, and six died of the results, but the return was refused. A letter in the Lancet of July 7, 1860, from a "Military Surgeon" stated that numbers of soldiers have had their arms amputated in consequence of mortification after vaccination; and a Baptist minister and ex-soldier, the Rev. Frederick J. Harsant, gave evidence before the Commission of another Shorncliffe disaster in 1868, he himself, then a soldier, having never recovered, and having had unhealed sores on various parts of his body for more than 20 years. Eighteen out of the twenty men vaccinated at the same time suffered; some were months in hospital and in a much worse condition than himself (6th Report, p. 207). In the same volume is the evidence of twenty medical men, all of whom have witnessed serious effects produced by vaccination, some being of a most terrible and distressing character.]
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 smallpox mortality in prevaccination 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 no ice 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!’
[Brief statement of the argument: The chances of a
person having small-pox a second time may be roughly estimated thus: Suppose the average
annual death-rate by small-pox to be 500 per million, and the average duration of life
forty years. Then the proportion of the population that die of small-pox will be 500 x 40
= 20,000 per million. If the proportion of deaths to cases is one to five, there will be
100,000 cases of small-pox per million during the life of that million, so that one-tenth
of the whole population will have small-pox once during their lives. Now, according to the
law of probabilities alone, the chances of a person having small-pox
twice will be the square of this fraction, or one-hundredth: so that on the average
only one person in 100 would have small-pox twice if it were a matter of pure chance, and
if nothing interfered with that chance. But there are interferences which modify the
result. (1) Those that die of the first attack cannot possibly have it a second time. (2)
It is most frequent in the very young, so that the chances of having it later in life are
not equal. (3) It is an especially epidemic disease, only occurring at considerable
intervals, which reduces the chances of infection to those who have had it once. (4) It is
probable that most persons are only liable to infection at certain periods of life, having
passed which without infection they never take the disease. It seems probable, therefore,
that these several conditions would greatly diminish the chances in the case of any person
who bad once had small-pox, so that perhaps, under the actual state of things,
chance alone would only lead to one person in two hundred having the disease a second
time.
The above is only an illustration of the principle. Professor Vogt goes more fully into
the question, and arrives at the conclusion that out of every 1,000 cases of small-pox the
probability is that ten will be second attacks. Then by getting together all the
European observations as to the actual number of second attacks during various epidemics,
the average is found to amount to sixteen in 1,000 cases, showing a considerable surplus
beyond the number due to probability. Further, the proportion of deaths to attacks has
from early times been observed to be high for second attacks; and it has also been
observed by many eminent physicians, whose statements are given, that second attacks are
more common in the case of persons whose first attacks were very severe, which is exactly
the reverse of what we should expect if the first attack really conferred any degree of
immunity.
Now the whole theory of protection by vaccination rests upon the assumption that a
previous attack of the disease is a protection; and Professor Vogt concludes his very
interesting discussion by the remark: ‘All this justifies our maintaining that the
theory of immunity by a previous attack of small-Pox, whether the natural disease or
produced artificially, must be relegated to the realm of fiction." If this is the
case, the supposed probability or reasonableness of an analogous disease,
vaccinia, producing immunity wholly vanishes.]
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 smallpox, 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 1,908,838, 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 smallpox, 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. [It is not alleged that over-crowding, per se, is the direct cause of small-pox, or of any other zymotic disease. It is, perhaps rather a condition than a cause; but under our present social economy it is so universally associated with various causes of disease—impure air, bad drainage, bad water supply, unhealthy situations, unwholesome food, overwork, and filth of every description in houses, clothing, and persons—that it affords the most general and convenient indication of an unhealthy as opposed to a healthy mode of life, and, while especially applying to zymotic diseases, is also so generally prejudicial to health as to produce a constant and very large effect upon the total mortality.]
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.