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.
Hamburgh187115,440
Rotterdam187114,280
Cork18729,600
Sunderland18718,650
Stockholm18747,916
Trieste18726,980
Newcastle-on-Tyne18715,410
Portsmouth18724,420
Dublin18724,330
Liverpool18713,890
Plymouth18723,000

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.

CHAPTER IV
TWO GREAT EXPERIMENTS WHICH ARE CONCLUSIVE AGAINST VACCINATION

Those who disbelieve in the efficacy of vaccination to protect against small-pox are under the disadvantage that, owing to the practice having been so rapidly adopted by all civilized people, there are no communities who have rejected it while adopting methods of general sanitation, and who have also kept satisfactory records of mortality from various causes. Any such country would have afforded what is termed a “control” or test experiment, the absence of which vitiates all the evidence of the so-called “variolous test” in Jenner’s time, as was so carefully pointed out before the Commission by Dr. Creighton and Professor Crookshank. We do, however, now possess two such tests on a limited, but still a sufficient, scale. The first is that of the town of Leicester, which for the last twenty years has rejected vaccination till it has now almost vanished altogether. The second is that of our Army and Navy, in which, for a quarter of a century, every recruit has been revaccinated, unless he has recently been vaccinated or has had small-pox. In the first we have an almost wholly “unprotected” population of nearly 200,000, which, on the theory of the vaccinators, should have suffered exceptionally from small-pox; in the other we have a picked body of 220,000 men, who, on the evidence of the medical authorities, are as well protected as they know how to make them, and among whom, therefore, small-pox should be almost or quite absent, and small-pox deaths quite unknown. Let us see, then, what has happened in these two cases.

Perhaps the most remarkable and the most complete body of statistical evidence presented to the Commission was that of Mr. Thomas Biggs, a sanitary engineer and a town councillor of Leicester. It consists of fifty-one tables exhibiting the condition of the population in relation to health and disease from almost every conceivable point of view. The subject is further illustrated by sixteen diagrams, many of them in colours, calculated to exhibit to the eye in the most clear and simple manner the relations of vaccination and sanitation to small-pox and to the general health of the people, and especially of the children, in whose behalf it is always alleged vaccination is enforced. From this wealth of material I can give only two diagrams exhibiting the main facts of the case, as shown by Mr. Biggs’ statistics in the Fourth Report of the Royal Commission, all obtained from official sources.

The first [diagram (No. VIII.)] shows in the upper part, by a dotted line, the total vaccinations, public and private, since 1850.[13] The middle line shows the mortality per million living from the chief zymotic diseases—fevers, measles, whooping-cough, and diphtheria—while the lower line gives the small-pox mortality. We notice here a high mortality from zymotics and from small-pox epidemics, during the whole period of nearly complete vaccination from 1854 to 1870. Then commenced the movement against vaccination, owing to its proved uselessness in the great epidemic when Leicester had a very much higher small-pox mortality than London, which has resulted in a continuous decline, especially rapid for the last fifteen years, till it is now reduced to almost nothing. For that period not only has small-pox mortality been continuously very low, but the zymotic diseases have also regularly declined to a lower amount than has ever been known before.

The second [diagram (No. IX.)] is even more important, as showing the influence of vaccination in increasing both the infantile and the total death-rates to an extent which even the strongest opponents of that operation had not thought possible. There are four solid lines on the diagram showing respectively, in five-year averages from 1838-42 to 1890-95, (1) the total death-rate per 1,000 living, (2) the infant death-rate under five years, (3) the same under one year, and (4), lowest of all, the small-pox death-rate under five years. The dotted line shows the percentage of total vaccinations to births.

The first thing to be noted is the remarkable simultaneous rise of all four death-rates to a maximum in 1868-72, at the same that the vaccination rate attained its maximum. The decline in the death-rates from 1852 to 1860 was due to sanitary improvements which had then commenced; but the rigid enforcement of vaccination checked the decline owing to its producing a great increase of mortality in children, an increase which ceased as soon as vaccination diminished. This clearly shows that the deaths which have only recently been acknowledged as due to vaccination, directly or indirectly, are really so numerous as largely to affect the total death-rate; but they were formerly wholly concealed, and still are partially concealed, by being registered under such headings as erysipelas, syphilis, diarrhœa, bronchitis, convulsions, or other proximate cause of death.

Here, then, we have indications of a very terrible fact, the deaths by various painful and often lingering diseases of thousands of children as the result of that useless and dangerous operation termed vaccination. It is difficult to explain the coincidences exhibited by this diagram in any other way, and it is strikingly corroborated by a diagram of infant mortality in London and in England which I laid before the Royal Commission, and which I here reproduce ([No. X.]). The early part of this diagram is from a table calculated by Dr. Farr from all the materials available in the Bills of Mortality, and it shows for each twenty years the marvellous diminution in infant mortality during the hundred years from 1730 to 1830, proving that there was some continuous beneficial change in the conditions of life. The materials for a continuation of the diagram are not given by the Registrar-General in the case of London, and I have had to calculate them for England. But from 1840 to 1890 we find a very slight fall, both in the death-rate under five years and under one year for England, and under one year for London, although both are still far too high, as indicated by the fact that in St. Saviour’s it is 213, and in Hampstead only 123 per 1,000 births. There appear to have been some causes which checked the diminution in London after 1840, then produced an actual rise from 1860 to 1870, followed by a slight but continuous fall since. The check to the diminution of the infant death-rate is sufficiently accounted for by that extremely rapid growth of London by immigration which followed the introduction of railways and which would appreciably increase the child-population (by immigration of families) in proportion to the births. The rise from 1860 to 1870 exactly corresponds to the rise in Leicester, and to the strict enforcement of infant vaccination, which was continuously high during this period; while the steady fall since corresponds also to that continuous fall in the vaccination rate due to a growing conviction of its uselessness and its danger. These facts strongly support the contention that vaccination, instead of saving thousands of infant lives, as has been claimed, really destroys them by thousands, entirely neutralising that great reduction which was in progress from the last century, and which the general improvement in health would certainly have favoured. It may be admitted that the increasing employment of women in factories is also a contributory cause of infant mortality, but there is no proof that a less proportion of women have been thus employed during the last twenty years, while it is certain that there has been a great diminution of vaccination, which is now admitted to be a vera causa of infant mortality.

Before leaving the case of Leicester it will be instructive to compare it with some other towns of which statistics are available. And first as to the great epidemic of 1871-2 in Leicester and in Birmingham. Both towns were then well vaccinated, and both suffered severely by the epidemic. Thus:

Leicester.Birmingham.
S.P. cases per 10,000 population327213
” deaths ” ” ”3535

But since then Leicester has rejected vaccination to such an extent that in 1894 it had only seven vaccinations to ten thousand population, while Birmingham had 240, or more than thirty times as much, and the proportion of its inhabitants who have been vaccinated is probably less than half those of Birmingham. The Commissioners themselves state that the disease was brought into the town of Leicester on twelve separate occasions during the recent epidemic, yet the following is the result:

1891-4.Leicester.Birmingham.
S.P. cases per 10,000 population1963
” deaths ” ” ”1·15

Here we see that Leicester had less than one-third the cases of small-pox, and less than one-fourth the deaths in proportion to population than well-vaccinated Birmingham; so that both the alleged protection from attacks of the disease, and mitigation of its severity when it does attack, are shown, not only to be absolutely untrue, but to apply really, in this case, to the absence of vaccination!

But we have yet another example of an extremely well-vaccinated town in this epidemic—Warrington, an official report on which has just been issued. It is stated that 99·2 per cent. of the population had been vaccinated, yet the comparison with unvaccinated Leicester stands as follows:

Epidemic of 1892-3.Leicester.Warrington.
S.P. cases per 10,000 population19·3123·3
” deaths ” ” ”1·411·4

Here then we see that in the thoroughly vaccinated town the cases are more than six times, and the deaths more than eight times, that of the almost unvaccinated town, again proving that the most efficient vaccination does not diminish the number of attacks, and does not mitigate the severity of the disease, but that both these results follow from sanitation and isolation.

Now let us see how the Commissioners, in their Final Report deal with the above facts, which are surely most vital to the very essence of the enquiry, and the statistics relating to which have been laid before them with a wealth of detail not equalled in any other case. Practically they ignore it altogether. Of course I am referring to the Majority Report, to which alone the Government and the unenlightened public are likely to pay any attention. Even the figures above quoted as to Leicester and Warrington are to be found only in the Report of the Minority, who also give the case of another town, Dewsbury, which has partially rejected vaccination, but not nearly to so large an extent as Leicester, and in the same epidemic it stood almost exactly between unvaccinated Leicester and well-vaccinated Warrington, thus:

Leicesterhad1·1mortality per 10,000 living
Dewsbury”6·7” ” ” ”
Warrington”11·8” ” ” ”

Here again we see that it is the unvaccinated towns that suffer least, not the most vaccinated. The public of course have been terrorised by the case of Gloucester, where a large default in vaccination was followed by a very severe epidemic of small-pox. The Majority Report refers to this in par. 373, intending to hold it up as a warning, but strangely enough in so important a document, say the reverse of what they mean to say, giving to it “very little,” instead of “very much” small-pox. This case, however, has really nothing whatever to do with the question at issue, because, although anti-vaccinators maintain that vaccination has not the least effect in preventing or mitigating small-pox, they do not maintain that the absence of vaccination prevents it. What they urge is, that sanitation and isolation are the effective and only preventives, and it was because Leicester attended thoroughly to these matters, and Gloucester wholly neglected them that the one suffered so little and the other so much in the recent epidemic. On this subject every enquirer should read the summary of the facts given in the Minority Report, paragraph 261.

To return to the Majority Report. Its references to Leicester are scattered over 80 pages, referring separately to the hospital staff, and the relations of vaccinated and unvaccinated to small-pox; while in only a few paragraphs (par. 480-486) do they deal with the main question and the results of the system of isolation adopted. These results they endeavour to minimise by declaring that the disease was remarkably “slight in its fatality,” yet they end by admitting that “the experience of Leicester affords cogent evidence that the vigilant and prompt application of isolation ... is a most powerful agent in limiting the spread of small-pox.” A little further on (par. 500) they say, when discussing this very point—how far sanitation may be relied on in place of vaccination—“The experiment has never been tried.” Surely a town of 180,000 inhabitants which has neglected vaccination for twenty years, is an experiment. But a little further on we see the reason of this refusal to consider Leicester a test experiment. Par. 502 begins thus: “The question we are now discussing must, of course, be argued on the hypothesis that vaccination affords protection against small-pox.” What an amazing basis of argument for a Commission supposed to be enquiring into this very point! They then continue: “Who can possibly say that if the disease once entered a town the population of which was entirely or almost entirely unprotected, it would not spread with a rapidity of which we have in recent times had no experience?” But Leicester is such a town. Its infants—the class which always suffers in the largest numbers—are almost wholly unvaccinated, and the great majority of its adults have, according to the bulk of the medical supporters of vaccination, long outgrown the benefits, if any, of infant-vaccination. The disease has been introduced into the town twenty times before 1884, and twelve times during the last epidemic (Final Report, par. 482 and 483). The doctors have been asserting for years that once small-pox comes to Leicester it will run through the town like wild-fire. But instead of that it has been quelled with far less loss than in any of the best vaccinated towns in England. But the Commissioners ignore this actual experiment, and soar into the regions of conjecture with, “Who can possibly say?”—concluding the paragraph with—“A priori reasoning on such a question is of little or no value.” Very true. But a posteriori reasoning, from the cases of Leicester, Birmingham, Warrington, Dewsbury, and Gloucester, is of value; but it is of value as showing the utter uselessness of vaccination, and it is therefore, perhaps, wise for the professional upholders of vaccination to ignore it. But surely it is not wise for a presumably impartial Commission to ignore it as it is ignored in this Report.[14]