The natural inference from these figures, viewed in the light of the history of smallpox in Great Britain, is that compulsory vaccination has been steadily eradicating the disease; but this is not Mr. Coleridge's conclusion: He says it is due to the large number of persons who have refused to be vaccinated! This would be laughable if it were not really serious; it is sad and serious that a man of Mr. Coleridge's education and social position should so consistently mislead the uncritical readers of the Contemporary Review to whose pages he has unfortunately very free access. If Mr. Coleridge really believes these things he is either very stupid or very ignorant; if he knows them to be otherwise, but wilfully deceives the public, he is immoral. He suffers from the worst form of bias, the anti-scientific. {the end of long footnote}
There is still that group of persons who object to everything—anti-vivisection, anti-meat eating, anti-breakfast, anti-hats and of course also anti-vaccination. They are anti the usual and the normal that are quite good enough for the most of people. They generally also believe that the earth is flat; they are past praying for, all we can do with them is to look them, like the difficulty of Jonah and the whale, "full in the face and pass on."
Many people at the present time allow themselves to be persuaded into being anti-vaccinators because neither they nor their deluders have ever known what an epidemic of smallpox is, have never seen with their own eyes the awful spectacle of a person suffering from smallpox in any of its forms—discrete, confluent or hemorrhagic. Thanks to this very Jenner, the world has now for 100 years been almost free from epidemic, virulent smallpox and most perfectly so in the vaccinated countries, so that millions, the majority, of Englishmen, have never seen a case of smallpox at all. Not knowing the awful danger they have escaped, through Great Britain having had compulsory vaccination since 1853, they have become lax in their belief in the necessity for the continuance of that precaution. "They jest at scars that never felt a wound." Towns such as Gloucester in England, in which a large number of children have been allowed to grow up unvaccinated, have always been visited sooner or later by a serious outbreak of smallpox. It must be so; the laws of natural phenomena can not be changed to suit the taste of those persons who are mentally incapable of understanding them. They can not be evaded; ignorance of the law is no more an excuse in the realm of natural than of man-made law.
We now come to that undesirable product of present-day, grandmotherly legislation, the conscientious objector. As I am not a politician, I shall not say anything for or against the policy of inserting in a bill which makes vaccination compulsory a clause giving to the conscientious objector the power or right to refuse to have his child vaccinated, but as a medical man who knows a little of the history of medicine, I can only describe it as gratuitous folly. I am one of those who believe that the laity should have no say in the matter of whether any given procedure is or is not advantageous for the public health. The efficacy of universal inoculation of vaccinia as a prophylactic against variola is a question of scientific medicine to be decided on technical grounds and ought not to be a matter open to debate by the public at all. It is perfectly monstrous to suppose that the ordinary person, quite untrained to weigh evidence for or against the advisability of the carrying out of a particular form of national immunization against a horrid disease, is qualified to form any opinion. He might as well be consulted on the advisability of making the channel tunnel or on the safest type of aeroplane or on any other subject involving the technical training of the engineer. To permit the so-called "man in the street" to say whether he shall or shall not permit the carrying out of some important piece of civic hygiene is to introduce a principle subversive of all system and obstructive of all progress in the science of public health. It is absurd that in a case like this the pronouncements of the judges are to be submitted to the criticisms of the jury. England has already had one or two pretty severe lessons through allowing such places as Gloucester and Leicester to exercise their right of private judgment on the question of vaccination. In Gloucester where there was at one time a vigorous anti-vaccination movement, a serious epidemic overtook the city a few years ago (1896). What science pronounces to be beneficial, the layman must submit to. What we want in these days is less superstition and more faith—in science. I am informed that there are more than 2,000 unvaccinated children in the schools of this city at the present moment, and all because a piece of legislation allows any unintelligent, prejudiced or credulous parent to decide on the momentous question of the vaccination of his children.
Our quarantine regulations are extremely strict, and rightly so, on the subject of smallpox; but is it not a farce to take so much trouble about the health of our immigrants when inside the city we are all the time encouraging a high degree of receptivity towards this very disease? I should call this a very clear case of straining at the international gnat and swallowing the municipal camel. The community at present is at the mercy of its least instructed members. A most sensible suggestion is that if an outbreak of smallpox occurs in Halifax, the cost of it should be borne by the unvaccinated and by the anti-vaccinators. The fact is we have forgotten what smallpox is like. In 1796 before Jennerian vaccination, the death-rate from smallpox in England was 18.5 per cent. of deaths from all causes; in London between 1838 and 1869 it was 1.4 per cent., while in 1871—the worst year for smallpox since vaccination became compulsory—the deaths from smallpox were barely 4.5 per cent. of deaths from all causes, a proportion which was exceeded 93 times in the eighteenth century. At the present moment the deaths from smallpox in London constitute a little under 0.24 per cent. of deaths from all causes, or 77 times less than in pre-Jennerian times.
According to MacVail, in the pre-vaccination period smallpox was nine times as fatal as measles and seven and one half times as fatal as whooping cough. To-day in the vaccinated community its fatality is negligable, in the unvaccinated it is as high as it was in the Middle Ages. In the city of Berlin, where vaccination is absolutely compulsory, there is no smallpox hospital at all; the cases of smallpox in that city being only a few unvaccinated foreigners. In 1912 the deaths in New York City were as follow: 671 from measles, 614 from scarlatina, 500 from typhoid fever, 187 from whooping cough and 2 from smallpox.
In London there were in 48 years of the seventeenth century no less than 10 epidemics of smallpox; in the whole of the eighteenth, 19; and in the nineteenth no epidemic at all during which smallpox was responsible for more than one tenth of the deaths from all causes in any one year.
In Sweden, the highest death-rate before vaccination was 7.23 per 1,000 persons, the lowest 0.30; under permissive vaccination the highest was 2.57, the lowest 0.12; under compulsory vaccination the highest was 0.94, the lowest 0.0005.
It is so frequently said that the disappearance of smallpox is due not to vaccination, but to improved general hygiene, that we must look into this criticism with some care. In the first place, a large diminution in the mortality from smallpox occurred before there was any great change in the unsanitary conditions of the English towns, before there was any enforcing of the isolation of patients either in hospitals or in their own homes. Since the introduction of vaccination, measles and whooping cough still remain in the status quo ante, while smallpox has been exterminated in all fully vaccinated communities, these two diseases of children are as prevalent as ever in England even although the general sanitary conditions have been immensely improved in that country. Of course the effects of vaccination wear out in time, and that is why it is well to be revaccinated once or twice. Now there has been a remarkable progressive change in the age-incidence of smallpox "which can only be explained," says Dr. Newsholme, "on the assumption that vaccination protects children from smallpox and that the protection diminishes, though it never entirely disappears, as age advances.
The "conscience clause" should be immediately removed from the act in which it was inserted on the grounds that it is weak and reactionary in principle, not in the interests of the development of the legislative aspect of the science of public health, and that it permits in certain unintelligent communities quite a considerable number of unvaccinated children to grow up as a permanent menace to their town and district.