The Army and Navy as a Conclusive Test

In the Report of the Medical Officer of the Local Government Board for 1884, it is alleged that when an adult is revaccinated “he will receive the full measure of protection that vaccination is capable of giving him.” In the same year the Medical Officer of the General Post Office stated in a circular, “It is desirable, in order to obtain full security, that the operation (vaccination) should be repeated at a later period of life”; and the circular of the National Health Society already referred to states that “soldiers who have been revaccinated can live in cities intensely affected by small-pox without themselves suffering to any appreciable degree from the disease.” Let us then see how far these official statements are true or false.

In their Final Report the Commissioners give the statistics of small-pox mortality in the Army and Navy from 1860 to 1894, and, although the latest order for the vaccination of the whole force in the Navy was only made in 1871, there can be no doubt that, practically, the whole of the men had been revaccinated long before that period;[15] but certainly since 1873 all without exception, both English and foreign, were revaccinated; and in the Army every recruit has been revaccinated since 1860 (see 2nd Report, Q. 3,453, 3,455; and for the Navy, Q. 2,645, 6, 3,212-13, and 3,226-3,229). Brigade-Surgeon William Nash, M.D., informed the Commission that the vaccination and revaccination of the Army was “as perfect as endeavours can make it,” and that he can make no suggestion to increase its thoroughness (Q. 3,559, 3,560).

Turning now to the [diagram (No. XI.)] which represents the official statistics, the two lower solid lines show the small-pox death-rate per 100,000 of the force of the Army and Navy for each year, from 1860 to 1894. The lower thick line shows the Army mortality, the thin line that of the Navy. The two higher lines show the total death-rate from disease of the Navy, and of the Home force of the Army, as the tables supplied do not separate the deaths by disease of that portion of the Army stationed abroad.

Looking first at these upper lines, we notice two interesting facts. The first is, the large and steady improvement of both forces as regards health-conditions during the thirty-five years; and the second is the considerable and constant difference in the disease mortality of the two services, the soldiers having throughout the whole period a much higher mortality than the sailors. The decrease of the general mortality is clearly due to the great improvements that have been effected in diet, in ventilation, and in general health-conditions; while the difference in health between the two forces is almost certainly due to two causes, the most important being that the sailors spend the greater part of every day in the open-air, and in air of the maximum purity and health-giving properties, that of the open sea; while soldiers live mostly in camps or barracks, often in the vicinity of large towns, and in a more or less impure atmosphere. The other difference is that soldiers are constantly subject to temptations and resulting disease, from which sailors while afloat are wholly free.

Turning now to the lower lines, we see that, as regards small-pox mortality, the Navy suffered most down to 1880, but that since that period the Army has had rather the higher mortality. This has been held to be due to the less perfect vaccination of the Navy in the earlier period, but of that there is no proof, while there is evidence as to the causes of the improvement in general health. Staff-Surgeon T. J. Preston, R.N., stated them thus: “Shorter sea-voyages; greater care not to overcrowd; plentiful and frequent supplies of fresh food; the introduction of condensed water; and the care that is now taken in the general economy and hygiene of the vessels” (Q. 3,253). These seem sufficient to have produced also the comparative improvement in small-pox mortality, especially as the shorter voyages would enable the patients to be soon isolated on shore. The question we now have to consider is, whether the amount of small-pox here shown to exist in both Army and Navy demonstrates the “full security” that revaccination is alleged to give; whether as a matter of fact our soldiers and sailors, when exposed to the contagion of intense small-pox, do suffer to “any appreciable degree”; and lastly, whether they show any immunity whatever when compared with similar populations who have been either very partially or not at all revaccinated. It is not easy to find a fairly comparable population, but after due consideration it seems to me that Ireland will be the best available, as the statistics are given in the Commissioners’ Reports, and it can hardly be contended that it has any special advantages over our soldiers and sailors,—rather the other way. I have therefore given a [diagram, XII.], in which a dotted line shows the small-pox mortality of the Irish people of the ages 15 to 45 in comparison with the Army and the Navy mortality for the same years. (The figures for this diagram, as regards Ireland, have been calculated from the table at p. 37 of the Final Report, corrected for the ages 15 to 45 by means of Table J. at p. 274 of the Second Report.)

This dotted line shows us that, with the exception of the great epidemic of 1871, when for the bulk of the Irish patients there was neither isolation nor proper treatment, the small-pox mortality of the Irish population of similar ages has been on the average below that of either the Army or the Navy; while if we take the mean mortality of the three for the same period (1864-1894) inclusive, the result is as follows:

Army, mean of theannual small-pox death rate,58per million.
Navy ”” ” ”90”
Ireland (ages 15-45)” ” ”65·8”[16]

If we combine the Army and Navy death-rates in the proportion of their mean strength so as to get the true average of the two forces, the death-rate is 64·3 per million, or almost exactly the same as that of Ireland.

Now if there were no other evidence which gave similar results, this great test case of large populations compared over a long series of years, is alone almost conclusive; and we ask with amazement,—Why did not the Commissioners make some such comparison as this, and not allow the public to be deceived by the grossly misleading statements of the medical witnesses and official apologists for a huge imposture? For here we have on one side a population which the official witnesses declare to be as well vaccinated and revaccinated as it is possible to make it, and which has all the protection that can be given by vaccination. It is a population which, we are officially assured, can live in the midst of the contagion of severe small-pox and not suffer from the disease “in any appreciable degree.” And on comparing this population of over 200,000 men, thus thoroughly protected and medically cared for, with the poorest and least cared for portion of our country—a portion which the official witness regarding it declared to be badly vaccinated, while no amount of revaccination was even referred to—we find the less vaccinated and less cared for community to have actually a much lower small-pox mortality than the Navy, and the same as that of the two forces combined. The only possible objections that can be taken, or that were suggested during the examination of the witnesses are, that during the early portion of the period, the Navy was not wholly and absolutely revaccinated; and secondly, that troops abroad, and especially in India and Egypt, are more frequently subjected to infection. As to the first objection, even if revaccination were not absolutely universal in the Navy prior to 1873, it was certainly very largely practised, and should have produced a great difference when compared with Ireland. And the second objection is simply childish. For what are vaccination and revaccination for, except to protect from infection? And under exposure to the most intense infection they have been officially declared “not appreciably to suffer”!

But let us make one more comparison comprising the period since the great epidemic of 1871-2, during which the Navy as well as the Army are admitted to have been completely revaccinated, both English and foreign. We will compare this (supposed) completely protected force with Leicester, an English manufacturing town of nearly the same population, by no means especially healthy, and which has so neglected vaccination that it may now claim to be the least vaccinated town in the kingdom. The average annual small-pox death-rate of this town for the twenty-two years 1873-94 inclusive is thirteen per million (see 4th Report, p. 440); but in order to compare with our Army and Navy we must add one-ninth for the mortality at ages 15-45 as compared with total mortality, according to the table at p. 155 of the Final Report, bringing it to 14·4 per million, when the comparison will stand as follows:

Per Million.
Army(1873-94)small-poxdeath rate37[17]
Navy”””36·8
Leicester””ages 15-4514·4

It is thus completely demonstrated that all the statements by which the public has been gulled for so many years, as to the almost complete immunity of the revaccinated Army and Navy, are absolutely false. It is all what Americans call “bluff.” There is no immunity. They have no protection. When exposed to infection, they do suffer just as much as other populations, or even more. In the whole of the nineteen years 1878-1896 inclusive, unvaccinated Leicester had so few small-pox deaths that the Registrar-General represents the average by the decimal 0·01 per thousand population, equal to ten per million, while for the twelve years 1878-1889 there was less than one death per annum! Here we have real immunity, real protection; and it is obtained by attending to sanitation and isolation, coupled with the almost total neglect of vaccination. Neither Army nor Navy can show any such results as this. In the whole twenty-nine years tabulated in the Second Report the Army had not one year without a small-pox death, while the Navy never had more than three consecutive years without a death, and only six years in the whole period.

Now if ever there exists such a thing as a crucial test, this of the Army and Navy, as compared with Ireland, and especially with Leicester, affords such a test. The populations concerned are hundreds of thousands; the time extends to a generation; the statistical facts are clear and indisputable; while the case of the Army has been falsely alleged again and again to afford indisputable proof of the value of vaccination when performed on adults. It is important, therefore, to see how the Commissioners deal with these conclusive test-cases. They were appointed to discover the truth and to enlighten the public and the legislature, not merely to bring together huge masses of undigested facts.

What they do is, to make no comparison whatever with any other fairly comparable populations, to show no perception of the crucial test they have to deal with, but to give the Army and Navy statistics separately, and as regards the Army piecemeal, and to make a few incredibly weak and unenlightening remarks. Thus, in par. 333, they say that, during the later years, as the whole force became more completely revaccinated, small-pox mortality declined. But they knew well that during the same period it declined over all England, Scotland, and Ireland, with no special revaccination, and most of all in unvaccinated Leicester! Then with regard to the heavy small-pox mortality of the wholly revaccinated and protected troops in Egypt, they say, “We are not aware what is the explanation of this.” And this is absolutely all they say about it! But they give a long paragraph to the Post Office officials, and make a great deal of their alleged immunity. But in this case the numbers are smaller, the periods are less, and no statistics whatever are furnished except for the last four years! All the rest is an extract from a parliamentary speech by Sir Charles Dilke in 1883, stating some facts, furnished of course by the medical officers of the Post Office, and therefore not to be accepted as evidence.[18] This slurring over the damning evidence of the absolute inutility of the most thorough vaccination possible, afforded by the Army and Navy, is sufficient of itself to condemn the whole Final Report of the majority of the Commissioners. It proves that they were either unable or unwilling to analyse carefully the vast mass of evidence brought before them, to separate mere beliefs and opinions from facts, and to discriminate between the statistics which represented those great “masses of national experience” to which Sir John Simon himself has appealed for a final verdict, and those of a more partial kind, which may be vitiated by the prepossessions of those who registered the facts. That they have not done this, but without any careful examination or comparison have declared that revaccinated communities have “exceptional advantages” which, as a matter of fact, the Report itself show they have not, utterly discredits all their conclusions, and renders this Final Report not only valueless but misleading.

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. 309), as constituting the bulk of the thirty-five thousand of default, under the heading—“Removed, not to be traced, or otherwise accounted for.”

One of the Commission’s official witnesses, Dr. MacCabe, Medical Commissioner for Ireland, distinctly affirms this. He says (2nd Report, Q. 3,073) that he formerly had charge of the Dublin district, and that “out of a population of a quarter of a million, 100,000 live in tenement-houses, that is to say, houses that are let out in single rooms for the accommodation of a family. It is amongst that class, to a very great extent, that the defaulters exist. The relieving officer, when he goes to the tenement-dwelling where the birth occurred, finds that the parents have gone to some other tenement-dwelling and there is no trace of them.... A great number of these defaulters occur in this way.”

Now weekly tenants do not live in the best and most sanitary parts of towns, and the records of every epidemic show that such insanitary districts have an enormously greater proportion of the small-pox deaths than the healthier districts. Yet the Commissioners declare that there is “absolutely no difference between the vaccinated and the unvaccinated” except in respect of vaccination. Again we stand amazed at a statement so contrary to the fact. But the Commissioners must of course have believed it to be true, or they would not put it in their Final Report, upon which legislation may be founded affecting the liberties and the lives of their fellow countrymen.

I submit to my readers with confidence that this statement, so directly opposed to the clearest and simplest facts and to the evidence of official witnesses, proves the incapacity of the Commissioners for the important inquiry they have undertaken. By their treatment of this part of the subject they exhibit themselves as either ignorant or careless, in either case as thoroughly incompetent.

The next passage that calls for special notice here is par. 342, where they say, “We find that particular classes within the community, amongst whom revaccination has prevailed to an exceptional degree, have exhibited a position of quite exceptional advantage in relation to small-pox, although these classes have in many cases been subject to exceptional risk of contagion.” It seems almost incredible that such a statement as this could be made as a conclusion from the official evidence before the Commissioners, and it can only be explained by the fact that they never made the simplest and most obvious comparisons, and that they laid more stress on bad statistics than on good ones. They trust, for example, to the cases of nurses in hospitals,[19] as to which there are absolutely no statistics in the proper sense of the term, only verbal statements by various medical men, and they overlook or forget the largest and only trustworthy body of statistics existing as to revaccination—that of the Army and Navy! “A position of quite exceptional advantage!!” When the small-pox mortality of more than 200,000 men, all revaccinated to the completest extent possible by the medical officials, shows no advantage whatever over the whole comparable population of Ireland, and a quite exceptional disadvantage in comparison with almost unvaccinated Leicester![20] There is only one charitable explanation of such a “finding” as this—namely, that the Commissioners were by education and experience wholly incompetent to deal intelligently with those great masses of national statistics which alone can furnish conclusive evidence on this question.

At the end of the main inquiry, as to the effect of vaccination on small-pox (pp. 98, 99) the Commissioners adopt a very hesitating tone. They say that—“where vaccination has been most thorough the protection appears to have been greatest,” and that “the revaccination of adults appears to place them in so favourable a condition as compared with the unvaccinated.” But why say “appears” in both these cases? It is a question of fact, founded on ample statistics, which show us clearly and unmistakably—as in comparing Leicester with other towns—that vaccination gives no protection whatever, and that the best and most thorough revaccination, as in the Army and Navy, does not protect at all! It is no question of “appearing” to protect. As a fact, it does not protect, and does not appear to do so. The only explanation of the use of this word “appears” is that the Commissioners have founded their conclusions, not upon the statistical evidence at all, but upon the impressions and beliefs of the various medical officials they examined, who almost all assumed the protection as an already established fact. Such was the case of the army-surgeon who declared that the deaths were much fewer than they would have been without revaccination; and who, on being asked why he believed so, answered that it was from reading of the small-pox mortality in pre-vaccination times! He had made no comparisons, and had no figures to adduce. It was his opinion, and that of the other medical officers, that it was so. And the Commissioners apparently had always held the same opinions, which, being confirmed by the opinions of other official witnesses, they concluded that comparisons of the revaccinated Army and Navy with ordinary death-rates were as unnecessary as they would certainly have been puzzling to them. Hence “appears” in place of “is” or “does”; and their seven conclusions as to the value and protectiveness of vaccination all under the heading—“We think,” not “We are convinced,” or “It has been proved to us,” or “The statistics of the Army and Navy, of Ireland, of Leicester and of many other places, demonstrate the (”protectiveness” or “inutility”—as the case may be) of vaccination.” I trust that I have now convinced my readers that the best evidence—the evidence to which Sir John Simon and Dr. Guy have appealed—DEMONSTRATES complete INUTILITY, as against what “appears” to the Commissioners and what they “think.”

One other matter must be referred to before taking leave of the Commissioners. I have already shown how completely they ignore the elaborate and valuable evidence, statistical tables and diagrams, furnished by those who oppose vaccination, such as were brought before them by Mr. Biggs of Leicester, Mr. A. Wheeler, and Mr. William Tebb, who, though all were examined and cross-examined on the minutest details, might as well never have appeared so far as any notice in the Final Report is concerned. But there is also a very elaborate paper contributed by Dr. Adolf Vogt, Professor of Hygiene and Sanitary Statistics in the University of Berne, who offered to come to London and submit to cross-examination upon it, which, however, the Commission did not consider necessary. This paper, a translation of which is printed in the Appendix to the 6th Report, p. 689, is especially valuable as the work of a thorough statistician, who, from his position, has access to the whole body of European official statistics, and his discussion goes to the very root of the whole question. The treatise is divided into nine chapters, and occupies thirty-four closely printed pages of the Blue Book; but, being an elaborate argument founded mainly on a scientific treatment of statistics, there was probably no member of the Commission capable of adequately dealing with it. Yet it is of more value than fully nine-tenths of the remainder of the voluminous reports, with their 31,398 questions and answers. Professor Vogt’s treatise covers almost the whole ground, medical and statistical, and enforces many of the facts and arguments I have myself adduced. But there are two points which must be especially mentioned. His first chapter is headed—“A Previous Attack of Small-pox does not Confer Immunity.” I have long been of opinion that this was the case, and have by me a brief statement, written six years since, to show that the rarity of second attacks may in all probability be fully explained by the doctrine of chances. But I had not statistics sufficient to prove this. Professor Vogt, however, having the statistical tables of all Europe at his command, is able to show not only that the calculus of probabilities itself explains the rarity of a second attack of small-pox, but that second attacks occur more frequently than they should do on the doctrine of chances alone, indicating that, instead of there being any immunity, there is really a somewhat increased susceptibility to a second attack![21] This being the case, it becomes really ludicrous to read the questions and answers and the serious discussions as to whether a “good vaccination” protects more or less than a previous attack of small-pox. Some think the protection is the same, but the greater number think it is not quite so much. Even the most ardent vaccinists do not claim a greater protection. But none of them ever doubt the fact of the protection gained by having had the disease, and yet none of them, nor any of the Commissioners, thought that any evidence, much less proof, of the fact itself was needed. They took it for granted. “Everybody knows it.” “Very few people have small-pox a second time.” No doubt. But very few people suffer from any special accident twice—a shipwreck, or railway or coach accident, or a house on fire; yet one of these accidents does not confer immunity against its happening a second time. The taking it for granted that second attacks of small-pox, or of any other zymotic disease, are of that degree of rarity as to prove some immunity or protection indicates the incapacity of the medical mind for dealing with what is a purely statistical and mathematical question.

Quite in accordance with this influence of small-pox in rendering the patient somewhat more liable to catch the disease during any future epidemic, is the body of evidence adduced by Professor Vogt, showing that vaccination, especially when repeated once or several times, renders the persons so vaccinated more liable to take the disease, and thus actually increases the virulence of epidemics. This has been suspected by some anti-vaccinators; but it is, I believe, now for the first time supported by a considerable body of statistics.

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

CHAPTER VI
SUMMARY AND CONCLUSION

As the diverse aspects of the problem which has been discussed in the preceding pages are somewhat numerous and complex, owing to the vast mass of irrelevant but confusing matter with which it has been encumbered at every step of its progress for nearly a century, a brief summary of the main points here referred to, and a statement of their bearing on the essential problem, will now be given.

I have first shown the nature of the tests which seemed to the early enquirers to establish the protective influence of vaccination, and have given the facts which the two greatest living specialists on the subject—Professor Crookshank and Dr. Creighton—consider to prove the fallacy or insufficiency of all the tests which were applied. This is followed by a statement of the abundant evidence which in the first ten years of the century already showed that vaccination had no protective power (pp. 10-12). But the heads of the medical profession had accepted the operation as of proved value, and the legislature, on their recommendation, had voted its discoverer £30,000 of public money, and had besides, in 1808, endowed a National Vaccine Establishment with about £3,000 a year. Reputations and vested interests were henceforth at stake, and those who adduced evidence of the failure or the dangers of vaccination were treated as fanatics, and have been so treated by the medical and official world down to the appointment of the last Royal Commission.

I next give the reasons why doctors are not the best judges of the effects, beneficial or otherwise, of vaccination, and follow this by proofs of a special capacity for misstating facts in reference to this question which has characterized them from the beginning of the century down to our day. The successive annual reports of the National Vaccine Establishment give figures of the deaths by small-pox in London in the eighteenth century, which go on increasing like Falstaff’s men in buckram; while in our own time the late Dr. W. B. Carpenter, Mr. Ernest Hart, the National Health Society, and the Local Government Board make statements or give figures which are absurdly and demonstrably incorrect (pp. 13-18).[23]

I then show the existence of so unreasoning a belief in the importance of vaccination that it leads many of those who have to deal, with it officially to concealments and misstatements which are justified by the desire to “save vaccination from reproach.” Thus it happened that till 1881 no deaths were regularly recorded as due to vaccination, although an increasing number of such deaths now appear in the Registrar-General’s Reports; while a few medical men, who have personally inquired into these results of vaccination, have found a large amount of mortality directly following the operation, together with a large percentage of subsequent disease, often lasting for years or during life, which, except for such private enquiries, would have remained altogether unknown and unacknowledged (pp. 18-22).

The same desire to do credit to the practice which they believe to be so important leads to such imperfect or erroneous statements as to the vaccinated or unvaccinated condition of those who die of small-pox as to render all statistics of this kind faulty and erroneous to so serious an extent that they must be altogether rejected. Whether a person dies of small-pox or of some other illness is a fact that is recorded with tolerable accuracy, because the disease, in fatal cases, is among the most easily recognised. Statistics of “small-pox mortality” may, therefore, be accepted as reliable. But whether the patient is registered as vaccinated or not vaccinated usually depends on the visibility or non-visibility of vaccination-marks, either during the illness or after death, both of which observations are liable to error, while the latter entails a risk of infection which would justifiably lead to its omission. And the admitted practice of many doctors, to give vaccination the benefit of any doubt, entirely vitiates all such statistics, except in those special cases where large bodies of adults are systematically vaccinated or revaccinated. Hence, whenever the results of these imperfect statistics are opposed to those of the official records of small-pox mortality, the former must be rejected. It is an absolute law of evidence, of statistics, and of common sense that when two kinds of evidence contradict each other, that which can be proved to be even partially incorrect or untrustworthy must be rejected. It will be found that all the evidence that seems to prove the value of vaccination is of this untrustworthy character. This conclusion is enforced by the fact that the more recent hospital statistics show that small-pox occurs among the vaccinated in about the same proportion as the vaccinated bear to the whole population; thus again indicating that the earlier figures, showing that they were proportionately five or six times as numerous, and the death-rate of the unvaccinated twice or thrice that of the average of pre-vaccination days, are altogether erroneous, and are due to the various kinds of error or misstatement which have been pointed out (pp. 25-30).

Having thus cleared away some of the misconceptions and fallacies which have obscured the main question at issue, and having shown that, by official admission, the only valuable evidence consists of “large masses of national statistics,” which should have been dealt with by a commission of trained statisticians, I proceed to show, by a series of diagrams embodying the official or national statistics brought before the Commission, or to be found in the Reports of the Registrar-General, what such statistics really prove; and I ask my readers to look again at those diagrams as I refer to them.

[Diagram I.] exhibits the most extensive body of national statistics available, showing at one view the death-rates from Small-pox, from the other chief Zymotic Diseases, and the Total Mortality, from 1760 to 1896. The first portion, from 1760 to 1836, is from the “Bills of Mortality,” which, though not complete, are admitted to be, on the whole, fairly accurate as regards the variations at different periods and between different diseases. The second part, from 1838 onwards, is from the Reports of the Registrar-General, and is more complete in giving all deaths whatever. Its lines are, therefore, as it were, on a higher level than those of the earlier period, and can only be compared with it as regards proportions of the different mortalities, not so accurately as to their total amounts. The main teaching of this diagram—a teaching which the Commissioners have altogether missed by never referring to diagrams showing comparative mortalities—is the striking correspondence in average rise and fall of the death-rates of small-pox, of zymotics, and of all diseases together. This correspondence is maintained throughout the whole of the first part, as well as through the whole of the second part, of the diagram; and it proves that small-pox obeys, and always has obeyed, the same law of subservience to general sanitary conditions as the other great groups of allied diseases and the general mortality. Looking at this most instructive diagram, we see at once the absurdity of the claim that the diminution of small-pox in the first quarter of our century was due to the partial and imperfect vaccination of that period. Equally absurd is the allegation that its stationary character from 1842 to 1872, culminating in a huge epidemic, was due to the vaccination then prevailing, though much larger than ever before, not being quite universal—an allegation completely disproved by the fact that the other zymotics as a whole, as well as the general mortality, exhibited strikingly similar decreases followed by equally marked periods of average uniformity or slight increase, to be again followed by a marked decrease. There is here no indication whatever of vaccination having produced the slightest effect on small-pox mortality.

The [second diagram] shows that, even taking the Commission’s favourite method of comparing the zymotics separately with small-pox, all of them except measles show a similar or a greater decrease during the period of official registration, and also agree in the periods of slight increase, again proving the action of the same general causes (which I have pointed out at p. 37), and leaving no room whatever for the supposed effects of vaccination.

[Diagram III.] shows that similar phenomena occurred in England and Wales as a whole, the other zymotics and the total deaths obeying the same laws of increase and decrease as small-pox. Comparison with diagram I. shows the much greater severity of small-pox epidemics in London, illustrating the fact, which all the statistical evidence of all countries strikingly enforces, that small-pox mortality is, other things being equal, a function of density of population, while it pays no regard whatever to vaccination. This is further shown by the short, thick dotted line which exhibits the total number of vaccinations since 1872, when private as well as public vaccinations were first officially recorded, and which proves that the continuous decrease of vaccination since 1882 has been accompanied by a decided decrease, instead of an increase, in small-pox mortality.

[Diagram IV.] shows the statistics of mortality in Ireland and Scotland from small-pox and certain chosen zymotics, from the tables which were laid before the Commission by the official advocates of vaccination. These show two striking facts, which the Commissioners failed to notice in their Final Report. First, the smaller amount of small-pox mortality in Ireland than in Scotland, the latter being alleged to be well vaccinated, the former imperfectly so; and, secondly, the similar difference in the two chosen diseases and the general parallelism of the two. Here again we see clearly the influence of density of population, Scotland having a very much larger proportion of its inhabitants living in large manufacturing towns.

The next three diagrams, [V.], [VI.], and [VII.], show small-pox mortality in Sweden, Prussia, and Bavaria—countries which at previous enquiries were adduced as striking examples of the value of vaccination. They all show phenomena of the same character as our own country, but far worse as regards epidemics in the capitals; that of Stockholm, in 1874, causing a death-rate more than 50 per cent. higher than during the worst epidemic of the last century in London! The diagram of small-pox and zymotics in Bavaria is given merely because the statistics were brought before the Commission as a proof of the beneficial results of vaccination in well-vaccinated communities. It was alleged by Dr. Hopkirk that almost the whole of the population were vaccinated, and admitted by him that of the 30,742 cases of small-pox in 1871 no less than 95·7 per cent. were vaccinated! The epidemic was, however, less severe than in Prussia, again showing the influence of density of population, less than one-seventh of the Bavarians inhabiting towns of over 20,000, while one-fourth inhabit similar towns in Prussia; but we see that during the latter half of the period chosen small-pox greatly increased, and the other zymotics remained very high, indicating general insanitary conditions. And this case was specially brought before the Commission as a proof of the benefits of vaccination! In their Final Report the Commissioners omit to point out that it really indicates the very reverse.

We then come to the two cases that afford most conclusive tests of the absolute uselessness of vaccination—Leicester and our Army and Navy.

[Diagram VIII.] shows the death-rates from small-pox and from the other zymotics in Leicester during the period of official registration, together with the percentage of vaccinations to births. Up to 1872 Leicester was a fairly well-vaccinated town, yet for thirty-four years its small-pox mortality, in periodical epidemics, remained very high, corresponding generally with the other zymotics. But immediately after the great epidemic of 1872, which was much worse than in London, the people began to reject vaccination, at first slowly, then more rapidly, till for the last eight years less than 5 per cent. of the births have been vaccinated. During the whole of the last twenty-four years small-pox deaths have been very few, and during twelve consecutive years, 1878-89, there was a total of only eleven small-pox deaths in this populous town.

[Diagram IX.] is equally important as showing a remarkable correspondence, if not a causal relation, between vaccination and disease. From 1848 to 1862 there was a considerable decrease of both general and infant mortality, and also in infant mortality from small-pox. This, Mr. Biggs tells us, was when important sanitary improvements were in progress. Then the more thorough enforcement of vaccination set in (as shown by the dotted line), and was accompanied by an increase of all these mortalities. But so soon as the revolt against vaccination began, till the present time, when it has diminished to about 2 or 3 per cent. of births, all mortalities have steadily decreased, and that decrease has been especially marked in infant lives. It is very suggestive that the lines of infant mortality have now reached the position they would have had if the slow decrease during 1850-60 had been continued, strongly indicating that some special cause sent them up, and the removal of that cause allowed them to sink again; and during that very period vaccination increased and then steadily decreased. I venture to declare that in the whole history of vaccination there is no such clear and satisfactory proof of its having saved a single life as these Leicester statistics afford of its having been the cause of death to many hundreds of infants.

[Diagram X.] exhibits the check to the decrease in infant mortality, both in London and for England, since the enforcement of vaccination (p. 57), and thus supports and enforces the conclusions derived from the preceding diagram.