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.