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Vaccination Judged By Its Results (S376a: 1885)

Editor Charles H. Smith's Note: A letter or article printed in the 24 March 1885 issue of the Pall Mall Gazette. Original pagination indicated within double brackets. To link directly to this page, connect with: http://people.wku.edu/charles.smith/wallace/S376A.htm

     [[p. 1]] It is a very common notion that the utility or uselessness of vaccination is a question for medical men alone, and that no other persons are competent to give a judgement upon it. But this is not the opinion of the best authorities. In the Parliamentary Report on "The History and Practice of Vaccination" (1857), it is rightly asserted that "evidence on the protectiveness of vaccination must now be statistical." Now in order to deal properly with the statistics of any question it is necessary to be completely unprejudiced, and also to have some special aptitude for figures. In both these qualities the medical profession are deficient. Having upheld the practice of vaccination for eighty years, and drawn from it £100,000 a year of public money, both professional prestige and personal interest are at stake, and we should be unwise to expect from men in this position a perfectly unbiassed judgement. At the same time much evidence can be adduced to show that they have an especial faculty for making mistakes in figures. I can only here refer to such cases as that of the National Vaccine Establishment, whose annual reports gradually increased the one unchangeable fact of the London small-pox mortality before vaccination from 2,000 to 5,000 annually, the true number, as given by Dr. Farr, being 1,740. Sir Lyon Playfair gave this same fact as 4,000. Dr. W. B. Carpenter published the statement that in the last century the small-pox mortality in London in six months was often greater than it now is in all England in any whole year; the greatest year's mortality in London being 3,992 in 1772, while it was 23,000 in England and Wales in 1871! Surely, then, we are justified in doubting the special arithmetical and statistical skill of doctors of medicine. We now possess a valuable body of facts as to mortality from small-pox and other diseases in the Registrar-General's Reports for the last forty-six years, and in other official returns. I propose, therefore, briefly to review these and other statistics, and to point out the conclusions which may logically be deduced from them.

     The supporters of vaccination rely mainly on four classes of facts as proving their case:--(1) The great decrease of small-pox mortality after the discovery of vaccination; (2) the continued decrease of small-pox in proportion as vaccination becomes more general; (3) the almost complete security afforded by revaccination; and (4) the much greater mortality of the unvaccinated than the vaccinated.

     1. That a very great and sudden decrease in small-pox mortality occurred about the time of the discovery of vaccination is quite true, but that it was the result of vaccination there is no proof whatever. Small-pox attained its maximum in London more than thirty years before vaccination was heard of, and during the following thirty years it steadily declined. A real and valid cause for this decrease existed in the disuse of inoculation, which it is universally admitted tended rather to spread the disease than to check it. Hence the more rapid decrease of small-pox mortality under incipient vaccination than under inoculation. Small-pox began to diminish under improved conditions of life, just as [[p. 2]] leprosy, plague, and scurvy have successively diminished and disappeared. Our greatest statistician, Dr. Farr, tells us that "Small-pox attained its maximum mortality after inoculation was introduced. The annual deaths from small-pox (in London) from 1760 to 1779 were on an average 2,323. In the next twenty years, 1780 to 1799, they declined to 1,740. The disease, therefore, began to grow less fatal before vaccination, indicating, together with the diminution of fevers, the general improvement of health then taking place."

     In Sweden, where accurate registers have been kept for more than a century, the same phenomena are noticed. Small-pox mortality decreased suddenly after the year 1800 to an amount quite incommensurate with the very partial adoption of vaccination. In 1816 vaccination was made compulsory in Sweden, and since that date small-pox mortality has rather increased than diminished, the epidemic of 1874 being more severe than any since 1800.

     2. Figures are often adduced to show that smallpox decreased after vaccination was made compulsory in 1853, and again after it was made penal in 1867. But the disease manifests itself in a series of epidemics of differing intensities and at irregular intervals, and it is easy so to manipulate the figures as to show any proportionate decrease that may be desired. In my pamphlet, entitled "Forty-five Years of Registration Statistics," I have laid down the small-pox mortality per million in a curve, and have shown by corresponding curves the official vaccination per million and the mortality from typhoid fevers. These curves show that, with much irregularity, there has been a slight progressive decrease of small-pox mortality for the whole period of official registration, while there has been a decidedly greater decrease of typhoid fever. What has caused this latter decrease of mortality? Surely the answer will be, improved general sanitation with improved medical treatment. But that which will account for the greater effect will surely account for the less effect in an allied disease. Again, if we look at the curve of vaccination we find that during the later epoch of the penal law there has actually been less official vaccination than during the preceding epoch, except during the panic caused by the great epidemic of 1871-2, and that epidemic followed immediately after eighteen years of a very high rate of official and enforced vaccination! Surely, then, the assertion that more complete vaccination is always followed by a decrease of small-pox mortality is not supported by the evidence.

     3. For fifty years re-vaccination was pronounced to be impossible or useless. Now we are assured that is it our only safeguard, that it affords "full security," and that our re-vaccinated soldiers and sailors hardly ever die of small-pox. By a recent return we have full statistics of small-pox in our two services. Both are rigidly re-vaccinated, both consist of picked men, in both there is constant medical and sanitary supervision; yet the average of twenty-three years gives 83 per million as the annual mortality in the army, and 157 per million in the navy. Whence this difference? Surely some different conditions of life in the navy must be the cause; yet the advocates of vaccination assure us that sanitary conditions have little effect on small-pox, but that vaccination is everything. Now let us compare the navy mortality with that of some large towns during the same twenty-three years, and we find this astounding result, that five towns--Manchester, Leeds, Brighton, Bradford, and Oldham--with all their unsanitary conditions, poverty, overcrowding, and deficient physique, had a much lower adult small-pox death rate than the navy, the highest (Manchester) being 131 per million, and the lowest (Oldham) 89 per million. The fair conclusion from these facts is, I maintain, that the re-vaccination of our sailors is injurious to them, for with all the advantages they enjoy of special physique, abundant food, and constant medical supervision, their small-pox mortality ought to have been very much less than that of any dense manufacturing town.

     4. The last and most frequently adduced argument of the vaccinators is the alleged greater mortality of unvaccinated than of vaccinated small-pox patients. Dr. Lyon Playfair stated in the House of Commons that "an analysis of 10,000 cases in the metropolitan hospitals shows that 45 per cent. of the unvaccinated patients die and only 15 per cent. of the vaccinated." This and similar allegations form the sheet-anchor of the vaccinationist; but we are prepared to show that they are in part untrue in fact and altogether delusive in the conclusion drawn from them. We first say they are, primâ facie, untrue in fact, because we have ample hospital statistics of the last century, both in England and abroad, and they all agree that the mortality of patients, when all were unvaccinated, was about 18 per cent., exactly the same as the average mortality of our hospitals to-day! Next, we say that the system of determining the vaccinated is radically unsound, since direct evidence that the patient was vaccinated is set aside at the will of the medical attendant. Lastly, we can show that the greater death-rate of the unvaccinated, as a whole, is compatible with an equal or lower death-rate at each corresponding age, because the proportion of unvaccinated infants under one is enormously higher than at any other age, while the mortality of infants from whatever epidemic is excessively great. If we substitute the word "baptism" for "vaccination" exactly the same conclusion would be arrived at. The small-pox mortality of the "unbaptised" would be always greater than that of the "baptised," and thus we might have baptism equally recommended as a sure preservative against small-pox.

     To make this clearer let us give an illustrative case with such figures and proportions as are known to be probable. Of 10,000 cases of small-pox let 3,000 be infants and 7,000 adults. Of the infants let 2,000 be unvaccinated, and of the adults let only 500 be unvaccinated. Let the mortality of the infants be 60 per cent., and of the adults about 3 per cent., in vaccinated and unvaccinated alike. The result will be as follows:--

     Thus we see that even if the mortality of infants and adults is exactly the same in the vaccinated and the unvaccinated, yet by lumping the two together an enormously greater mortality is shown for the unvaccinated, merely because the unvaccinated predominate among infants, whose mortality is always greatest, and the vaccinated predominate among adults, whose mortality is always less. The whole thing is a mere arithmetical puzzle, utterly valueless and delusive, yet it has been again and again adduced as conclusive evidence of the value of vaccination, and probably has had more weight with the public and the Legislature than any other argument whatever.

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