VACCINATION. · 2008. 6. 6. · changeling at which the mother shuddered, and making ... 2nd April, . 1688 : " It is most clear to me, from all the observations that I can possibly

FOR AND AGAINST

VACCINATION.

A STATEMENT BY THE

ROYAL COLLEGE OF PHYSICIANS, I R E L A N D ;

WITH CORRESPONDENCE THEREON,

B E T W E E N

LIEUT.-GENERAL A. PHELPS,

President National Anti-Vaccination League,

AND

T. PERCY C. KIRKPATRICK, ESQ. , M.D., &.c,

President Dublin Sanitary Association.

THE NATIONAL ANTI-VACCINATION LEAGUE,

GARRICK HOUSE, SOUTHAMPTON STREET, LONDON.

1910.

FOREWORD.

IN February, 1910, the Royal College of Physicians, Ireland, stirred into action by the manly protest of some Ratepayers of the Enniscorthy district, who pre-ferred fine and imprisonment to the risk of having their children infected by the disease, or diseases, termed Cowpox, issued an Official Statement. The object of this formal and deliberate manifesto was to counteract the diffusion of the " pernicious doctrines taught by the opponents of that beneficent practice," i.e.% of Vaccination.

I t is obvious that in issuing a document of this kind, signed by the President, and countersigned by the Registrar, and carrying all the authority of the constituted representatives of the Medical Profession in Ireland, it was incumbent on the College to state nothing that was inaccurate, or even doubtful: the prestige of the pro-fession whose trustees they are, demanding that their solemn public utterances should be characterised by scrupulous veracity and fairness.

As these characteristics seemed to the President of the National Anti-Vaccination League, Lt.-General Phelps, to be conspicuously wanting in their statement, he addressed a letter, pointing out its inaccuracies, to the Dublin Press. His protest was printed in the Dublin " Daily Express," and " Freeman."

To this exposure of the errors and misstatements contained in their manifesto, the College vouchsafed no reply. But Dr. T. Percy C. Kirkpatrick, F.R.C.P.I., B.A. Dub., M.D.„ M.B., B.Gh., B.A.O., M.R.C.P.I., etc., President of the Dublin Sanitary Association, a society intimately connected with the College, whose President is one of its Vice-Presidents, ex-officio, intervened on its

4 FOREWORD

behalf, and wrote a letter to Lt.-General Phelps (sending it simultaneously to the Press) in which he defended the position which the College had so carelessly taken up.

General Phelps at once replied, and an exchange of letters took place. This correspondence is now submitted for the'careful consideration of its readers. They are requested to peruse it with open minds, and to form their own opinion on which side the truth lies.

The distinguished qualifications of Dr. Kirkpatrick in medicine and science, ensured that the utmost that could be said on the pro-vaccinist side would be laid before the public. He has done his best ; and the public can judge what defence the utmost medical skill and science can make for the practice : whether he has succeeded in making out his case, or has failed in every particular.

If the public decide that he has failed, and that General Phelps has overthrown all his pleadings, it should take steps to obtain the repeal of the Vaccination Acts which make it a penal offence to harbour a healthy child ; which grant licenses (in Great Britain but not in Ire-land) to break the law ; and which pervert the noble aim of the Medical Profession from the defence and maintenance of Health, into a craze for the dissemi-nation of Disease.

FOR AND AGAINST VACCINATION.

THE COLLEGE'S STATEMENT. T H E following is 'a copy of the College's " Statement " as it appeared in the columns of the " Irish Times " and other Irish newspapers, on the 8th February :—

The following statement of the President and Fellows of the Royal College of Physicians of Ireland in reference to the opposition to the vaccination of infants which has been reported to them to have arisen in t heEnn i s -corthy Union, has been sent to us for publication :—

The President and Fellows of the Royal College of Physicians of Ireland regard with grave concern the introduction into Ireland of the crusade against vacci- Protest against •nation, and the spread in certain districts of this country of the pernicious doctrines taught by trie opponents of that beneficent practice.

The President and Fellows would remind the public that an outbreak of smallpox is an ever-present danger in a population unprotected by vaccination,* whereas Vaccination and that dread and most loathsome disease has no terrors perfect pr,o-ior a population efficiently vaccinated and (better still) re-vaccinated. Smallpox is practically unknown in Germany, because re-vaccination, before the age of twelve years, was made c©mpulsory by law in the year 1874, Franco-Prussian shortly after the termination of the Franco-Prussian Germans saved War. In that war smallpox spared the re-vaccinated Re-vaccination. Prussian troops, whereas it raged as a destructive epidemic vaccinated.^ among the badly vaccinated French armies in the field and in beleaguered Paris. Re-vaccination had been compulsory in the Prussian Army from the year 1834.

* App. A, page 39.

6 FOR AND AGAINST VACCINATION

IrvaccinaUon.by I*1 T^3 compulsory vaccination was introduced into Ireland, which in recent years has become a well-vacci-nated country.* And it appears from the 45th annual report of the5 Registrar-General for Ireland that in the year 1908 not a single death from smallpox was registered in this country during the year, compared with only one death in 1907, and seven deaths annually on an average in the ten years 1898-1907. In the supplement to the quarterly returns of the marriages, births, and deaths registered in Ireland during the year 1907, the Registrar-General informs us that " there was one death from smallpox registered in the whole of Ireland during the year 1907 : the deceased was a male, aged 19 years.

0ned^thn?ted The death occurred in the Union of Balrothery, and Registrar's district of Holmpatrick in the County of Dublin, whither he (the deceased) had returned from Glasgow three days previous to his death. He had been vaccinated in infancy, and one mark was distinguishable,

N?t . J but he had not been re-vaccinated." re-vaccinated.

Contrast this remarkable exemption from smallpox with the appalling record included in the report on the tables of deaths which forms part of the report of the census of Ireland for the years 1841 and 1851. The

Iris8̂smaiiPox, deaths returned as being caused by smallpox in the ten

years ended 1841 were as many as 58,006 ;f and in the ten years ended 1851 the deaths from this disease were 38,275—a total death-roll of 96,281 in twenty years, or 4,814 deaths per annum.

purity of With regard to the purity of the vaccine lvmph supplied vaccine lymph. ° . * .

to the public vaccinators of Ireland, the President and Fellows have received the following statement from the Bacteriologist of the Local Government Board for

Bacteriologist's Ireland :—" Every batch of Government lymph is ex-guarantee. J * J r amined bacteriologically by me, on at least two occasions, and not passed for issue unless found in all respects satisfactory/'

* See evidence in Appendix B (page 40) showing that Ireland was a well-vaccinated country in 1863.

f App. B, page 40.

FOR AND AGAINST VACCINATION 7

In Lord Macaulay's " History of England " occurs Lord Macaulay's the following graphic description of " that disease over escnpion« which science has since achieved a succession of glorious and beneficent victories." Writing of Queen Mary's death from smallpox in 1694, he states that it was then the most terrible of all the ministers of death. " The smallpox was always present, rilling the churchyards with corpses, tormenting with constant fears all whom it-had not yet stricken, leaving, on those whose lives it spared, the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover." Such was, or is* the disease from Deliverance by

' * immortal

which the immortal Edward Jenner delivered the nations. Edward jenner. Should the preventive treatment by vaccination fall into vwthoutvacdna-

r #

J tion Smallpox

abeyance, there is every reason to fear that smallpox would ra§e

would again stalk as "a pestilence through the land. With all the evidence before them, and having regard

to the strict precautions which are taken at the present day to secure that only the purest vaccine lymph shall be used, the President and Fellows would urge the people of Ireland to cling: to their faith in a preventive measure vaccination has

0 x nd Ireland of

which has rid their native land from one of the most smaiipox. terrible plagues which have ever afflicted the human race.

Signed, by order of the College, A. J. HORNE, President. JAMES CRAIG, Registrar.

4th February, 1910.

FOE AND AGAINST VACCINATION

LETTER I.

The following is a copy of General Phelps's reply as it appeared in the Dublin " Daily Express" and the " Freeman " of the 17th February :—

S I R , —

The responsibility which attaches to every public Statement «of statement by the Royal College of Physicians of Ireland, inaccurate.

that it should be strictly accurate, is very great. But in. the statement which they have put forth in reference to the growing opposition to compulsory vaccination they have put their imprimatur on^ assertions which can be shown to be inaccurate.

Sydenham des- Before inoculation or vaccination was introduced cnbes Smallpox

assligktjmdsafe i n to the Kingdom, the great Sydenham wrote, 2nd April, . 1688 : " I t is most clear to me, from all the observations

that I can possibly make, that if no mischief be done, either by physician or nurse, it (i.e., smallpox) is the most slight and safe of all diseases.'' This is proved by the

Mildness of statistics of recent epidemics in England. In five towns Smallpox in Eng- r °

land in 1903-06. i n England in 1903-06 there were 645 cases without one vaccinia more single death. Vaccinia is the cause of more deaths than deadly than ^

smallpox, variola. Germany had had strict vaccination laws in its several

States from the beginning of the last century. Yet in Prussia alone, her compulsory vaccination, dating from

Disastrous Ger- •*• u ^

man experience 1834-5, did not save her from a disastrous epidemic of in 1871-72. ^~ u r

smallpox, in which she lost no less than 124,948 of her citizens. The usual shuffle by which this terrible and conclusive contradiction of pro-vaccinist claims is met,

Aiaw1n penisesCia0f is the absurd and unfounded suggestion that the Prussian law was neglected, and that many citizens remained unvaccinated. But if the College adopts this horn of the

Dilemma: dilemma, it is met by the fact that the majority of the ou?vacPc?natedkin cases were vaccinated. Thus in Cologne, of 2,282 cases

cologne. Q£ s m a Upox, of which the vaccinal condition was stated, no less than 2,248 were admittedly vaccinated or re-vaccinated. The College, therefore, if it were to adopt


this subterfuge, would at once impale itself on the other horn of the dilemma, and have to admit that smallpox went about in Cologne during the epidemic, picking out the vaccinated and re-vaccinated, and leaving the un-vaccinated severely alone.

The German Armv lost some hundreds of men from rFJ^nch^

German armies

smallpox in the Franco-German War, and the French Te.^^ted Army lost more. The correct numbers are not known. As re-vaccination was compulsory in both armies, this proves that other causes, such as insanitation, depression, privation, etc., really control smallpox, vaccination being p ^ ^ ^ t * irrelevant.

In 1841-51 the deaths from smallpox in Ireland were no irishsmaiipoxin • « - ' • • x # 1841-51 due to

doubt excessive. This was due to the inoculation of wanVof sanitation.

smallpox, neglect of isolation, and other insanitary conditions. In England and Wales there are now ^^aEnniSd" millions of unvaccinated persons. Yet smallpox is absent. and Wales-It is brought in occasionally from well vaccinated localities by vaccinated patients, but dies down at once. Sanitation and isolation kill it.

Macaulav's rhodomontade is discounted by the quota- uMacaulav's

•/ T- rhodomontade.

tion above given from Sydenham. We have been repeatedly told by Ministers in their places in Parliament that they will not guarantee the purity of lymph, or the absence of extraneous disease germs from it. Before the College can pretend to guarantee the issue of " only the purest vaccine lymph/' it is necessary that they should be able to identify the disease germ of the vaccine disease, Gefm of vaccinia

J o unknown, there-

and prove the absence from its virus of every otherfore lymph can-disease germ. But it is notorious that all attempts to guaranteed. identify the disease germ of cowpox or smallpox have failed. There is no test for lymph. This being the case, the pretence made by the Royal College about " purity " in this connection is unworthy of them and their great trust.

Yours, etc., A. PHELPS, Lieut.-General,

President National Anti-Vaccination League.


T H E REJOINDER OF T H E DUBLIN SANITARY

ASSOCIATION.

LETTER II .

The Dublin Sanitary Association's reply appeared in the " Freeman's Journal '' and the " Daily Express " of the i s t March, as follows :—

Dublin Sanitary Association, Committee Rooms,

12 and 13, William Street, 28th February, 1910.

S I R , — Widedesi?edlirity * a m directed by my Council to forward to you the

enclosed letter, which deals with a matter of great public interest, and my Council consider that the widest pub-licity should be given it.

Yours faithfully, ISAAC YEATS, Secretary.

Dublin Sanitary Association, 12 and 13, William Street,

Dublin. February 24th, 1910.

S I R , —

The Council of the Dublin Sanitary Association have read with deep regret a letter over your name which was published in some of the Dublin newspapers of Thursday, February 17th, 1910. In that letter you attempt to throw discredit on a statement recently published by the President and Fellows of the Royal College of Physicians of Ireland, the object of which was to prove to the people of Ireland the efl&cacy of vaccination, and especially of re-vaccination, as a preventive of smallpox.

The Council have taken the trouble to investigate the several points in relation to which you criticise the statement of the Royal College.

FOR AND AGAINST VACCINATION I I

You begin by invoking " the great Sydenham " to prove that " i f no mischief be done, either by physician or nurse it (i.e., smallpox), is the most slight and safe of all diseases/' In quoting this passage you omit to state S y d ^ ^ s ^ k e

that Sydenham is speaking of discrete, or, as he calls it, smaiipox. " distinct " smallpox—a fact which is sufficiently obvious, for Sydenham fully recognises the gravity of confluent smallpox and of the purpuric and hemorrhagic forms of the disease. " In the confluent k ind/ ' he writes, " there Knew danger of

' y confluent

is most danger, and the greatest number die on the elev- smaiipox. enth day." And again—" Sometimes also in this disease . . . purple spots appear in the spaces between the eruptions, which are generally forerunners of dea th / '

That smallpox " is the most slight and safe of all diseases " you say " is proved by the statistics of recent epidemics in England. In five towns in England in g ^ T w 1903-06 there were 645 cases without one single death. known. Vaccinia is the cause of more deaths than variola." We do not know what were the five towns to which you refer, but we do know that in the years 1003-1006. smallpox in 1903-06smaii-

J J *-* J r pox more fatal

caused 1,404 deaths in England and Wales. In those than vaccinia. years 109 deaths were referred to " cowpox and other effects of vaccination." These facts do not bear out your statement, which may, however, be accepted for the years IQ07 and IQO8 in which the deaths attributed to in 1907-08, yac-

, , T ' . n n C i l l i a m ° r e f a t a *

smallpox were 10 and 12 respectively, whereas those than smaiipox. attributed to " cowpox and other effects of vaccination " were 12 and 13 respectively. In this connection, it is worth remembering that in iqo6^-the latest year for vaccinal

0 J J % fatalities m 1906.

which particulars are as yet available—vaccination was successfully performed on 686,992 children, 29 of whom succumbed, or one in every 23,689 vaccinated (Seventy-first Annual Report of the Registrar-General of Births, Deaths and Marriages in England and Wales, 1908).

I t is not correct to state that " Germany has had strict Germany badly J vaccinated in

vaccination laws in its several States from the beginning 19th century, of the last century." As a matter of fact the practice of vaccination among the general population languished in


Germany as decade followed decade in the nineteenth century, and this neglect of the great preventive of smallpox was largely responsible for the terrible explosion of the disease in 1869, which culminated in the destructive epidemic of 1870 and 1871.

Prussian recruits g u t from 1834 everv recruit who entered the Prussian compuls©rily ^~

vaccinated since Army was compelled to be re-vaccinated, with the result that in the following 35 years, 1835 to 1869, only 77 Prussian soldiers died of smallpox.

Franco-German Xhe accuracy of the statistics as to the relative preva-War: argument J r

from impugned, Jence and fatality of smallpox in the French and German wi»ll not press. J • tr

Armies in the great war of 1870 and 1871 has been impugned, and we will not press them in this argument. But some salient facts cannot be called in question. Of the French Army, 372,918 men were made prisoners of

French prisoners w a r . Of these rather more than 15,000 contracted small-of war and Ger- %J} macomelaredrmy P o x ' anc^ ^ e deaths numbered 1,963, or 13 per cent, of

those attacked. In the German Field Army (with a strength of more than a million men), 4,991 cases ol smallpox • occurred, of which 297 proved fatal—a rate ol mortality equal to 5.95 per cent, of the attacks.

Prussia badiy Prussia was badly protected by vaccination at the protected in 1871, . V» i

hence severe time of the Franco-German war, and we are therefore epidemic m that .

year. not surprised to find that whereas only 409 deaths occurred among the troops (mobilised and immobilised), smallpox slew 59,839 persons in Prussia in 1871, and 5,508 in Berlin alone, the population of which city was then 826,341, or much less than the number of men in the German Army.

stringent Ger- I t was these hard facts which led to the enactment of man Vaccination . r A «i r> i o

Law of 1874. the stringent German Vaccination Law of April 8th, 1874. In accordance with its provisions, young children must be vaccinated before the end of the calendar year following the year of birth, and all school children must be re-vaccinated in their twelfth year. Obedience to this law is enforced by fine or imprisonment.

New Law ob- Xhe result of the operation of this law has been that viates necessity *

fc^smaujpox i n Germany no difficulty attends the provision of hospital


accommodation for isolated and smallpox patients. This is abundantly proved in a Report to the Local Govern-ment Board for England by Dr. R. Bruce Low on the arrangements in Germany for the isolation of smallpox cases (1903).

In the opinion of Dr. Wutzdorff, Director of -the Imperial Health Department, and other medical au-thorities, with whom Dr. Low conferred, the immunity from smallpox displayed by people " residing in and around a general hospital, when that disease was being isolated there, is entirely due to the almost complete antecedent protection of the population by compulsory vaccination and re-vaccination."

Professor Minkowski, the Chief Physician of the Augusta Hospital, Cologne, expressed the opinion that " the German immunity from smallpox was due to general compulsory vaccination and re-vaccination ; it could not, he asserted, be attributed to the German method of isolation, which, he pointed out, would completely fail if it were carried out among a population which had not received the practically complete protection conferred by statutory vaccination and re-vaccination."

Professor von Noorden, chief medical officer to the Frankfurt General Hospital, and his senior assistant, " had complete confidence in the vaccination and re-vaccination, already undergone by the general population, to prevent the spread of smallpox to patients when cases of this disease were admitted to the General Hospital/ ' . Dr. Brandhomme, who is Medical Officer of Health for the City of Frankfurt-on-Main, " placed statutory vac-cination and re-vaccination in the forefront of all current protective measures ; without these he would have little hope of checking the onset of an epidemic."

At an interview with Professor Weintrand, Chief Physician of the General Hospital at Wiesbaden, and with his senior assistant, Dr. Wolff, both physicians assured Dr. Low that " they placed their chief trust in statutory vaccination and re-vaccination to prevent the

M FOR AND AGAINST VACCINATION

spread of smallpox, and that it would be impossible to ioslate such cases on the site of the Wiesbaden General Hospital had not the population undergone vaccination and re-vaccination/'

I t is noteworthy that Main is the only town in Germany visited by Dr. Low where provision for the isolation of smallpox has been made on a separate site.

Irenĉ Trmy You a s s e r t that re-vaccination was compulsory in the siibsSiated. F r e n c n Army in the war of 1870-1871. This statement

is contrary to the generally received opinion and should be substantiated. You make capital of the fact that

t̂akl sSinoxed m a n y vaccinated persons contract smallpox. But this is due to the temporary nature of the immunity from the disease conferred by primary vaccination in infancy. A

Rneces€arny It11 secondary vaccination at an age approaching puberty has puberty. a far m o r e reaching and enduring protective power. And

you ignore or suppress the fact that the controlling influ-ence of even a primary vaccination on the virulence of an

Sheffield:fatality attack of smallpox, as observed in an outbreak in Sheffield among * '

unvaccinated. j n J 8 8 8 , was such as to reduce the rate of mortality from 49 per cent, among unvaccinated patients to 4.9 per cent, among vaccinated patients.

In your letter you attribute the excessive prevalence and fatality of smallpox in Ireland in 1841-1851 to " the inoculation of smallpox, neglect of isolation, and other

use of sanitation i n s a n i t a r y conditions/' Far be it from us to decry the admitted; but • n r i r • • i • i •

vaccination an marvellous influence for good of sanitation and isolation absolute pre- ° .

ventive. i n the management of the acute infections, smallpox included. But what we do maintain is this, that in rela-tion to this most infectious disease, we have an absolute preventive, which is more than can be said of any other of the acute infections in the present state of our knowledge.

statement exag- The statement that " in England and Wales there are gyrated that °

miihonsofunvac- n G W millions of unvaccinated persons is exaggerated, cinated persons *• T

arenowinEng- though it is, unfortunately, likelv to be true at no distant land and Wales. ° , . . ^ , . r

date, if the conscientious objector has his way—for it appears from the Annual Report of the Medical Officer of the Local Government Board for the year 1907-08 that

FOR AND AGAINST VACCINATION *5

the operation of vaccination was successfully, performed 0 n 935>338* children whose births were returned by the J ^ g ^ *&£& vaccination officers in 1906, the latest year for which fully vaccinated, particulars are at this date available. We have seen unvaccinated infants struck down by smallpox, and we shudder to thinkf of the miserable fate which awaits the unhappy children of the " conscientious obiector " of Miserable fate

r r J J predicted for un-

England and Wales, should smallpox, unfortunately, be hXyianddIndin

introduced even " from well vaccinated localities by Wales-vaccinated patients."

Macaulav's " rhodomontade," as you term it, is based Macauiay'sstate-' J ' ment based on

on the classical description of smallpox by Thomas Sydenham, Sydenham—" Of the Regular Smallpox of the years 1667 and 1668, and part of the year 1669/' and " Of the anomalous or regular smallpox of the years 1670, 1671 and 1672 "—and by Richard Mead, Plrysician to King And Mead. George II. , whose " Discourse on the Smallpox " is dated " London, September 29th, 1747/'

You, sir, are inaccurate in stating that it is " notorious JLittJe^00+

m f?r+ > ' o doubt that exist-

that all attempts to identify the disease germ of cowpox s^f^ 6^ or smallpox have failed." and that " there is no test for vaccinia a

* # sporozoon,

lymph." Recent investigations both in Europe and in America leave little room for doubt that the exciting cause of smallpox is the introduction into the system of a sporozoon, analogous in many particulars to the malarial parasite, and that the so-called " vaccine bodies " found in both vaccine vesicles and smallpox pustules, are in reality a phase in the life-history of that sporozoon. (Councilman, IQ04.) Glycerinated calf-lvmph which has Giycerinated caif , T • i-i • o - i i lymph sterile and

been used, practically universally, since 1899, is both efficient. sterile and in so far as pathogenic or disease producing organisms are concerned, even more efficient than the original lymph.

* This is an error. In 1906 there were 935,338 btrths, not vaccina-tions. The number of vaccinations in tha t year was 686,992. The difference represents the number that escape vaccination in various ways, 53,828 being exempted.

f App. A, page 39.

i 6 FOR AND AGAINST VACCINATION

imaiipox1!!?^ W e cannot but think that it has never fallen to your pitai needed, i0i f0 vjsj.f. a i a r g e smallpox hospital. Had you done so,

you would never have tried to discredit a preventive measure which, if adopted, is the most potent weapon in the hands of the Medical Profession in the struggle with one of the most loathsome diseases which have ever afflicted the human race.

I am, On behalf of the Dublin Sanitary Association,

T. PERCY C. KIRKPATRICK, President.

To Lieut.-General A. Phelps, President, National Anti-Vaccination League.

LETTER III .

(" Dublin Express/ ' gth March).

We have been asked to publish enclosed reply to the statement which appeared in our columns on the i s t inst. :—

23, Augustus Road, Edgbaston. yth March, 1910.

S I R , —

I am in receipt of the letter from the Dublin Sanitary Association of the 24th ult., with which you favour me, which has been delayed in reaching me, and which, I now see, you have given to the Press. Assuming that you are writing for information, and not as a repre-sentative of the Royal College of Physicians, Ireland, I have pleasure in giving you the particulars required.

With respect to the comparison between the deaths due to vaccinia and variola, it must be remembered that many cases of the former are hidden under the present system of certifying deaths. A medical man once avowed that he omitted vaccinia from certificates of death, " to

Deaths due to vaccinia hidden

under Certification.

FOR AND AGAINST VACCINATION *7

save vaccination from reproach."* If you look at the official reports of fatal cases of vaccination occurring at Misterton in 1876, at Norwich in 1882, at Derby in 1882, and at New Humberston in 1889, you will find 12 death certificates in these cases, but vaccination mentioned in only one of them (see page 91 of " What about Vaccination/5 by Alfred Milnes, M.A., London). For the 29 who succumbed in 1906, or one in 23,689 vaccinated, as quoted by you, you may safely substitute many times that number. It is interesting to note the diminishing number of those admittedly* killed by vac-cination. In paragraph 184 of the Dissent appended to the Report of the Royal Commission on Vaccination, these fatalities were 1 to 14,159 primary vaccinations. The reduction to 1 in 23,689 is possibly a paper reduction ; perhaps only a condemnation of former procedure.

In their statement the Royal College of Physicians, Ireland, stated that in the Franco-Prussian war, " small-pox spared the re-vaccinated Prussian troops whereas it raged as a destructive epidemic among the badly vac-cinated French armies/ ' but I see you are somewhat better informed, and "wi l l not p res s" the figures. -I wish you had candidly dismissed them as ridiculously false. The numbers are conjectural; when the legend was invented it was roundly asserted that 23,469 French died. But we have killed that false statistic.

Still you assert that " Prussia was badly protected by vaccination at the time of the Franco-Prussian war." This means that in Prussia the law was habitually dis-regarded. Do you really believe this ? Have you realised what it means ? Up to its terrific epidemic of 1871—2, Prussia was acclaimed as the thoroughly vaccinated country from which Jenner had banished smallpox. Dr. Seaton, Medical Inspector of the Privy Council, told the Parliamentary Committee on Vac-cination, 1871, Question 5603, " Prussia is well protected, but in Prussia they leave vaccination until the children

Official reports

Proving falsification.

Alleged reduction in vaccination fatalities.

D.S.A. more prudent than

R.C.P.I. respect-ing Franco-

German War.

Up to 1871-72 Prussia

acclaimed as thoroughly vac-cinated country

Testimony of Dr. Seaton, and

Dr. Simon coolly thrown over-

board

* App. C, page 46.

i 8 FOR AND AGAINST VACCINATION

Dilemma; if Ger-many was badly vaccinated, then

unvaccinated cases of Smallpox

must prepon-derate.

Facts in Berlin ;

in Bavaria

in Cologne;

in Neuss;

in Krefeld ;

in Wesel.

Vaccination therefore no protection.

are twelve months old." Dr. Simon, another Inspector, based his case for compulsory vaccination on the fact that Germany was well vaccinated, and consequently free from smallpox : see Appendix to same Report, p. 357, and generally. Sir John Simon prudently shirked cross-examination before the Royal Commission of 1889. Now that the epidemic which devastated Prussia in 1871—2 has to be accounted for, you coolly throw these contem-porary witnesses overboard, and boldly assert that Germany was badly vaccinated, and " this neglect oi the great preventive of smallpox was largely responsible for the terrible explosion of the disease which culminated in the destructive epidemic of 1870 and 1871."

If you are correct in thus contradicting the official, contemporary, witnesses for vaccination, it follows that you believe that the unvaccinated in Germany in that epidemic furnished the larger number of victims. If not, your contention has no point. You cannot have it both ways.

Here are a few facts :— In Berlin in 1871—1872 there were 20,391 cases of

smallpox, of which 17,038, or 83.6 per cent., were vac-cinated persons.

In Bavaria in 1871, there were 30,742 attacks, 29,429, or 95.7 per cent., occurring in vaccinated persons.

In Cologne in 1871—1873 there were 2,282 cases, whose vaccinal condition was recorded, of which 2,248, or 98.5 per cent., were vaccinated persons.

In Neuss from 1865 to 1873 there were 247 attacks, the whole 100 per cent, being in vaccinated persons.

In Krefeld in the epidemic, there were 118 cases, of which 117, or 99.1 per cent., were in vaccinated persons.

In Wesel from 1870 to 1873 there were 523 cases, of which 8 (including 4 babies) were unvaccinated ; so 98.4 per cent, were in vaccinated persons.

I t follows, if Drs. Seaton and Simon were right in 1871 in saying that Prussia and Germany were " well pro-tected/ ' that vaccination is no protection at all.

FOR AND AGAINST VACCINATION x9

But if they were wrong, and your contradiction of them JpeSySa is correct, and the Germans paid little or no attention to their vaccination laws, then we have the instructive lesson, that smallpox left the crowds of unvaccinated whom you postulate, severely alone, and went for the vaccinated with disconcerting pertinacity. Make up your mind upon which horn of the dilemma you prefer to be impaled ; but do not quote Germany again until you have made up your mind.

You throw a doubt upon my assertion that the French Army was as much re-vaccinated as the German. That is, of course, an admission that if it was as I say, your argument, from the excessive liability of the French troops, and the superior immunity of the Germans, is blown-to pieces. The highest authority is Dr. Bayard. Dr. Bayard

± o J J proves

Writing in 1872 he said, " Re-vaccination originated in 0^^f^y France. Every young soldier is re-vaccinated on his entrance into a regiment. Our army knows of no excep-tions. " The fact is that defeat, privation, misery, dirt, Hence vaccina-

' * ' J} ' tion Was proved

made the French army more liable to smallpox and every irrelevant, other disease than the German army. Vaccination thus revealed itself as an irrelevant grotesquery.

With everv respect for the German authorities whom Facts preferred r to authorities.

you quote, I prefer facts. I t is an extraordinary instance of the power of sug- Failure otab-

J x- o solute preventive

gestion to make people believe the impossible, that you admit in one sentence that re-vaccinated Prussian soldiers take smallpox, and in another call vaccination " an absolute preventive/ ' I t does not seem to have occurred to you that the very possibility of re-vaccination de-molishes the claim of vaccination to prevent smallpox. For if an artificial attack of cowpox cannot protect against Re-vaccination

, , , . ,., . , -i -i. ' 1 -,-, fatal to claims

itself—a theoretically milder disease than smallpox— made for . . vaccination.

much less can it protect against the severer disease, smallpox. As a matter of fact, Dr. Alfred Russel Wallace, Dr.A.R.waiiace / ^ v i . - shows vaccinated

O.M., has shown that the vaccinated are rather more more liable than liable to the disease than the unvaccinated. smallpox.

You quote Councilman (1904) as having, with little


room for doubt, identified a sporozoon as the " exciting Sporo

nzo!maand c a u s e °^ a smallpox." When the £1,000 offered for a pure reward,of £i,ooo. culture of vaccine by a London City Company has been

awarded for this discovery, it will be time enongh to examine the claim. Meantime, it can wait, or drop into the limbo into which Koch's tuberculin and the cholera comma bacillus have gone.

R̂ovafcSmmS ^ s *° g ly c e r m a t ed calf lymph, you have surely o ver-sion/and claims looked the disclosure in Par. 21^ of the Dissent appended for purity of gly- ^ • * *

caffninmeh *° the final report above quoted. The following, nearly verbatim, extract, throws light upon your assertion that it is sterile and free from pathogenic germs—" When the assertion is made that the transmission of specific disease by vaccination is exceedingly rare, it must be borne in mind that the fact that vaccination with calf lymph, and, therefore, independent of a certain contamination, is capable of evoking symptoms indistinguishable from those of that specific disease, has only recently been brought to the notice of the profession/' For the lay mind, the conclusion seems inevitable, that where two diseases produce identical symptoms, they are the same disease.*

"Lancet/' Com- The failure of the glycerine in this connection is well purity of lymphs, known, and has caused the suggestion of chloroform,

etc., in substitution for it. The ghastly results of the examination of various " lymphs " on the market by the Commissioner of the " Lancet " (28th April, 1900, and 7th June, 1902) has hopelessly disproved all claims as to

Blood m an the purity of vaccines All vaccine is admittedly con-taminated with blood, which fact alone condemns it.

Visits to Small- I do not see the connection between visiting a smallpox irrelevant hospital, and judging of the value of a secret remedy,

vaunted as preventing the disease afflicting the inmates. The problem is chiefly a question of statistics. Properly treated, a case of smallpox, even if vaccinated, appears to be still, as Sydenham described it, the most slight and safe

* App. D, page 47.

FOR AND AGAINST VACCINATION 2 1

of all diseases. I t is the treatment which makes it a Ti™^Tx™th* loathsome disease. Dealt with as it at first was in som|iIS^^

ste,r

Gloucester, where the smallpox hospital was a disgrace to H°spitai. civilisation, it becomes a serious disease, and emulates the treatment by becoming loathsome. In Gloucester, when dealt with rationally, the death rate fell to almost nothing.

The population of England and Prussia being nearly Ha^stoaaS-

equal, it is interesting to note that the smallpox deaths j ^ * * ^ in the two countries in 1906—7—8 were, in Prussia, 41, 31, and 62 ; and in England, 21, 10, and 12. That is, that your " preventive measure " prevents in inverse proportion to its amount. The less there is of it, the better it acts ! Cannot this grotesque delusion be said to be one of the most loathsome superstitions which has ever afflicted the human race ?

Sanitation is the only remedy for smallpox, typhus, and sanitation only t7 J i l l - remedy for

other dirt diseases. To attempt to render a human being smallpox. immune to disease A (smallpox) by infecting him with disease B (cowpox) is as absurd as it would be for a man to hang obscene pictures in his children's school-room with the idea of rendering them immune from lying.

A. PHELPS, Lieut.-General. President National Anti-Vaccination League.

T. Percy C. Kirkpatrick, Esq., President Dublin Sanitary Association.


LETTER IV.

To the Editor of the " Daily Express/ '

S I R , —

I am directed by the Council to say that they would feel obliged by your kindly inserting enclosed letter in the " Daily Express/ '

Yours faithfully, ISAAC YEATS,

Hon. Secretary. Dublin Sanitary Association,

Committee Rooms, 12 and 13, William Street, 18th March, 1910.

[COPY.]

Dublin, 18th March, 1910. S I R , —

Suppression of There is not a scintilla of reliable evidence that mem-vaccinia as cause n r ,1 J • i x • x i • i 11 T

ofdeathincertifi-bers of the medical profession act so dishonourably and dishonestly as to suppress " vaccinia " as a cause of death in any case where it proved to be such.

M. de Freycinet's The " round assertion " that 23,469 French soldiers assertion that died of smallpox in the Franco-German War is made on soldiers died of the authority of Monsieur de Freycinet, Minister of War Smallpox in r -ŷ

Franco German l o r F r a n c e . War.

Prof. H. Tmmer- The statement that Prussia wais badly protected by n'eliect̂ f vrac- vaccination at the time of that great war is

s based on the oination in Berlin c , , . . ,1 . -, ,

in 1860-70. following sentence m the masterly monograph on vac-cination and re-vaccination by Professor H. Immermann, of Bale, in Nothnagel's " Encyclopaedia of Practical Medicine (1902) " :—" But it must be mentioned that in the decade from i860 to 1870 vaccination in Berlin fell somewhat into disuse, and, as a consequence, a soil was prepared for the pandemic of 1871 and 1872.''

We have never contended, and do not contend, that primary vaccination confers a life-loug immunity against


smallpox. We admit that its protective efficacy wanes Pt̂ n7wanSSa" with the lapse of time, and that, therefore, re-vaccination protection; is called for before the age of puberty. But abundant and irrefutable evidence exists that a primary vaccination, even when it has ^ceased to prevent smallpox in an indi-vidual, still possesses the power to mitigate the virulence mitigates disease. of the disease, and so to stave off death.

You dispose of the opinions expressed by the highest sanitary authorities in Germany to the accredited repre-sentative of the highest sanitary authority in England in three words, " I prefer facts." But surely the difficulties Provision of safe

} ir J hospital accom-

which attend the provision of safe hospital accommodation modation easy in r r Germany, diffi-

for smallpox patients in the United Kingdom, and the cultin England. non-existence of those difficulties in the German Empire, are " facts."

For London, with its population of five millions, 2,500 in London 2,500 * r # b e d s ; m Berlin

beds have to be reserved in hospitals far removed from I2bedssufficiemv the metropolis to cope with a possible smallpox epidemic. For Berlin, with its two millions of population, 12 beds in a pavilion of a general hospital within the city are sufficient. How do you explain these " facts ? "

Is it a fact, or is it not, that the "mortality from small- sudden faiim J Smallpox mor-

pox in the Prussian Army fell suddenly after the intro- taiitym Prussian r J J Army in 1834

duction of compulsory re-vaccination in 1834 \ i n a i i n

the pandemic of 1871—1872 the deaths from the disease per 100,000 were 29.2 in the army compared with 252.8 in the civil population of Prussia; and that from 1874 to 1901 there were only two deaths from smallpox in the whole Prussian Army—one in 1884—5 and the other in 1888—9 ?

Is it a fact, or is it not, that in the civil population of sudden fan in 7 r r Smallpox mor-

Prussia exactlv the same reduction of mortality from taiity in Prussia J after enactment

smallpox which had followed the adoption of re-vaccina- ofiawofi875. tion in the Prussian Army in 1834 was observed to occur suddenly after the enactment of the German Imperial Vaccination Law, which came into force on April 1st, 1875 ?

And lastly, is it a fact, or is it not, that in the neigh-


^rnlifox^?6 louring Austrian Empire, in which vaccination is not 1871-72 and 1891 compulsory, no such reduction in the mortality from

smallpox succeeded the pandemic of 1871—72 until after 1891, since which year the Administrative Govern-ment Authorities have been most active in promoting vaccination ?

Yours faithfully, T. PERCY C. KIRKPATRICK, President..

General Phelps, 23, Augustus Road, Edgbaston.

LETTER V.

23, Augustus Road, 2yd March, 1910.

SIR — ' I am in receipt of your letter of the 18th inst., and

am glad to see that you have dropped the superior, rebuking, tone of your first letter. Also that you are: beginning to be dimly aware that you have got into trouble over the Franco-German statistic, which the Royal College of Physicians, I., so foolishly quoted in their manifesto. Let me place your dilemma once more-

Diiemmaof briefly before you. If, as you assert, Germany was badly restated, vaccinated when the epidemic of smallpox slew 124,948

of its citizens, then you have to explain why smallpox left the unvaccinated severely alone, as shown in the. figures which I quoted in my former letter. If you admit the truth, which is, that Germany was well vaccinated, before the epidemic began in 1870, then you have to confess that vaccination will not save a population from smallpox. Until you declare on which horn of this dilemma you prefer to be impaled, your position is absurd. Your straightforward course is to state which alternative you select, or confess that you have inadvertently-promulgated falsehood.


You state that there is " not a scintilla of reliable Mc^ai suPPres-sions in Death

evidence that members of the medical profession" certificates; suppress vaccine as a cause of death in their death certificates. The adverbs " dishonourably and dis-honestly " are not mine. But if you will look at the Birmingham Medical Review of May, 1874, p. 34, you will find Dr. May's explicit statement to his class as Dr. May; follows :—"A death from vaccination occurred not long ago in my practice. Although I had not vaccinated the child, yet in my desire to preserve vaccination from reproach, I omitted all mention of it in the certificate of death." This is a good sparking scintilla, I think. Moreover, in the Dissent appended to the Royal Com- Dissent to Royai

7 r r J Commission;

mission on Vaccination, para. 190, it is stated, with reference to deaths from " erysipelas after vaccination/' that " There is ample reason" for believing that many other such cases have occurred, but in which no mention of vaccination appeared in the certificate of death." The scintilla here is an illuminating shower of sparks. And a full blaze of conflagration is to be found in the Medical and Chirurgical Review, Volume XL, pp. cvi., Med.andctun

. ° r r Review;

cviii., in the following words : " This attempt to conceal everything that appears unfavourable, so frequently resorted to by certain pretended friends of vaccination, cannot be too much reprobated. It shows the business to have got into very bad hands. Were truth their only object, they would court investigation, not endeavour to suppress it." It is not " dishonourable and dishonest " to be obsessed with a fixed idea : I would rather call it 0 êd1dea°f

pitiable and mentally disabling. It is not natural for the members of a sanitary association to believe in the use and sanity of returning excrete pus out of a sore into v^j^S


His disavowal.

Dr. Carpenter.

" Lancet's " honourable withdrawal.

Appeal for can-did recantation,

Reduction in Smallpox deaths

in Prussia not l a w sudden, but „

gradual. ToJ2-

Minister for War, France, who uttered the Franco-German myth in 1882. In your normal condition you would not appeal on a medical question from medical to lay au-thority. Yet, if you will come out of your trance, and refer to page 727 of the sixth Report of the Royal Com-mission on Vaccination, you will see that Sir William Collins had a report from Dr. P. Jeunhomme explaining how this hoary statistical lie was faked, and confessing that there was not authority for the statement made by M de Freycinet. Dr. Carpenter, too, inadvertently used this fossil fable, and in a letter to the " Daily News " of the 7th August, had to confess that he had erred.

In 1901 the " Lancet " burnt its ringers by inadver-tently quoting this falsehood. On its mistake being pointed out, the Editor honourably withdrew the figures, saying :—" We regret to have published them, as their falsity has been established.—Ed. L." Is it too much to ask that you and the Royal College of Physicians,. Ireland, will be equally honest ?

You always seem to stand on your head as regards facts, when you write on this subject. You ask, with a little touch of former hoity-toity condescension, " Is it a fact, or is it not, that in the civil population of Prussia exactly the same reduction of mortality from smallpox . . . was observed to occur suddenly after the enactment of the German Imperial Vaccination Law, which came into force on April 1st, 1875." I wonder that the date did not put you on your guard. To withdraw you from your land of dreams to realities : the smallpox deaths per million in Prussia for the five years before the new

came into force were as follows 1—1871—2,432. —2,623. 1873—356. 1874—95. 1875—36.

You have, as usual, got the figures upside-down. The sudden improvement which you' state followed the law which came into force on 1st April, 1875, preceded it, gradually, in the five years before that characteristic date.

What bearing has your assertion that there are 2,500


Hospital irrelevant.

empty beds in London smallpox hospitals, on the hard E^hSmffipox fact that there were in the three years ending 1908, 134 smallpox deaths in Prussia, the much vaccinated, and 43 smallpox deaths in England the little vaccinated ? Surely Alice's mad hatter never was more inconsequent.

This letter is long enough, so I will not deal with your other minor fallacies ; but will just ask you whether you seriously believe that the thousands of vaccinated persons who have died of smallpox, died mitigated deaths ?

Yours faithfully, A. PHELPS,

T. Percy C. Kirkpatrick, Esq., M.D., President, D.S.A.

' Mitigated'" deaths ?

LETTER VI.

The following is a copy of Dr. Kirkpatrick's letter to General Phelps as printed in the " Dublin Express " of the 26th April:—

Dublin Sanitary Association, 12 and 13, William Street, Dublin.

23rd April, 1910. DEAR S I R , —

In reply to your letter of the 23rd ultimo, may I state w ^ ^ t i S again that my quotation of the statistics of the prevalence Mndae

utFreycLet. and mortality of smallpox in the French armies during the Franco-Prussian War was made on the authority of the Minister of War for France ? In my letter of February 24th I admitted that the accuracy of the statistics as to the relative prevalence and fatality of smallpox in the French and German armies in the war of 1870 and 1871 had been impugned, and accordingly I did not press the argument based on those figures.

You say that the adverbs, " dishonestly and dis- S n ^ a n d 8

honourably/ ' as applied to those medical men who gî STakified


wilfully and designedly give a false certificate of the cause of death in order to support the cause of vaccination are not yours, but surely you do not object to their use in this connection. To our minds such conduct fully merits such a description. I stated that there was not a " scintilla of reliable evidence " that medical men had

Erysipelas foi- acted so. That erysipelas has followed vaccination is lowing vaccina- J r

tiondeaanth Cnotsin8 ̂ nie, a n d that such erysipelas has caused death is equally evidence that true, but this is not evidence that vaccination was the

vaccination was '

cause of death, cause of death, or even that it should be mentioned in the death certificate. Your quotation from the " Medico-chirurgical Review " is not evidence as to the point at all.

With respect to your dilemma, it is well when preparing one in a controversy to be sure that both horns are sharp.

Gv^Ste'd mel1 Even supposing that Germany in 1870 was a well-vac-proSc'teTlglhist cinated country, it by no means follows that it was a Rê ĉkTation country well protected by vaccinatioii from smallpox.

necessary for pro- Most 0f ^ supporters of vaccination are now agreed as to the necessity of re-vaccination to afford this pro-tection, and no one claims that in 1870 Germany was well re-vaccinated.

The smallpox statistics for Germany since the intro-duction of the law enforcing compulsory vaccination and re-vaccination give the fullest support to this con-

ĜmSny8weii Mention. In that country since 1875, in spite of the vacchStSn̂ nd frequent introduction of smallpox, that disease has not re-vaccination. S p r e a ( ^ a n d measures for its prevention are there found

amply sufficient, which in countries where re-vaccination is not compulsory, have failed to prevent epidemic outbreaks of the disease.

mor?aiity°was That the smallpox mortality was decreasing in Germany GerSnŷ lfore before the compulsory law of 1874 is true, and this is the law of 1874. what one would have expected after the severe epidemic

of 1870 ; but the important consideration which you overlook is that since that time nearly 40 years have elapsed without a further similar outbreak, and this, too, has occurred without those strict regulations as to isola-tion of infected persons that have been adopted without


a similar success in other countries. The comparison of the figures for Germany with those for Austria since the year 1874 leaves one in no doubt as to the part played by vaccination and re-vaccination in the prevention of smallpox.

Yours faithfully, T. PERCY C. KIRKPATRICK, President.

General Phelps, 23, Augustus Road, Edgbaston.

LETTER VII.

S I R , —

Yours of the 23rd ult., in answer to mine of the 23rd March, scarcely accounts for the interval of one month which the D.S.A. have taken in putting it together. In your letter of the 18th March, you quoted M. de j ^ 8 £ ! ^ £ . Freycinet as your authority for the " round assertion " dXutFnmnS-th

tha t 23,469 French soldiers died of smallpox in the G™itt^dar

Franco-German War. In doing so, you either knewT that he had been obliged to disavow the accuracy of the figures, or you were ignorant of the fact. In either case, you are, in honour, bound ,to admit the truth, and to formally withdraw the falsehood which you have promulgated unawares.

You try to drown me with adverbs again, as to the ^ ^ false certification which Dr. May avows and justifies, and which neither you nor the Medical Profession at _ vaccinated

J Smallpox deaths

large have ever, as far as I am aware, denounced. The and chicken-pox ° ' • ' or pustular

notorious fact that medical men certify fatal cases of dermatitis. smallpox among the vaccinated as chicken-pox, or pustular dermatitis, or what not, is not due to their "wilfully and designedly" certifying falsely, but to the fact that they cannot believe their eyes when they see vaccinated persons—possibly vaccinated by themselves—


die of smallpox. As I before explained, they, most of suggeSi?onf. them, do this as victims of suggestion ; that they do it is

merely proof of a pitiable and mentally disabling obses-sion.*

It is diverting to see how you try to wriggle and shuffle off the dilemma into which your quotation of the Franco-German falsehood has led you. You insinuate that though vaccination did not save Germany, " no one. claims that in 1870 Germany was well re-vaccinated."

G^m^rmy No one denies that the German Army was thoroughly re-vaccinated, re-vaccinated then. If he resisted, the King's Ordinance-

Did males m Ger- ' o many suffer less directed that the recruit should be held down and re-man females ?

vaccinated in ten places on each arm. Under the law of conscription this ensured that practically every male citizen was re-vaccinated, as he had to become a recruit. This makes it probable that, although compulsion was very severe and strict on female Germans, the males were a trifle more re-vaccinated than the females. Do you assert, then, that males suffered less than females in the pandemic of 1871-2 ?

jenner Tenner denounced re-vaccination : he admitted that denounced J

re-vacdnation. it would rob his discovery of half its merits. You say " that erysipelas has followed vaccination

is true, and that such erysipelas has caused death is equally true, but this is not evidence that vaccination was the cause of death, or even that it should be men-tioned in the certificate of death." To a mother mourning the death of a child from erysipelas arising in and with a vaccination sore, would this sound either ingenuous or

jenner's avowal consoling ? That vaccine and erysipelas are inseparable, that vaccine and ° # ^ 4 - •*•

erysipelas are {$ avowed by the immortal Tenner. On page ioo of his inseparable. . J J

FOR AND AGAINST VACCINATION 3*

You ask how it is that in Germany nearly 40 years have elapsed since the severe epidemic of 1871-2, without a further similar outbreak. And you allege that this has been achieved without strict regulations as to isolation. I have much pleasure in giving you the answer :— Vaccination and re-vaccination, enforced with German thoroughness, had not only failed to banish smallpox, but had led to the terrific epidemic in which 124,948 German citizens, mostly vaccinated, had died. This means that from 1^ to 2 millions of mostly vaccinated and re-vaccinated persons had taken the disease, which had generally begun in each town with vaccinated persons. About this time the French Milliards came in, and san-itation was invoked. Drainage, water-supply, sewerage, slum clearing, etc., were attended to. Professor Virchow inspired the Berlin municipality. The Spree, which had become an open sewer, was cleansed and purified. The new vaccination law extended the term for vaccination from one to two years, thus somewhat alleviating the brutal tyranny of the previous law. And where vac-cination had ignominiously failed, sanitation succeeded.

A strict isolation law was passed, with compulsory notification. Instead of aggregating smallpox in crowded hospitals, power was given to segregate cases in their own houses. The disease-mongering superstition of vac-cination was foolishly retained ; but sanitation, the real banisher of smallpox, typhus, and typhoid, was sys-tematically pushed, and in proportion to its adoption these so-called infectious diseases disappeared. If vaccine had been got rid of with other filths, Germany would now be free from smallpox, as England is now rid of that " beggar's disease," instead of showing a three times greater liability, to it, as Prussia does. The 134 deaths from smallpox in much vaccinated Prussia, which I quoted, and which you ignore in your letter, imply from 1,300 to 3,000 cases in three years ending 1908. In England the 43 deaths occurring in the same period imply some 430 to 1,000 cases. If this goes on you will

Real cause of decrease of Small pox in Germany

is sanitation.

Professor Vir-chow and Berlin

municipality.

Isolation notification.

Prussia more liable to Small-

pox than England.


have to devaccinate Prussia again, and to assert that her population is well " protected " when smallpox is absent, and badly " protected " when the disease is present.

Open minds who may honour us by reading this correspondence will say that the D.S.A. " speaks an infinite deal of nothing, more than any man in all Dublin. His reasons are as two grains of wheat hid in two bushels of chaff : you shall seek all day ere you find them, and when you have found them they are not worth the search."

A. PHELPS, President N.A.V.L. 23, Augustus Road.

2nd May, 1910.

T. Percy C. Kirkpatrick, Esq., M.D., President D.S.A.

LETTER VIII .

Dublin Sanitary Association, 12 and 13, William Street, Dublin.

lyth May, 1910.

DEAR SIR ,—

I beg to acknowledge the receipt of your letter of May 2nd. May I again say that on finding that the truth or falsity of the figures given by M. de Freycinet for the deaths from smallpox of French soldiers in the Franco-German War could not be established by any available official returns, I at once withdrew the argument. The use that has been made of it in the argument since has been entirely by yourself.

You say I try to drown you with adverbs when I say there is no reliable evidence that medical men wilfully and designedly give false certificates as to the cause of

Franco-German War, argument

from at once withdrawn.


death, and you answer by saying there is not wilful dishonesty, but a " pitiable and mentally disabling obsession/' Surely even you do not consider that such a statement is evidence on the point. Your description of the vaccination of German recruits is not proof that in vaccination of

* German recruits

1870-71 Germany was well re-vaccinated, though the no proof that ' ' J ' ° Germany was

picture you draw may raise a prejudice against vaccina- ^^g0^" tion. Jenner's opinion on the necessity of re-vaccination does not touch the question at all. I am not aware that .N°°°®9iaims

1 infallibility for

anyone claims a general infallibility for Jenner. Had you Jenner. taken the trouble to understand the meaning usually attributed to the terms you use you would not have been led into the error of considering " erysipelas" and Erysipelas and

0 J r Erysepelatous

" ervsipelatous inflammation" as terms of identical inflammation not ^ t

x identical.

meaning.* A doctor may not be justified in concealing any of the Doctor not ex-

J J ° pected to certify

causes of death, if bv that you mean the immediate causes every previous ' * J condition of

of death, but no one expects him to state in a certificate patient, every previous condition of the patient that may have had a share directly or indirectly in leading to the death. A vaccination wound may be infected with erysipelas, just as any other wound may be, but though this is so, one is not justified in assuring that erysipelas was given by vaccination. Did you understand anything of the pathology of either condition you would see that a vaccinated person might die of erysipelas without the vaccination being in any way casually connected with the „ ., .

0 J J J Classifying vac-

event. To classify vaccinia " w i t h other filths" is cima with filths ^ begs the question

merely begging the question ; it is not argument, though it indicates very clearly the state of mind of the person who tries to use it as such.

With regard to the condition of Germany, I have just smallpox in 0 German Empire

received the official figures for the year 1908. In the for 1908. German Empire for that year there were 434 cases of smallpox in a population of some 57 millions, and of these 434 smallpox patients 65 died, or 1.03 per million in-

* App. E, page 48.


habitants. Of those who died 41.45 were foreigners. The figures with regard to the vaccinal condition of the patients are interesting :—

Vaccinal Condition. Deaths. Cases.

Detailed I. Unvaccinated . . . . 30 66 analysis.

Unknown . . . . 3 13 Unsuccessful . . . . 4 21 Vaccinated too late 6 26

Total unprotected . . 43 126

II . Once vaccinated . . 10 123 Re-vaccinated too late 2 42

Total insufficiently vaccinated . . 12 165

II I . Re-vaccinated . . . . 10 143

^rro^tfon68 ^ w e ^ a ^ e g r o u P s I- a n d II- together, we have 55 deaths afforded. a n d 291 cases of those insufficiently vaccinated against

10 and 143 respectively of those vaccinated and re-vaccinated. If we compare group I. with groups II . and III . , we have 43 deaths and 126 cases compared with 22 deaths and 308 cases among those who have received any protection whatever from vaccination. Group I. must bear a very much smaller proportion to the total population than groups II . and I I I , yet the number of deaths in it were very nearly double that in groups II . and I I I . One would think that even to those who look

vaccmatian has 0 n vaccinia as a " filth disease " these figures would some controlling • • 1 1 -IT • n

influence on suggest that vaccination had some controlling influence Smallpox. ° °

on smallpox. insular position. The insular position of Great Britain affords a much

greater protection against the introduction of smallpox than is possible for Germany, and we find that the cases in the latter country for the year under consideration were very widely distributed throughout the Empire.

Writing on behalf of the Association, I have to inform


you that so far as this Association is concerned, this correspondence is now closed.

Yours faithfully, T. PERCY C. KIRKPATRICK, President.

•General Phelps, 23, Augustus Road,

Edgbaston, Birmingham.

GENERAL PHELPS'S REPLY.

23, Augustus Road, Edgbaston.

23yd May, 1910.

DEAR S I R , —

It is with much regret that I learn from your letter of the 17th inst., that this illuminating correspondence hetween us is Lo cease. But it is always so : the Pro-Vaccinist case is like Don Quixote's Helmet. The Imperial Vaccination League also found that it dare not defend vaccination in open debate, and stipulated that its addresses should not be subjected to the strain of public discussion. With an open-minded love of fair «'D̂ uyExprei/

f

play, and an unusual readiness to hear both sides of this important question, the " Daily Express " has given us an arena in which some aspects of vaccination have been openly discussed. And I think I may say, without risk of denial, that once more the anti-vaccinist side has prov̂ reSedy routed the champions of Jenner's evil quack nostrum, forsmaiipox. and has convinced you—against your will—that sanita-tion, and not disease-mongering, is the only remedy for smallpox. That disease is merely the beneficent cry of nature for the sanitation, neglect of which has caused it.

I t is a curious thine: that you throw overboard every Tenner jettisoned J J for condemning

medical witness whom I cite. You now iettison poor re-vaccination, -J r with every

Jenner, because in a lucid interval he very sanely pointed medical witness. out that re-vaccination is fatal to the whole theorv of


German males vaccination. 4 In the pandemic of 1871—72, male Ger-more re-vaccin- • -t .

femaiestbnTnce m a n s were, by reason of the law of conscription, more "sma^l*0 r e " v a c c i na t ed than their sisters. Accordingly, they

furnished more than their even share of smallpox deaths.* In your apology for inaccurate certification, I think you

have written " casually" by oversight, instead of " causally " and " assuring " instead of " assuming." However that may be, I protest with my whole strength, against your unwholesome and dangerous doctrine, that

protest against m c ases where there are two or more contributory causes doctrme that J

Doctor can pick 0f death (I did not sav " previous " causes ; this is your and choose v r ' J

for̂ ifiratfon §-̂ 0SS) ^he doctor certifying the death is justified in picking and choosing which of them he may enter in his certificate, and which he may suppress. In cases in which a child dies of tetanus, or erysipelas, or any other disease origi-nating in a vaccination sore, and which but for that vaccination sore would not have been there, it is dishonest to omit vaccination from the certificate of death, as was done in the cases which I quoted in my letter to you of the 7th March. I t would be death to the respect which we ought all to feel for medical men as healers of disease

suppression and and trusted friends, if we came to know that such sup-prevarication . . . _ . - _

wouidkiu respect pressions and prevarications guided their hands when due to medical x. . . n ~,~ .,

men. signing death certificates. The whole truth and nothing but the truth, should appear in death certificates ; when erysipelas, gangrene, or tetanus originate in a vaccinatioxi sore, and one of them is a contributory cause of death, then the omission of vaccination from the death certificate is a deception which, I am grieved to find, the ethics of the

u^smlSfi&x. D.S.A. excuses. Nothing can justify such lax morality. I did not classify " vaccinia " among the filths, as you

misquote, but " vaccine/ ' The former is a disease. Difference The latter is pus out of a sore—filth of the filthiest. Do

between vacciuia ., , , r i .... i • i -r i

• and vaccine, you remember the cry of horror with which London received the news that Hospital poultices were used to

Poultices and feed ducks ? That horror was due to the recognition of such pus in the poultices as filth.

* App. F , page 49.


When you say that " the insular position of Great Isp̂ teitfony?a

Britain affords a much greater protection against the introduction of smallpox than is possible for Germany," you seem to imply that the fact that smallpox usually originates in our sea-ports is not due to our insularity, or else that Germany has more seaports than we. I cannot follow you in this novel theory.

The official figures from Germany which you quote, ^^If^t* as a triumphant offset, I suppose, to the figures which fatalities. I gave to show that Prussia is suffering more from small-pox than England, are instructive in a way which you apparently do not comprehend. I reproduce them here with the illuminating addition of a column of the fatality rates, that is, the percentage of death in each category :—

Vaccinal Condition. Deaths.

I. Unvaccinated Unknown Unsuccessful Vaccinated too late . .

11. Once vaccinated Re-vaccinated too late

Total insufficiently vaccinated

III . Re-vaccinated

Total S.P. in whole German Empire, 1908

30 3 4 6

1 0 2

12

1 0

65

Cases.

66 1 3 2 1

2 6

1 2 3

42

165

143

434

Fatal i ty Rates per cent.

45-45 23.0 19.0 23.07

8.1

4.76

7.2

6.Q9

14.9

Anti-Vaccinist towns.

Before vaccination was invented, the average death ft̂ bemorlv°iran

rate used to be 18 per cent, in the eighteenth century. lthanninGEn™fish In the following anti-vaccinist centres, Nelson and Northampton in 1903 ; Loughborough in 1904 ; Keighley in 1903 and 1905, Oldham in 1906 ; there were a total of 645 cases without a single death. Vaccinated Germany apparently develops a more fatal kind of smallpox than

3'S FOR AND AGAINST VACCINATION

those cities, and is little advanced in treatment as com-pared with the unenlightened, unscientific people of 1700-1800.

Germarnfî refs The m o s t favoured were the " re-vaccinated too late," given elucidated. 0f w n o m o n i y 4 ^ 5 p e r c e n t . died. If all the 434 had been

in this happy category, the total deaths would have been not 65, but about 20 !

Do you then advise that we should all be " re-vaccinated too late ? " Is that the ideal protection ?

The " re-vaccinated " died at a greater rate than the " re-vaccinated too late ! "

Of those whose vaccinal condition was " unknown " 23 per cent. died. Had they been " vaccinated too late " 23.07 per cent, would have died ! I t is safer to have your vaccinal condition " unknown" than to be " vaccinated too late ! " And so on.

Figures The figures are evidently the result of fraud, conceal-selt-condemned. ° J '

ment, or blundering. If the cases certified to have died of " chicken-pox "—which disease never killed a child— or of " pustular dermatitis " or what not, with the ages of the cases, could be added, we should have materials

^thatm^va^ ^o r beginning an analysis of the state of smallpox in the sû eredinireTonm German Empire. At present all we can say for certain i§t?eva?Smted ^s> ^ ^ m u c h- v a cc ina t ed Germany suffered more from

England. smallpox than little vaccinated England, in IQO8. 'And with this fact satisfactorily established, I reluctantly bid you farewell.

I am, Yours faithfully,

(Signed) A. PHELPS, President, N.A.V.L.

T. Percy C. Kirkpatrick, Esq., M.D., President, D.S.A.

N.B.—The marginal notes must not be taken to be parts of the letters, they are merely guides for the eye of the reader.


APPENDIX A.

LEICESTER'S EXPERIENCE.

Report by Dr. MILLARD, M.O.H. Leciester, for 1903 :—

*' Indeed, not many towns of equal size have suffered less from Small-pox, the total number of deaths during the twenty-one years of neglected vaccination (1883-1903,1 being only 50, i.e., less than three a year, or an average annual mortality of only 1.3 per 100,000 population."

He recalls tha t Dr. Coupland (Inspector of the Local Government Board) had a similar surprise in investigating the previous epidemic, for he quotes Dr. Coupland's memorable words :—" In this epidemic, a t least, the natural liability to Smallpox unaffected by vaccination was not so great as had been supposed."

The " control experiment " in Leicester suggests to Dr. Millard :—* (1) " That the par t played by unvaccinated persons in determining

Smallpox incidence has been overrated. (2) That modern preventive measures—notification, isolation, etc.—

if thoroughly carried out, are more efficacious in preventing the spread of Smallpox than has hitherto been supposed." /

Report of Dr. MILLARD for 19.05 : —

" I t was certainly the case tha t the unvaccinated state of the popu-lation of Leicester did not play as great a part in the spread of the •disease as I, in common with most other medical men, expected tha t it would."

Dr. MILLARD in his report for 1906 says :— " As regards the question of compulsion, I have seen no reason to

modify my views previously expressed. I t would appear, indeed, t ha t even in strong pro-vaccinist circles, it is coming to be realised that the effect, from a public point of view, of young children remaining unvaccinated, is not so disastrous as was formerly believed. I t is probable tha t the experience of Leicester and of other centres of anti-vaccination during the last epidemic has helped to bring about this more moderate a t t i tude ."

In his Report for 1908 Dr. MILLARD says :— " As was mentioned in the Report for 1906, a joint statement was made

by the honorary Secretaries of the Jenner Society and the Imperial Vaccination League (Times, April 25th, 1906) that there was ' a growing opinion tha t in consequence of altered social conditions, and improved •sanitary administration, it is not absolutely necessary to have infants


of a few months old vaccinated, except in the presence of epidemic-Smallpox/ and they therefore advocated the postponement of vac-cination until school age. Such an expression of opinion from the-leaders of the two societies specially formed to promote vaccination marked a very important change of front, and must make it rather-difficult for any one now to take up the extreme position, formerly so often held, tha t compulsory infantile vaccination was a vital necessity, to be enforced a t any cost."

I t is estimated tha t there are between 60,000 and 80,000 unvaccinated children in the town of Leicester, the Vaccination Acts having been a dead letter there for the past 20 years. Has Leicester been decimated with smallpox, as was freely prophesied in the early years of the town's neglect of vaccination ? Here is the Medical Officer of Health's answer in his Annual Report for 1909 recently issued :—

" The disease did not appear in Leicester, and it is now three years since the last case was reported and five years since a death occurred.

" As the experience of Leicester during the epidemics of 1903 and 1904 was very different from what had been expected by many people, and as it has an important bearing upon the vexed question of the necessity of compulsory vaccination, it may be well to quote the-figures of the epidemics.

" In the 1903 epidemic there were 394 cases, with 21 deaths, yielding a case mortality of only 5:3 per cent.

" In the 1904 epidemic there were 321 cases, with 4 deaths, yielding a case mortality of only 1.2 per cent.

" Several of our large cities suffered from more or less extensive epidemics about this period, bu t in none was such a low case-mortality as 1.2 per cent, recorded. In view of the large proportion of u n -vaccinated persons in Leicester such a result is specially remarkable.'^

An ounce of fact is worth a pound of alarmist prophecy.

APPENDIX B.

SMALLPOX IN IRELAND,

Exact statistics of the mortality from Smallpox in Ireland are only available from the year 1864 onwards. On the taking, however, of the census in 1841, in 1851, and in 1861, inquiries were made as to the number and causes of death amongst the population, since the date of the previous census. From the information so obtained it has been

FOR AND AGAINST VACCINATION 4 1

•calculated tha t the average annual death-rate from Smallpox per million living during the periods in question, was as follows :—

1831—41 . . • . . . . 725 per million. 1841—51 493 1851—61 213

(See Table B, page 256, Second Report Royal Commission on Vaccination).

INOCULATION IN IRELAND.

The prime explanation of these heavy death-rates is no doubt to "be found in the fact tha t Ireland was the last country in the United Kingdom to abandon the practice of Smallpox inoculation.

Inoculation prevailed in Ireland very extensively from the year 1725 to the year 1840, when it was first prohibited by Statute. In 1807, the Dublin College of Physicians (now the Royal College of Physicians of Ireland) when reporting on the progress tha t vaccination was making in Ireland, made the following curious profession of faith in variolous inoculation :—

" The smallpox is rendered a much less formidable disease in Ireland by the frequency of Inoculation for it, than in other parts of His Majesty's dominions, where prejudices against inoculation have prevailed. Hence parents, not unnaturally, object to the introduction of a new disease, in the shape of vaccination, preferring to trust to the practice with the mildness and safety of which they are well acquainted."

One would have thought that , with this extraordinary blunder on their books, the College would have been chary of placing on record a blessing of vaccination, which it is safe to say will read as stupidly to our children as the foregoing extract reads to us.

In 1840 variolous inoculation was made a penal offence in England, Wales, and Ireland. Despite this prohibition, however, the English National Vaccine establishment had repeatedly to deplore its con-tinuance, especially in Ireland. Thus we read :—

1850.—"The Board again entreat the attention of the Government to the fact tha t Inoculation for the smallpox still continues ; and that the disea.se is communicated by vagrants to those unprotected by vaccination in town and country. The contagion is carried through-out the land by wandering Irish, and no care, however great, can be successful in eradicating smallpox whilst the neglect of vaccination and the practice of variolous Inoculation are permitted in Ireland."

In 1868 a further prohibition was inserted in an Act passed on the 31st July.

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Despite these enactments, however, the practice w âs still carried on,, especially in the West of Ireland, a t least until the year 1875. I n July of tha t year a man was convicted and sentenced to five years' penal servitude a t the Sligo Assizes for inoculation. He inoculated a child, and the child died. Further particulars as to the persistence of the practice were given by Dr. Grimshaw (Registrar-General for Ireland) in his evidence before the Royal Commission on Vaccination.

In view of these simple facts, is it any wonder tha t smallpox so largely prevailed in Ireland during the period 1831-61 ?

SMALLPOX IN IRELAND AFTER 1864.

Exact statistics began with the passing of the Registration Act, 1863. The following table gives the average annual number of deaths, and the average annual death-rate per million of the population since tha t date, in decennial periods. The figures for the previous inter-censal periods are also added for convenience of comparison :—

P E R I O D . Total Deaths

from Smallpox-

Annual Averages

Deaths | Deaths per million living

1831 to 1841 1841 to 1851 1851 to 1861

Intercensal periods

April, 1861, to D e c , 1870* 1871—1880 1881—-1890 1891—1900 1901—1908 (8 years) . .

58,006 38,275 12,727

2,852 7,550

241 235

65

5,801 3,827 1,273

293 755

24 23

725 493 213

52 143

4,9 5.1 1.8

T H E PROVISION FOR PUBLIC VACCINATION.

In 1840-41 provision was made for vaccination in Ireland, as in England and Wales, a t the expense of the Poor Rates. Further Acts were passed in 1851 and 1858, and in 1863 an Act was passed making the practice compulsory as from the 1st January, 1864.

No records are available as to the number of Vaccinations between the years 1840 and 1864. Conclusive evidence tha t Ireland was as well vaccinated during the period 1841-1863, as, if not better than, a t any later period is, however, afforded by the Army records of the vaccinal condition of recruits found fit for service. Here are the average

* April 1861 to December, 1863, number returned on 1871 Census forms ; 1864 and following years, numbers registered under Registration Act which came into operation on 1st January, 1864.


annual figures for England, Scotland and Ireland during the 13 years 1860-1872 :—

England Scotland Ireland

PROPORTION PER 1000 (1) Had marks I (2) Had marks I Had neither of Vaccination of Smallpox | (1) nor (2)

74 109 70

54 79

These figures show that , a t the time of the great epidemic of 1871-2, Ireland was the best " protected " portion of the United Kingdom.

In April, 1871, Sir Dominic Corrigan, M.D., boaste'd before a Select Committee of the House of Commons (of which he was a member, and before which he gave evidence as to the state of vaccination in Ireland) tha t Ireland was then enjoying great freedom from smallpox because vaccination had been carried out very well, and the people were most favourably disposed towards it. The feeling of the whole country, he said, was in favour of it. Never was a boast more effectively stultified. Before the end of the same year 660 persons died from smallpox in Ireland, and in the next year (1872) the number reached a total of 3,243. During these two years the smallpox mor-tality amounted to 376 per million 'of the population. In Dublin it reached a total of 5,000 per million, and in Cork 9,600, the highest recorded death-rate during the epidemic in any large town in the United Kingdom.

If, as the sequel showed, the compulsory law of 1863 was powerless to prevent the great epidemic of 1871-72, it is absurd to give it any credit for the subsequent diminution of smallpox.

SMALLPOX AND OTHER FEVERS DECLINE TOGETHER. The causes which have produced that diminution are not far to seek.

They are precisely the same as those which have produced the following equally striking diminution of scarlet fever :—

AVERAGE ANNUAL D E A T H - R A T E FROM SCARLET F E V E R IN IRELAND,

PER MILLION OF POPULATION.

1864—5 (2 years) . . 560 Annual Average during the 22 years, 1864—1885, 450.

1866—70 1871—75 1876—80 1881—85

1886—90 1891—95 1896—1900 1901—05 1906—08 (3 years)

544 550 324 272

139 103 91 81 24

J Annual average during the ) 23 years, 1886—1908, 88.

1


The same lesson is also enforced by the following Table which shows the Annual Average Number of Cases of Fever (other than Scarlet Fever) and of Smallpox treated by Medical Officers in Dispensary Districts. I t has been summarised from the Annual Reports of the Local Government Board for Ireland.

Period. 1865-1874 1875-1884 1885-1894 1895-1904 1905-1909 (5 years)

Cases of Fever. 17,791 10,204 4,114 2,376 1,374

Cases of Smallpox

1,590 518

19.8 '96.7 41.2

The teaching of this table is plain. Is it not clear tha t the same causes which have been adequate to produce the striking decline shown in the first column must also have played an enormous part in effecting the reduction shown in the second column ? These causes include such measures as the Public Health (Irela,nd) Act of 1878, and the Infectious Disease (Notification) Act, 1889. That Vaccination can have had little or nothing to do with the decline of Smallpox shewn above is proved by the following table which shows tha t the operation was as extensively observed in the first period as in the last.

NUMBER OF CASES OF VACCINATION AND RE-VACCINATION PERFORMED

BY POOR L A W MEDICAL OFFICERS OF DISPENSARY DISTRICTS SINCE

1863, WHEN THE COMPULSORY VACCINATION ACT WAS PASSED.

Year ended Sept

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30th, 1864 1865 1866

1867

1868

1869

„ 1870 1871

'» 1872 1873 1874 1875

1876 „ 1877

1878

Births Year ending

December 136,414 144,970 146,090

144,388

146,051 145,659

149,846 151,355 149,278 144,377 141,288 138,320 140,469 139,659 134,117

Number of cases of

Vaccination 191,810 169,142

137,124 125,741

131,426 125,672

140,220 179,889 282,484 138,873 139,587 137,340 114,487 117,679

133,045


Year ended Sept. 30th, 1879

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1880

1881 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891

1892

1893 1894 1895 1896 1897 1898

Half-year ended 31st March, 1899 Year ended 31st Mar.

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, 1900 1901 1902 1903 1904 1905 1906 1907

1908 1909

Births Year ending December

135,328 128,086

125,847 122,648 118,163 118,875

115,951 113,927 112,400 109,557 107,841 105,254 108,116 104,234

106,082 105,354 106,113 107,641 106,664 105,457 103,900 101,459 100,976 101,863 101,831

103,811 102,832

103,536 101,742

102,039

—

Number of cases of

Vaccination 126,911 147,828 113,557 132,825 106,071

102,548 102,312 94,861 96,489 92,498 88,995 90,278 90,693

86,200 90,370

106,448 186,495 89,105 85,105 84,098 38,091 81,269 90,917

103,776 117,720 158,685 181,651 86,448 83,736

81,382 79,723

[NOTE.—Over 90 per cent, of all the primary vaccinations in Ireland are performed by Poor Law Medical Officers.

The large number of operations in 1904-05 was due to the presence of Smallpox an

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