Russel Wallace : Alfred Russell Wallace (sic)
on Vaccination (S420: 1890)
THE RIGHT HON. THE LORD HERSCHELL IN THE CHAIR.
Sir JAMES PAGET, Bart.
Mr. BRET INCE, Secretary.
7035. (Chairman.) You have during the last few years devoted your attention to the question of the protective effect of vaccination, have you not?--I have.
7036. I believe that up to 15 years ago you accepted vaccination as a scientific operation, not having yourself investigated the matter at all?--No, not at all.
7037. What led to a change in your attitude towards vaccination?--Merely making acquaintance with some persons who disbelieved in it, and who gave me some books. After reading those books for a short time I saw that there was a tremendous conflict of testimony and also apparently a conflict of statistics; that led me to devote more time to the subject, and to take every available opportunity of obtaining information, at all events on the statistical side of it.
7038. Can you mention to the Commission any particular book which led to your making investigations yourself?--The book which was given me first of all was called "Papers on Vaccination." It consisted of a number of miscellaneous papers full of a great deal of trash and a great deal of very poor matter, but with some apparently very good matter and facts which startled me and led me to investigate the subject.
7039. Do you mean that it was a published collection of pamphlets?--It was a collection of miscellaneous pamphlets published by some of the anti-vaccination people, I do not know whom; it was anonymous, I rather think; but that was merely the starting point.
7040. You have regarded the question whether vaccination is efficacious or not, as I understand, purely as a statistical and not a medical question?--Purely as a statistical question. It has been admitted officially that it is now at all events, and for many years past has become, a purely statistical question.
7042. On what ground do you think so?--Mainly on the ground that it is entirely opposed to and in conflict with the, I may say, universal testimony so far as it can be obtained, of persons in the last century, as to the mortality of small-pox patients, who were then of course all unvaccinated. There is a long chain of evidence, some of which I published with the authorities in a small book of mine; and I have had since sent to me by Dr. Creighton a list of, I think, more than 30 towns in which the small-pox mortality was recorded for a series of years; and the whole taken together, with all the other evidence that could be obtained, brings out the small-pox mortality at about 18 per cent. of the cases on an average of the whole.
7043. Ranging between what limits?--Ranging throughout the whole of the last century.
7044. But an average implies that there is a maximum and a minimum?--Yes, the maximum here appears to be 36 per cent. And the minimum 10 per cent.
7045. (Professor Michael Foster.) Does that include Dr. Morton's cases?--I do not know Dr. Morton's cases.
7046. (Chairman.) What are those statistics which range between 10 and 36 per cent?--These are the statistics of Dr. Jurin chiefly. I have here also an appendix to a sermon by Dr. S. Squire on behalf of the London Small-pox Hospital, dated 1760, and giving the hospital statistics for 14 years, and a quotation from Frewen, as to Hastings, from the "Philosophical Transactions," vol. 37, page 108. The total amounts to no less than 23,596 cases with 4,295 deaths, giving an average of 18.2 per cent.
7047. The range between 10 and 36 per cent. is a very large range?--Yes, it is rather a large range; it is a similar range to what occurs now, I believe.
7048. Is the 10 per cent. taken on a small number of cases?--Yes, the 10 per cent. is only on 268 cases, but there are several others, and it goes on in a regular series.
7049. Do you know what the sources of those statistics are?--Yes, I give the authorities in my book.
7050. Have you taken them from those sources?--This is the manuscript supplied to me by Dr. Creighton; but I did take a large number myself from the original sources when I published my little book.
[[p. 7]] 7051. I think the Commission would desire to know those which you have taken yourself from the original sources?--The greater number of those cases of Dr. Jurin and Dr. Lambert are given in a French paper, entitled "Analyse et Tableau de l'influence de la Petite Verole; par E. E. Duvillard. Paris, 1806" (pages 112 and 113).
7052. Dr. Lambert's cases are only 72 in number, I gather?--Yes.
7053. You would hardly, I presume, regard those as of statistical value?--No, but they are items which help to make up the whole. Of course they all consist of a comparatively small number of cases, but when added together they make up the total upon which the average was taken.
7054. (Professor Michael Foster.) Where were Dr. Jurin's cases taken from?--A great many of them occurred in different towns in England, such as Shaftesbury, Dedham, Plymouth, Northampton, Stratford-upon-Avon, Bolton, and a number of places besides.
7055. He got returns, did he not, from medical men of the number of cases which they had observed, and the number of deaths which they had met with?--I do not know how he got them. One of the statements here is that it is "A careful inquiry from house to house communicated to me by persons of credit."
7056. If you would read his papers in the "Philosophical Transactions," and afterwards his separate papers, you would see that they were gathered from various towns?--Very probably.
7057. Those statistics are not quite on a par with small-pox hospital statistics, are they?--I do not know. I presume that many of them are hospital statistics. I should like to give you other evidence before we quit this point, in order to show the general opinion of scientific men of the eighteenth century. I have recently found an extract from a work by the great mathematician, Daniel Bernouilli, who also states, as a matter of statistics, that the proportion of deaths of those attacked on a great number of epidemics of small-pox is from an eighth to a seventh part. This very important statement is as follows:--"Il est constaté par une longue suite d'observations, que la petite vérole emporte la troizième ou la quatorzième partie de chaque génération; j'ai vu des listes qui marquent la quatorzième partie; j'en ai vu d'autres de Breslau qui vont jusqu'à la troizième partie; quelques-unes vont encore un peu au-delà. On sait encore que cette maladie enlève environ la huitième on la septième partie de ceux qu'elle attaque, pour qu'on prenne la proportion sur un grand nombre d'épidémies. Ces épidémies sont si différentes, que les unes enlévent au-dela du tiers des attaqués, pendant que d'autres n'imposent ce tribut fatal qu'à un sur 20, 30, 40 ou même davantage." (Daniel Bernouilli, in "Mémoires de l'Académie Royale des Sciences," 1760, p. 7.) The writings of several other persons who have referred to the matter in the last century all show that that was the universally accepted proportion. I am not aware that anybody has given any evidence to show that there was any other proportion than about 18 per cent., more or less, when a large number of cases are taken. In a small number of cases, as I have said, the proportions vary between 10 per cent. and 36 per cent.
7059. Modern experience, at all events, appears to show that even an attack of small-pox is not an absolute protection, and that persons who have presumably been inoculated might some of them, nevertheless, have the disease; you have not considered that at all?--No, I do not know whether they had been inoculated or not.
7060. Why do you say that on account of these statistics the comparison of vaccinated and unvaccinated mortality in official and medical statistics must be rejected?--Simply because in the last century, with very bad treatment of the disease, and very bad sanitary conditions, especially in our great towns, with a condition of unsanitariness which we have not existing now, the average mortality was only 18 per cent.; and now we are told that the average mortality of unvaccinated persons, as unvaccinated persons only, is 30, 40, 50, and even 60 per cent., giving an average of about 40 per cent. That is more than double the average of the last century.
7061. Supposing it were an established fact that the average mortality in unvaccinated persons was 40 per cent., would not that simply tend to show that the disease was more malignant in its character than it had previously been?--It would if that was established; but I have other evidence which shows that it is not established.
7062. But I do not quite understand why the mere fact that the average mortality was formerly 13 per cent., and that it is now said to be 40 per cent. proves that there must be something wrong in the division?--I do not say that it absolutely proves it, but it throws an immense doubt upon it.
7063. It is consistent with either of two hypotheses, one that it may be from an erroneous distribution, and the other that it may be that the disease is more virulent than it was?--It is just within the bounds of possibility, but I think it is in the highest degree improbable.
7064. You think the probability is that it arises from an incorrect distribution of the cases of vaccinated and unvaccinated?--Partly from an incorrect distribution, and partly from the fact that the unvaccinated and the vaccinated are not taken from the same class of people; they differ in quality as well as in quantity.
7065. That is not so, is it, in the case of all statistics?--No. I say that the vaccinated and the unvaccinated now are not two bodies that are fairly comparable as an entire population that was vaccinated, and an entire population that was unvaccinated would be.
7066. But in some of the hospitals the vaccinated and the unvaccinated come from the same class, do they not, if they are properly distributed?--They may sometimes come from the same class, but the general evidence and opinion is that they come from very different classes.
7068. There the vaccinated and unvaccinated, if properly distributed, would come from the same class of the population, would they not?--Perhaps so, but certainly not over the whole community.
7069. However, you have not looked into those statistics?--Perhaps you will allow me to give one more statement which I have here. In the first Report of this Commission, at page 98, I find it stated as from a report of the Royal College of Physicians, dated 1807, that natural small-pox has been supposed to destroy one sixth of all those that are attacked. That exactly agrees with the general statistics that I have been speaking of, and it shows that that was the general opinion of medical men at the beginning of this century. In consequence, at all events, of what appears to me the doubt upon the point, I wish to confine my evidence to the statistics dealing with large populations, showing the progress of small-pox mortality in correspondence with the progress of vaccination, so far as it can be ascertained. That appears to me to be the most safe way of arriving at a conclusion on this question.
7070. What is the first point to which you wish to call the attention of the Commission?--I have here a diagram constructed from a table given on pages 31-33 in the Appendix to the Report of the Medical Officer of the Local Government Board for the year 1884. (The diagram was handed in. See Appendix II., Diagram A: facing page 179.) The small-pox mortality has been worked out by myself to the proportion per million, and it shows the small-pox mortality in London for one century or a little over, from the year 1780 to the year 1882 or the year 1883.
7071. What are the materials prior to the Registrar General's reports from which you obtained the number of deaths from small-pox in London?--I presume from the Bills of Mortality. At all events, it is given in this official return as being the mortality.
7072. Is the mortality per million given in the report, or have you turned it into the mortality per million?--I have calculated it myself. In the report, they give it per thousand deaths, but as I wished to have the whole of my diagrams on one plan, I have calculated myself the proportions per million.
7073. From what have you taken the statistics of the population within the Bills of Mortality?--I have taken the statistics of the population from the year 1800 from the census returns.
[[p. 8]] 7075. That is very material, is it not?--It is somewhat material; but I apprehend that it would not make much difference, because this part of the diagram is of no importance comparatively, except to show what is perfectly well known, that the small-pox mortality was enormously large, and that there was a constant succession of epidemics in the city. If the population of London belonged to different areas afterwards, it would simply require them to be still a little larger.
7076. Where do you get the population before 1800 from?--The populations for one or two periods are given also, I believe, in this first report. There were two periods referred to, one a period about 1740 or 1750, and another a period about 1706, when an estimate was made, and it is stated in this report that that estimate is believed to be trustworthy. So far as I remember the population of London was, in the early part of the last century, about 1740, estimated at 550,000, and I think (I will not be sure as to these figures at the moment) later in the century, about 1760, it was estimated at 660,000.1 Then by taking a tolerably gradual increase down to the estimate in 1800, which was 980,000 according to the census, there is not much room for error. The growth was comparatively small until this century, when the growth of London became much more rapid. But it cannot affect this diagram to any material extent. The important point to which I wish to draw the attention of the Commission is this, that the mortality in the last 20 years of the last century is known to be a diminution on the preceding 20 years. That is stated by Dr. Farr. But taking these last 20 years, as compared with the next 20 years, there is with the usual ups and downs of epidemics an enormous and very rapid and steady decrease down to 1822. As vaccination was introduced in 1799, this decrease from 1799 to 1822 has been usually attributed to vaccination. My first point is that it could not possibly be due to vaccination, for this reason; that the diminution, so far as we can estimate it, is to one fourth of what it was. The average from 1780 to 1800 is nearly 2,000 per million; whereas from 1800 it diminishes rapidly and steadily down to 1822, when it is about 400 per million. Consequently, the diminution is to one fourth of the amount of what it was before; it is diminished by three fourths. In order for that diminution to be due to vaccination, it is necessary that at that period about three fourths of the population should have been vaccinated. But taking all the evidence that I can get from various sources (there is no accurate evidence), it appears certain that nothing like one fourth of the population could possibly have been vaccinated at that time.
7077. I do not understand why you say that three fourths must have been vaccinated to produce that result?--If the diminution of three fourths is due to vaccination you must have three fourths of the population vaccinated to produce that effect.
7078. Supposing that vaccination has a protective effect, and that you have a considerable number of people who are protected, and who, therefore, do not take the disease, and do not become centres of infection to others, would not or might not that produce a diminution beyond what would simply correspond with the exact number who are vaccinated?--I do not think it possibly could when there was such a very large number still unvaccinated--when the bulk were still unvaccinated; for instance, three fourths were unvaccinated and one fourth vaccinated.
7079. I understood you to say that it cannot produce such a result, but I do not quite understand your mathematical calculation; because, if each person who takes the small-pox is a source of infection to others, then, if you diminish the number of persons who take it by even one fourth, you diminish the possible centres of infection, do you not?--Possibly you do; but it appears to me, when an epidemic is scattered all over a country, especially at that period when there was no possibility and no attempt at isolation or anything of the kind, having a certain proportion like one fourth or one fifth even absolutely protected, could not possibly affect the means of distribution.
7080. (Dr. Bristowe.) I think you base your view on the assumption that vaccination should be an absolute protection?--If vaccination is not an absolute protection it would require a still larger proportion to have been vaccinated to produce the effect.
7081. (Chairman.) Have you taken into account that a large proportion of the population would have had small-pox at that time, or would have been inoculated, and would, therefore, have been protected in that way?--Yes, but no more than there would have been in the last century, but rather the other way. Those who were protected by small-pox or by inoculation were more in that earlier period because they were more inoculated. Inoculation began to decrease as vaccination increased.
7082. When was the time that inoculation chiefly prevailed?--About the middle of the 18th century, from, I believe, about 1720; but, I believe, it prevailed at the maximum from 1740 right up to the end of the century. No: I believe it began to diminish in the last 20 years of the century, and to that has been imputed the slight diminution in small-pox mortality.
7083. If it prevailed as a maximum to the end of the century the latter period would be more protected than the former, would it not, because you would have a greater proportion of the population inoculated?--I do not mean to say that it continued in full force to the end. I corrected myself, and said that I believed that the slight diminution of small-pox is imputed to the growing dislike to inoculation in the latter portion of the 18th century. I think that is the common opinion.
7084. You have given us a comparison between the period from 1800 to 1820 and the previous 20 years, and suggested that that could not have been the result of vaccination. What is the next point that you wish to bring before the Commission?--I have some figures to show what was the probable amount of vaccination at that period. There is a considerable amount of converging evidence of different kinds. At Walker's London Vaccine Institution, which was by far the greatest centre for carrying out vaccination in London, in the earlier part of the century, from 1803 to 1825, they vaccinated 65,750 persons; and, added to that, 237,120 were vaccinated by vaccinators appointed by them, making a total of 302,870. Then I deduct for the three years 1822 to 1825, 43,270, leaving 259,600. Then the National Vaccine Institution during the same period, or at all events from 1808 to 1816, vaccinated about 45,000, and from 1816 to 1822 they vaccinated 40,000, making a total of 85,000. Then if we add to that, as an estimate for the higher classes who were vaccinated privately, 42,000, we have a total of 386,600 vaccinated up to 1822. The mean population of London between 1800 and 1822 was 1,200,000. The annual births were about one thirty-second part of the population, or 37,500. The deaths under one year of age were about one fifth of that number, being 7,500. That is an extreme estimate; it is much above all the tables. That leaves the annual addition to the unvaccinated population 30,000, and during 20 years that would mean 600,000. Added to the 1,200,000, that makes 1,800,000 for what may be called the total effective population of London during the period of 1800 to 1822. Out of those the total number vaccinated was 400,000, leaving 1,400,000 unvaccinated. That, of course, is merely an estimate, but all the evidence of various kinds seems to point to that being rather an over than an under estimate.
7035. Have you estimated at all how many of those 1,400,000 would have been afflicted with small-pox, or inoculated?--That, of course, cannot be arrived at.
7086. (Sir James Paget.) Do you consider that none but the rich people were vaccinated by private practitioners at that time?--I should say that the upper classes generally were, but that the lower and a large portion of the middle classes would be vaccinated at this institution, which was very energetic, seeking them out in every direction and offering vaccination to them free.
7087. Surely it was very much the custom then, as now, for all but the poorest persons to have their own medical attendant, who could vaccinate, and did so? Perhaps so; but I am strongly inclined to think that the great bulk of the population of London, if they were vaccinated at all, would be vaccinated by those officials who offered vaccination to them free.
7088. Have you any knowledge or means of estimating the proportion?--None whatever, except from the [[p. 9]] estimate given now. Even now the number vaccinated by private practitioners, I think, is only about one third or one fourth.
7089. Are there not now persons publicly appointed for the purpose of vaccinating, as there were not then?--In London they were very energetic, as is shown by their appointing a large number of persons in all parts of the town to vaccinate.
7090. (Professor Michael Foster.) Was there not in the early years of that century a great deal of non-medical vaccination?--Yes, a great number of those people who were appointed were non-medical.
7091. Were there not volunteer vaccinators? Did not a lady exercise her charity by vaccinating all her neighbours?--Yes, no doubt.
7092. (Sir James Paget.) Were those vaccinations recorded?--I do not know. I should think probably not. It is very difficult and probably impossible to get at any accurate statistics, but in support of this general view there are a number of facts stated officially which seem to show that that estimate cannot be above the mark, but rather below the mark. I will take, for instance, such a statement as this, which you had before you in the early part of your inquiry. Mr. Thorne Thorne stated first of all that the public vaccinations were doubled immediately after the Act of 1853; and then a statement of Mr. Simon's was referred to, that in 1867 they again doubled. If the proportion was much greater than one fourth in 1822, and it went on increasing to 1853, and then was doubled and then again in 1867, you would have a much greater number vaccinated than the total population. I do not suppose those figures were meant to be accurate, but they evidently gave the impression and belief of official and well-informed persons that there were enormous increases in the number of vaccinations respectively at the two periods. That is a long way ahead of 1820.
7093. (Chairman.) But you might double the vaccination in any year as compared with the preceding year without making any very large increase in the number of vaccinations in proportion to the whole population?--Yes, if it was only doubling once, but the statement was that after, and in consequence of the alteration of the law, the vaccinations were doubled, meaning not for one year only, I presume; at all events, that the number was greatly and permanently raised.
7094. But for a series of years you might double the number without very largely affecting the proportion which the vaccinated bore to the whole population?--If there were more than one fourth of the whole population vaccinated, and the number vaccinated yearly went on increasing and the vaccinations were doubled, and then when you got to the next period you again doubled the vaccinations you would soon come to the whole population.
7095. Supposing that at the time it is supposed to be doubled you had half the population of London unvaccinated, and you doubled in any given year the number of children vaccinated, as compared with the children vaccinated in the preceding year, that proportion in relation to the half unvaccinated--say, a million--would not be very large. You might have twice the number of children this year vaccinated that were vaccinated last year, and yet you might have still a very large proportion of unvaccinated people left; because the number of children born in any given year would only bear a certain definite proportion to the total population?--No doubt.
7096. If that goes on long enough, no doubt it may produce the effect you mention?--As the years go on the unvaccinated die out, and when you get to a certain period (as now), when vaccination is said to be performed in the cases of 95 per cent. of the children born, it must very soon, if it has not already done so, cause the whole population or a larger proportion than even 95 per cent., to be vaccinated.
7097. You said that if it were the case that after 1853 the vaccinations doubled, and after 1867 they doubled again, it would follow that the population must have been more than vaccinated, unless you were right in saying that only one fourth were vaccinated before that date; but that did not seem to me absolutely to follow?--I still think so; because if we go from this period, 70 years ago, up to the present time, you have very few persons living who were children at that period.
7098. I am talking of 1853 and 1867; a person born in 1820 was only 47 in 1867?--Exactly; but if the number vaccinated was one fourth and it went on increasing to one half by the time you get to 1853, and then you have the number of yearly vaccinations doubled, and then again doubled further on, all the early unvaccinated ones would have died off, and you would have more than the whole population vaccinated.
7099. Do you know what proportion the births in any one year bear to the total population of London?--About one thirtieth or one thirty-second of the whole population. It is probably more now, but that is what it was in the early part of the century. The numbers given by the Registrar General for the years 1871-80 come to a little more than one twenty-eighth of the population.
7100. Are those all the facts bearing upon the extent of vaccination which you wish to lay before the Commission?--Mr. Simon says in his paper, that for the five years from 1848 to 1852, even then the vaccinations were less than one third of the births, that is with regard to England. In 1854-6 he estimates the vaccinations in London at about three fifths of the births. If the vaccinations in London were only three fifths of the births so late as that, we may be pretty sure that they had not reached one third of the births at this period (1822); and if they had not, taking into consideration the immense bulk of the adult unvaccinated population, it is a very high estimate to consider that one fourth were vaccinated at that period.
7101. When vaccination was first introduced, and when there would probably have been a certain enthusiasm about it, would not a much larger number of children above the ordinary vaccination age, and even adults, be vaccinated than possibly at a later period?--That I do not know. We have records showing that there was a great opposition to it, and that people still continued to be inoculated, in fact, we know that it was of so common occurrence that it was found necessary in 1840, to pass an Act of Parliament to make inoculation illegal.
7102. What is the next point which you wish to lay before us?--The next point which I wish to lay before the Commission is that, undoubtedly, whatever proportion you accept, from this period of 1822 onwards a steadily increasing proportion of the population has become vaccinated through the much more perfect vaccination of infants, and the partial vaccination of adults; and my point is, that having reached this position of very general vaccination, if you take as nearly as you can the average, you see by the successive curves and elevations of my diagram that there has been no diminution of small-pox from that period (about 1850 to 1860) down to 1883 where the diagram terminates.
7103. Why does it terminate with 1883?--It terminates with 1883 simply because they were the only statistics I had available. I carried it down a little further in the last edition of my book, but the essential point is not altered, and the important thing is that after 35 years of vaccination you have a great epidemic in 1838 and then after another 33 years of vaccination, part of it legal and part of it rigidly compulsory, you have this enormous epidemic of 1871; and if those are put into the average you will see that during this latter period you actually have a rise in the small-pox mortality coincident with the admittedly great increase in the efficiency of vaccination, and of the proportion of the population who have become vaccinated.
7104. When do the Registrar-General's statistics begin?--The Registrar-General's statistics begin in 1838; they just begin at that epidemic.
7105. After that date the number of persons who died of any particular disease was more accurately ascertained than it had been prior to that date; was not that so?--There are many opinions as to that. That is a medical question which I do not wish to go into.
7106. But a good deal turns, does it not, upon whether you can depend upon the Bills of Mortality in relation to population before that time, 1838, as exhibiting the same accuracy as the Registrar-General's statistics subsequently to that date?--It may be so, but I have no reason to suppose that any alteration in their accuracy would affect the matter in one way rather than in another; in fact many declare that it would affect the question adversely.
7107. What would strike one is this, that people were not likely to have been returned as buried who were [[p. 10]] not buried, whereas a great many people may not have been returned who nevertheless had died of a particular disease; the Bills of Mortality depend upon burials, do they not?--Yes.
7108. More people might have died than were returned; at all events the error would have been in that direction?--No doubt.
7109. They might possibly omit to return people as dead and buried who nevertheless were?--Yes.
7110. Therefore if there were an error you would expect to find it rather in the way of omission than otherwise, would you not?--No doubt; but I apprehend that the effect of any such error upon this diagram would be infinitesimal; the omission of a few deaths, say five or ten deaths per annum, would make no difference in a diagram like this.
7111. Do you think that if there were no compulsion with regard to certificates and the duty of registration, one might not have very considerable errors in the returns?--I have no knowledge of that, but I presume the people who compiled the Bills of Mortality were paid for it, and I should think it very likely, though I do not know, that their payment depended upon the amount of work they did, in which case they would be likely to exaggerate rather than to diminish the returns.
7112. Did it depend upon that?--That we do not know; we have very little information upon the subject.
7113. (Sir William Savory.) Did you construct that diagram yourself?--I did entirely.
7114. With your own hand?--With my own hand, and also made the calculations.
7115. Are you aware that it is entirely opposed to other diagrams and calculations which have been laid before us?--On the contrary, with every one with which I have compared it it agrees entirely; it is official. The diagram for England and Wales is published also in my book, but there are no early statistics for England and Wales.
7116. This table, which I may refer you to from Dr. Ogle, is from 1838 to 1857. You are aware perhaps that this table is in striking contrast to yours?--I beg pardon; there is no reason why it should not be in contrast; I do not see that it is in contrast as a matter of fact, but it is a different one because it deals with a different population entirely.
7117. (Professor Michael Foster.) You have a diagram for England and Wales in your book; in its main features that is similar to the one for London?--It is very similar as it appears to me. The two epidemics occur at the same period, and the general average of the line is to my eye very similar. I cannot say that I see any contradiction.
7118. (Sir William Savory.) Do your figures for London and for England and Wales correspond with those in the table I drew your attention to?--I have not compared them, but being obtained from the official statistics, I do not see how they can differ unless there has been an error made by somebody. I think there can be no error in mine because I was very careful about it.
7119. (Chairman.) Is there any other point upon that diagram to which you wish to call attention?--No. I think the chief point shown by that diagram is that towards the end of this period there is no diminution visible in small-pox mortality, whereas there has been admittedly an enormous increase in vaccination.
7120. If it were brought up to the present time would you still say that the same result would be shown?--Certainly; that would be only seven years longer.
7121. And during those seven years there has been very little small-pox?--Very little. There is no question that small-pox is on the whole diminishing. The whole question is of course to what the diminution is due.
7122. What is the next point to which you would draw the attention of the Commission?--I have two more diagrams which I think are instructive though they are not quite so full. These are two small diagrams with regard to Scotland, one taken from the Registrar-General's returns for Scotland, the other from a table published by Dr. Seaton in his Handbook of Vaccination. (The diagrams were handed in. See Appendix II., Diagrams B. and C., facing page 179.) The first diagram goes from 1855 to 1880. Compulsory vaccination was introduced into Scotland in 1863. Immediately afterwards, from the beginning of the year afterwards, there was an enormous decrease in the small-pox mortality down to 1870. At that time it was confidently stated by many eminent medical men that the compulsory Act had practically stamped out small-pox. Immediately afterwards in 1871 there came that terrible epidemic which was really worse in Scotand, I suppose, than in almost any other country taken as a whole; not a city, but a country; it lasted three years. During those three years there was a most enormous mortality from the epidemic; 2,000 per 1,000,000 of the population perished during that one epidemic. Since then, of course, it has gone down and it has been very low. Soon after this compulsory Act was passed, it is stated that 95 per cent of the births were vaccinated; and a little later, after 1870, that 96 per cent. of the births were vaccinated. We may assume, therefore, that during the whole of that period vaccination was carried to the fullest possible extent.
7123. If vaccination were only made compulsory in 1867, although after that 95 per cent. of the births were vaccinated, it would leave in 1870-71 a large unvaccinated portion of the population?--No doubt, but still though it was not compulsory it is to be supposed that there was a good deal of vaccination in Scotland previously to that time.
7124. Nevertheless, when you are speaking of making it compulsory you would not be surprised that an epidemic coming eight or nine years after its introduction should find a large proportion of the population unprotected?--Of course it would; but it is not generally the case that an epidemic attacks only adults and leaves the children; and the children must have been all vaccinated at that period. That also appears to me to bear out the teaching of the other diagram, that vaccination has no beneficial influence upon small-pox mortality.
7125. How would the diagram appear if carried down to the present time; has there been any change since?--No. I believe there have been no epidemics except local ones since that period at all; the epidemics come at long intervals; but this other diagram appears to be very instructive because it gives the comparative mortality, dividing Scotland into three districts, first the large towns, next the rural districts, and then the islands; and it is a most suggestive thing, I think, that whereas in the large towns, both in periods of epidemic and in periods of repose, the curve stands permanently above that of the rural districts; in the same manner with one minute exception, the curve of the rural districts stands permanently above that of the islands. That is exceedingly suggestive of the fact that pure air and thinness of population is highly beneficial, whereas crowding together is one of the chief causes of the spread of small-pox.
7126. But even without crowding, you would expect from the nature of the disease that if people were congregated together the number of cases where small-pox broke out would be likely to be larger?--Of course, that is the point.
7127. I do not quite see how that last statement of yours bears upon the vaccination question?--It does not bear directly, but it bears upon the allegation that in sanitation we have a real aid to preventing and checking of small-pox, whereas in the matter of vaccination the evidence, at all events, is not so clear.
7128. But is it necessarily connected with insanitation; may it not be that even if you make your town as healthy as it possibly could be, but have a large number of people congregated together, if any disease breaks out it has more centres to spread from?--Certainly, that is so.
7129. It is a question of town as opposed to country--No doubt; it is a question of healthy conditions. Everybody admits that country life is a more healthy condition of life than that in town.
7130. Is it only a question of healthy conditions? I should have supposed that in a disease of this sort if would depend upon something more than healthy conditions; that people living together would be more likely to spread it than where they were living in small towns and villages?--But people living in small groups in country towns and villages would be meeting together at times when opportunities would arise for the spread of disease.
7131. But taking 100,000 people in the country and 100,000 people in towns, the chance of the disease [[p. 11]] spreading in a town would be very much greater, would it not, than in the country?--No doubt it would.
7132. Is that all you have to say with regard to those two diagrams?--Yes. I have here a diagram for Sweden which corresponds very nearly to the diagram for London small-pox, and appears to me to give exactly the same teachings. (The diagram was handed in. See Appendix II., Diagram D: facing page 179.) Here, as in every country in Europe in which statistics are available, small-pox was very terrible in the eighteenth century, and the diagram shows a very sudden decrease at the commencement of the 19th century. In London the decrease was gradual; here, however, the decrease is wonderfully sudden. You have a series of epidemics extending some way back. Then you have, after the very terrible epidemic in the year 1800, the fact that the mortality comes down and remains at nearly the same level for a long time. Now vaccination was introduced into Sweden in 1801 or 1802. Vaccination was rendered compulsory in 1817, and Sir John Simon says (in the Appendix to the First Report of this Commission, page 72, note) that in 1810 the vaccinations had amounted to nearly a quarter of the births; and yet down to 1810 you have a tremendous decrease of small-pox mortality when only about a quarter of the births had been vaccinated, and consequently a much smaller proportion of the whole population. From that period it went on, just as in London, to 1822 when it got to its minimum; there was then almost no small-pox, and from that period, there has been a continually rising gradient of mortality. At this period (1811-1815) I find it stated that the general mortality was 27,000 persons per million and that from this point it had been diminished one third (18,300 per million in 1871-1875); but certainly there is no diminution of one third in the mortality from small-pox. What is still more extraordinary is, that in the capital of Sweden, where we may suppose that the vaccination laws were carried out under the immediate official eye most strictly, we have had a succession of the most terrible epidemics known in Europe. The epidemics of Stockholm are marked on the diagram by dotted lines cross-barred; and you have a series of epidemics rising in intensity till they culminated in the terrible epidemic of 1873, which was probably the worst known; 7,900 persons per million died in Stockholm after a period of 56 years of compulsory vaccination. It appears to me that that is a result which could not possibly have occurred had vaccination any preservative influence against small-pox.
7133. What are the materials for that table?--Those materials, and they have been published many times, were originally furnished by Rektor P. A. Siljeström, and they have been given in Dr. Pearce's book on "Vital Statistics" up to a certain point; the latter part is from statistics furnished to myself by Rektor Siljeström, a noted statistician in Sweden. The figures have been quoted again and again, and the crowning point, that terrible epidemic, has been frequently brought forward in official publications. It is quoted in your own returns, and the figures are admitted to be correct; there is no doubt about that.
7134. What is the next table which you desire to lay before the Commission?--I have a similar but shorter diagram for Prussia, showing the result of 60 years of vaccination. (The diagram was handed in. See Appendix II., Diagram E: facing page 179.) The main portion of it agrees with a table which is given in the Report of this Commission, which I use as far as it goes, and it has been supplemented since 1871 by a table given in a work by Dr. Lotz, of Bâle, who is really a writer in favour of vaccination.
7135. That table only goes down to 1870?--It goes to 1873.
7136. What is the source of it down to that date?--The source of it down to 1871 is a table given in Dr. Pearce's "Vital Statistics," and for the years since 1871 figures furnished by Dr. Lotz. The figures for the Berlin epidemic, which I also show, are taken from the some authority, but are, moreover, confirmed by Dr. Seaton in his "Report of the Medical Officer of the Local Government Board," new series, No. 44, in which he gives the very same results of the Berlin epidemic of 1871. This diagram is merely to show that the evidence from this country runs exactly parallel with the others. Compulsory vaccination was introduced in 1833 into Prussia. The text of that law is given in the Report of the Epidemiological Society for 1853, showing that it was an exceedingly strict law, by which everybody was vaccinated, and that for almost every official purpose a person must be revaccinated; and yet, after more than 30 years of this rigid vaccination, we have in Berlin an epidemic which is only comparable with the great epidemics of the 18th century in London.
7137. Are you aware that it is alleged that there was not practical compulsion between 1834 and 1874?--I am aware that it is alleged so, but not that it has been proved.
7138. You are probably acquainted with the law of 1834?--I have seen the law as quoted in the work of the Epidemiological Society.
7139. That did not impose what we should call direct compulsion, did it?--It appeared to do so, certainly, very direct compulsion.
7140. What would you call direct compulsion?--The law in Prussia is, first, that every child is required to be vaccinated before it is a year old, and parents who do not obey are fined. That is, certainly, a compulsory law.
7141. What is the date of that report?--1853.
7142. What does that profess to be a quotation from, because we have had the exact terms of the law, and I do not remember that being laid down?--This book from which I have been reading is Dr. Pearce's "Vital Statistics," and this is a quotation from some answers sent in reply to Sir John Simon's questions as to the vaccination laws in Prussia.
7143. You have at all events accepted the view that vaccination was compulsory since 1834?--Yes; I have.
7144. You have not continued your table down to the present time since 1873?--No; I had no means of doing that.
7145. You are aware that whatever was the compulsion before that, a law was passed in 1874 more strictly enforcing vaccination?--Yes; I have heard of that law, but I have not seen any evidence that the law made any important difference. It is alleged by many persons that the law made no difference.
7146. But you have not examined the statistics since that day?--I have not.
7147. (Sir James Paget.) May I ask whether in any statistics you have examined, you have ever seen so long a period with so low a range of mortality?--The range of mortality is about the same as in England.
7148. But have you looked to the past centuries?--It was never so low in past centuries.
7149. Nor any interval so long between two epidemics?--No; certainly not.
7150. (Chairman.) What is the next table to which you wish to call the attention of the Commission?--I have a diagram to show with regard to Vienna that a corresponding thing occurred there. (The diagram was handed in. See Appendix II., Diagram F: facing page 179.) Here, again, we have a rigid vaccination law introduced at I do not know what date. This diagram begins at 1828, and extends up to 1877 with an imperfection. Its purport is merely to show that in Vienna after many fluctuations and a generally low period of small-pox mortality for 40 years, you have a sudden epidemic which is not only worse than any which has occurred in Europe, I believe, but worse than the worst epidemic in London during the 18th century; not quite so bad, however, as that of Stockholm, but it is over 5,000 per million. Now the mortality in London never rose to over 5,000 per million once during the 18th century; consequently after about 70 years of vaccination, the greater part of it compulsory, you have as a sequence an epidemic in a European city with all the advantages of medical science and hygiene equal to any in that horrible London of the 18th century.
7151. (Sir James Paget.) Is that drawn to the same scale as the Prussian diagram?--Yes.
7152. The rate of mortality from small-pox seems to be greater in Vienna than in Prussia?--It is greater in Vienna than in Berlin.
7153. (Chairman.) But taking it throughout?--On the average, it is decidedly higher in Vienna. It ranges frequently at least on four occasions, above 1,000 per million.
7154. (Dr. Collins.) Would that be corroborative of, or corollary to your statement, that in towns the mortality is greater than when you take a country like Prussia?--Yes; certainly.
[[p. 12]] 7155. (Sir James Paget.) Would it not be correct to say that there is far less vaccination in Vienna than in Berlin?--That I do not know.
7156. It is so stated?--It may be so.
7157. (Chairman.) When you say that there has been a rigid vaccination law in Vienna, do you mean to say that it has been rigidly enforced in Vienna?--It is stated in the Epidemiological Report as being a compulsory law. I have no doubt it has been rigidly enforced.
7158. (Sir James Paget.) Is not Vienna reckoned amongst the towns which are badly vaccinated as contrasted with Berlin, London, and Edinburgh?--That I do not know.
7159. (Chairman.) Would you give us the source of the Vienna diagram?--The Vienna diagram is taken from a table in Dr. Pearce's "Vital Statistics," page 107, in which he says it is extracted from a work published by Dr. Vogt, of Berne.
7160. What is the next point to which you wish to call the attention of the Commission?--Now comes the last diagram, and I think the most important, I have to lay before you. (The diagram was handed in. See Appendix II., Diagram G: facing page 194). The diagrams I have hitherto shown apply to countries in which vaccination is compulsory more or less; it is at all events compulsory now and has been for a considerable time, and the consequence of that is that you cannot find any comparable populations either without vaccination and with it, or with more vaccination and less vaccination; and that is a very unfortunate thing as regards arriving at true conclusions, because it is well known, nothing is a matter of more common knowledge in science than that when you are seeking after causes, you must have experiments which shall be strictly comparative, that is to say, one shall only differ from the other in regard to that special cause being present or absent. As an illustration I would just mention Dr. Tyndall's celebrated experiments on organic infusions and the production of life. The essential point of all his experiments was that each set should be exactly alike except in the condition that to the one of them, air should have access, and that from the other air should be excluded. In the same manner, Mr. Darwin, in making his experiments upon the fertility of seeds from self-fertilised and cross-fertilised plants took care to grow his plants in the two halves of the same flower-pot, so that both experiments should be exposed to exactly the same conditions, and that when they arrived at maturity and produced seeds it could not be said that there was any difference in the conditions of the plants, except in the condition of the one being from seed of self-fertilised and the other from seed of cross-fertilised plants. Now, if we had a really good case of that kind, that is to say, a tolerably homogeneous population, of which one half was not vaccinated at all, and the other half had been vaccinated for a series of years, we should have an absolute test and demonstration. Fortunately, for the purpose of arriving at the truth, we have an approximation to that condition of things in France. France is the only country in Europe in which there is no compulsory vaccination; but though not compulsory it is strongly encouraged in all the departments and is performed, free, by official paid vaccinators. Those vaccinators give in returns to the Prefects of the departments annually, who send them up to the Imperial Academy of Medicine, and they are published in the annual Reports to the Minister of Agriculture, giving the number of vaccinations performed in each department with the number of births, of small-pox cases, and of deaths from small-pox. These reports appeared to be almost unknown in England till about 25 years ago; two or three of them were obtained by Mr. Gibbs, of Darlington, who published some tables which he drew out from them, and he found, much to his astonishment, by arranging the different departments in the order of their more or less vaccinated condition, that in the less vaccinated departments there was actually less small-pox mortality, and in the more vaccinated, more small-pox mortality.
7161. Was he doing that as an opponent of vaccination and not as a scientific inquirer merely?--I hope we are all scientific inquirers, but, at any rate, he was a very strong opponent of vaccination.
7162. You will, no doubt, admit that a scientific inquirer who starts with a bias is not as safe an inquirer as one who starts with an even mind?--No doubt; but unless one falsifies his figures the figures remain; still it was open to the objection, and I think it was objected to his drawing any conclusions from his two or three returns, upon the ground that the moment a small-pox epidemic occurs the people get frightened and rush to be vaccinated; consequently there would be an increase of vaccination in any one year in which there was an epidemic, seeing that people would rush to be vaccinated from fear of the epidemic, and the increased vaccination would be a consequence, instead of a cause. I wished, therefore, to get a long series of these reports, and, partly through the assistance of Mr. Gibbs, and also of Mr. Wheeler, of Darlington, I have been enabled to obtain a series of 17 more years, making a series of 20 almost continuous years of those reports for the whole of France. These reports I must tell you, are summarized yearly. The departments are arranged alphabetically, consequently they really teach you nothing as they stand, giving, as they do, the number of vaccinations in the year, the number of small-pox cases in the year, the number of small-pox deaths in the year, and of the births also in the year, which is a most important thing. I have with very considerable labour taken out the whole of the materials, afforded by the 20 years of those reports for France. Some departments are imperfect, some are very imperfect; in some they appear to have done nothing whatever, but just sent in their report of the number of vaccinations in order to get their fees; but those are few, and out of the total number there are the reports of 67 departments, which are either quite or nearly perfect.
7163. Out of how many would that be?--87 or 85, I forget the exact number; at all events about six sevenths or five sixths of the whole are tolerably perfect. From those I have worked out the statistics in this way. I have got out for each department for the whole 20 years the averages of the vaccinations to births (they are all in per-centages), and the average of small-pox deaths to births. Then having got them all out in the way in which they were arranged alphabetically I have re-arranged them in the order of the amount of vaccination performed, which varies considerably in France. Taking the whole 20 years we get this diagram. These vertical columns indicate the departments, beginning with the one in which vaccination in lowest; the blue columns represent the amount of vaccination per cent. of births, from 10 to 100; the lowest have less than 30 per cent. of births vaccinated, the whole showing the average of the 20 years. They increase by tolerably regular increments all the way up until we arrive at the maximum in which the whole vaccinations for the 20 years have been more than the births, implying that there had been a considerable number of adult vaccinations. Therefore we have the whole series from the least vaccinated population up to the very largely vaccinated population. The black columns represent the small-pox mortality in proportion to births. I wish to call attention to this, that as far as I can judge by the eye, there is absolutely no relation whatever between the mortality by small-pox and the amount of vaccination. In the lowest vaccinated departments you have some of the lowest mortality; in the highest vaccinated departments you have some of the highest mortality; and there are some in the middle. Altogether the general effect is to show that the amount of small-pox mortality increases as the amount of vaccination increases. In order to determine whether that was a real fact, or only a deception of the eye, I have taken them out upon another plan. I have extracted the 10 departments in which there was least vaccination, and the 10 departments in which there was most vaccination, and have got out the averages by adding together the vaccinations and births for those departments. Then I have taken in another set, the 20 which are the least vaccinated departments and the 20 which are the most vaccinated departments. In order that it might not be objected that these were selected groups, I have taken, also, the half which are least vaccinated and the half which are the most vaccinated, and the result is that taking them in tens the least vaccinated departments have least deaths from small-pox, and the most vaccinated departments have most deaths from small-pox; and when you take the twenties you find that the least vaccinated have the least deaths from small-pox, and the most vaccinated have the most deaths from small-pox; and when you divide them into halves you find again that the half which is the least vaccinated has the least deaths, and the half which is most vaccinated has the most deaths. That really supports the view I have submitted to you from my previous diagrams, that so far from vaccination producing any visible diminution of small-pox mortality it goes rather the other way.
[[p. 13]] 7164. Do you draw the conclusion that they establish that vaccination creates small-pox?--I do not draw the conclusion that vaccination creates small-pox, but I draw the conclusion that it has no beneficial effect whatever.
7165. You do not absolutely draw the conclusion that you were pointing to from these diagrams?--All I can say is that that is the logical conclusion from the evidence if there could not be shown to be certain special conditions other than vaccination which have led to the result.
7167. Let me ask you this: Have you divided those departments at all according to their being chiefly rural or chiefly urban, or in some such way as that?--That is just the point I was coming to. In order to try for my own satisfaction how they were distributed, I have upon this map of France taken the 20 least vaccinated departments and coloured them red, and 20 of the most vaccinated departments and coloured them blue, merely for the sake of ascertaining whether there were any facts of local distribution which would account for the difference, and I think you will see that, as far as possible, they are pretty much equally distributed. You have little-vaccinated communities north, south, central, east, and west; you have highly-vaccinated communities north, south, central, and east and west; they are so mixed together that it is impossible to say that there is any influence of locality or race to account for the difference.
7168. I was speaking rather of the larger and more populous places, like Paris, Lyons, and Marseilles?--Above the name of each department. I have given the population per square mile in figures, and I have taken out some results from that. The departments vary in density of population from 68 per square mile in the case of Lozère to 12,000 per square mile in the Department of the Seine. The Department of the Seine is very small, it contains the city of Paris and its suburbs, which would swamp the others, so I left it out.
7169. It does not come into your plan, does it?--It comes into this diagram, but in trying to see the influence of density of population I have left it out as being unfair, because the department contains practically the city and suburbs and nothing else. Leaving that out, the departments do not differ very much in size or population, 54 out of the 67 having from 100 to 200 persons per square mile. I have first taken 20 departments in which small-pox mortality was greatest; they have an average density of 327 per square mile. The 20 departments in which there was the least small-pox mortality have a density on the average of 305 per square mile. There is a decided difference corresponding to what we might expect, that is to say, those with the least density of population have a somewhat less mortality. Then I have taken the 10 most densely populated departments, and they have a small-pox mortality of 0.9 per 100 births, and the 10 least densely populated, which have a mortality of 0.66 per 100 births. That shows a decided influence of density of population upon the mortality from small-pox, but it does not at all account for the striking difference shown between those groups of departments, nor remove the fact that after taking the series of returns throughout the result goes against vaccination rather than in favour of it.
7170. Was there much difference in some of the same departments in the proportion of vaccination from year to year?--Sometimes, but not very much. On the whole, the departments that were least vaccinated were least vaccinated throughout the 20 years, but there were some departments in which there was a good deal of difference.
7171. Were there any in which vaccination appeared to be diminishing?--That I could not see; during an epidemic there would be a sudden increase of vaccination, but taking the 20 years it comes all into the average and produces a perfectly fair result. It does not matter whether you have twice as many one year as you have another; if you take it over 20 years the result of the 20 years gives you very fairly reliable indications of the amount of vaccination.
7172. But suppose there had been a very large vaccination in the earlier years and very little vaccination in the later years, that would render a place possibly a very badly protected place, would it not?--No doubt; But there is no such case as that.
7173. Whose books are those that you made use of?--The whole of the set that I used belonged to Mr. Wheeler, of Darlington, who will be before you probably shortly.
7174. Are they official books, so that one can see them?--It is entitled "General Report on Vaccinations and Re-vaccinations performed in France, prepared for the Imperial Academy of Medicine, and presented to the Minister of Agriculture." The years I have were 1865 to 1867, and from 1871 to 1887. I tried all I could to get the intervening years 1867 to 1871, but it appears they are not to be had; they are out of print, I believe.
7175. Could you tell us whether a great deal of the difference seen depends upon whether the epidemic of 1871 attacked particular districts or not. Did France suffer very largely in the epidemic of 1871?--Yes; at one time I was going to leave out the year 1871, but I thought that would not be fair. I do not think one year can make much difference to the whole statistics where you have such a period as 20 years. It would be better still if we could get 40 years.
7176. I suppose in 20 years in some places the 1871 epidemic might account for a good portion of the figures?--Yes, but it is in epidemics that we principally want protection.
7177. But still if you have two places, one visited by an epidemic and the other not affected by it, the one would seem to suffer much more than the other, although it might happen that there might be an equal amount of want of protection in both places?--It appears to me that there ought not to be any "happening" in the case; if there is an epidemic the district ought to be protected.
7178. But do you understand vaccination as a protection against attack, whether all are vaccinated or not?--Certainly not.
7179. Suppose you have two populations in each of which there is a very considerable number of unvaccinated, it is within experience that the epidemic may operate at one place, but not necessarily in every place where there are a number of unvaccinated people?--Certainly; but it is in the unvaccinated departments that you ought to have the effects of the epidemic most severely felt.
7180. You do not suggest that even in the vaccinated departments there is complete protection by vaccination even assuming vaccination to be complete protection?--I do not quite see the argument.
7181. What I ask is, how largely the 1871 epidemic bulks in the statistics you have given us, or how far it has a sort of uniform operation in all the departments?--I have here all the figures that I have taken out, which I will offer to the Commission if they like to have them, and that will give an answer to all these questions, but it takes a great deal of examination to get the facts. (The table was handed in. See Appendix II., Table H: page 180.)
7182. (Professor Michael Foster.) Have you made any observation about the apparent effect of military operations in the several departments?--I have not; they have all been included in the returns.
7183. You cannot make a distinction between those departments in which there were great military operations during the Franco-German war, and those in which there were not?--I do not think I could, and it would only affect one year.
7184. (Sir William Savory.) Are the returns of the number of vaccinations in each department in proportion to the population?--I have given it in proportion to the births.
7185. But the proportion of vaccinations to population?--The proportion of vaccinations to births practically gives you the proportion to the population, because the proportion of births to the population does not usually vary. This way in which I have shown it is the only way of representing it upon the diagram. The actual vaccinations would have proved nothing, because all the departments differ in population, and consequently in the annual number of births.
7186. As to the mortality from small-pox, is the calculation made in the same manner?--Yes, both are made in the same manner.
7187. (Chairman.) You have first the years, then you have the births and the number of vaccinations, are those numbers totals or per-centages?--The set of [[p. 14]] papers you have before you is only taking out my materials ready to work out; the working by which I got out the per-centages is in a separate paper. The figures before you are the actual number of births, vaccinations, and deaths; I have added them up to get the average for the 20 years. Then I use them afterwards to get the proportions that I have here of the vaccinations to births and of deaths to births.
7188. (Dr. Bristowe.) You have not another diagram showing the proportion of deaths to the population, have you?--No; I thought that would be only confusing it, because the proportion of births to population varies very little year by year, and very little between one part of the country and another. The births are the essential thing, because what you want to know is what proportion of children born year by year are vaccinated.
7189. (Chairman.) But you want to know the proportion they bear to the total population too. Now take two years in the Alpes Maritimes when there appears to have been an epidemic of small-pox which frightened the people, and the vaccinations were considerably greater than the births; would that not be consistent with the view that a considerable number of adults were vaccinated, and yet that the younger portion of the population were very badly vaccinated as they were before and afterwards; would that not compare very badly with a district in which the population had been regularly vaccinated throughout?--No doubt that would be so. You might find an extreme case, but taking it all round they balance each other.
7190. (Chairman.) The Alpes Maritimes is a district in which there was a very large number of small-pox deaths; I find as many as 2,117 deaths; whereas in many of them the great majority of the deaths were in the year 1871. I see in the first five cases that is so. Then I come to the Alpes Maritimes where it is not so, you have in that year 322 deaths, the next year 209, then 243, 175, 112, 161, and 339. Now, it is quite true that in 1879 and 1880 you find a very large number of vaccinations. You have births 6,300, and vaccinations 9,000, which would seem to indicate a considerable number of adult vaccinations. Then, I find that in 1865 out of 5,487 births there were only 2,437 vaccinations, and for 4,080 births only 1,512 vaccinations. With 5,136 births there were 1,448 vaccinations. In the next year with 6,029 births you have 5,351 vaccinations; but there, again, there was a considerable epidemic. Then, again you have 5,255 births and 2,910 vaccinations; then you come down again. In taking the earlier of these figures does not it appear to be a very ill-vaccinated community, although, owing apparently to the large number vaccinated by reason of epidemics the total number averages 4,331 to 5,013?--I do not quite follow that.
7191. An epidemic which causes a large number of adults to be vaccinated may affect the average over 20 years, and give the impression of a much better protected population than actually exists, may it not?--But if the excitement or fear of an epidemic led to vaccination it would also, one would naturally suppose, lead to a greater amount of infant vaccination, because infants are most liable to infection; it does not at all follow that they would be chiefly adults.
7192. But does not an epidemic produce a large number of adult re-vaccinations?--Certainly, a considerable number. It may add to the per-centage somewhat, but I very much doubt whether the adult vaccinations ever approach even to a small fraction of the infant vaccinations.
7193. (Dr. Bristowe.) Have you taken any trouble to ascertain what is the birth-rate in different districts in France?--It could be done, of course, but to do so one would require to get the population statistics of France. I have tried to get them, and found that there were no accurate returns.
7194. You know the birth-rate differs in different parts of England?--I have no doubt it does in France too, but we can only take the materials that we have.
7195. But you have been assuming that the birth-rate is uniform?--Not uniform; but, roughly speaking, we know pretty well that amongst the same nation, though there will be some differences, there will not be enormous differences.
7195a. (Chairman.) I find in one place the births are given as 6,516 in one year, and the next year 2,642?--Yes, I noticed some remarkable differences in the births year by year occasionally.
7196. Then going up to 4,300, and then down to 3,300?--Yes, still I expect it would work out to a fair average over a number of years.
7197. (Sir William Savory.) When were those tables worked out?--I have worked out the whole of them myself recently; I have only just finished them.
7198. Do you know that before the Commission of 1871 Mr. Gibbs gave similar evidence to this?--I am quite aware of what evidence he gave, but he gave his figures founded on one year; mine were founded on 20 years' tables.
7199. In the table he gave he left out, did he not, the birth-rate?--No, I think he gave it as I did upon the proportion of deaths to births.
7200. Sir John Simon, who was examined upon this point, was asked, "Did you notice the evidence that was given by Mr. Gibbs with regard to small-pox in France, by which he endeavoured to show that in those parts of France where vaccination had been most attended to there was most small-pox"? and he replied, "Yes, my attention was drawn to it. (Q.) Are you able to show that there is any inaccuracy in that statement?--(A.) It seemed to me one of the absurdest misapprehensions of a statistical paper that it had ever been my fortune to see. (Q.) In what way?--(A.) The returns did not profess to give the relative proportions of population vaccinated and unvaccinated in the districts spoken of, but only the numbers vaccinated in the particular year under consideration; and even here, in great part, the vaccinated and revaccinated were lumped together. The case requires to be read just in the inverse direction to that in which it has been quoted to the committee"?--Yes, that is exactly what I remarked at first, that the objection can be made that it is an inverse conclusion. I admit the force of the objection as regards one year, but I certainly do not admit the force of the objection as regards averages of 20 years.
7201. You think that removes the whole force of the objection?--Certainly; I do not see that it has any hearing whatever when you take it over 20 years.
7202. (Professor Michael Foster.) Why do you say that you do not think that vaccination causes small-pox when you say your tables go to show it?--I do not say that I do not think it; I think I should say that the tables fully go to show it, but that it must be remembered that there are other circumstances to be borne in mind which affect the conclusion.
7203. (Mr. Hutchinson.) Supposing an alarming epidemic occurred would not that tend to produce these discrepancies?--That is occasionally the fact, but the rule is to go on tolerably regularly just as in England. where even with all our rigidity there are fluctuations in the number of vaccinations annually, and in France, of course, there are still greater fluctuations; still on the whole I say that the least vaccinated and the most highly vaccinated departments are so every year.
7204. (Chairman.) I see that there are years left out in some cases, was that because you had not the materials?--Yes, the materials were imperfect. I have run the pen through a great many, through those that were rejected for insufficient material. Where there are only one or two years omitted, I have not rejected them because we have still 18 or 19 years of the period to go upon.
7205. (Mr. Hutchinson.) Is it not the fact that in most of the cases where the black column is very high there is a large city in the district?--I think not, but there may be a large town here or there. Here is one case, Morbihan, where there is 186 population to the square mile. The Alpes Maritimes is one of the Departments with the scantiest population, but Nice and Cannes are in the Alpes Maritimes. I looked over the columns and I could not see any relation between towns and cities and the small-pox mortality; that is to say, no constant relation.
7206. (Chairman.) What is the next point which you wish to place before the Commission?--That completes my points with regard to statistical evidence. The only other thing I should like to bring before you, if I may be allowed to do so, is a few remarks upon what appear to me to be mis-statements or insufficient statements in the First Report of your Commission. The first thing I should like just to call attention to is that the statistics have been given in for Christ's Hospital, and for Denmark, down to the year 1850, that is 40 years ago; and for Sweden down to the year 1855. The effect of that [[p. 15]] upon the Swedish diagram, you remember, was that whereas down to 1855 there had been a comparatively small amount of small-pox mortality, afterwards it went on increasing, and culminated in these tremendous epidemics. The diagram for Sweden is printed in your report, and it can be compared with mine, and they agree, as far as they go; but continuing it down as far as I could get it, entirely alters the bearing of it. Then I find in the First Report, Appendix I., page 72, this statement in Sir John Simon's paper:--"It seems probable that the small-pox death-rate of London during the eighteenth century ranged from 3,000 to 5,000." Now at first sight, one would think that "from 3,000 to 5,000" meant in any year, but the context, I think, shows that it means on any average 10 years, and also that it means per million, though it is not so definitely stated; but even as meaning per million, and upon a decennial average I submit that it is erroneous. In the 10 years, 1780 to 1789, the small-pox deaths averaged 1712, with a population of about 750,000, giving 2,300 per million, and in the 10 years, 1790-99, the last 10 years of the century, the deaths averaged 1,768, with a population of about 925,000, giving 1,910 per million. Therefore, in the two decenniads it was a little over and a little under 2,000 per million instead of 3,000, which Sir John Simon gives as the lowest.
7207. What is the cause of the difference; where do you get your populations from?--I get that population of 1801 as given in the census returns, and there are facts given in this First Report, Appendix I., page 101, which give earlier populations, which I have taken and interpolated as far as I could. Then, again, the greatest mortality in the century was in the decade 1710-1719, when with a population of about 550,000, 2,100 died, giving a mortality of 3,820 per million. Those figures are given at page 101 of the Appendix. The population for 1746-55 is given within the Bills of Mortality as 653,900, and I take that for one of my data. Consequently, if it were 653,900, which is nearly 654,000 for the average between 1746 and 1755, I do not think I can be wrong 20 years later in taking it at only a little over 700,000. Then there is another point which I think is much more important. In Sir John Simon's paper of the year 1857, which is partially given in this Report, on page 72, column 2, it is stated that, "the small-pox mortality of the British navy had not reached a third, nor that of the army a fourth of the London rate." Nothing more was said. Now I submit that that is exceedingly misleading, because that implies (and this is given as a proof of the influence of re-vaccination in the navy) that it is fair to compare a body of healthy, well-conditioned men with the mixed population of London, comprising all from infants up to the aged of the community. Fortunately in this same Report I find the means of making a better comparison. At page 114 of the Appendix, Table B., I find that if we take the ages 15 to 45 (which is about the average age of soldiers and sailors), and about the same epoch, 1847-53, the small-pox mortality of these is less than one third (88 per million) that of the general population, which is 305 per million. At the same time it is only one fourth of the small-pox mortality of London for the same period which is given as 380 per million, so that we find there is absolutely nothing left for the influence of re-vaccination; that is to say, the mortality of the army and navy as compared with the mortality of the population of the same ages and for the same period is practically the same, with very slight difference.
7208. What statistics of the army and navy are you taking for that purpose?--As far as I have gone now I have taken no statistics, except those which Sir John Simon gives. I accept Sir John Simon's statement for the moment that the army and navy do not reach a third and a fourth of the proportion of the general London rate. We have the general London rate, and by taking one third or one fourth of that we can arrive at the small-pox mortality of the army and navy. Then there is something more that I should like to say in this connexion. In the Appendix of Sir John Simon's original paper which I have referred to this morning, at page 11 it is stated that in the 10 years from 1837 to 1846, the portion of the army stationed at home who are all stated to have been vaccinated or re-vaccinated, had a small-pox mortality of 220 per million per annum, which is more than double the death-rate of the general population of adults of approximately the same ages. That is a very striking thing.
7209. What date did that paper of Sir John Simon's refer to?--It referred to the 10 years 1837 to 1846, and in that same paper I find it stated in the Appendix, page 12, by Dr. T. Graham Balfour, the surgeon to the Royal Military Orphan Asylum at Chelsea, who gave information upon the army and navy, that "it is a standing order of the service [navy] that all men and boys who have not satisfactory marks of either [vaccination or small-pox] shall be immediately vaccinated." Now this same Dr. Graham Balfour who was surgeon to the Royal Military Asylum for Orphans gives this information, that since the opening of the institution, in 1803, the vaccination register has been accurately kept; and he concludes in these words, after saying that every one who enters must be vaccinated if he has not been vaccinated before, "Satisfactory evidence can, therefore, in this instance be obtained that they were all protected." Then he gives statistics to show that during 48 years from 1803 to 1851, of 31,705 boys there were 39 cases and 4 deaths, giving a mortality at the rate of 126 per million, and concludes by saying, that "The preceding facts" (with regard to the army and navy and the asylum) "appear to offer most conclusive proofs of the value of vaccination"; but he has given no comparison whatever with persons of the same age and living under similar healthy conditions. When, however, we make that comparison we find, on the contrary, that it offers conclusive proof of the inutility of vaccination, because this mortality of 126 per million is actually more than the general mortality of the population ranging from 10 to 15 years, which I presume was the average age of the boys living in this institution. That figure of mortality can be obtained from the First Report of the Commission, page 114, Table B., so that we have an opportunity of comparing the mortality of a thoroughly revaccinated population with the ordinary population of the country of the same age who have not been revaccinated.
7210. Does he say they are all revaccinated?--He says they are all revaccinated if they do not bear marks of vaccination or of having had small-pox.
7211. Why do you speak of them as revaccinated as compared with the vaccinated population?--Only because those who had not had small-pox were vaccinated. This in the case of the boys is "vaccinated" undoubtedly; I was wrong before in saying "re-vaccinated." Now, with regard to the army and navy, and this asylum, Appendix E., in Sir John Simon's original paper, which has been omitted from the papers printed for this Inquiry, contains figures which are most important, because you have it there stated that this amount of mortality occurred in what they considered a perfectly protected population; that is to say, a population in which they had been all vaccinated, whether as children, adults, or boys; that is one of the points. There is one more point in corroboration of this. We have the recent figures of the army and navy. The House of Commons Return "Small-pox (Army and Navy)" of 1884, gives the small-pox mortality in each of those services for the 23 years, 1860 to 1882. The average small-pox mortality for the 23 years is, army 83 per million, navy 157 per million. I quoted that some years ago and took a great deal of trouble to try and get a comparable population to compare with them; but fortunately in your first report I find a much better comparable population, for in the appendix to the First Report, page 114, Table B., we find for the period 1854-1887 and for the ages 15-45, which is in very fair and close agreement with the average or the entire ages of the army and navy, a mean small-pox mortality of the adult population of England and Wales of 131 per million, not greatly above that of the army and navy.
7212. You would not say that your comparison would quite hold good if you were dealing with the army alone, would you?--The mortality in the army alone is somewhat less, but I would say it is so because the army are picked men, they are healthy and they undergo an examination before they come in; they are under medical supervision constantly, and they live under better sanitary conditions than the bulk of the population. That will account for the difference between them and the general population in reference to small-pox mortality.
7213. Are you aware with regard to the navy that at that time the navy were not completely vaccinated that a number of small-pox cases which go to the credit of the navy occurred amongst foreigners who went into the service upon the coast of Africa and elsewhere, and who were reckoned in the navy though they were not under orders to be vaccinated?--I do not know how [[p. 16]] that may be, but of the army I have taken only those for home service.2
7214. For the army; but are you sure that you have done that for the navy?--I am not sure whether I have for the navy; it is quite possible there may be a difference there, but taking the army alone, the home service army, the difference between 83 per million and 131 per million is not a great difference, and certainly does not correspond with the statement that vaccination offers a complete protection against small-pox when one remembers that they have such an amount of deaths as that, considering the advantages they enjoy over the average of the community at the same age.
7215. (Sir William Savory.) How do you account for the difference between the mortality in the army and navy?--I account for the difference entirely from the fact that the navy live under less sanitary conditions owing to their being crowded together in ships, and neither isolation nor separation being possible.
7216. Would the periods when re-vaccination was made compulsory be at the same dates in the army and navy?--They were not, but I find in the very earliest reports of the 40 years which I have quoted, that the statement is made upon the authority of a medical officer of the Government, Dr. Graham Balfour, that every sailor entering the service is vaccinated if satisfactory marks of vaccination or small-pox are not found, and I am told that that is merely an official difference without being any real difference; that practically those who came into the navy had all been vaccinated thoroughly.
7217. Did not the period at which that law was made make a difference?--I do not think it made any difference in reality; looking at the discipline the navy are subjected to I do not think it could make much difference.
7218. (Professor Michael Foster.) How is it that some cases were returned as "unvaccinated"?--I presume it would be because they could not find the marks.
7219. (Sir William Savory.) When you wrote that originally, were you aware of that fact?--I was not aware of it, because in the Parliamentary Report it was not mentioned. It never mentioned that there were different periods at which the compulsion was introduced.
7220. Since your attention has been called to it, you think it would make no difference?--My opinion is that it would make no difference.
7221. You prefer to explain the difference between the mortality of the army and navy by the fact you have stated, rather than by the other?--That, I think, is the real cause, and the other is the hypothetical cause which we do not know.
7222. (Dr. Collins.) Can you tell us whether since the last enactment with respect to the navy there has been any year included in that return without a death from small-pox in the navy?--Yes, there have been years without any deaths from small-pox in the navy.
Adjourned till Wednesday next at 1 o'clock.
* * *
THE RIGHT HON. THE LORD HERSCHELL IN THE CHAIR.
Sir JAMES PAGET, Bart.
Mr. BRET INCE, Secretary.
7223. (Chairman.) There are two or three questions which occur to me upon such a cursory examination as I have been able to give to these tables; in Table H. you give Vienne twice, that I suppose is intended to refer to the two departments named Vienne which there are in France?--I did not notice myself that Vienne was given twice; it is possibly owing to the fact that there are two Viennes.
7224. I observe that it is dealt with twice in your "diagram showing the vaccination and small-pox mortality in 67 departments." On looking at it I find that the figures throughout are the same except that the figures for the first three years are transposed, the one begins with 2,682, 4,750, and 5,900 births; 3,005, 10,007 and 2,875 vaccinations; they are not exactly but almost the same, because in the fourth column the figures are 5,899, 4,749, and 2,682 births, and 2,875, 10,007, and 3,005 vaccinations, so that they are with very slight variations, the same figures, in the other years from 1871 onwards, with a slight exception, they are exactly the same figures throughout. The result worked out is that the totals of the two final columns are made exactly or practically the same, 134,823 and 134,821 for births, and the total of small-pox deaths is the same, namely, 1,153 in one and 1,153 in the other, but the centre column is worked out as 110,122 in the one, and in the other 97,111. Now in your chart one finds a very different proportion of deaths to vaccination, a much greater proportion of deaths to vaccination in the one case than the other, but surely those must have been the figures for the same department; you ought surely not to have the same number of deaths and vaccinations year after year in the two departments?--I notice that now, and it is a great puzzle to me that I did not notice that at first. Is there nothing in the manuscript to show the difference? Is there no prefix to either of them?
7225. No.--It is a curious thing; I went straight past and did not notice it.
7226. One of them has the population given and the other not; why is it that one of them has not the population given?--That I took from the book for my own information.
7227. Does not that look as if those were two versions of the same information?--I am very sorry that I have not the original reports here which would enable me to go into that; it is a puzzle to me, I cannot go into it.
[[p. 17]] 7228-9. I do not understand how the one figure comes to be 110,122 and the other 97,110, as representing the vaccinations, because there is so little difference between the figures in the columns, there is not enough difference to enable one to make such a difference as that, there is only a difference of about 11 in the total figures.
(Sir William Savory.) The result of that difference of total is that it separates the one Vienne from the other Vienne in the chart by 18 places amongst the department?--Yes, but that depends upon the vaccinations.
7230. (Chairman.) But they are the same?--No, the total vaccinations are considerably different.
7231. Only 11 difference?--The figures are 4,855 and 5506, that is a considerable difference.
7232. (Sir William Savory.) There is 13,000 apparent difference between the totals of the two columns, and yet as the columns appear here there is actually only 11 difference?--There is evidently some mistake there; owing to the two names the figures have got mixed up and confused.
7233. Is not there a confusion between Vienne Haute and Vienne?--Yes, there is no doubt a confusion between them, owing to the two names being the same; I was quite unaware that the names were the same.
7234. (Dr. Bristowe.) Still the addition is wrong?--The addition is wrong, no doubt, but still there is the question whether in the original reports the figures are misplaced. I cannot understand it at all.
7235. (Chairman.) I did not quite gather why you said you had not put in the years 1868, 1869, and 1870; was it because they were not obtainable, or because you had not access to them?--They were not obtainable by us. We wrote to Paris for them and could not get them, though we tried to get them all we could.
7236. Was it because they were out of print?--I believe it was because they were out of print; very few of them are printed; there is no demand for them.
7237. (Sir William Savory.) Do not you know that they were published for the years 1868 and 1869 by the Academy?--I daresay they were published, but I do not know of my own knowledge.
7238. (Chairman.) You have not distinguished between vaccinations and re-vaccinations; that I understand was impossible?--I purposely did not distinguish between vaccinations and re-vaccinations, because it would have introduced a complication, and I did not consider it fair to leave out the re-vaccinations, because when you are running over a considerable series of years you ought to take the whole.
7239. Supposing you have small-pox present in any department, and therefore a considerable number of people re-vaccinated, do you think it would afford a satisfactory comparison with another department where you had had no re-vaccinations as to the state of vaccination?--It would not for one year, but when you take it over 20 years the chances are that they will balance each other, because you will have had the small-pox in all the departments more or less during the 20 years.
7240. Is it not the case that in some departments it has been constantly present more or less, whereas in others not at all?--No doubt; but I do not think that re-vaccinations are specially numerous in those departments.
7241. Have you taken pains at all to ascertain whether that is the case. It seems to me that in several departments there are a number of small-pox cases, and therefore people presumably alarmed, and on that account for several years you have the vaccinations exceeding the births, whereas one finds a considerable difference between the vaccinations and the births in previous years; would not that indicate that there had been a considerable amount of re-vaccination going on?--Yes.
7242. Whereas taking a department like Correze there had been no increase of vaccinations, over births since 1862, so that there had been nothing to stimulate vaccination there?--Yes; but I noticed that in some cases where the vaccination was very low there had been a considerable number of re-vaccinations; I did not think it fair to leave them out.
7243. There is no physical separation between department and department; have you inquired whether that may have occurred in the neighbourhood of a department where small-pox was going on?--But the departments are large, and it is hardly likely that what was going on just upon the boundary would affect the whole department to any great extent.
7244. But it would affect the whole calculation, would it not?--The labour of getting out those tables is very great, and dealing with the tables in any other way would involve an amount of detailed discussion to which literally there would have been no end, if in these 67 departments running over 20 years one had to examine all the details of the re-vaccinations, and not only that, but to try to find out why the re-vaccinations occurred.
7245. Let me take you over the Department of Correze; in Correze the high ratio of vaccination to births since 1871, in fact throughout from that date, has been pretty constant, has it not?--It has.
7246. The figures show a very high vaccination rate and not a very satisfactory rate as regards the relation to small-pox deaths, but the whole of the small-pox deaths took place in 1871 and 1872, and there has not been a single death since that date?--But also the high rate of vaccination has continued, showing that it was not the immediate fear of small-pox which caused it.
7247. But I am not now upon the question of the fear of small-pox, but upon the question of the preventive character of vaccination; it is true you have taken 20 years, but the whole of the death-rate upon those 20 years is concentrated in the year of the epidemic; since that date there has not been a single death from small-pox, but there has been a high vaccination rate. When you look at your general results, Correze stands as a place highly vaccinated, but with a bad record as regards small-pox mortality. Did you not think it necessary to look to see to what that bad record is attributable?--But the high vaccination rate began before the small-pox; it began in 1867.
7248. In 1866 there were 31 deaths from small-pox, and presumably a large proportion of the number put down as vaccinated were re-vaccinated. Take the year 1871: there were 18,000 vaccinations as against 9,000 births; you would not question that a great deal of that was re-vaccination owing to the epidemic?--No doubt.
7249. Do not you think it rather an important consideration to see whether the deaths were concentrated in a single year or distributed?--It is an important consideration, but I do not think it is a consideration which could be made the subject of statistics.
7250. But it is a consideration which would have to be taken into account in weighing the value of statistics, is it not?--If you can go into it in every department, yes; but I did not think it right to weigh it in one department and leave it out in others. You must weigh it in all departments, and, if you do that, then the labour would be beyond all human possibility; you would have to go into an endless inquiry if you dealt with such details; that is the very thing that broad statistics are intended to avoid. It would not be possible, in fact, for us to do it; the information is not given in the returns.
7251. Take Indre again, 47,000 vaccinations, 40,000 births, and 37 small-pox deaths; all those small-pox deaths except five in the last year occurred in 1871; there was not a single small-pox death between 1871 and 1887?--There were five in 1887, and between the two dates there were none, and that is the case in a great number of departments, but I do not see what one is to do; is one to leave those out?
7252. I am not saying that you are to leave them out, but one does not accept statistics blindfold; one inquires what they show?--One inquires what they show, no doubt.
7253. You would have one say, as I understand, that because of what your tables show, the conclusion to be drawn is that vaccination is the cause of small-pox; if one looks blindfold merely at the table is not that what it shows?--I do not think the difference is quite enough to show that, but it tends to show that.
7254. One is bound, is he not, to press one's investigations a little further?--Yes. Only what I would suggest is that the true way to press it further is to deal with a still larger body of statistics.
7255. Would it not be interesting to inquire what would be the result if you were to shut out the great epidemic of 1871-72?--I began to work it out with the intention of doing that, and then I thought I should [[p. 18]] have the objection made to me, why do you choose to leave out one year?
7256. You might have both?--It would be a very good thing to have both, and I very much wish that some competent statistician could get these statistics and more than I have got, and deal with them competently in a way that I have no doubt they can be dealt with.
7257. Take the Department of Sarthe; take the year 1871; there were 9,579 births, 2,767 vaccinations, and no small-pox deaths. Now Le Mans is one of the principal towns in the Department of Sarthe. The Report for that year states that in Le Mans the number of deaths was raised to 347 in 1870, and 832 in 1871. That occurs in the Report for the year 1871, under the heading Department de la Sarthe?--And may I ask does that occur in the same Report as those which I used?
7258. Yes. In the summary there are some notes which appear to indicate that they had not returns for the whole department, and that therefore there is no entry; you have treated it as meaning that there were no small-pox deaths, whereas in the body of the Report it is stated that there were 832 in the town of Le Mans alone?--That goes to show that the tables furnished were imperfect.
7259. Sarthe shows one of the smallest death-rates with a very moderate amount of vaccinations. If you were to take the deaths in Le Mans alone and add them to the others in that year it would make the ratio of death to vaccination very high, would it not?--Yes, if the return is imperfect and does not give the deaths that would be so, but I took it for granted that the tabular returns were complete.
7260. I do not think they put noughts in the tables; they put dots?--I do not think that the absence of a figure can make an imperfect record; it does not always.
7261. (Sir William Savory.) It does not mean "nothing"?--If it does not mean "nothing" it is impossible to say what it means; it some cases it must mean nothing, because the other figures are all apparently correct; there are the number of births, vaccinations, and cases, and dots for the number of deaths.
7262. (Chairman.) If these dots meant that they had not records for the whole, and therefore did not make the entry, that might invalidate some of these figures, might it not?--Yes, no doubt.
7263. (Professor Michael Foster.) Where is the entry for the Rhone Department in 1871; there is no entry?--No, there was a blank altogether then.
7264. That must make a great difference to the statistics of that department, the entire absence of the remarkable year 1871?--Yes, no doubt, but that seems to be balanced by the very heavy mortality in other years; of course, the epidemic was not universal.
7265. (Mr. Meadows White.) Is there any reference in the next year to the omitted returns of 1872?--No, I looked in a great many cases and found it was hopeless; they never referred to it except generally by some remark of the reporter that, unfortunately, many of the returns were defective. I should like to remark that throughout the whole of the 20 years' reports that I had, the figure 0 never once occurred, consequently I took it for granted that the dots must mean "0" otherwise it would follow that there was never a year in any of the departments (though sometimes there were very few small-pox cases) in which there were no deaths, and that would be exceedingly unlikely. I noted that, and wrote to a friend in Paris to get information as to what it meant, but I could get no information as to what it meant.
7266. (Chairman.) With the blanks as they appear you have made your average for the 19 years?--Yes.
7267. There are some very startling differences, you will observe, in the birth returns?--Yes, there are some very remarkable differences; but it only occurs in two or three departments; as a rule the births run very regularly indeed. My idea was that probably the returns were not made up when the report had to be given in, and that the births neglected to be given in in one year were added to the next and so made the inequality. That is the only way in which I can explain it.
7268. (Dr. Bristowe.) I suppose the same thing would apply to the vaccination returns?--Yes, there is no reference to it.
7269. (Chairman.) In La Vendée you have very striking variations; this might make considerable alterations in the figures necessarily?--No doubt it may make considerable alterations in the figures; the only question is how far they would affect the comparison, whether they would be likely to affect it more in one direction than in another. There are several departments in which the returns of vaccination are complete but nothing else.
7270. (Dr. Bristowe.) What are your deductions from those tables?--The results of the tables are exhibited in the diagram. If the tables are incorrect or incomplete, to that extent the result is imperfect. I have simply drawn out and obtained the proportionate statistics from the tables and put them in the form of that diagram; of course, I cannot be answerable for the tables otherwise, but they being official tables, published under the highest official authority of France and presented to the Government, I naturally concluded that the tables were correct.
7271. (Sir James Paget.) Are they published by the Government or by the Academy of Medicine?--They are published by the Government; they are presented by the Academy of Medicine to the Minister of Agriculture and published.
7272. (Chairman.) I see one instance which perhaps may afford one a guide to the extent to which there was sometimes re-vaccination. Take the Seine et Oise since 1872, when there were 12,869 births and 11,891 vaccinations, which is less by a thousand nearly than the births. I find after the general statement a report of a particular doctor, Monsieur le Docteur Le Duc, that of the vaccinations which he performed, 830 in number, 354 were primary and 476 were re-vaccinations; so that in the case of that particular doctor who vaccinated, more than half were re-vaccinations. Therefore one cannot conclude merely from the fact that the vaccination rate is below the birth rate that those were primary vaccinations?--No, not quite all, but in many cases there is a special note in the margin to say "plus" so many re-vaccinations.
7273. That is rare, is it not?--It is rather rare, but in these cases I added them on as re-vaccinations.
7274. In these tables they are all treated as vaccinations, yet in the report of this particular doctor they are more than half re-vaccinations?--Yes, but I thought it was more uniform to include them all when I could, there being sometimes a remark and sometimes no remark.
7275. We get here sometimes a remark, whether successful or not, of Doctor Le Duc's 354 primary vaccinations all were successful but three; of his re-vaccinations there were 196 successful, being at the rate of 191 out of 400 for the males, and 5 out of 10 for the females.
7276. (Sir Guyer Hunter.) In reference to the diagram before us, when you placed that before the Commission you said it was probably the most important that you had?--I thought so.
7277. You also mentioned the methods adopted by Messrs. Darwin and Tyndall in carrying out their researches; from that am I to infer that you attach great value to accuracy in scientific inquiries?--Of course.
7278. In your answers to Questions 7058 and 7059 you admit that you had not considered how far prior inoculation bore upon the statistics quoted by you in your answer to Question 7057?--I simply answered that I did not know whether the persons had been inoculated or not, because there were no means of getting at the fact.
7279. Then in answer to Question 7166 you admit that your conclusion in answer to Question 7165 might be vitiated if special conditions had to be taken into account?--Yes.
7280. Then in answer to Question 7074 you admitted that as regards the statistics of population included in the London Bills of Mortality you could not tell whether the London census and the London Bills of Mortality were the same, although this, as you state in answer to Question 7075, is "somewhat material"?--It is somewhat material, but if I made a mistake in that it would tell against myself, because the mistake I made was taking the population of London too large in the last century, consequently I should make the mortality in London in the last century appear less than it really was, and that would have been against my argument, [[p. 19]] which was that the enormous decrease at the beginning of the 18th century could not have been due to the amount of vaccination which was performed; therefore the mistake I made, if there is any mistake, was against myself.
7281. In answer to Question 7084 you admitted that as regards the 1,400,000 unvaccinated in London between the years 1800 and 1822 you had taken no note of those who had been protected either by having been inoculated or through having had small-pox, and in your answer to question 7086 you stated that you had left out of account those who were privately vaccinated; and in answer to question 7092 you stated that it is "probably impossible to get any accurate statistics"?--In answer to question 7086 I did not say that I had left out of account those who were vaccinated by private persons; I made an allowance for them; I might not have made sufficient allowance of course, because it is a matter of estimate only.
7282. You stated that the upper classes generally were vaccinated by private practitioners, "but that the lower and a large portion of the middle classes would be vaccinated at this institution"?--Yes, at this institution. I have allowed what I considered a sufficient amount for the higher classes who would be vaccinated privately by their own medical men.
7283. After that, may I now ask you, do you still regard the data which you have brought before the Commission in these respects as having the accuracy which a Darwin or a Tyndall would regard as requisite?--In some respects, yes; but, of course, where the official statistics are inaccurate it is to be wished that they were more accurate, but I did not manufacture the statistics, I only made use of them.
7284. Then with regard to certain statistics, in your answer to Question 7067 you admitted that you had not paid much attention to the statistics of the Metropolitan Asylums Board hospitals?--That was, I think, an oversight of myself in not clearly understanding the point, but I see that I had myself examined the statistics of the Metropolitan Asylums Board hospitals at the time when I published my little book and quoted those statistics. I see that they are included in the statistics I did examine, but I did not go into the details of them as regarded vaccinated and not vaccinated, because that is out of my department altogether; that is medical evidence.
7285. You quoted certain statistics relating to a century that is past?--Yes.
7286. And with regard to which we have no proof of accuracy: the discussion upon that point has already shown pretty clearly that there is a want of accuracy upon many points. You have also quoted the statistics of foreign countries, which we have no means of verifying, or the reverse; why did you select those statistics when you had at your disposal the more valuable statistics obtainable from the Registrar-General and the Metropolitan Asylums Board hospitals, those being official data obtainable in this country?--The answer to that is that a few years ago I published a little book, and confined myself strictly to the registration statistics in this country, and drew my inferences from the statistics furnished by the Registrar-General in this country only. Then some people said to me, Why did you not go back earlier than the century? Why did not you go back to the past century, and show the enormous amount of small-pox which there was then? I therefore give now a larger extent of statistics which, though not strictly accurate, are quite accurate enough for the purpose of showing the great contrast between the heavy small-pox mortality of the last century and the small-pox mortality at the present time. Nobody says that you want any great accuracy in large figures. Where you have a small-pox mortality of 1,000, or 1,500, or 2,000 in 1,000,000, accuracy is not of the slightest consequence for a comparison with the present mortality. It is not a matter in which minute accuracy is wanted; the differences are so large that minute accuracy is not needed.
7287. Do you think after the discussion we have just had with regard to the French table, that the inaccuracies pointed out with regard to it are of no importance?--I do not say that; I have been speaking now with regard to our own statistics of the previous century, and all the other diagrams I have brought forward with regard to Sweden and Prussia. Sweden is one of the countries in which the statistics are the most perfect in Europe. I do not consider that any doubt has been thrown upon these statistics; and as regards Prussia it is the same. Upon those relating to France there has been some doubt thrown; but if the data given officially are accurate, then to draw them out in this manner is the best means of getting accurate results. I took the data as I found them.
7288. Would you take the data if you knew they were wrong?--Certainly not, if I knew that they were wrong generally.
7289. But it was these you yourself have tried to impress upon us as being the most valuable?--So they are if they are generally correct; the question is whether the deficiency in the data will make a great difference in the result; it is quite a chance which way it turns, the one way or the other. I do not think it likely that there should be such an amount of inaccuracy as completely to reverse that diagram.
7290. (Professor Michael Foster.) I do not quite understand what you regard as the result of the table; your generalized diagrams are legitimately deduced from the details, and show a very close connexion between small-pox and vaccination, either that small-pox increases vaccination or that vaccination increases small-pox?--That is so, no doubt.
7291. What is the conclusion that you draw from the whole of that. By your larger diagram, as I understand, you show that there is no connexion between vaccination and small-pox, whereas your three diagrams at the end, which are legitimately deduced from the other, show that there is a definite connexion?--They do show that there is a definite connexion. When asked that question at the last meeting I said they did show it, but that I did not press that conclusion, because there were conditions which I could not go into, but which others might go into, which would show different results.
7292. There is a contradiction between your results, one being that there is no connexion between vaccination and small-pox, and the other that there is?--The diagram, looked at generally, shows that there is no apparent connexion, but when you follow it out by means of averages there is a connexion shown.
7293. (Chairman.) Supposing it to be shown in one department that a fear of small-pox produced vaccination, whereas in other departments the vaccination was mostly primary, would not that be likely to show the result which is produced, that you often find the largest amount of vaccination in the places where there was most small-pox?--If that happened for a great many years in a department it would produce that result, but my general impression from the tables was that that was not the case.
7294. Still, that you would admit as a possible connexion between the amount of vaccination and the number of deaths?--Yes.
7295. (Professor Michael Foster.) Did not the deaths from small-pox in 1871 range from 50 to 95 per cent. of the total deaths?--Yes.
7296. So you dilute the mortality of those years with the mortality of the whole 20 years?--Yes, I show the whole period.
7297. In this way you get that relation between small-pox and vaccination--that is to say, the increase of vaccination due to small-pox--which you say is apparent in your analysis, but which is not apparent upon a general survey of your diagram?--Perhaps you may, but the question is whether taking it over the whole period will do more than bring them to a balance?
7298. You have, as you say, legitimately drawn from your diagram a relation between small-pox and vaccination, and that is only intelligible upon one of two hypotheses--either that vaccination causes small-pox or small-pox causes vaccination?--I do not think those are the only two hypotheses.
7299. Or else the relation is only apparent and not real?--I think it might be due to the extreme mortality in certain places, either in the very unhealthy places or in towns.
7300-1. Either it is real or unreal; if it is real it must be that either vaccination causes small-pox or small-pox causes vaccination; if it is an unreal relation then we have to discuss how the unreality is introduced?
(Mr. Picton.) But is not the prevalence of small-pox in the more vaccinated districts very slight indeed.
(Professor Michael Foster.) It you look over all the details of your table you will see that wherever the [[p. 20]] small-pox rose up then the vaccination rose up?--The only other alternative is that there might be a great difference between the mortality of the departments depending purely on unsanitary conditions and unsanitary mode of life, as to that I do not know.
7302. But still all ranging so as to bring about that general result?--It does seem so.
7303. (Sir William Savory.) One more point with regard to the accuracy of these tables. Upon the first page under the head of High Alpes you reckon up the total and get 711 under the heading of "small-pox deaths," it is a simple question of addition, do you know that that really adds up to 1,011, that it is 300 out by simple addition, and that instead of giving a per-centage of 35.55 it gives a per-centage of 50.55?--Yes, apparently it does; that is a mistake evidently, but I do not think that there are many mistakes of addition of that kind, for I went over all of them twice.
7304. You would hardly like this table to go forth in this form as worthy of your scientific reputation, would you?--I have not had the opportunity of comparing it with my manuscript yet.
7305. But so much is at stake. Are these returns compulsory in the several departments?--That I do not know, except that they are official records, that is all we know of them; they are presented in the regular official form.
7306. Vaccination is not compulsory?--No, vaccination is not compulsory.
7307. So that young persons may be vaccinated at any age?--I presume they can; I do not know.
7308. Are not those very important facts? Have we not the important fact in our own country that between 1840 and 1853, before vaccination was made compulsory, when small-pox increased there was increased vaccination; and was it not in consequence of the discontent with that state of things, was not that one of the arguments used, that vaccination was made compulsory; is it not a very fair inference that there is a relation between the fear of small-pox and vaccination?--It may be explained in that way.
7309. At all events is not that inference more scientific than the one that you draw from it?--I do not see that that could make any difference when you have the same law for the whole country. In France you have no compulsion for one department more than the other.
7310. But is it not likely that the law would be obeyed with more strictness in one department then another?--That is shown by the diagram.
7311. Would not that invalidate the inference you draw from it?--My inference is drawn from the diagram.
7312. But you have not, as I submit, data sufficient to draw an inference?--That is a question.
7313. After what has occurred with regard to these tables do you still put forward this diagram as showing that vaccination instead of diminishing small-pox has rather an influence in increasing it?--I do not wish to put that forward as proved by this diagram, certainly.
7314. What conclusion do you ask us to draw?--The conclusion I would ask you to draw is what I stated first, namely, that there is no apparent connexion in a beneficial sense between vaccination and small-pox.
7315. (Professor Michael Foster.) But surely there is a direct connexion by your diagram between small-pox and vaccination?--Yes, but that may be caused by the point Lord Herschell has dwelt upon so much, the increased vaccination following epidemics.
7316. (Sir William Savory.) Would not that account for the whole?--No, I do not think it could possibly account for the whole.
7317. Would not the returns from some departments be more accurate than those of others; in some departments you would get a higher ratio in both, in other departments where they are more lax and where you do not know that vaccination is compulsory, or even that the making of returns is compulsory, would that not affect it?--Yes.
7318. Seeing these results are in striking contrast to our own Registrar-General's returns, do you think that they are likely to be as accurate as his?--There is nothing comparable in our own returns because we have not got the comparison between populations very much more vaccinated and very much less vaccinated. We cannot make a comparison between different populations as in the different parts of France.
7319. We can construct a table from our returns showing the relation of vaccination to small-pox more accurate than those diagrams appear to be?--Those facts I have used myself in the previous diagram; still I quite admit that the errors which have been pointed out, and the doubt thrown upon the tables themselves as to the meaning of the dots, whether they mean no deaths at all, or no returns, are such as to render the result untrustworthy.
7320. Why did you choose that particular 20 years?--I choose it because it was the only 20 years I could get; it is the last 20 years and comes down to the present time.
7321. But do not you see that in those 20 years you start immediately with an epidemic?--The first three years were obtained by Mr. Gibbs; he lent me those to start with. I saw the little value of such a short period, and I tried to get complete successive years down to the last published, and I succeeded in getting all, except the three years before 1871.
7322. There is a grave statistical defect in it at all events of beginning with the great European epidemic of 1872?--I do not think that is a statistical defect if you have a sufficiently long series of years, because small-pox is an epidemic disease, and if you leave out the epidemics you leave out the essential thing.
7323. If you have several epidemics, that is all right, but that is no argument, having only one epidemic, for beginning with that?--If you leave out the epidemics in the 20 years you entirely falsify the result.
7324. (Chairman.) Only may not the epidemics in any particular department have been so severe and the deaths in subsequent years so few that to include that epidemic in that particular department swamps, so to speak, the result of 20 years; that it is so enormously disproportionate to anything you find afterwards that spreading it over 20 years would give an inaccurate view of the whole. Is it not dangerous if you have a specially exceptional time affecting the particular number of years you are dealing with?--It would if you had a very short number of years, say six or eight or ten; I should very much prefer to have an earlier period of 20 years to add to my 20, but the most serious difficulty I feel now is from the uncertainty as to the accuracy of the tables themselves; if the tables are inaccurate, that is to say, if they do not give the years in which there were no deaths, then, of course, I admit the whole thing is uncertain and valueless.
7325. Take Vienne with its 1,153 small-pox deaths over the 20 years; that will give, roughly speaking, something over 50 per year, including the epidemic, if you average it; but of those 1,072 deaths occurred in one year?--It is a question whether the epidemic of that year was not the cause of the immunity afterwards by simply killing off the susceptible people.
7326. It could hardly be so, because taking the Vosges, out of 1,786 small-pox deaths, 1,759 were in the one year 1871; there must have been a number of people in existence who could not have been affected by the epidemic of 1871?--No doubt, but still the population of the department is nearly 400,000.
7327. (Sir William Savory.) Would not the fact of the Franco-German war which began in 1870, the investment of Paris upon the 19th of September, and the capitulation on the 27th of January 1871, have an influence?--It might; but I do not see how we are to deal with it upon a question of the mortality except by leaving it out altogether.
7328. Assuming the probability or possibility that these are disturbing causes of accuracy, surely that invalidates your table very materially?--I do not think it does, if the table is long enough; it is a question of the period it extends over.
7329. (Sir James Paget.) But the war not equally effective in different parts of France?--That was the reason which induced me not to leave it out, because many parts were not affected by it.
7330. (Sir William Savory.) Do you know that small-pox was intensely prevalent amongst the besieged garrison of Paris?--I have heard of that, but that would affect Paris itself; and the Department of the Seine, strange to say, does not come out the worst although it was so bad.
7331. (Dr. Bristowe.) Was not that because the cases of death from small-pox in Paris during the war were not enumerated, and therefore were left out?--No doubt it was, that might have been very possible.
[[p. 21]] 7332. (Mr. Meadows White.) I thought you had excluded Paris from your table?--I have excluded Paris from the results in the diagrams of averages, because of the inequality of the area, but it comes in at this part of the large diagram near the middle and does not affect the result at all. I give the Seine in my Table H.
7333. (Mr. Picton.) With regard to the proposed omission of the epidemic of 1871, would you expect vaccination to have no effect upon an epidemic?--I do not understand the point of the question.
7334. If vaccination prevents small-pox, it ought to prevent it in a time of epidemic?--That is my point of course; that is the reason I did not leave it out; I thought it would not be fair to leave it out.
7335. Might I ask you if I have formed a right conception of your intention in this diagram and the table? Is it your idea that, taking a range of 20 years, and the number of departments that you have analysed, there is sufficient generalisation to eliminate the effect of slight errors here?--Certainly, it is my opinion that there is enough to eliminate the effect of slight errors and also to eliminate the effect of diverse conditions such as inequality of vaccination, and things of that kind; but I admit that if the tables themselves are imperfect, it entirely invalidates the whole thing.
7336. But if the tables are imperfect, that may tell in both directions, may it not?--That is what I suggest, that it might tell in both directions unless the imperfection is very gross indeed. Then of course it might be very much more in some departments than in others.
7337. (Sir James Paget.) When you say it might tell in both directions, does it necessarily follow? Have we the right to assume that it does tell in either? Have we the right to conclude anything from that which might tell in either direction?--No; with regard to the errors, if the errors are as large as is suggested, and as they may be, and I own there is great doubt about it, then I admit that you cannot draw any conclusion from the whole table.
7338. (Professor Michael Foster.) But what Mr. Picton meant was that when the table had been rectified the rectification might tend in the direction of your conclusion?--Certainly, that is quite possible.
7339. (Mr. Picton.) As to the purpose of the diagram, you were asked whether you thought any relation was established between vaccination and small-pox, and you said you thought not, was not that so?--My conclusion was that it did not show any beneficial relation between vaccination and small-pox mortality.
7340. But if there is a beneficial relation between vaccination and small-pox mortality, you would expect that where there is more vaccination there should be less small-pox?--Certainly.
7341. And where there is less vaccination there should be more shall-pox?--Certainly, that is the very thing I endeavoured to arrive at by means of this diagram. The diagram had not come out as I expected, for I never expected it would produce that result; the utmost I expected was that it would show an indifferent result, I was surprised very much when that result came out.
7342. Do you still think that that final result does away with the indifference of the returns?--If the tables were quite accurate and it could not be shown that there were any special conditions affecting it then it would go in the way you suggest.
7343. The tables are not perfect?--The tables are not perfect.
7344. Therefore there may be an accidental effect upon the final conclusion?--What I now see, and am afraid of, is that the imperfection is very great and very irregular. If it is the fact that these dots often mean "no returns" then of course it is defective, but I took the dots in the column of deaths where cases are given as they are in almost all of them to mean "no deaths." If that is not the case, and that the fact of no deaths is never recorded at all, then of course the whole thing is imperfect I admit.
7345. (Chairman.) It is possible, and I am not sure if it is not so, that the dots may sometimes mean "no returns," and sometimes that there are no deaths: sometimes that there has been nothing to report, and at other times that it is not reported?--If so the whole thing is valueless.
7346. (Mr. Picton.) When you were asked why you took a foreign country you said you could not find in our country the possibility of comparing districts of more or less vaccination, but you are aware that there are districts of less vaccination and of more vaccination?--I am not aware that there are any districts in which there are differences at all comparable to the differences in the districts in France, or extending over a long series of years.
7347. Are you aware that Sheffield, for instance, is a very highly vaccinated town?--Yes.
7348. Leicester, on the other hand, being scarcely vaccinated at all?--That is so; but that has not been going on long enough to give any definite result.
7349. (Mr. Hutchinson.) You admit that Mr. Gibbs' periods were too short?--He really only took one year.
7350. You candidly admit that your table is inaccurate. Now supposing it were accurate and were divided into two 10-year periods, is it not possible that the relation of those lines would be quite reversed, and you might find that one of those which has a very tall black column might have a very low one?--But I have divided it into two 10-year periods; the one column shows the result of two 10-year periods, the next of two 20-year periods, and the last the division into half.
7351. It seems to me that your table merely represents the occurrence of results to a certain extent accidental, and that in the next 20 years you might have epidemics occurring here and not there, and you would have the column varying very generally?--I admit that the data are inaccurate, but still as far as they go the results appear to be very singular. I could not believe that even in 20 years, if there were a definite and constant relation between the amount of vaccination as a protection and small-pox, this result would not have come out in 20 years, the results would have balanced themselves in 20 years.
7352. In the places where a high mortality is shown it almost always occurred during a short period, only a year or two, and an epidemic?--Not always; some of the worst run right through the series of years.
7353. How do you explain the very rapid cessation of the epidemic in most places. In one column there frequently occurs a high mortality in one year, and then a series of years without any deaths?--Is it not the same to a considerable extent in England; that when an epidemic ceases you have perfect freedom?
7354. I am asking your opinion as to what induced it to cease so quickly?--That, again, is a medical question which I have not gone into at all.
7355. You know what the medical answer to that would be perhaps?--No, I did not know that it had ever been discussed medically.
7356. Supposing the answer to be this: that during the epidemic vaccination was in rapid progress, that the population all got vaccinated, and therefore the epidemic ceased on that account, should you see anything to object to in that theory?--It all depends upon one's antecedent belief in vaccination.
7357. That is the theory a medical man would give; have you any other?--I suggest my own, and that that will not apply to a series of 20 years, it will apply to the next year.
7358. (Professor Michael Foster.) Could not you call attention to the fact that epidemics ceased suddenly before vaccination?--That agrees with my interpretation, that the susceptible people had died out.
7359. (Mr. Hutchinson.) That the susceptible people would have been exhausted, but very rapidly exhausted?--Yes; there was a remarkable case in the diagram of Sweden. In the two first years of this century there was an enormous epidemic in Sweden, and in the next year it was down near the very bottom with a very small mortality indeed.
7360. Have you no suggestion to explain that?--Yes, my suggestion is that the community is divided between those susceptible of small-pox and those not susceptible; in a bad epidemic almost all the susceptible have it and get over it, or have it and die.
7361. Can you point to any comparable occurrence before the introduction of vaccination?--I have already pointed to the epidemic in Sweden, which was before the introduction of vaccination.
[[p. 22]] 7362. In what year was that?--In the very first year of the century, I think. There is a tremendous descent.
7363. But not the sudden cessation that we get in your table of recent epidemics?--No.
7364. And as comparing the time before vaccination and the time since, has not a remarkable feature of late been the shortness of the epidemics?--Generally, I think so.
7365. The others lasted a longer time, and did not really leave the locality?--The epidemic in Scotland in 1864 lasted four years, I think.
7366. You know possibly that the mortality is supposed to be greater now amongst those not vaccinated who contract small-pox, than it was in pre-vaccination times?--Yes.
7367. Considerably higher?--Yes.
7368. Have you any theory to explain that?--That is a medical question which I do not profess to go into; all I can say is that the explanations given upon our side of the question satisfy me.
7369. That would account for part of your apparent results of the mortality from epidemics in places which are yet well vaccinated; if the mortality is greater than it was in former times, the difference being as between 17 and 31 per cent., that explains a good deal?--No doubt.
7370. (Dr. Collins.) I gather that you were not aware before to-day that the signification of the two dots in some columns might be different in different places?--No.
7371. That, I presume, you consider to be a somewhat important criticism?--Not only important but vitally important; and I say if you cannot tell by the tables whether it was a case of no deaths, or simply of no returns with perhaps hundreds of deaths, the whole thing is valueless, I admit.
7372. I understood you to say that in going through the reports, you find that in certain years and certain places returns are given of small-pox cases, but that in many cases two dots occur opposite the corresponding year and place?--Yes, in many cases.
7373. Have you any reason to suppose that the small-pox cases are returned with more accuracy than the deaths?--If the dots merely mean no returns they are returned with less accuracy, but I do not see why it should be, it certainly appears to be more reasonable to suppose that the dots meant that there were no deaths.
7374. At any rate you think the more reasonable presumption to be in those cases in which there are figures and two dots only for the deaths that they were cases, but that they did not prove fatal?--I thought so, and I think so still.
7376. Lozere, I think, is the only other?--That is one, that makes three, I think; in all the others they seem to have had a more or less large mortality in that year.
7377. So that there are only three departments apparently in which there are no deaths from small-pox?--Yes.
7378. But in one other, the Rhone, there are no returns either for births, vaccinations, or small-pox deaths in 1871?--No, there are no returns at all.
7379. What is the total result in the Rhone district as regards the small-pox rate and the births?--The proportion of deaths is rather low, 0.54.
7380. And in the Sarthe district?--In the Sarthe district it is low also.
7381. Is there much difference between the two?--Yes, Sarthe is very much lower; it is not much above one twentieth of the Rhone.
7382. Although in both of them the epidemic of 1871 was excluded?--Yes.
7383. (Chairman.) No, in Sarthe the epidemic was not excluded; the deaths are not taken there, but the vaccinations are.
7384. (Dr. Collins.) I suppose you have no reason to know one way or another as to whether the signification of "no returns" to be read for the two dots applies to any other year than 1871 of the returns?--I cannot say at all.
7385. (Sir W. Savory.) But the epidemic, you know, extended over more years than the year 1871?--Yes.
7386. (Chairman.) In Sarthe it applies to 1872 also, because in Sarthe there is the mention that the epidemic had very much diminished and was disappearing, but that there were still some deaths?--In the Pyrenees Basses there are 244 deaths in 1872, but it diminished generally very much after 1871. I do not think there is any place in which the deaths were as many in 1872 as in 1871.
7387. (Dr. Collins.) Having regard to the criticisms which you have heard and the argumentative questions which have been addressed to you, do you consider, as I think you said, that the table is rendered wholly valueless?--Yes, for this purpose I should say it is; I should prefer to withdraw it.
7388. (Sir James Paget.) In your evidence you stated that it is quite clear that there is an immense diminution in the prevalence of small-pox as between the last century and the present; that the prevalence of small-pox in this century has always been far less than in the corresponding period of the last century?--With the exception of the epidemics certainly.
7389. That has been the case not only in this country but throughout Europe?--Yes.
7390. And in America?--America I know nothing about. I have seen no statistics.
7391. But throughout Europe there has been a great diminution in its prevalence?--Yes.
7392. May I ask to what you ascribe the diminution of its prevalence throughout Europe?--It is very difficult to determine what has caused the diminution of any disease. I cannot say what has caused the plague to die out, nor can I say what caused the leprosy or the scurvy to die out in this country.
7393. Is it not known what has caused scurvy to diminish?--It is known to a considerable extent, no doubt, and I presume the same general causes have led to it. Of course, I have been dealing entirely with London only, and in London, I think the causes are very easy to be seen. It was just about the termination of the last or the beginning of this century that the enormous extension of London took place in the suburbs, or what we call now the West End. Streets have gradually spread all round London so as to make London an entirely different city from what it was in the last century, when it was crowded, undrained, and, according to all accounts, in the most horribly unsanitary condition.
7394. To that you would ascribe a great deal of the diminution of small-pox?--To that, with the change of habits. We had the introduction of a much larger supply of fresh vegetable and fruit into London in the early part of the century; we have extended the use of tea and coffee, and have adopted different habits and better habits, better drainage and more cleanliness; every sanitary habit has come into use since the beginning of this century, and has increased down to the present time.
7395. Was the change in the sanitary condition as sudden and as complete or great as the diminution of small-pox?--It would require a very elaborate historical inquiry to go into that, but the diminution of small-pox in London was tolerably sudden, though not so very sudden as it has been in other countries.
7396. Taking the two periods of the 20 last years of the last century and the 20 first years of this, do you think the difference in sanitary conditions could have been so great as the contrast in the prevalence of small-pox between the two periods?--There was a very great difference, and one cause which has been often assigned has been the cessation of the practice of inoculation. That also has no doubt operated.
7397. But the diminution of small-pox was coincident in nearly all the countries of Europe; were there corresponding changes in the sanitary conditions of all the countries of Europe?--That I cannot say.
[[p. 23]] 7398. Is there any reason to believe there were?--That I am unable to say. The change has taken place undoubtedly, but how far it took place and exactly when it would require a person well acquainted with each country to determine.
7399. Has there been any change in all the countries of Europe corresponding to that in London coincident with the diminution of small-pox?--That I cannot say at all.
7400. It has been said, I suppose with some truth, that in the East Indies and the West Indian islands and elsewhere, the introduction of vaccination has been followed by a great diminution of small-pox; may that be generally accepted as true?--I think I have seen statements rather to the reverse effect.
7401. Where are they to be found?--I cannot say at the moment, but I think I have read reports from officials in India to the effect that small-pox is spreading very much since the introduction of vaccination; but it is mere memory; I can give no authorities at all.
7402. There are no official records of that, are there?--Not that I can lay my hand upon.
7403. Would it be true in nearly every case that there has been a diminution of small-pox following upon vaccination?--I admit the diminution of small-pox, but the whole question is as to the cause of the diminution.
7404. Where vaccination has been introduced later than the beginning of this century the same result has followed in small-pox, has it not?--That is a general question about which I know nothing; I cannot answer that.
7405. Would you be disposed to assign the contrast between the prevalence of small-pox in the beginning of this century and the end of the last to sanitary conditions?--To general changes, and to the cessation of inoculation.
7406. The exercise of inoculation was not supposed to increase materially the mortality from small-pox in the last century, was it?--It has always been quoted as doing so.
7407. You yourself stated in the course of your evidence that the practice of inoculation was diminishing in the last 20 years of the last century?--Yes, and the small-pox mortality was diminishing in the last 20 years of the last century.
7408. Was not inoculation diminishing much more in the first 20 years of this century?--Yes.
7409. It was diminishing, was it not, at a far greater rate than small-pox was diminishing?--Yes, perhaps it was. I believe that the figures show that the 17th century mortality from small-pox was not so bad as that of the 18th century, generally speaking.
7410. (Chairman.) Is it not the fact that the last 10 years of the last century do not seem to show very much change as compared with the 10 preceding years?--No, I think not.
7411. I am referring to the diagram; the variation of the height of the columns differs somewhat, but if you compare 1780-90 with 1790-1800, there does not seem to be much to choose between them?--No; but Mr. Farr stated from his examination of the statistics that there was a decided diminution in the last 20 years of the century as compared with the preceding 20 years.
7412. But that does not appear upon the diagram?--It does not.
7413. (Sir James Paget.) Has there been a corresponding diminution in the prevalence of other epidemics than small-pox under improved sanitation; scarlet fever, for example?--I think there has been a corresponding diminution of typhus fever, which I show upon this diagram.
7414. But were you aware of the number of diseases which were included under the name of fever at that time which are now separated from it?--Yes, but I am speaking of the period since official registration; there is a decided diminution of typhus, quite as much as of small-pox.
7415. But that did not begin, according to the tables, till 30 or 40 years later than the diminution of small-pox; take the tables of the present registration, that was much later than the beginning of the century?--I have not examined the tables for typhus from the beginning of the century.
7416. The number of cases recorded as "fever" in this century has been diminished by the separation of cases which were not subsequently included under "fever"?--That is so.
7417. Taking such cases as scarlet fever or whooping cough, which are often cited, they have not diminished in anything like the same proportion as small-pox did; are we to suppose that there were special sanitary conditions which affect the occurrence of small-pox?--There are a great many opinions upon that point; there is the evidence and the opinion, which no doubt you will have before you, with reference to the fact that the diminution of small-pox does not imply a diminution of the total mortality, that it is made up by other diseases; but that is a question of purely medical statistics, to which I do not wish to pay any special attention.
7418. Now, as a method of testing the result, would it not be fair to take the case of persons living under exactly the same conditions, the same class of population with the same habits of life, and then to see whether the vaccinated have less small-pox than the unvaccinated?--Yes, certainly, if you could get population living under the same conditions.
7419. Take the whole population of Sheffield and the returns we have from Dr. Barry; they are, on the whole, very similar; I think I may say that in every instance Dr. Barry found the vaccinated less susceptible to small-pox than the unvaccinated?--Yes, but that, of course involves a question I do not wish to go into, but which, no doubt, you will have before you, as to the accuracy of the distinction between the vaccinated and the unvaccinated.
7420. But he has distinguished them by taking the vaccinated, on the one side, and the unvaccinated and doubtful on the other side, and the vaccinated still show a majority of cases of immunity?--Perhaps so; that is, as I say, a point upon which I do not wish to give evidence.
7421. Is it not fairer to take that case and other cases like it as a simpler example of the influence of vaccination than to take the whole of France, with populations so unlike and with returns in which there are evident uncertainties?--I do not see myself that the case of the vaccinated and the unvaccinated in a town is such a simple case, because the unvaccinated would be necessarily, to a very large extent, of the very lowest class, including the tramps and the criminal classes, and also children who were too delicate to be vaccinated, and children who got small-pox before they were vaccinated, and involving a number of conditions which render the separation between the vaccinated and the unvaccinated not a fair separation.
7422. Taking what you say, that the poor are much less vaccinated than the rich, is that really true?--I think it is if you take the poor down to the very dregs of the population.
7423. I speak rather of the ordinary inhabitants of a place--the children in the schools, or children in the same ranks of life; is there so important a difference between the conditions of the vaccinated and the unvaccinated as there is in their susceptibility to small-pox?--I cannot give an opinion upon that; we have, however, other statistics which exactly contradict those of Sheffield; we have the celebrated statistics of Dr. Keller in Austria.
7424. May I ask whether you are aware that Dr. Keller's statistics have been found to be partly false?--I am not aware of that.
7425. (Chairman.) Are you aware they have been gravely called in question?--I am aware that every statistic is called in question by those who do not like the results produced from it.
7426. (Sir James Paget.) Are you aware that the statistics which he quoted have been examined and found not to justify the results he collected from them?--I have seen that stated, but I have seen it contradicted again.
7427. We may take it that Dr. Keller's statistics are not now received as unquestioned; but taking our own country, are there any statistics upon which the vaccinated have presented a larger proportion of cases of small-pox than the unvaccinated?--I cannot say; but, as I have said already, I do not think the two cases are comparable; it is impossible here to get two com- [[p. 24]] parable populations. In Leicester, in another 20 years, we shall have it, but as yet we have not had two populations comparable, one vaccinated and one unvaccinated.
7428. Taking another condition, that of the isolation of every case of small-pox, that would be a condition very gravely affecting the occurrence of the disease, would it not?--That can be done in one place as well as another.
7429. But you are aware that it has not been?--I cannot say.
7430. (Chairman.) Whether it has been done or not, in making the comparison you would have to consider it as a factor of importance whether in one place it had been done and in others it had not?--Certainly; but those are points which are entirely connected with modern medical history, a subject upon which I do not profess to give an opinion. Though I have read a good deal upon the subject, I have no first-hand knowledge upon the subject.
7431. (Sir James Paget.) May we not take it that such facts bear with importance upon the question whether the diminution of small-pox in this century could be deemed to be due to sanitation to the complete exclusion of vaccination?--Of course it can be taken into consideration if the statistics are perfectly trustworthy.
7432. You would regard the introduction of vaccination and the diminution of small-pox as what may be called a casual coincidence?--Yes, as a casual coincidence.
7433. Do you think it is reasonable to believe that the whole of the medical observers of that time were deceived?--My own opinion is that they were deceived; but, of course, that is solely a matter of opinion.
7434. But throughout Europe?--I do not see any evidence, in the extreme rapidity with which the practice of vaccination was accepted, that there was any careful investigation of the subject before they accepted it.
7435. (Professor Michael Foster.) Have you studied that part of the subject?--I have only read upon it, but I do not wish to give an opinion upon it.
7436. Do you think that the men who had an idea that they were making an experimental investigation into the matter, on the one hand inoculating and on the other hand observing cases of exposure to infection, were not capable of making observations?--I think their observations were not so conclusive as they thought they were; I thought that was universally admitted now.
7437. (Sir James Paget.) In what sense?--The conclusions stated by Jenner and his contemporaries were that vaccination prevented small-pox absolutely during the whole of life.
7438. But would it do more than modify that statement if it could be shown that they were mistaken in claiming absolute protection for it?--No doubt; but it shows the frame of mind in which they were when from the experience of two or three years they jumped to the conclusion that it gave protection during the whole of life; seeing that the numerous cases of small-pox after vaccination compelled them to give it up.
7439. Do you think that all the best medical observers of that time, the beginning of this century, were completely mistaken in thinking that vaccination did protect from small-pox?--I think they were mistaken in considering that it was a protection at all, but especially mistaken and more than mistaken in believing that it acted for a whole lifetime.
7440. (Professor Michael Foster.) You have read the record, that persons were inoculated and exposed to contagion and no small-pox followed?--Yes, but there are a great many persons who are insusceptible.
7441. (Chairman.) Supposing a person who had been in the habit of inoculating, and had been, therefore, accustomed to watch for years the results of inoculation, afterwards inoculates a number of vaccinated persons, and then comes to the conclusion that vaccination is a protection, must he not have seen something different from the ordinary course of things to lead him to that conclusion?--I presume he had.
7442. (Professor Michael Foster.) Do you think that in the hundreds of cases in which this trial was made they happened to hit upon unsusceptible persons?--As a matter of fact, as far as I am aware, there were not hundreds of cases, nor did they all succeed.
7443. There were hundreds.--I do not profess to know more than superficially the medical history of it.
7444. You are speaking generally?--Yes.
7445. (Sir James Paget.) May I ask you, for example, whether you think, as Lord Herschell puts it, that those who had been in the habit of inoculating could discern no difference between the results of inoculation upon those who had been previously vaccinated, and the results of inoculation upon those who were unvaccinated?--No doubt they could observe the difference, but I cannot judge what happened so long ago; moreover, a great many of those inoculations seem to have been made immediately after vaccination, and I apprehend it is quite possible that the vaccination itself should have rendered them insusceptible to an immediate inoculation.
7446. But many were not so treated?--No doubt.
7447. (Dr. Bristowe.) Is not that really granting the whole case of the vaccinators, to say that vaccination rendered persons insusceptible to a following inoculation?--Not at all; I have no knowledge of medicine or of the theories of medicine, but I have seen it stated as a general physiological fact that almost any disease has the effect of preventing the taking of another disease immediately afterwards.
7448. What is your authority for that?--I forget really; I do not profess to give any authority for these things, that is only my impression.
7449. (Professor Michael Foster.) Do not you know that vaccine and small-pox can run together in the same body?--I thought it was very rare.
7450. (Sir James Paget.) Is it not the fact that if a person be inoculated with small-pox within a week of his being vaccinated both the diseases will appear?--You are now asking medical questions about which I know nothing whatever.
7451. (Chairman.) Would not any inaccuracy or blunder in the record of those experiments where there was an actual inoculation of small-pox after vaccination be a factor of some importance in judging whether vaccination was or was not to some extent a protection. If a certain number of competent persons in the habit of inoculating observed that when they inoculated after vaccination there was some difference observable from that which was seen when they inoculated without or before vaccination, would not that go to show, if observed by a number of people in different places, that there was some relation between vaccination and small-pox?--It was thought to prove it at the time, but I do not profess to have any medical knowledge. As you are aware, there are many eminent men who have medical knowledge who answer your question decidedly in the negative. I answer your question upon my own conclusion.
7452. You do not mean to say that you accept that conclusion because you have weighed it against other opinions and judged it the better, but because it accords with the conclusion you have formed from other data?--Upon ordinary reading I have weighed the one against the other so far as I could judge; but as I say I do not wish to give any opinion upon the medical aspect of the matter, I confine myself to this point which appears upon this report, the words have been repeated several times that, after the first 40 or 50 years "the evidence for vaccination must now be statistical." Those are words used, I forget whether by Dr. Farr or somebody else; I think they are adopted in this report by Sir John Simon himself, that "after a certain time the evidence must now be statistical." Consequently, I say, we have to put all the early experiments aside, the question is, Does it succeed or not. I have endeavoured to show before you upon the earlier diagrams, that with increasing vaccination that result has not been produced, but that there has been no diminution but in some cases an actual increase of small-pox. That is the vital question after all at the present day. Is small-pox mortality done away with as it was promised it should be by the extension of vaccination. Now we have had an extension of vaccination apparently to the utmost limits of which it is [[p. 25]] capable as far as primary vaccination goes, still there is no diminution of small-pox and in some cases there is a decided increase in the virulence of epidemics.
7453. (Sir James Paget.) In what countries is there an increase in the virulence of epidemics?--That has been so in Berlin, Vienna, and Stockholm, the last two especially.
7455. Does that diagram show the total deaths or the deaths per 100,000, or per 1,000,000?--The whole of my diagrams show deaths per 1,000,000.
7456. (Professor Michael Foster.) The epidemic of 1874 in Sweden was very much less than the epidemic of 1809 in the whole of Sweden?--Whatever it is it is shown on my diagram.
7457. (Sir James Paget.) The epidemic of 1874 had a mortality of 935 per 1,000,000 and the epidemic of 1784 had a mortality of 5,800 per 1,000,000. There is no epidemic of this century which comes within more than one third of the mortality of the epidemics of the previous century?--Not in the case of a whole country like Sweden, but in the case of cities there is.
7458. With regard to the mortality in Stockholm, have you compared the death-rate in 1874 of the epidemic in Stockholm with the death rate of the epidemic of 1784 in Stockholm?--My point was not a comparison with the last century; I admit there has been an enormous decrease in the prevalence of small-pox in this century. The point I called attention to was the increase of the epidemic during the present century coincident with the increase in vaccination.
7459. (Chairman.) But has there been an increase of vaccination? I think we are told that Stockholm was very early a very well vaccinated place, has there been any particular increase in vaccination there?--Vaccination was made compulsory in 1817, but as it was made compulsory upon infants only it would not have covered the whole population till 40 or 50 years afterwards.
7460. (Sir James Paget.) But why should we not compare Sweden as a whole as well as Stockholm? Taking the whole of Sweden there has been an immense diminution in the mortality from epidemics?--Compared with the last century, but not compared with the early part of the present century; the last one is as severe as the one at the beginning of the century, that is the point.
7461. That vaccination does not wholly prevent an epidemic?--Exactly; that vaccination carried on as well as it can be apparently (because if it had been carried on in the same way the whole population would have felt the benefit of it) does not afford protection, because when you get an epidemic which kills 7,500 per 1,000,000 that is something dreadful.
7462. But has that epidemic destroyed more in this century than the last?--I do not suppose it has destroyed half as many in this century as in the last.
7463. But you regard that as the result of sanitation rather than of vaccination?--I do not know from what it results.
7464. (Chairman.) If it results from sanitation, taking those places where small-pox is supposed to have disappeared by reason of sanitation, why should they have these tremendous outbreaks at any particular date?--That is going beyond the evidence that I wish to give, which is merely that vaccination carried out to its fullest extent has not prevented the spread of small-pox. It is impossible for me to give any reasonable or probable account of why small-pox has decreased in this century and then increased again.
7465. (Sir James Paget.) Have you any knowledge of what number of persons in Sweden are unvaccinated?--I have none whatever, except that it has been always supposed to be a well-vaccinated country.
7466. Supposing that there were left 10 per cent. unvaccinated that would leave 400,000 unprotected?--If that is a satisfactory explanation to those who advocate vaccination it is not to me; it is a means of explaining it, but it is not a satisfactory result to me to have to see such a number as that shown by the diagram for the epidemic of 1874.
7467. Is there any return of the number of people unvaccinated?--That is entirely beside the question to me; our legislation should be for the saving of human life and not saving certain persons while permitting the destruction of others.
7468. (Chairman.) But supposing small-pox has become a more severe disease than it was, so that of the people unprotected it kills a larger proportion than it did, is it inconsistent with such a hypothesis that you should find a very large number of deaths although vaccination may have saved a great number of lives?--I do not admit the hypothesis.
7469. But assuming the hypothesis to be a correct one, that would explain the phenomenon, would it not? If that were established you would admit that vaccination had done some good, would you not?--Then one must suppose that small-pox has become more virulent from 1820 down to the present time.
7470. (Mr. Hutchinson.) In the earlier period they vaccinated adults, did they not?--I presume some adults would be vaccinated who chose.
Adjourned till Wednesday next at 1 o'clock.
* * *
THE RIGHT HON. THE LORD HERSCHELL IN THE CHAIR.
Sir JAMES PAGET, Bart.
Mr. BRET INCE, Secretary.
7471. (Sir William Savory.) Upon the first day of your examination you handed in a diagram headed "A Century of London Small-Pox," will you just tell us what you consider the chief points shown in that diagram are?--The chief point that I consider that that diagram shows is that from about 1822 to the end of the diagrams, 1884, there is no decrease of small-pox comparable to the admitted increase of vaccination.
7472. Will you just refer, please, to an answer given by Dr. Ogle (in the first report of the Commission) to Question 341. I think you see in that that he has made a diagram of certain periods of years which include pretty well the same time as is included in your diagram; he starts with the period from 1771 to 1780, and then he takes the period from 1871 to 1880, and he compares the relative mortality from small-pox in those different periods; do you consider that those results correspond with yours?--I really see nothing but what is admitted with regard to the higher amount of small-pox mortality in the 16th and 17th centuries compared with the 18th. At the end of the answer I see something to the effect that he is working upon the assumption, which I admit is a true assumption, that the death-rate was higher in the 17th and 18th centuries than it is now.
7473. But taking the last period, 1871 to 1880, he says the deaths from small-pox were 20 per 1,000 from all causes, and then he goes back 100 years and finds that the small-pox deaths were 97 per 1,000?--But I do not think that it is a fair comparison to take a corresponding period in the last century, because the small-pox mortality diminished at the end of the century, before the introduction of vaccination.
7474. But what would be your explanation of the relative mortality from small-pox in those two periods given by Dr. Ogle?--I tried to give a general notion of what my opinion was as regards the causes of it upon the first day of my examination.
7475. You said, I think, that vaccination had nothing to do with it?--I do not think it had anything to do with it, but I would like to add another fact, which I think is a contributory cause with regard to London, that is, that during the present century the population of London has gone on increasing at an enormous rate, quite out of all proportion to what it did in the 18th century. In the early part of the 18th century it was practically stationary, but in this century it has begun to increase; that increase has been due largely to immigration into London. Taking it in decennial periods by average, during the first 30 years of this century, from 1800 to 1830, the increase of the population was equal to 200,000 in each 10 years, whereas in each of the 10 years from 1830 to 1880, the increase was 400,000 to 500,000. If we take the 10 years from 1840 to 1850, as I have already explained, we find the increase of population during those 10 years exceeds the difference of the births over the deaths by 348,000, representing that amount of immigration. Now, I should remind you, that these immigrants consisted chiefly of adults or of whole families who had gone through their enormous infantile mortality in the country, and they came with their weeded out population into London; that must make an enormous difference in the death-rate, and make it very much less than if the population had grown, as it had formerly done, in a normal way, as in the country.
7476. (Chairman.) The age at which they would come would not be that age at which there is the most expectation of small-pox?--No, they came in as adults, and, therefore, they had passed the period of infancy in the country.
7477. You cannot, I presume, give at all the proportion of those who would be adults to those who would come in as children?--No.
7478. The larger number would be likely to be children?--No, the largest proportion would be adults.
7479. Have you at all estimated what proportion of those coming in in this way would bear to the total population of London?--During the 30 years, when about 200,000 every 10 years were coming in, the population of London was under 2,000,000; during the last 30 years the population had increased nearly to 4,000,000.
7480. Supposing you take half of those to be adults?--I should say, if you took half to be adults you would have to take in a much larger proportion of those who would be beyond infancy; that is to say, not infants, amongst whom the greatest mortality would occur.
7481. Would that make a very great difference?--I think so many coming in every year would, because you must reckon the totals as time goes on, of course.
7482. (Sir William Savory.) Will you give me the exact figures upon which you calculated the proportion of deaths from small-pox to the population from 1800 to 1838?--The populations were taken from the census returns, and the other figures from the table in the Government report.
7483. Will you furnish the exact figures to the Commission; that is to say, the deaths from small-pox and the population upon which you calculate for the figures which correspond to the diagram; are the results worked out anywhere?--The deaths per million and the materials of this Table No. 5 are extracted from the annual report of the Medical Officer of the Local Government Board for the year 1884 and published in 1886; from that I get the deaths, and from the census return for London I get the population; the exact figures are in the published report.
7484. (Professor Michael Foster.) Do you know how the number of deaths was ascertained in the area from which that census was taken?--I do not know.
7485. Then how were the death figures obtained?--Where I had not got them given in any authoritative manner already, I obtained them by dividing the deaths by the population.
7486. With regard to the number of deaths, do they refer to the same area as that for which the census was taken?--They do, of course, after the beginning of the official reports, but whether they do before that or not I do not know.
7487. Before that was it not the Bills of Mortality which gave the number of deaths?--I have not been able to ascertain that. I do not find it mentioned in any f the reports I have seen as to what was the area to which the deaths referred; it is admitted that they are comparatively imperfect as compared with the returns after 1838.
7488. But if you are dealing with the returns from the Bills of Mortality which are taken from one population, and with the census which is taken from another [[p. 27]] population, one does not know how much error would come in--No doubt it would make a certain amount of error.
7489. (Sir William Savory.) It would be very important that you should give us the figures upon which you made your calculation.
(Chairman.) The material you extracted for the purpose of making that diagram?--I have here the figures which I worked out myself, and from 1838 they are worked out on the Registrar General's death-rate per 1,000 persons living.
7490-1. (Sir William Savory.) I think you stated that your diagram showed that there was very little diminution in the relative mortality from small-pox in the latter part of the period, namely, from 1838 to the present time?--In the latter part of the period with which I am dealing, which is from 1822 to 1884, I said there was rather an increase of small-pox than a decrease.
7492. Will you look at the table in the first report of the Commission handed in by Dr. Ogle and printed at page 114; it is the second appendix, marked Table A.; is that in accordance with your tables?--I presume it is. I have not compared them.
7493. Would you say that there is no material decline shown in that table?--It is impossible to tell by looking at a table; you can tell by looking at a diagram, but you cannot tell by looking at a table without reckoning up and making averages.
7494. It is very simple; the deaths are placed opposite the years from 1837 to 1887. We start with over 1,000 deaths in the year 1838, and we end with 37 in 1887?--Yes, I see that.
7495. Why have you excluded the tables of England and Wales?--I have not excluded the tables of England and Wales at all.
7496. It shows practically the same thing as your table for London, does it not?--Yes.
7497. (Professor Michael Foster.) You told us on a former occasion that it was practically the same?--Yes.
7498. (Sir William Savory.) Then we come to this, that this table for England and Wales ought practically to agree with yours, unless there is an error somewhere?--The two diagrams are upon such a totally different scale that it is difficult to compare them, but I see no important difference.
7499. But clearly this table of Dr. Ogle's shows a striking diminution in the death-rate?--Dr. Ogle's table goes over a different period from that which I have been speaking of. I have always referred to the period from 1822 to the end.
7500. There is not a very wide difference; this of Dr. Ogle's is from 1838 to 1887; but you may start from the corresponding period upon your diagram, namely, from 1838 to 1887; does that show a striking diminution?--That is not my point at all. I am perfectly aware that you can divide up a series of tables and diagrams so as to make the increase or decrease greater or less according as you divide them up; that is the reason why I so much prefer diagrams to tables; it depends entirely how you make your division; how near to an epidemic.
7501. (Professor Michael Foster.) But in the diagram which accompanies Dr. Ogle's evidence, which gives us, with the exception of the years from 1843 to 1846, the whole period from 1838 to 1887, there is very obviously a continuous decline of small-pox all along, allowing for ups and downs?--That is so; but that is not the same period as I have given.
7502. But that is the case, that there is a continuous decline, a decline over the whole period from 1838 to 1887?--I do not think I have ever said that there was not; that is coming to a different subject, upon which I have not even offered an opinion, namely, the mortality in England and Wales. I had nothing to do with that mortality in England and Wales.
7503. But did not you say that the curve of the mortality was, on the whole, similar to that of London?--Yes, similar, but I did not say it was identical.
7504. (Sir William Savory.) Does that of England and Wales confirm or oppose your tables?--There is not a very great difference.
7505. May I ask, does this table of Dr. Ogle's, to which I have invited your attention, confirm or oppose your two tables?--His diagram is identical with one of those in my book; there is no question of confirming or of opposing; here are the maxima and minima; they are all the same, only his vertical scale is about three times as large as mine.
7506. But does Dr. Ogle's diagram oppose his table?--I do not say it does; his diagram is made from his table.
7507. Then you would be prepared to say that Dr. Ogle's table coincides with your diagram?--My result is given in my diagram.
7508. But it is easily seen by this table of Dr. Ogle's that the decline in small-pox is very striking during the period from 1838 to 1887--it is simply seen at once, and it would either support or oppose your result?--I do not think it opposes my result in the least.
7509. Then I conclude you accept it?--Yes, of course, I do.
7510. Have you considered the question of age in relation to the question of the mortality from small-pox at different periods?--I have looked at the question a little, but not in a manner to enable me to give evidence upon it.
7511. I suppose you would agree with all those who say that in pre-vaccination times the death-rate from small-pox fell chiefly upon children and the young?--Yes, I think that is admitted generally.
7512. Do you know that the diminution in the mortality from small-pox since the vaccination period has been chiefly in reference to children?--Yes.
7513. Children under five years of age?--Yes.
7514. There is a most striking difference in that respect, is there not?--Yes, in the mortality from small-pox, no doubt.
7515. How do you explain that?--I do not think that I am called upon to explain it--I think it is a medical question entirely; a question for medical statistics.
7516. Is there any explanation which offers itself to your mind?--The explanation which offers itself to my mind is suggested by the fact that during that same period which the Registrar-General's Return shows us, namely, from 1841 to 1881, there was no decrease of infant mortality.
7517. But you have just admitted that there was?--There was a decrease of infant small-pox mortality but no decrease of general infant mortality. The figures are given thus:--For the first ten years, from 1841 to 1850, the number was 157, from 1851 to 1860 it was 155, a minute decrease; from 1861 to 1870 it was 162, and from 1871 to 1880 it was 158, greater than during the first period by one; showing, at all events, no decrease,--showing that the death toll is the same, whether you think you save lives from small-pox or not; but that is a question which other gentlemen can go into more fully than I can.
7518. Will you turn to page 120 in the First Report of the Commission, and look at Table F (a).--"Tables showing the nearly continuous fall since compulsory vaccination and during its completer enforcement of the share of total small-pox mortality borne by children; with the general decline in small-pox mortality among the infant population: and the fluctuations of small-pox mortality among the population above infancy?"--I have it.
7519. Do you dispute the fact there has been an enormous decrease of the mortality from small-pox amongst children under five years of age since the introduction of vaccination?--Not at all. I have nothing to do with either disputing or affirming it.
7520. But will you do either the one or the other because it is a very striking thing?--I accept it as a fact, undoubtedly.
7521. May I ask again, whether any explanation suggests itself to you of that great decline?--Anything that suggests itself to me in the way of explanation will be utterly valueless.
7522. You will not offer an explanation of it?--I will not.
7523. Are you aware that it has been pretty well shown that a like diminution in the mortality under five years of age, does not apply to any other disease to which children are subject, such as measles and the like?--I believe that is the case. I do not know it of my own knowledge.
[[p. 28]] 7524. Do you prefer to leave that remarkable matter unexplained?--Unexplained, except so far as to say that it has not resulted in a diminution of the general loss of infant life. I am not a medical man, but I believe you will have a gentleman before you who will explain it far better than I can, if it is to be explained.
7525. (Sir James Paget.) Do you think that the maintenance of the general rate of mortality is to be ascribed in any sense to the diminution of the death-rate from small-pox?--I have heard a great deal of it, and they appear to me to be in some relation of cause and effect.
7526. The diminution in the mortality from small-pox would naturally and necessarily create an increase in the number of deaths from other diseases?--I do not admit that the diminution is due to vaccination.
7527. Do you think that the diminution of deaths from small-pox would naturally increase the deaths from other causes?--I do not say that the one actually causes the other--it is difficult to express it, but I have seen it stated as a fact that unless you can modify the general causes which lead to death by zymotic diseases--any diminution in one class of diseases is made up by the increase of another. I do not give that as my own knowledge, and I did not wish to say anything about it, but you would persist in asking me these question on matters which are outside my personal knowledge.
7528. But as a scientific man--do you think that probable?--I have made no study of these things; you will have before you gentlemen who have made a study of them. I have confined myself to the broad study of general statistics, which I think give the most probable and accurate conclusions.
7529. (Sir William Savory.) May it stand in this way, that I have called to your notice this remarkable decline in the mortality of children under five years of age, and that you prefer not to explain it?--It is not a question of preferring not to explain it, but it would require an amount of study and of time to explain it, which I have not given.
7530. Then going back to the point which has been referred to before, with regard to the navy, you point out that there is a striking difference between the mortality in the army and in the navy, and you account for that by the difficulty of carrying out sanitary precautions in the case of the navy--I think that is so?--Yes.
7531. Since you made that statement it has been pointed out to you that compulsory vaccination came into force at a later period in the case of the navy than in the case of the army, still looking to that fact, your attention having been called to it, you say you think that has nothing to do with the difference, but that it still depends in your opinion upon what you call the imperfect method of isolation as compared with the hypothetical consequence of vaccination?--I beg pardon, but that does not quite state my position correctly.
7532. Will you correct me?--I have not admitted that compulsory vaccination was first introduced into the navy at a definite period, because it is a well known fact that vaccination was introduced into the navy before it was introduced into the army--I believe in 1801.
7533. Was that compulsory vaccination?--No, not compulsory vaccination, but vaccination. I read to you a statement of Dr. Graham Balfour, of the Medical Department of the Navy, who stated that it was at that time, in 1835, a rule of the service that every recruit entering the navy should be vaccinated; consequently it applied to the crews throughout--it is a question simply of some new regulation or some new law--it does not at all necessarily follow that compulsory vaccination was introduced at a particular period because a change in the law was made at that period.
7534. It was made the law, was it not, in 1871?--Yes, but I say that I entirely dispute the assumption that because the law was made then there was no compulsory vaccination before. At a time when men were pressed into the navy, as they were at that early period, it is not likely that the authorities would have had any scruple in vaccinating them when it was the rule of the navy that they should be vaccinated.
7535. (Chairman.) Are you aware that as regards natives taken on board Her Majesty's ships on the coast of Africa, Kroomen, for example, if deaths happened amonst them they were reckoned as happening in the navy; but that compulsory vaccination was not considered to apply to them until a later date?--I do not know whether that was so or not.
7536. It would be desirable, when you are comparing the deaths in relation to vaccination, to ascertain whether those who were so put down as dying from small-pox were or were not vaccinated--that is of importance, is it not?--No doubt it is of importance. What puzzled me was that these deaths occurred some years after this new law for compulsory vaccination was passed, and then we find after that that exceptions were made--that such and such persons were not vaccinated. If so, what was the good of the law?
7537. As I understand, it did not apply to those temporarily taken into the service on foreign stations. That may have been so.
7538. (Sir William Savory.) Will you refer to the table upon page 99 of Dr. McVail's book, where he states that the mean annual small-pox death-rate per million living in the army in the period from 1860 to 1870 was 105; in 1871 it was 210; and afterwards from 1872 to 1882 it was 44. Then in the navy from 1860 to 1870 it was 213, which was double the number that it was in the army; and then in 1871, when vaccination is made compulsory in the navy, it was 260 against 210. Then after it had been in practice for 10 years it was 62 in comparison with 44, that is a very singular coincidence if compulsory vaccination had nothing to do with it, is it not?--Yes, but the periods are too short; we continually have that kind of thing happening.
7539. That is your explanation?--Yes, the periods are too short.
7540. Still you call the introduction of vaccination the hypothetical cause of the diminution and the imperfect isolation the real one?--Yes, because I have given you official evidence that there was compulsory vaccination before then.
7541. You made the statement?--I quoted the authority of Dr. Graham Balfour in the navy that it was the rule of the service that all recruits were vaccinated.
7542. (Professor Michael Foster.) But why in 1864 did the Admiralty go to the trouble of issuing the order that all new entries should be vaccinated, if that had been regularly done before?--That I cannot tell.
7543. (Dr. Bristowe.) May I ask who is Dr. Graham Balfour?--Dr. Graham Balfour was the surgeon of the Royal Military Orphan Asylum. He gives the information.
7544. He seems to have been an army surgeon?--Yes, only he gives information as to the navy; it is called, "The Army and Navy Asylum." It is given in Sir John Simon's original paper, but it has not been reprinted in this, and therefore I cannot refer to it.
7545. (Sir William Savory.) I want to call attention to your diagram of vaccination. Referring to the second diagram, Deaths in England and Wales, were you aware at the time you constructed that diagram that these statistics of public vaccinations for the year 1872, are wholly incomparable with those taken in 1873; they do not represent similar facts. Up to 1878 both vaccinations and re-vaccinations were included in the statistics upon which that curve is based, and that after that year re-vaccinations are not included. Thus in 1859 the vaccinations were actually 8 per cent more than the total births; were you aware of that?--I am not sure whether I was aware of it or not; I do not think I was.
7546. May I ask if you copied the figures directly; what source do they profess to come from; is it not a table in the Eleventh Annual Report of the Local Government Board which was the source of your information?--I think it was; yes, it was.
7547. Is there such a table as that in the report?--If I took it from that, there must be certainly. I have not seen the report now for several years, therefore I cannot remember.
7548. You are not aware?--I say from the figures in this table I have calculated the number in proportion to the population in each year.
7549. But in the report from which you obtained your figures, is it not stated in the note that the deaths are not comparable, inasmuch as the re-vaccinations were included in the one and not in the other?--Yes, that was a note by Mr. Wheeler, who edited the second edition.
7550. With such a note as that before you, do you still offer us this chart?--I have not offered it.
[[p. 29]] 7551. But this being in a book from which you took your figures, and those tables coming from your widely-respected and high authority, you do not contradict it?--That evidence was not in existence, as appears from this note. Mr. Wheeler says he has examined every report of the Local Government Board in order to try and give the total vaccinations; he says they are not tabulated, that they are only given for the years since 1872. The changes in the mode of giving this information are exceedingly puzzling, and it is very difficult to get comparable returns for that reason. There is the other case, in which up to a certain period in the last century measles were included with small-pox, and even in the present century there has been an alteration made by taking out chicken-pox. There are continual alterations of that kind, which it is impossible to get rid of.
7552. That may excuse an error to some extent, but it would hardly justify the maintenance of this diagram on your authority, would it?--I do not think it would make very much difference; I cannot tell.
7553. Do not you think that the difference would be very considerable?--It is a point I have not gone into. I left the editing of the second edition of the figures to a gentleman who knows a great deal more of the subject than I do. He has introduced this note.
7554. What was the object of introducing this vaccination chart in the second diagram in your book?--I suppose the object was to show if there was any relation between vaccination and the decrease of the mortality.
7555. And you do not think that conclusion would be in any degree invalidated by the fact we have just been considering?--I think that what I referred to most was the earlier part, in which there would be no alteration. I pointed out that the increase of vaccination was not followed by a decrease of small-pox.
7556. Passing to another subject, you showed us, I think, a chart for Scotland?--Yes.
7557. Will you just tell us what that was intended to show? You state in your pamphlet, page 9, that the conclusion that "the progressive efficiency of legal vaccination has diminished small-pox," as stated by Sir Lyon Playfair, "is absolutely untrue, since there has been a decrease rather than an increase of efficient vaccination." Again, have you looked at the question of age in relation to small-pox in Scotland?--This diagram was simply to show to the eye what cannot be so well shown in tables. I consider you may look over tables for ever, and you cannot really get anything out of them; but when you see the thing put in a diagrammatic form it appeals to the eye at once, and you can see by the eye at once the effect.
7558. I should like you, if you please, after that statement, to look at the exceedingly simple table extracted from the Registrar General's reports for Scotland, and see if that does not show a diminution?--This refers to the ages; that has nothing to do with my diagram.
7559. That question of age seems to be a very important point in relation to the decline of small-pox?--That is a question which another gentleman will go into. I do not wish to go into it at all.
7560. (Sir Charles Dalrymple.) You contradict flatly Sir Lyon Playfair's statement; you say his statistics necessarily give false results unless they are classified according to the age period of the patient, and then you say you have not gone into the question of age at all. How can you say, therefore, that his statements are necessarily false?--Mr. Wheeler, who will follow me, is prepared to go into all these questions fully; I have already stated that I do not wish to go into them.
7561. (Chairman.) Do we understand that this second part of your pamphlet, including the quotation from Sir Lyon Playfair's speech, is by you or by Mr. Wheeler?--By me.
7562. Then the statement on page 27, "that such statistics necessarily give false results unless they are classified according to the age periods of the patients" is by you?--Yes.
7563. Then I do not understand why you refer us to Mr. Wheeler for the further consideration of it?--Because I have not since then looked further into the question, whereas he has devoted a great deal of time to this investigation. We thought it necessary to divide the subject, whereas if one person were to be asked questions upon the whole range of the subject it would involve an enormous occupation of time. I had not the remotest idea that I should be questioned upon the whole range of the subject, upon which I have protested again and again that I did not wish to give evidence, and have no evidence of value to give.
7564. (Sir Charles Dalrymple.) You handed us this pamphlet, did you not?--I certainly did not.
7565. Do you repudiate the statement?--I do not repudiate the statement, but since this was printed I have got rid of the greater part of my books and pamphlets connected with the subject. I have not kept up my knowledge of the subject, and am not prepared to go into it.
7566. (Dr. Collins.) I shall be right in saying that this statement in the pamphlet has reference to the fatality of a given number of cases of small-pox as between the vaccinated and the unvaccinated?--Yes.
7567. It does not relate, does it, to the age distribution of a given number of small-pox deaths?--It related to the age distribution of the vaccinated and the unvaccinated patients.
7568. But not to the age distribution of a given amount of the mortality from small-pox upon the population?--No.
7569. (Sir William Savory.) It certainly does?--However, that is such a difficult and complex subject to go into in all its details that it is perfectly impossible for a person to go into it without the evidence.
7570. Would you mind telling us the evidence upon which you base the statement that the vaccinated and unvaccinated patients in small-pox hospitals come from different classes?--I think I can answer that question. In this report of the Local Government Board, Appendix, page 2, "Digest of the vaccination officer's returns with reference to children whose births were registered in the year 1882," I find it stated that of 889,000 births, 763,000 and odd were successfully vaccinated, and then it goes on to account for those who died unvaccinated and a few who had been registered as insusceptible of vaccination, and a few who had contracted small-pox before they could be vaccinated, and a considerable number, 7,000, as having their vaccination postponed by medical certificate, leaving 35,423, or 4 per cent., as "removed, not to be traced, or otherwise unaccounted for." That, I think, is very vital to that question; it shows that the unvaccinated residue of the population are the nomad population, the population who have no fixed homes, but are continually on the move, the inhabitants of weekly or nightly lodgings, tramps, criminals, and so on.
7571. I hardly follow that. Your statement is that the vaccinated and unvaccinated patients in small-pox hospitals come from different classes?--I think the statement I have read shows that.
7572. Is that the only answer you have?--That is the only portion of direct evidence I can quote to you.
7573. Can you give us any other evidence for that statement besides that which you have just read?--I think that is sufficient myself.
7574. (Sir James Paget.) The 34,000 would be distributed over the whole of England and Wales?--Yes.
7575. Do you think that would make any difference in the number who are admitted to the London small-pox hospitals?--Those are said to be all who are unvaccinated in the course of the year. Wherever they are they drift into the hospitals when they are attacked by small-pox.
7576. What proportion of those would be likely to come to the London small-pox hospitals?--That I cannot tell; but you will remember there is that number every year.
7577. (Sir William Savory.) Upon the first day of your examination you were asked, at Question 7041, "in your view the comparison of vaccinated and unvaccinated mortality in official and medical statistics must be rejected," and in answer you say, "I think so." Then you were asked, "On what ground do you think so," to which you replied, "Mainly on the ground that it is entirely opposed to and in conflict with the, I may say, universal testimony, so far as it can be obtained, of persons in the last century, as to the mortality of small-pox patients who were then of course all unvaccinated." On that ground, would you reject all the official and medical statistics which are before us now. Do you prefer the evidence which [[p. 30]] is to be obtained in the last century to the evidence we have before us at the present day?--I should remark that the evidence of the present day agrees with the evidence of the last century strikingly upon this point, that when you neglect the division into vaccinated and unvaccinated the mortality from small-pox comes to very nearly the same, and I think that is a coincidence which could hardly have come by accident.
7578. (Professor Michael Foster.) You compared amongst the unvaccinated in the previous century cases from towns and from small-pox hospitals, but in this century you have taken the number of patients from hospitals only?--I should think they are comparable, but very much to the advantage of the present century.
7579. Taking people going to the hospital, are they comparable with cases which occur in ordinary practice in the country; do you not have all the bad cases taken to the hospitals?--I believe now they have many mild cases taken too. However, that is a question which Mr. Wheeler is going into very fully. I can give nothing but a general statement upon it.
7580. For instance, you have not thrown into your calculation of the fatality in the present century cases such as the Sheffield epidemic, where we have the number of attacks and the deaths?--I have not, because that was not done at the time I made my calculation.
7581. If that was a per-centage of nine deaths upon the attacks, would not that very largely modify your general result?--No doubt it would to some extent.
7582. But that, I understand, is not the argument that you take now; that the mortality is the same as it was in the last century?--Generally it is; it is nearly enough the same.
7583. Then there are the large number of cases at Chemnitz, where, again, we have the opportunity of obtaining the number of cases and the number of deaths; that was an exceedingly mild epidemic, and the number of deaths was exceedingly slight; if you add that in then you again reduce your total per-centage?--No doubt, but the evidence of the last century went to show that the per-centage was very much the same, whether you took them from the hospitals or from private practice. It is pretty well known that in the last century the treatment of small-pox cases was simply abominable; therefore it is not likely that the patients were better off at home than in the hospitals.
7584. That has no reference to the point that your data for determining the fatality from small-pox within the present century are imperfect because you have neglected great opportunities for correction?--I have no doubt, if you took the whole of the cases, you would have a lower per-centage, but then you would have to take the different surroundings.
7585. Then the per-centage would not be the same?--As far as I can see, the per-centage in the hospitals is much the same.
7586. But you do not contend that the per-centage altogether would be the same?--No, I do not suppose that it would.
7587. (Sir William Savory.) I will ask you to look at Tables B. and D. on pages 116 and 117 of the First Report of the Commission; those are statistics showing the death-rate from small pox under different conditions of vaccination, and tell us whether you can say why they should not be accepted?--That is a point upon which, as I say, other gentlemen will give evidence; I cannot explain it myself.
7588. You have no explanation to give of it?--No, I have no explanation to give of it.
7589. You know there are some very remarkable facts, such as those stated by Mr. Marson of the Small-pox Hospital, on the complete immunity of the nurses who have been re-vaccinated in consequence of their having been re-vaccinated. He stated, "The committee have heard, no doubt, that in the 35 years during which I have been at the Small-pox Hospital, I have never had a nurse or a servant the whole time who has taken small-pox there. I re-vaccinate them when they come there, and they never have small-pox, although they are exposed to infection every day"?--I do not put the slightest weight upon that. In the first place it is much too small a number, and in the next place more than paralleled in the last century, by the cases of which we have the facts published in the evidence of the epidemic at Kilmarnock; there you have it for 34 years, during which not a solitary person over 30 died of small-pox.
7590. (Chairman.) Do you mean did not die of it, or did not take it?--Did not die of it.
7591. (Sir William Savory.) But here you have period of 35 years in which not a single person has even taken small-pox, and there is similar testimony elsewhere?--I have read the testimony, and I have also read many statements to the effect that such statements as these are not always accurate; that there has been occasionally a nurse who has taken it.
7592. Here is a statement of fact, that when persons are perfectly vaccinated and re-vaccinated, although constantly exposed to infection, yet, without exception, none of them contracted small-pox. Do you think if an equal number of persons, who had not been vaccinated, were exposed in the same way, they would all escape?--They might, I think, if they were nurses; some of them, do doubt, would have had small-pox.
7593. (Professor Michael Foster.) Do you know the phrase used in the last century regarding those who never took small-pox in their lives, that they were spoken of as "insusceptible of infection," and what the calculation was as to the remainder?--I should think half the population.
7594. One in 20?--That I cannot believe to be true.
7595. If you read the work of Dr. Haygarth, of Chester, you will find the statement there that "some persons are incapable of infection by the small-pox. The proportion of mankind thus exempted has been observed to amount to one in 20," 5 per cent.?-- He could not have observed over the whole population. A mere statement like that, without the evidence upon which it is founded, is valueless.
7596. I am merely quoting that as an opinion; he was not discussing the question; he merely happened incidentally to have to refer to what was the acknowledged opinion apparently of the profession at the time. This was about 1778, and he speaks in that way incidentally that "the proportion of mankind exempted has been observed to amount to one in twenty"; he was a very competent observer, and probably we shall have later on his observations brought before us in another aspect?--I quoted to the Commission the other day the statement of another eminent observer, the mathematician Bernouilli; the facts he stated, which were generally accepted, would bring it to about one-half, as I said.
7597. (Dr. Bristowe.) Do you regard him as an authority on any medical subject?--He dealt with it as a statistical subject, and he would have, no doubt, got the very best evidence of the day, and the case at Kilmarnock also shows that.
7598. (Professor Michael Foster.) How many of those who survived at Kilmarnock had had the small-pox before?--That we could calculate from the figures given. It appears to me from what we know of the proportion of cases to deaths that there were more than half of the population of Kilmarnock who never had small-pox.
7599. (Sir James Paget.) What was the degree to which they were exposed to small-pox?--They were tremendously exposed. It was a small crowded Scotch town, with an epidemic every four years.
7600. Have you got the return of the proportion of cases to deaths?--There is a return of the deaths.
7601. Does that give the cases?--No; but you can calculate that proportionally all the way through from the tables.
7602. Are you prepared to place these facts and statistics before us?--No; but I gave it as being good, or rather better, than the general statement that the proportion was one in twenty. I never heard such an extraordinary statement as that before.
7603. (Professor Michael Foster.) There were extraordinary statements, were there not, at that time?--No doubt.
7604. Do you know Condamine's writings? He says small-pox is a river which everyone must cross, and he will cross it most safely if he goes in the boat of inoculation?--Those are mere general expressions, and as such are valueless.
7605. "Everyone" is a more general expression than "one in twenty," but "everyone" will hardly apply to a condition of things from which half suffered?--People exaggerate very much. Where is there any disease in [[p. 31]] which half suffered? Even in the Plague I doubt very much whether half suffered.
7606. You are not aware of cases in which half the population were struck down with the small-pox?--I am not aware of cases in which half the population were struck down.
7607. (Chairman.) Do not more than half the population suffer from measles?--That I cannot say.
7608. (Professor Michael Foster.) Do you know anything of the stories of small-pox amongst the Mexicans, and also amongst the North American Indians, as described by Cattlin, who, speaking of the tribe of Pawnees, says that they lost more than half the number of the tribe by small-pox?--I do not know that. It was objected to me on the last occasion that I had gone to foreign countries at all for regular statistics; but if we are to go to the Mexicans and North American Indians we should certainly be beyond the region of statistics.
7609. (Dr. Bristowe.) McVail says that in Kilmarnock of every thousand children born alive 161 died of small-pox. If that were the case, and small-pox were fatal at the rate of 20 per cent., it follows, does it not, that nearly all the children took small-pox?--I beg your pardon, almost all those children you will find died under the age of four years, and the mortality of infants under four years from small-pox is from 40 to 50 per cent., even in this century, and was probably much more at that time, consequently you would only have to double that number for the number who had small-pox. It involves a calculation to get that out.
7610. (Professor Michael Foster.) May I return to the question of the relative fatality of small-pox in the last century and this? You state, I think, that it is exceedingly improbable that there could be any increase in the fatality of small-pox in this century as compared with the preceding?--I think so; but that is a point upon which I do not profess to give information. Other gentlemen will, I believe, go into it.
7611. Do you think it cannot be understood upon the hypothesis that vaccination is a protection?--I have seen attempts to explain it upon that hypothesis, but they do not seem satisfactory to me.
7612. Which attempts do not seem satisfactory to you?--The attempts to explain it upon the hypothesis that vaccination is a protection. I have read those explanations, but they do not seem satisfactory to me.
7613. Which explanation in particular?--I really did not pay much attention to it, and I cannot repeat it to you. I cannot say which explanation, but it was an explanation given in one of the official reports. I rather think it was in one of your reports.
7614. Was that Dr. Ogle's explanation?--Yes, I think so.
7615. Based upon the idea of the contagion of small-pox behaving in the same way as a living being, and varying; that in the struggle for existence against vaccination the weaker varieties of small-pox tended to die out--That seemed to me, in the first place, highly hypothetical, and in the second, unintelligible; perhaps I did not take sufficient care to follow his argument.
7616. Is it unintelligible?--It was when I read it.
7617. And now?--I do not follow it.
7618. Is it not a matter of experience with all these diseases, that when they break out in a new population they are exceedingly virulent, that the number of cases is very great, and that the fatality of deaths to cases is very great. Those cases I was referring to just now of the Mexicans and the North American Indians are cases in point, and that feature applies not only to small-pox but to diseases of a like nature, so that besides those whom it attacks the disease seems to produce an effect upon the others who are not attacked, rendering them, so to speak, less liable?--I have read the statement very often that new diseases amongst a population very often produce terrific effects, as, for example, measles in the Pacific Islands. But these are questions of medical theory upon which I do not form an opinion.
7619. Before you say it is incredible or improbable, is it not obvious that, if vaccination is a protection, it is, as it goes on, creating within ourselves a new population which is, under that aspect, more susceptible than the old population was when small-pox was more prevalent, so that it would not be so improbable after all?--I cannot say that I have followed the argument.
7620. I will now call your attention to one or two points about Sweden. Did you not state that in Sweden there had been an increase of small-pox since the commencement of this century?--In answer to Question 7454? The diagram I gave shows that.
7621. Do you think it does show that?--I think it does show it, certainly.
7622. I have not had the opportunity of examining your own diagram, but here is a diagram which you saw (I put it into your hand at our last meeting), which appears to be framed on official data the same as yours, and which corresponds to the statements which are in the reports concerning the mortality in Sweden to be found in Sir John Simon's appendix up to a certain year, only that they are continued beyond that year. I suppose one may take those data to be correct?--Yes, I presume so. This diagram appears to show a great increase in the epidemics during the present century from 1820 to 1880. There is a regular increase shown apparently upon that diagram.
7623. If you divide that into three periods, which is apparently as convenient a division as could be taken, of 23 years each, you will find that the amount of small-pox is really about the same right through, even including the epidemic of 1873. Taking the first period from 1816 to 1838, the mean of those several years gives 174. I am not quite sure about one or two units. Then from 1838 to 1861 the mean is 163, and from 1862 to 1884 the mean is 169, and that includes the great epidemic of 1871; so that on the whole there has not been an increase of small-pox. The question was about epidemics. Is there any increase in the mortality from epidemics of small-pox in Sweden during this century?--Yes, the diagram I gave shows that, and it does it as plainly as possible notwithstanding all your figures.
7624. You do not wish to maintain that there is an increase of small-pox mortality?--I have not said that, but it looks as if it would come out so if the figures were accurately calculated.
7625. I have calculated as well as I am capable, and it shows that the mortality is on the whole very much the same?--It is a very extraordinary thing that the epidemics should have become more and more severe.
7626. How more severe? Do we know very much about the cause of epidemics?--That again is a medical question; I know nothing about it.
7627. You say it is extraordinary, and one must offer some explanation. Supposing that vaccination is a protection, and supposing that the effects of vaccination are only partial, as in every case must be admitted, what one would expect then would be that there would be epidemics occurring from time to time, and that some of those under certain conditions might be very considerable.
(Chairman.) I do not understand why you suggest that the occurrence of epidemics is inconsistent with the protective power of vaccination. Where all the population are not vaccinated, would you not have a continually accumulating number of those who were not protected, and who therefore would be subjects for small-pox?--It appears to me that you would have a continually diminishing number as vaccination is carried out.
7628-9. But suppose vaccination to have been as completely carried out as it ever is carried out, at the outset of the period I spoke of, still there is a certain per-centage, say 10 per cent., not vaccinated. After a certain number of years as that goes on, you will have a very considerable number of people unvaccinated, because you would only have vaccinated 90 per cent of those who lived?--That would not give an increasing number.
7630. But you would have a considerable number. Supposing Sheffield with a population 90 per cent. of whom were vaccinated; then you go on each year adding to your unvaccinated as well as to your vaccinated class; your unvaccinated class would grow, would it not?--Yes.
7631. Therefore there would be an increasing number of people who were unprotected?--They would only grow exactly parallel with the vaccinated; they would remain in the same proportion.
7632. But supposing an epidemic comes you have the material for it, and why should they enjoy the benefit of protection when they have not been protected?--In the first place, there is the increased virulence of the epidemic, the greater number of deaths [[p. 32]] per million. It is not only that a greater number have died, but a greater number per million who have died in each successive epidemic.
7633. (Professor Michael Foster.) We have a certain number of rises and falls, and the rise is very great indeed at the various epidemics; it is not a continuous variation in one direction?--No, it is not.
7634. It is just what one would expect from a certain number of unprotected persons occurring in the midst of the protected, such protection as there is making itself manifest, inasmuch as the very highest rise for Sweden in 1873 was only 920 per million as against 1,000, which was the rate in the feeblest epidemic in the period before compulsory vaccination, and which is a mere fragment compared to the rate in epidemics a little further back where we have in one case 7,196 per million for the whole of Sweden, and between 3,000 and 4,000 in other cases?--I do not see the bearing of all that at all; the point is, that from early in the century down to the latter part of the century you have a greater amount of deaths from small-pox.
7635. But I am just suggesting to you that if you examine those figures and divide them into periods that is not the case?--Even if it is an equal amount it is equally remarkable and inconsistent with the supposed protection of vaccination, because it is certain that you could not have had the amount of people vaccinated at the beginning of the century that you had at the end. What you call the "protected body" has been increasing the whole time and the other has been proportionately diminishing, and yet the small-pox mortality, taking your favourable view of it, has not diminished. I say that is not a satisfactory result, and not consistent with the efficacy of vaccination as a protection.
7636. Do we know very much about how vaccination was going on in Sweden during that period?--I expect you will have some more direct evidence upon that point, but we know very well from our own experience that a whole nation cannot be vaccinated in any but a long time; it is absolutely impossible.
7637. May we interpret this by the corresponding circumstances of England and Wales where we have some knowledge of how vaccination is going on?--I think they probably correspond fairly.
7638. According to that diagram of Dr. Ogle's, which you saw a short time ago, we have had a definite decline since 1838?--Yes.
7639. A very considerable decline?--I doubt the "very considerable," if you take the great epidemics.
7640. We may divide that period of Dr. Ogle's into three periods from 1838 to 1887, and those periods we may take as he has done?--Yes, I know the dates.
7641. The mean in the first period, taking the maxima and minima is 400, of the second period it is 313, and of the third period, including part of the great epidemic, it is 170?--Yes, I know that.
7642. Which is in the ratio of about 178 to 43. So that where we have evidence of vaccination we have distinct evidence of decline, and of marked decline in the ratio of 178 to 43?--But you may make the decline very different according to the way in which you divide up the eras.
7643. There is no doubt that upon the whole era there is a decline?--A slight decline.
7644. In those three periods there is corresponding to changes in the vaccination a similar decrease of the small-pox mortality. You referred at a previous meeting to the epidemic in Stockholm, I think?--Yes.
7645. You observe the great contrast there is between the epidemic in Stockholm in 1873 and the whole of Sweden. There must be obviously some special cause at work whatever that may be?--It is just the same in London as compared with England, and as in all dense populations as compared with scanty populations.
7646. You are aware that Stockholm is as compared to the rest of Sweden badly vaccinated?--I do not know that.
7647-8. It is stated so. Then there was one reference in your evidence in which I could not follow you. In answer to Question 7209 you refer to Dr. Graham Balfour, at page 12 of the Appendix. It is as to the question of the Royal Military Asylum at Chelsea. Following that out, which I suppose is the same case as that recorded on page 72 in our own report, you say that there were 39 cases and four deaths giving a mortality at the rate of 126 per million; which you regard as a high rate, and you say it is actually more than the general mortality of the population ranging from 10 to 15 years; but I find in this statement here, about half-way down the paragraph on page 72, that those four deaths were of non-vaccinated persons?--Dr. Balfour in his original report does not say so, and Sir John Simon says, "were believed already to have suffered from small-pox."
7649. They were not vaccinated?--Sir John Simon states they were not vaccinated, but I presume they had suffered from small-pox; because Dr. Balfour says distinctly that every child who on entering the asylum had not suffered from small-pox or had not been well "vaccinated, was vaccinated"; and he adds, "satisfactory evidence can therefore in this instance be obtained that they were all protected"; and therefore I do not like a phrase like that throwing doubt upon the statement of the original authority, without giving his authority for it.
7650. In answer to Question 7212 you speak of the army as being under better sanitary conditions and under medical supervision, and, therefore, on the whole as being affected with less mortality than the civil population. Do you know anything about phthisis in the army?--No.
7651. Do you know that the mortality from phthisis in the army is very much greater that in the civil population?--No, upon medical subjects I do not profess to know anything--certainly not in the army.
7652. I mean as indicating circumstances affecting their mortality and health?--But why should you take one disease like that? I take the whole mortality. I find that in the whole mortality they are better off than the general population of the same age.
7653. If phthisis is so abundant in the army, then the circumstances tending to their health cannot be of so very high a character. Then in your book you refer to the statistics of Keller?--I have not offered that evidence, and I would rather not go into that--there is really no end to the discussion possible upon a question like that. It appears that the facts are disputed; therefore how can we discuss a question of which the facts are disputed.
7654. Have you read the painful story connected with that?--I have read the story connected with that, and I have read the answer to it, and they do not appear to me to be at all satisfactory in the way of evidence, and official evidence that his statistics were wrong--he was a government official.
7655. You know that when he left his office he did what is unusual, took his documents away with him referring to this matter, and that when search was made at his dwelling there was no trace of the documents?--I do not know that that has anything to do with the question, or with me, certainly.
7656. And that then when an attempt was made to recover the documents by asking several of those who had supplied him with the original documents to give duplicates of papers which they had sent in, those duplicates thus sent in did not agree with the returns as published by Keller.
(Dr. Collins.) Out of how many returns were duplicates sent in?
7657. (Professor Michael Foster.) You are aware that the whole matter was discussed at the International Medical Congress at Washington, and that there is an official document upon the subject prepared by the representatives at the Congress?--How could that be called official--not as regarded the Austrian Government.
7658. "Official" so far as the Congress is concerned, Congresses make use of the phrase "official," and that when those returns were examined as far as they went (there were I believe about 13 out of the number) they gave conclusions altogether different from those of Keller?--Is Dr. Keller dead, may I ask?
7659. Dr. Keller is dead. Apparently the figures which Keller had introduced into his documents which he published are different from those in the original reports as attested by several persons, and the change was always in one direction?--Has there been any official inquiry by the Austrian Government, may I ask?
7660. That I do not know.--That would be the only thing that would be satisfactory. I do not see why other persons' statements or opinions are to be taken [[p. 33]] without evidence. It appears to be assumed that Dr. Keller forged documents on purpose to support his theory.
7661. That is the only conclusion at which it is possible to arrive?--He being a man in charge of a considerable Department of Health under Government, I would rather not accept that without the most demonstrative proof--that is all I can say to it.
7662. (Mr. Hutchinson.) Is this pamphlet of yours still in print?--Yes.
7663. I understood you rather not to wish to accept the responsibility for the whole of it--may I ask you questions upon it?--It is some years since this was first printed (1885). I have not attended to the subject since.
7664. Your name carries very great weight, and it still appears upon this pamphlet. Now, may I ask you to go back to another point? I quite admit a great reduction of small-pox in the first 20 years of this century--how do you explain that?--I am unable to explain it, it is one of those great changes which take place in diseases, and probably will take place again.
7665. Can you give any reason for that--is it not very extraordinary?--It is.
7666. If it were not due to vaccination was it not a most extraordinary coincidence?--It was a coincidence, but whether it was very extraordinary or not I do not know.
7667. (Chairman.) There had been no substantial decline in the last quarter of a century prior to 1880, had there?--Yes, it is distinctly stated by Dr. Farr that there was.
7668. I have been taking out the figures from this document which you made the basis of your calculation, taking the last quarter of the last century--and working it out in averages quinquennially the figures come out in this way. The average of the first two years is 83½, for the first quinquennium is 104 3/5ths, the next quinquennium 85, the next quinquennium 89, the next quinquennium 93 2/5ths, and the next quinquennium 89 2/5ths, which does not seem to show any sensible decline. Now if you begin with 1800, and take the quinquennial averages, they are these: first 71 2/5ths, then 71 4/5ths, then 51 4/5ths, then 35 4/5ths, 34 3/5ths, 34 1/5th; you have no continuous decline in the last quarter of the last century at all comparable to the first 30 years in this century at all comparable to the first 30 years in this century?--Certainly not.
7669. I do not mean comparable in the amount, but you have not the same phenomena then as you have in the first 30 years of this century.
(Professor Michael Foster.) Was it not commonly admitted that there was an increased proportion of small-pox deaths to deaths from other causes, the alleged ground being inoculation?--It was so.
7672. I suppose that the fatality of small-pox has rather changed its ground as regards the age of those who died in pre-vaccination times; it used to kill the children; it now kills the adults; is that the general result?--I accept that.
7673. Have you any explanation of the fact to give?--I have no explanation to offer of the fact; it does not come within my line.
7674. Have you ever heard any suggestion which should explain why now adults should die when formerly children died?--I have never discussed this question with medical men.
7675. Is it not a very extraordinary fact?--It, no doubt, is extraordinary, but I have no doubt you will have before you gentlemen who will probably give an explanation of it.
7676. You think so?--I do.
7677. (Chairman.) Do you admit that it is a relevant fact to be considered, and one of the facts to be investigated in going into the question of the protective effect of vaccination?--It is, no doubt.
7678. (Mr. Hutchinson.) A very strongly-marked fact?--Yes, it is a very strongly-marked fact.
7679. The children suffer less, and adults a little more possibly?--A great deal more it is generally admitted.
7680. Have you no explanation whatever to give of that fact?--No.
7681. I think that the epidemics which have occurred since vaccination came into use, though some of them have been severe, yet have been very much shorter as a rule than they were in pre-vaccination times?--They have been less frequently repeated, but I do not know that they been shorter in duration.
7682. I thought that was shown by your tables?--Not exactly.
7683. But in pre-vaccination times you state that they never subsided completely?--They never subsided completely, except that in the case of Kilmarnock they appear to have subsided completely, and you have alternate series of years with no deaths at all.
7684. Have you calculated out the mean age in Kilmarnock?--Yes; that is the extraordinary feature I alluded to, that practically the whole mortality was in children up to or under four years of age; there were a few at five and hardly any above, two or three only per annum.
7685. Do you know the mean age of death in Kilmarnock from small-pox?--I do not know that the mean age is of much use, but I make it between two and three, from the look of the tables.
7686. Do you know what Dr. McVail has stated it to be?--The mean age at death from small-pox was two and a half years in the last century.
7687. What should you say that it is now; do you know that Dr. McVail records it as 20 years?--Yes.
7688. A very remarkable difference?--A wonderful difference, but I do not see that it has any particular bearing upon the protective efficacy of vaccination.
7689. It bears upon those in early life having been protected, and the less protection of those in later life; that those who are old are now less well protected?--Yes, that is a fair conclusion on the face of it.
7690. Supposing you admitted, as I suppose most medical men would, that the period of protection by vaccination is not life-long, it would very well fit the facts, would it not?--I do not see why adults should be more liable to small-pox than they were in the last century.
7691. I do not know that they are more liable now than they were in the last century, but there is still a reason why they might be more liable, inasmuch as many in the last century had had the small-pox and been protected for life?--Yes, but I do not think that the Kilmarnock statistics show that.
7692. Supposing we found that the protection afforded by an attack of small-pox was greater than that afforded by vaccination, which we should grant, and that it lasts much longer, that would help to explain it, would it not?--It might tend to explain it, but I do not think it would fit the whole.
7693. You explain the present epidemics by there being a certain number of the population who are in a state of susceptibility to small-pox; have you made any attempt to ascertain what part of the population it is which is susceptible to small-pox?--I know the medical theory is that it is the unvaccinated who are susceptible.
7694. And those who have outworn the protection of vaccination?--Yes.
7695. Do you know whether there is any difference between the different classes of the community, the different professions for instance?--I believe there is a great difference between the very lowest classes of the community and the higher.
7696. I think you speak as if you believed it was the general opinion that small-pox and fever were more severe amongst those in feeble health; is that your opinion?--I have always understood that a person with a strong constitution and good health would be better able to withstand a disease than a person with a weak constitution.
7697. You are aware that there are medical opinions to the reverse effect?--Yes, I am aware that there are medical opinions to the reverse.
7698. That specific fevers are worse amongst the strong?--Yes, no doubt; that may have to do with many different points altogether, the diet, and so on.
7699. What part of the public is likely to be the [[p. 34]] best vaccinated; is any one profession likely to be better vaccinated than another?--I do not know.
7701. Are there many disbelievers, do you think, in vaccination in the medical profession?--It depends upon what you mean by many; there are many now, I should say.
7702. But taking the profession generally they are staunch believers in vaccination, they can have it for nothing and in their own families they do it repeatedly?--That I know nothing about; it is not always that doctors take their own prescriptions.
7703. Do you know anything about the comparative mortality in the medical profession from small-pox?--No.
7704. Would you be astonished to know that it is extremely different. The figures have been carefully calculated by Dr. Ogle. I believe you will admit that typhus and scarlet fever are fairly to be compared with small-pox?--I do not know anything about that; that is a medical question.
7705-6. Dr. Ogle says that the deaths of medical men are 13 per million attributable to small-pox as against 73 per million of the general population, whereas in scarlet fever, against which they have no protection, we have the remarkable fact of 59 medical men per million dying from that cause against 16 of the public; can you offer any explanation of that?--I know nothing about that. May I ask at what age are the public compared with the medical men?
7707. All adults above 20. The apparent contrast is extreme; have you any explanation to offer other than that the medical men are protected by vaccination?
(Sir William Savory.) They being also the most exposed.
(Mr. Hutchinson.) Sir William Savory asked you about the protection of nurses in hospitals. We thought that a remarkable fact, but here also are the medical men who are exposed to infection only suffering in the ratio of 13 to 73?--Of course the medical men are in a very different position from the bulk of the lower classes.
7708. (Chairman.) But we are speaking of the result of similar exposure of the medical officers as compared to the public in small-pox as compared with typhus?--But may I ask, is it not the case still that, notwithstanding the change of incidence, small-pox is, speaking broadly, an infantile disease, whereas the others are mainly diseases of adults.
7709. But these are taken over the population, both from the general population and the medical profession above 20 years of age?--But it makes a difference as regards the susceptibility of medical men under exposure. Being exposed to fever and to small-pox they catch the fever more readily.
7710. But scarlet fever is also a disease of infants, is it not?--Yes; but I did not notice that scarlet fever was mentioned so much.
7711. (Professor Michael Foster.) What did you mean by small-pox being an infantile disease?--I said, is it not still an infantile disease notwithstanding its large mortality amongst adults; it used to be regarded specially as an infantile disease.
7712. (Mr. Hutchinson.) I put it to you, as you have attended closely to statistics, whether you see any explanation of the fact?--It requires a good deal of consideration, and I do not see any explanation at the moment.
7713. In you pamphlet, at page 38, you write that vaccination is "the probable cause of about 10,000 deaths annually by five inoculable diseases of the most terrible and disgusting character;" may I ask what those diseases are?--They are quoted here (page 77 of my vaccination pamphlet) but that is a matter entirely outside the evidence I have offered.
7714. But this pamphlet goes out with your great name containing the statement that "vaccination is the probable cause of about 10,000 deaths annually by five inoculable diseases of the most terrible and disgusting character." Which of those diseases is the principal one, and shows the largest increase?--The largest increase appears to be in syphilis.
7715. No, I think in cancer?--I beg your pardon. Syphilis is the one that has doubled. Cancer has not doubled.
7716. Have you any reason for thinking that it materially increases the mortality from syphilis: we admit it may increase it by a few cases?--There is only the reasons shown in this Table, that there has been a steady increase five years by five years from 1850 to 1880.
7717. I do not wish to press you?--I am quoting statistics published by the Registrar General.
7718. But are you aware that medical men explain that without attributing it to vaccination?--Yes, of course they do.
7719. Why do you place cancer in that category?--Because it is always referred to as one of the diseases conveyed by vaccination.
7720. Have you any reason for calling cancer an inoculable disease?--Personally I have not.
7721. Can you adduce any medical evidence whatever to that effect. I would not press you on a medical point excepting that you have laid it down so?--I thought it was admitted to be a disease that could be transmitted by blood infusion.
7722. If we turn to statistics, could you say at what age, as a rule, cancer occurs, in childhood or in adults?--I presume it is a disease of adults.
7723. What result would the saving of life in early youth have upon the prevalence of a disease of senility or adult life, and which never happens in childhood? In other words, would anything which diminished the mortality from small-pox in the early periods naturally increase the mortality from such a disease in later life?--I do not think that has anything to do with it.
7724-5. But supposing cancer comes in later life the number who survived to old age would increase the number of cancer cases, would it not. My argument is that we should expect cancer to increase, and that rather it is a triumph of vaccination that cancer has increased as proving that a larger number have survived to adult and senile periods. The facts you quote prove just the opposite to what you imply as far as I can make it out.
(Sir James Paget.) Respecting the increase of syphilis, is there any evidence that the diseases thus named have been the same from the beginning of this Return to the end; have not there been since the beginning of this Return a number of diseases returned as syphilitic which were not so returned 20 or 30 years ago?--I do not know.
7726. (Mr. Hutchinson.) You are aware that medical science has advanced and that we now class a number of diseases under that head which we did not formerly?--I cannot answer that question.
7727. (Chairman.) Have you gone at all into that question of the comparative classification of diseases at different periods?--No.
7728. However you admit that if there had been a change of classification, and if a larger number of diseases have been now included under syphilis that would account for the increase?--Yes, I presume so.
7729. (Sir James Paget.) You are aware, no doubt that in the earlier records there were no deaths attributed to syphilis from diseases of the brain or the liver, whereas in the later returns they are so included?--But there has been a steady increase period by period.
7730. There has been a steady increase of knowledge of the diseases which used to be regarded as ordinary diseases of the brain and liver, but which are now regarded as syphilitic diseases of the brain and of the liver. Now with reference to pyæmia, is there no doubt that there has been always that one disease put down under that one name?--As to that I have no medical knowledge.
7731. But this is accepted as your clear and distinct judgment upon evidence which you have approved, and with your authority it is spread and is accepted?
7732. (Mr. Meadows White.) In answer to Question 7041: "In your view the comparative of vaccinated and unvaccinated mortality in official and medical statistics must be rejected" you say, "I think so," and that answer is amplified a little in reply to Question 7060. Supposing they are not rejected but accepted what would be your opinion; supposing they were [[p. 35]] accepted, would it make any difference in the conclusion to which you arrive?--It would make the greatest difference. It all depends upon that. If they could be demonstrated as they are put forth it would pretty nearly settle the question. That is, however, one of the great points that I understand other gentlemen who are likely to be called will deal with.
7733. With regard to the question of the change in the statistics of infantile mortality from small-pox is not that a statistical question as much as any other?--Yes, of course.
7734. I do not understand why you did not take that into consideration?--Simply because I have endeavoured to confine myself to broad general statistics over a long period of years as being the most trustworthy and satisfactory upon the whole, because the great thing we want to know is, whether, after the greater part of a century of vaccination, we have arrived at the result which we anticipated, or which in any degree ought to have resulted. I maintain that we have not. These little details are of very little importance comparatively, if the broad results are not satisfactory.
7735-6. (Mr. Picton.) You have been asked a good deal about the rapid diminution of small-pox between 1800 and 1820, have you in your statistical studies tried to ascertain how far vaccination spread, how many cases of vaccination there were?--I endeavoured to give you that in my evidence upon the first day.
7737. Do you consider there is any sufficient ground for making vaccination the cause of the rapid diminution of small-pox?--That was my special point, that from all the evidence we could get down to about 1822 I could not arrive at the conclusion that more than one fourth of the population could possibly be vaccinated at that time, whereas there had been a very great decrease of small-pox amounting to three-fourths.
7738. As a matter of statistics, would you think it a proper thing to contrast that with the case of Sheffield, for instance, where 95 per cent. of the children were vaccinated. Would it be a fair statistical argument that where you have 25 per cent. vaccinated a rapid diminution of small-pox, 95 per cent. ought to abolish it altogether?--No doubt that is a fair argument. And now moreover there is some evidence to show that it is not 95 but nearly 99 per cent. of the population who are vaccinated.
7739. (Sir James Paget.) Where is that to be found?--It is a statement put forward as being so very valuable, of an actual examination of an immense number of persons, a house to house inquiry, in the East End of London to show the number of persons who have been vaccinated and not vaccinated, and the result came out, I think, that 98.7 or 98.8 have been vaccinated and only 1.2 or 1.3 not vaccinated. I am quite certain of the figures; the statement referred to is in the report of Dr. Buchanan for 1884, "Vaccination and Public Vaccination," page v.
7740. (Mr. Picton.) I am anxious to have this as clear as possible that your reply to the question of the diminution of small-pox from 1800 to 1820 is that there is no evidence of a sufficiently extensive practice of vaccination to at all make that an efficient cause?--Exactly, there must have been another cause in action. Even if vaccination is a cause there must have been another cause.
7741. Might I refer again to the table to which your attention has been called in the first report of the Commission, opposite page 114, where the statistics of small-pox are divided into three periods from 1838 to 1887. They are divided into three periods according to the urgency with which vaccination was insisted upon. In the final period from 1882 to 1887, where our attention is called to, the considerable diminution of small-pox, we have the words "Vaccination obligatory but more efficiently enforced by medical officers and others." Have you compared the statistics of vaccination for that period as given in the Local Government Board's Annual Report, the 16th Report for 1886-87?--I think I have seen it, but I do not exactly know what your point is.
7742. I will put it in this way. You are aware that from 1873 to 1886 the per-centage of successful primary public vaccinations to births is given as 56, and in 1886 it is given as 53.0; thus there is a fall in the rate of successful vaccinations of nearly 3 per cent.; that there is a variation and a diminution in the rate of successful vaccination during that period which shows no increase of vaccination whatever?--That was the point I endeavoured to insist upon in my diagram, but it has been objected that the former part included re-vaccinations; whereas the latter part did not.
7743. I am not dealing with the re-vaccinations. I am dealing at present with the primary successful public vaccinations to births. Does not that column of figures seem to show that whatever may have been the state of the law it did not increase the number of primary vaccinations to births during that period at all?--No, that is why I wished to get the accurate statistics. It is said that not having the number of re-vaccinations, and not having the number of private vaccinations you cannot tell what the number is; but my own opinion would be that the one would follow the other, and that there would not be much difference.
7744. There is a column given of re-vaccinations as well as of primary vaccinations, may I ask whether you observed that the rise and fall are parallel with each other as nearly as you can observe?--It would take too much time to go over those figures to get anything out of them.
7745. (Dr. Collins.) Does the dotted line in the second of your diagrams in your book which relates to England and Wales represent official vaccination?--I understood it to represent the vaccinations at the expense of the poor rate.
7746. You do not claim that it represents accurately the ratio of the primary vaccinations to births?--No.
7747. It represents certain doses of vaccination as it were applied to the population at certain times?--Yes.
7748. You have been asked with regard to our own Registrar-General's statistics whether there is any similarity between the curve of small-pox death-rate in London and in England and Wales. You would not à priori necessarily expect that there should be a close similarity, would you?--No.
7749. Is it not the fact that during the 10 years from 1871 to 1880 there were recrudescences of epidemic in London which did not affect the rest of the country?--Yes; and to a slight degree the country too--both were represented.
7750. Would you give me the deaths from small-pox per million living in the four decades there given; for England and Wales first?--For England and Wales the annual small-pox mortality was for the four years 1847 to 1850, 292; from 1851 to 1860 it was 222; from 1861 to 1870 it was 162; and from 1871 to 1880 it was 245.
7751. Now will you give the rates for London?--From 1847 to 1850 the small-pox mortality was 402; from 1851 to 1860 it was 280; from 1861 to 1870 it was 276; and from 1871 to 1880 it was 457.
7752. Apparently the last decade for London has the heaviest mortality of the four, has it not?--It has the heaviest mortality, and the last for England and Wales is the heaviest except the first; but that is merely an illustration of what I have said several times, that it depends entirely upon how you divide up a table as to whether you get an increase or a decrease shown. This division shows an increase at the latest period--the division that Professor Foster read showed a decrease--that is the reason why I say that a diagram showing at once to the eye the ups and downs shows the results far better and more truly than a table which can be divided so as to show different results.
7753. (Sir William Savory.) But in your book you say, speaking of the relation of the second diagram to the first, "Here, too, we perceive a similar decrease in small-pox mortality"?--Yes; upon the whole.
Adjourned till Wednesday next at 1 o'clock.
* * *
THE RIGHT HON. THE LORD HERSCHELL IN THE CHAIR.
Sir JAMES PAGET, Bart.
Mr. BRET INCE, Secretary.
9543. (Chairman.) We understand you desire to make some corrections of, and additions to, your former evidence. The first matter you wish to speak about has reference to a new diagram of London small-pox, which I believe you have prepared?--In consequence of the questions that were asked, numbers 7482 to 7490, I endeavoured to find out what my error was as to population; and I was fortunately led by Mr. Wheeler to a reference to the Eighth Report of the Registrar-General, which he kindly lent me, and in that I find the actual population of London given for the area within the Bills of Mortality from 1801 to 1831, and that, with the population I used before for the earlier date, about the middle of the 18th century, enabled me, by interpolation, to get the whole series of populations for the earlier period of the diagram, which, I suppose, is tolerably accurate. In consequence of that I have drawn out a fresh diagram upon a small scale, the latter part being exactly the same as the previous diagram, and the earlier part being made by using the corrected populations. (The diagram was handed in. See Appendix II., Diagram J: facing page196.) The only remark I have to make upon that is that it does not seem to me to require any alteration in what I said. The amount of fall here is quite as great as in the other diagram, because, though the populations here are smaller, and, therefore, the amount of small-pox per million larger, the population increases considerably to 1830, and the average fall, if the two diagrams are compared, shows very little difference, and all that I said about the rapid fall here (from 1800 to 1822), and the comparative slight fall there (from 1823 to 1884), I think will remain without needing any alteration.
9544. (Professor Michael Foster.) That is a diagram of the small-pox rate of mortality?--Yes.
9545. (Chairman.) Just to elucidate this, where do you get your populations from for the 20 years from 1780 to 1800?--I think it is stated upon the diagram. An epoch in the 18th century (I forget what date it is) has been given as the best estimate of the population then, and I have taken it by interpolation between that and 1801.
9546. How do you mean "by interpolation"?--Between that date and 1801, simply by making a regular scale of increase. At the later period, where the increase is not quite regular, I drew it out upon a large curve to avoid a great deal of calculation, and took it from that.
9547. Have you at all investigated the question as to how far the London Bills of Mortality can be relied upon as showing either the total deaths, or the proportion which deaths from any particular disease bear to the total deaths?--Not at all; but they have been always referred to as affording the best evidence available, and they have been used by all writers on the subject during the whole century.
9548. They may be the best available, but they may be so imperfect as to afford no true comparison with the statistics subsequent to the date of registration?--It does not appear to have been thought so by the persons best able to judge. For instance, the late Dr. William Farr, who is admitted to be one of the greatest authorities, used them, and apparently relied upon them.
9549. But if there had been any particular year in any one of the parishes in which the death-rate would have been, if it represented the total deaths, very much below what experience has ever shown to take place even under the best sanitary conditions, that would tend to show that the statistics could not be relied upon, would it not?--I daresay it would; but I know nothing whatever about that. Here are the figures I have used in making the diagram, which, perhaps, the Commission would like to see. (The table was handed in. See Appendix II., Table K: page 196.)
9550. Then next you desire to show the effect of including all official re-vaccinations upon the diagram at page 5 of your book on vaccination; is that the diagram you have put in?--I was asked a great many questions about it, and consequently I wish to show that the error which arose from the official re-vaccinations not being given in a tabular form after 1874, has only led to a very slight error, the correction of which does not require the alteration of a single word that I used in my book when speaking of this diagram. I have given the two lines on the diagram I have here; the lower line as given in my book, and the upper line with the re-vaccinations added. (The diagram was handed in. See Appendix II., Diagram L: facing page 197.) The general effect of the whole is the same as it was when the re-vaccinations were not added; there is a slight but a steady diminution of official vaccinations, including re-vaccinations. These, again, are the figures from which I made that alteration. (The table was handed in. See Appendix II., Table M: page 197.)
9551. (Mr. Meadows White.) Why is there that break in your Diagram J., between 1830 and 1840?--The reason of that break is that there were no returns given by the Registrar-General for that period; I do not know why; it is always referred to as a break in the returns.
9552. That has reference, apparently, to the epidemic of 1838. You will see Dr. Seaton's report quoted on page 51 of McVail's book. Does that correspond with your diagram?--I do not see what point this touches upon.
9553. It touches upon the relative severity of two epidemics; is that relative severity shown in your diagram?--This passage to which you have drawn my attention compares, apparently, four years with three years.
9554. He points out that if you take the two epidemics, one is spread over a longer period than the other; therefore, the conclusion Dr. Seaton arrives at is that, population to population, the severity of the 1838 epidemic was very much greater than that of 1871?--The early part of the 1837 epidemic is not given; it may have added a great deal to it and made it still more severe; that is where the blank occurs.
[[p. 122]] (Professor Michael Foster.) In England and Wales the per-centage from the epidemic of 1838 was much higher than in 1871.
(Dr. Collins.) But not in London.
9555. (Mr. Picton.) Your diagram of the deaths in England and Wales would show the epidemic of 1871 to be considerably worse than that in 1838, would it not?--It depends upon whether you take the whole period of the epidemic or whether you take one year only. Of course the diagram shows it year by year. The epidemic may have been worse though the total height was not so great. I find it does not show much difference.
9556. (Chairman.) 1838 was the first year, was it not, of the Registrar-General's report?--Yes, of the full registration.
9557. It appears, I believe, that in that year the London Bills of Mortality show a very much less total death-rate, something like half the total death-rate within the Bills of Mortality, that is shown in the Registrar-General's return, but the amount of small-pox is shown to be even still less, only about one-fourth, if I remember rightly, what is shown by the Registrar-General; so that if anything of that sort existed in the previous years, that would entirely destroy the possibility of comparison, would it not?--It is stated in that report that after registration began the Bills were sent in irregularly, consequently they are not comparable.
9558. But the point to be noted is that the error does not only relate to the total death-rate, but is noticeable in respect to particular diseases, that is to say, the total deaths returned being half, a particular disease returned is only a fourth?--But, may I ask, is not that a very common thing; do not diseases vary so immensely?
9559. In different localities you mean?--Both in different localities and in different years.
9560. Therefore any error in sending in the returns by a particular parish may, in the previous years, have made all the difference; so that whilst it would appear that there was little small-pox, there may have been a great deal if one particular parish failed to make its returns properly?--As far as one parish went, it would not very much affect the whole, unless it was a very populous parish.
9561. It might have been a very populous parish in which small-pox specially prevailed. Something of that sort must have taken place in 1838, for example, because the total deaths returned, as I say, are half, whereas the small-pox deaths returned are really less than a fourth of those returned by the Registrar-General. The point I am putting to you is whether the value of this must not entirely depend upon how far you can rely upon the Bills of Mortality as showing not only the deaths, but the deaths from particular diseases?--All I can say is that Dr. Farr, who had the very best means of judging, apparently did rely upon it and used it very largely, and made the calculations and tables that he deduced, from it.
9562. Still people who have very good means of judging do not always exercise the critical faculty to the fullest extent that is possible upon the materials with which they are dealing?--No doubt, still, I think it should be proved that they are wrong, and not merely assumed that they may be wrong.
9563. Then your next point is with reference to the evidence of great sanitary improvement towards the end of the eighteenth and the beginning of the nineteenth centuries?--In the course of my search for evidence as to the population of the area included in the London Bills of Mortality I came upon what appeared to be some exceedingly interesting results shown by Dr. Farr in McCulloch's Statistical Account of the British Empire, in which he contributed an article on "Vital Statistics." There are some tables and statements which bear, I think, very importantly upon that question. In the first place, he gives a table of deaths under five years to each hundred births, from the London Bills of Mortality for 100 years, in five periods of 20 years each, and he shows that there was a continuous decrease of mortality, beginning with the years 1730-49. It was then 74.5 per 100 born. and it goes on decreasing; in the next 20 years it is 63.0 per cent.; in the next 20 years 51.5 per cent.; in the next 20 years 41.3 per cent.; and in the next 20 years which brings us down to 1810-29, it is only 31.8 per cent. That remarkable decrease I have shown roughly in a diagram of these successive periods, beginning from 1730 and ending in 1830, one century of decrease of infant mortality. (The diagram was handed in. See Appendix II., Diagram N: facing page 197.) And what shows the great value that Dr. Farr placed upon his materials, was that he used these words after giving this table: "The method pursued in obtaining the following results is unexceptionable, and demonstrates that for the last century the mortality of children in London has constantly been on the decline." That is from the article Vital Statistics in McCulloch's Statistical Account of the British Empire, third edition, volume 2, page 543. That appeared to be so interesting to me that I tried to get from the Registrar-General's Reports the means of continuing that table down to the present time, but I entirely failed. I could not find information regarding London which enabled me to do it; but as regards England and Wales, I think I have succeeded in getting a continuation of the table, but as it is rather a complicated calculation requiring four different computations, I may possibly have made some slight mistake, but I think it is practically correct, and the result is given in the latter part of the diagram for England and Wales. I here give the materials from which I obtained it, and my method of obtaining it, so that it can be checked if necessary. (The table was handed in. See Appendix II., Table O: page 197.) That, I think, is most remarkable and most important, because it shows (contrary to what I think is the common idea) that during the eighteenth and the beginning of this century there was a continuous steady decrease in infant mortality, and then beginning about the time when vaccination began to be prevalent there ceased to be that rapid decrease of infant mortality; it became less and less, and for the last 40 or 50 years, I think it is, it was nearly stationary.
9564. But it was as great between 1730 and 1790 as between 1790 and 1830?--Yes, as I say, it was during a period which we are generally accustomed to look upon as being, and which generally was, under extremely bad sanitary conditions that there is a remarkable decrease.
9565. But there is no decrease in small-pox during that time?--I will come to that presently. I have another table upon that point.
9566. But when you stated that there was a decrease in the mortality I understood you to say also that that was attributable to improvements in sanitation?--That is a portion of it. I have another calculation from Dr. Farr which carries the evidence further.
9567. You say that the decrease ceased, but it seems to have been going on from 1810 to 1830 in the same way as it went on from 1790 to 1810?--Yes, that is so.
9568. It did not seem to cease at the time when vaccination came up?--No; I say rather from the time when vaccination came to be more enforced by law. I only mention it, but there is the striking fact that during the latter part, especially of the eighteenth century, and the beginning of this century, there was a remarkable improvement in infant health which has not been continued since. Unless Dr. Farr's figures and my figures are all wrong I think that is clearly shown.
9569. (Sir William Savory.) When you speak of increase and decrease of mortality are you speaking of absolute numbers?--No; they are all per thousand or per million.
9570. (Chairman.) Where does Dr. Farr get the number of births in London for the purpose of comparing them with the Bills of Mortality?--He gets the numbers from the Bills of Mortality.
9571. Those would be the number dead, but as regards the number born, where would he get those from?--They would be taken also from the Bills of Mortality.
9572. Those would be christenings?
(Professor Michael Foster.) Yes, it is not necessarily births.
(Chairman.) In the subsequent period you have taken, I suppose, the proportion of registered deaths to registered births.
(Witness.) Yes; I have taken all the information I could get from the Registrar-General's reports.
9573-4. But what I mean is that the registered deaths and registered births, you will acknowledge, are not necessarily strictly comparable to registered baptisms and registered burials in the Bills of Mortality?--That is so.
[[p. 123]] 9575. (Dr. Bristowe.) Your figures would seem to show, unless I misunderstand you, that that great improvement in the health of children took place before sanitary measures were really adopted?--Yes; arising not from what we call sanitary measures but, I presume, from changes in the mode of living and customs.
9576. But did I not understand you that this improvement had taken place up to the year 1830, and that since then it had not continued?--Not so strikingly.
9577. Whereas since that time sanitary measures have been adopted thoroughly throughout the country?--Some sanitary measures.
9578. And not before?--No. Then pursuing the question of sanitary improvement in Questions 7393, 7394, and 7664 and 7766 and 7671, I was asked my opinion of the cause of the sudden decrease of small-pox in England and throughout Europe in the nineteenth century. I ascribed it to sanitary conditions of various kinds. I wish now to refer to another table by Dr. Farr in his "Vital Statistics," which goes to prove this. This table which I have carefully copied and wish to put in, shows for the years 1801-10 as compared with 1771-80 a decreased general mortality of two-fifths, that is to say, from 5,000 to 2,920 per million, and a decrease in a group of 14 infant's diseases which he names, from 1,682 to 789 which is a decrease of half; in small-pox from 502 to 204; in fever from 621 to 264, the decrease being considerably more than half; in consumption from 1,121 to 716, the decrease being about two-fifths; in dropsy from 225 to 131, nearly one-half. (The table was handed in. See Appendix II., Table P: page 198.) In these five groups of diseases the total saving is from 4,151 to 2,104, almost exactly half. Now the important thing is that while that enormous change took place from the period 1771-80 to the period 1801-10 as the table shows, there has been no such change either before or since. It was a decrease which took place at the very period to which I imputed the change and which is required for the purpose of my argument, that is, during the period from the latter end of last century to the beginning of this century.
9579. (Chairman.) You have these figures with a gap of 20 years between each set of statistics; is that done purposely, or is that what you found in Dr. Farr's table?--My table is copied from his. He says something about it--I do not quite understand him--to the effect that that was for the purpose of giving typical groups of years which were not exceptional one way or the other, as regards epidemics, I take it, or anything of that kind; typical groups of years showing the sanitary improvements and beneficial changes which must have taken place when this great change in the amount of mortality occurred. The curious thing is that in the previous 150 years included in his table there is no such alteration, and that in the subsequent 20 or 30 years which he gives there is no such alteration, and that down to the present time, as far I can gather, looking at the Registrar-General's Reports, there is no such sudden alteration. There was a remarkable alteration from near the beginning of last century to the beginning of this century which was apparently unique. Now it appears to me that whereas this country and Western Europe are, practically, as regards similarity of race and intercommunication and everything else, one great country--quite as much one great country as the United States of America in respect to sanitary and other matters such as civilisation and knowledge--we may fairly suppose that such a remarkable change as that was not confined to this country only, but took place throughout Europe; and if so, it would, in my opinion, go very far to explain the remarkable decrease of small-pox which is so great a puzzle unless it is explained by vaccination.
9580. The proportion of people who died of old age appears to have been going down during the time when these diseases were diminishing?--That is a very vague description; they seem to go up and down without any permanent increase or decrease.
9581. Comparing 1871-80 with 1801-10 the proportion of those dying from old age goes down?--It does; but it is more both later and earlier.
9582. And I observe that in the last years, in which there has been that great decrease in the diseases you mentioned, the "unknown causes" go up to 88 per 100,000 as compared with none in the previous years, and "other diseases" were 289 as compared with 144 in the period 1771-80. And again inflammation, which had been 31 per 100,000 in 1771-80, goes up in the next period to 101, and in the following period to 307. May I not suggest that there may have been a different classification, because I see under the first head which you give, where there is a large diminution, there is "inflammation of brain"; may it not be that some of the cases which were formerly in the first class, "inflammation of the brain," may have come into the class of "inflammation" generally?--I think there is no doubt that the first heading is entirely children's diseases.
9583. But still they may have put some of the "inflammation of the brain" from amongst children's diseases into the general "inflammation" because there you see a very remarkable change, it goes up from 31 per 100,000 in 1771-80 to 307 per 100,000 in 1831-35?--That is a very small proportion of the whole--the whole is equally remarkable--from an average of 5,000 deaths by the 20 classes of diseases named per 100,000 living it decreases to an average of less than 3,000.
9584. The general heading "other diseases" in the periods you have compared goes up from 144 per 100,000 to 289 per 100,000 in the last period?--Yes; but there had been 211, 253, and 565 in the previous periods.
9585. But I am taking the period which shows the marked diminution; from the 1,682 to the 789 which you quoted a short time back?--But the diseases I have given as showing a marked diminution, show a marked diminution when compared with the whole of the three previous periods as well; they are not the diseases which go up and down very much, they have kept a tolerable level.
9586. But if you were to add to those the considerable number which are now under a separate classification, the contrast would not be so striking, would it?--It would not be so great. It is impossible to say that there is minute accuracy in the table, but the improvement shown is so very striking and great a fact that I do not see that any small changes or errors could affect it appreciably; they might affect it a little.
9587. But as the latest period taken is 1831-35, I suppose the article was not written recently?--It does not go later than that.
9588. Does that conclude all you have to say upon that point?--Yes, that is all I wish to say with reference to the point of sanitary improvement.
9589. Then the next point is something you wish to add with reference to the relation of general mortality to small-pox mortality in Prussia and Austria?--Yes. In Questions 7140 to 7159 it was suggested that Austria, and especially Vienna, was badly vaccinated as compared with Prussia and Berlin. It is upon that point I wish to bring forward some evidence which I think bears upon the question, which is exceedingly important; and that is, that for long periods, in fact during the greater part of the present century, there has been a striking difference between Austria and Prussia in respect to small-pox mortality, and also in respect to general mortality, that is an important point of which I was not aware previously. In the First Report of this Royal Commission, page 72, the small-pox mortality in Austria and Prussia is given for the period 1807-50 as regards Austria and 1810-50 as regards Prussia, Austria showing a small-pox mortality of 420 per million and Prussia of 206; that is to say, Austria having double the mortality of Prussia. Taking a recent period, 1874-84, Dr. Proust's report, which, you know, (Table 1, page 16), shows a mortality for Austria of over 500--it is in the form of a diagram, and therefore I cannot give the exact figure--compared to a mortality of 100 or less than 100 in Prussia. That shows with respect to this small-pox mortality, that the difference between Austria and Prussia is a permanent thing, that it has gone on from 1810 to the present time. But if we turn to the general mortality in Austria and Prussia, we find, again, that they have long differed in a remarkable degree, Austria having constantly a much greater mortality. This fact is shown by tables given in the 51st Report of the Registrar-General which I have here, Tables 47-50. From these tables we find that if we take the general mortality per 1,000 of the population in Austria we have in six periods of five years each extending from 1856 to 1885 these figures, 28.5, 29.7, 31.3, 32.7, 30.5, 30.1, the mean of which is 30.5. Then in Prussia we have for those very same periods, a totally different set of figures, much lower, namely, 26.3, 25.9, 28.1, 27.6, 25.4, 25.4 the mean of which is 26.4. Thus we have a difference of four per 1,000 equal to 4,000 per million as a constant difference [[p. 124]] between the general mortality of Austria and of Prussia, to the disadvantage of Austria. This, I think, is a most remarkable thing, because a difference of mortality of 4,000 per million would entirely overwhelm the difference of small-pox mortality which has been on the average only about 400 per million. That is also according to Dr. Proust's report, first table, page 16. It appears to me that these facts show that the greater small-pox mortality of Austria is only part of the general and long-continued greater general mortality in that country, it is one item in the general result. Then this has an important bearing also upon the mortality from small-pox of the Austrian and German armies; for Dr. Proust tells us at pages 21 and 87 that vaccination is obligatory in both armies, yet there is the same or even a greater difference than in the small-pox and general mortality of the whole population. In the Austrian army since 1874 we have figures varying from 80 to 280 per million of deaths from small-pox, whereas in the German army there are actually no small-pox deaths registered during the whole period.
9590. Does his report say that the provisions as to re-vaccination are the same in the Austrian as in the German army?--He does not say that they are not. He suggests a totally different explanation. He endeavours to explain the difference in the small-pox mortality, not by any inferiority in the vaccination, but by the effect of the surrounding population (page 21, paragraph 3). That appears to me to be equivalent to saying that the vaccination of adults only protects when they are not exposed to infection; because the presence of small-pox in the Austrian army is imputed to the fact that the soldiers are living in the midst of an infected community, and the freedom from small-pox of the German army to the fact that they are living in the midst of a community from which small-pox is almost entirely absent.
9591. Supposing it to be granted that vaccination is not an absolute protection and that there are a small number of people who are not absolutely protected, despite vaccination, would not the surrounding circumstances affect them?--That is true; but what we are always told is that although primary vaccination is not an absolute protection, yet re-vaccination is almost a perfect protection; in fact, the almost total immunity of the German army and of the population now has been imputed to this revaccination law and the consistency with which they have carried it out.
9592. Do you know that in Germany they had a law for the re-vaccination of soldiers, and yet there were allegations that it had been so badly carried out that until recent years it had not been satisfactory from the point of view of being a sufficient protection?--As to that I know nothing. I wish to point out, before we leave this subject, that the mortality of the Austrian army, admitting the soldiers to have been vaccinated or revaccinated as adults, is greater than that of the adult population of corresponding ages in our own country between the ages of 15 and 45; the small-pox mortality of our own male population between the ages of 15 and 45 being 131 per million, and the mortality of the Austrian army being from 80 to 280; so that it is really greater.
9593. (Mr. Meadows White.) Are those figures taken from the Austrian Government statistics?--They are drawn entirely from the report of Dr. Proust on vaccine, he, I presume, having full access to the official reports.
9594-5. (Professor Michael Foster.) Has there been any change in the relative mortality of Prussians and Austrians since the year 1873; that is to say, the mortality from all diseases? You say, do you not, that the greater mortality from small-pox in Austria is part and parcel of their greater mortality from all diseases?--It is.
9596. Has there been a remarkable change in the mortality from all diseases relatively between Prussia and Austria since 1873?--There has been some change, but it has been to the advantage of Prussia.
9597. You are aware of a remarkable change in Prussia with regard to the mortality from small-pox?--Yes; that is the point I am trying to meet.
9598. That is not accompanied by any change in the general mortality?--I think it is. The small-pox mortality in Prussia, taking the years 1810 to 1850, was 206 per million; from 1874 to 1884 it was under 100, so that it is a decrease to one half of what it was. In Austria it has, on the other hand, risen from 420 to 500.
9599. Is there an improvement in the general mortality in Prussia corresponding to their lessened mortality from small-pox?--I do not say corresponding; you never can have regular correspondence between small-pox and other diseases.
9600. But the general change in Prussia since 1873 is very remarkable, is it not?--It is; and the reduction in the general mortality is very remarkable.
9601. (Chairman.) As compared with what time?--As compared with the period from 1810 to 1850. Those are the only two periods I could get, one period being given in your report and the other being given by Dr. Proust.3
9602. What is the small-pox rate in the last period?--Less than 100 per million. The general mortality reduction has not been so great.
9603. (Professor Michael Foster.) Not in Prussia?--It has changed; the general mortality is reduced from 27.6 to 25.4. That, of course, is a very large reduction for a general mortality.
9604. What has been the change in Austria?--In Austria there is also an improvement, but it is still much higher; from 32.7 it has gone down to 30.1.
9605. What is the relative difference between the two?--Hardly any.
9606. What has been the change in the mortality from small-pox between the two countries, say, from 1873. I find that before 1873 there were only two years in which the mortality from small-pox was under 100 in a million, namely, in the years 1855 and 1856, when it was 96.7 per million, and 73.2 per million in Prussia; then after the year 1873 it fell down from 95 to 36, 31.3, and 12.6, and so on, which indicates a great change, and that smaller mortality means fewer cases as well, does it not?--The whole question is whether it can be shown that the re-vaccination of the Austrian Army is something totally different from the re-vaccination of the German Army. Considering that the two Governments are, at all events, equal in knowledge and in seeing the importance of science, that the scientific men of the one country are as good as those of the other, and that they are parallel in all respects in the higher classes, I cannot imagine that there should be any such enormous difference in the vaccination of the two armies as is shown by these figures, on the assumption that re-vaccination protects from small-pox.
9607. (Mr. Meadows White.) Is the law the same?--I have always understood that the general law in Austria is the same as it used to be in Prussia; but as to the two armies it is stated that all the recruits should be either vaccinated or re-vaccinated. If so we have to account for this enormous difference, that while in Austria it produces no effect, in Prussia it is said to produce this enormous effect of absolutely abolishing small-pox. It appears to me that this gives us the nearest we can possibly get in the present state of the world to a strictly comparable case. You have two armies in two neighbouring nations, rivals in almost everything, both adopting re-vaccination for their armies; in one small-pox ceasing, and in the other going on just as bad as ever.
9608. (Chairman.) Does that conclude what you have to say on the fourth head?--Yes.
9609. You next desire to reply to some questions on passages in your book relating to syphilis and cancer, which you were unable to answer at the time?--I wish to mention that it was suggested in those questions that the increase of syphilis mortality was due entirely to change of classification of the disease. I wish to remark upon that, that in order to prove that is the cause, it is necessary to show, not merely that there has been some change of classification, but that the diseases newly classed under this head are sufficient to explain the increase. They may not be one tenth of the number required. The transmission of syphilis by vaccination is now an admitted cause of that disease. The mere allegation that there has been a change in classification is not sufficient to account for the increase of the mortality ascribed to this disease. Then, again, I think, it must also be shown that the ordinary medical practitioners all over the country, are acquainted with this new classification, and regularly make use of it in their certificates of causes of death. Now on this point I [[p. 125]] happen to have come upon a passage in the "Lancet," which bears strikingly upon it. After speaking about medical literature in connexion with syphilis, and the neglect this disease has received from medical practitioners, it (the article) goes on to say: "To these and other causes, but principally the former, is to be attributed the fact that the average general practitioner is more or less imperfectly acquainted with syphilis, and that even among specialists in venereal diseases there should be these 'moot points' still remaining to be decided." I think, therefore, it has to be proved, not merely to be assumed, first of all that these new diseases which are now put under syphilis are sufficient to account for the great increase in the disease, and if they are sufficient, that they have been classified as such by all the general medical practitioners over the country.
9610. But it might, might it not, be retorted upon you that if you seek to prove that there has been an increase of those diseases resulting from vaccination, you must show that the two things you are comparing are comparable because they relate to the same thing?--I have only suggested, or rather adopted it (because it has been put forward by others) as my explanation. I say that the spread of it has been very strikingly coincident with the great increase of vaccination.
9611. (Dr. Bristowe.) But you are not going to give any evidence upon that point, are you?--I merely wish to show that the explanation suggested does not seem to me to be satisfactory, and to show why it does not seem to me to be satisfactory. Then there is another point I wish to mention with reference to cancer, which is still more important. In Questions 7723 and 7724 it was suggested that by the supposed saving of infant life by vaccination there would be more persons liable to have cancer, which is a disease of adults. I could not answer that question at the moment, because it came upon me unexpectedly; but as soon as I considered it at home I saw there was an easy answer to it; in fact, there are two answers to it. The first is, that during this period, when cancer has increased so much, there has been practically no saving of infant life, as I have previously shown; at all events, no sufficient saving of infant life to produce the slightest effect upon the comparative mortality of adults.
9612. (Chairman.) You mean the death-rate of children under five years of age is the same as before?--Yes; under one year especially, and under five it is very nearly what it was before; that is only a small part of the matter. The other answer is that if there had been any amount of saving of infant life it could not possibly have had the effect suggested unless you could prove that there was some connexion between small-pox and cancer--that those predisposed to cancer would be those, in larger proportion than the average, who would be saved from small-pox. Otherwise it does not matter how much you decrease infant mortality. It cannot alter the proportion per million subject to cancer or to any other disease; and that proportion is what has increased and has gone on increasing down to the latest returns. From 1865 to 1888 there been a constant increase of cancer mortality--almost year by year--from 302 per million to 591 per million, on five years averages. Not only is the supposed relation between the saving of infant life and the increase of cancer a pure fallacy, but if there had been a special saving of infant life commencing when the cancer began to increase, the effect would have been exactly the opposite; for, while infant lives were being saved (as compared with previous years), the effect would be to slightly increase the proportion of infants to adults in the population, and therefore to produce an apparent diminution of any purely adult disease per million of the whole population. So that I think it is perfectly demonstrable as a matter of figures and mathematics that any saving of infant life could not possibly affect cancer or any other disease of adults unless you can show a connexion between the two, unless you can show that those who would have died from small-pox had they not been saved by vaccination would be those particular ones who would afterwards die from cancer.
9613. But those in whose case there was a diminution of infant mortality must die of something?--They must die of something, but there is no reason that they should die of cancer more than of any other possible disease.
9614. But is there any reason why they should die less of that?--No. That is the point; it is the proportion to the whole population that is increased.
9615. (Sir William Savory.) As you put the matter forward at present, the evidence in favour of a connexion between vaccination and cancer is the same as the evidence in favour of a connexion between vaccination and syphilis. You show that there is an increase both in syphilis and cancer, and your suggestion upon the same ground is that vaccination is the cause of the increase in both?--That is the suggestion I have adopted. Now if you will allow me, I would like to make a few remarks upon the point of cancer. I have to acknowledge at once that I have made a technical error, though I doubt whether it is a real error, in having included cancer amongst inoculable diseases; but I should like to read a passage from an article contained in Quain's "Dictionary of Medicine," because it bears directly upon the point. This quotation is as follows: "Most instructive too are the facts of contagion which are to be learnt in the study of tubercle; the contagion introducible either by tubercular and certain septic inoculations through the skin or internally by the infective action of the milk or diseased organs of tubercular animals taken as food; and the contagium when introduced, gradually spreading as it multiplies and as lymph and blood carry it from the first infection spot to other organs, which now will repeat the process. And similarly in cancer (though the primary disease is at present of unknown origin and cannot be created by experiment) the repetition of the primary disease in secondary and tertiary propagations in the body of the sufferer is one of the most striking of all evidences of contagion; because of the great number of structural types which pass under the name of cancer, and the fidelity with which each of them is reproduced in the organ to which the contagion extends." That is taken from page 288. Then, two pages further on, on page 291, we have this: "Modern research seems more and more tending to show that the true unit of each metabolic contagium must either be, or must essentially include, a specific living organism able to multiply its kind." There is also given, I think, in the same article the case of four sisters who all died of cancer, but in each one it affected a different organ. The meaning of these two passages seems to indicate that in the view of the writer there was some germ transmitted hereditarily which produced cancer; and, if so, it appears to me to be still highly probable (though from the fact that cancer is a disease of adults those germs must lie dormant for a long period of years) that that disease must be capable of being transmitted by inoculation, although the proof of it may be exceedingly difficult owing to the long period during which it lies dormant.
9616. (Sir James Paget.) You have evidence, I believe, that consumption, a tuberculous disease, has diminished of late years considerably. Could that be reconciled with that statement you have just made, seeing that consumption could as well be inoculated as cancer; because we know as a matter of fact that tuberculous disease can be inoculated by insertion? Amongst the many things besides which might influence the increase of cancer, would you think it fair to select vaccination as the only means of increasing it?--I have suggested it; and the only other suggestion has been that which I have just referred to, which appears to me to be utterly unmeaning, having no relation to the case. There may be some other explanation; still to me that explanation I have given appears to be the probable one.
9617. (Chairman.) In the table you put in this morning, in which you call attention to the infantile diseases having fallen as between 1771-80 and 1831-35, consumption appears to have fallen from 1,121 to 567 per 100,000. The latter would be a vaccination period and the former a pre-vaccination period, and between those two consumption has fallen considerably?--Yes, it has fallen considerably.
9618. (Sir James Paget.) Putting that by the side of the fact that tuberculosis is inoculable by experiment, and that cancer has not been found to be inoculable under any conditions yet tried, what do you say?--I may be wrong, but I have always thought that consumption was very greatly a matter of healthy conditions.
9619. Why is not cancer?--That I do not know.
9620. (Chairman.) Does that conclude what you have to say upon that point?--Yes, it concludes that point as to syphilis and cancer.
[[p. 126]] 9621. (Sir William Savory.) Do you doubt that knowledge has increased and become widely and rapidly spread with reference to both syphilis and cancer of late years?--I have no reason to doubt it at all.
9622. If that be the case, would it not be likely as a matter of probability to lead to a better diagnosis, and the registration as attributable to those diseases of a great number of cases which heretofore were overlooked?--That might be said of all diseases.
9623. But it may be said of these. Is it not the fact, especially with reference to syphilis, that very great progress, more than in many diseases, has been made in our knowledge of syphilis in recognising its more advanced forms and effects upon internal organs?--But that would work both ways; because the greater knowledge need not necessarily put more diseases into syphilis; it might take some out.
9624. But which way is it more likely to operate if syphilis has been found to be playing a part in the destruction of life which years ago it was not suspected of doing?--The question is, is that sufficient to account for the striking increase of syphilis.
9625. Is it not more probable that this is the cause of its increased registration than any idea that the germ is conveyed from one person to another by vaccination?--It does not seem more probable to me; but upon that point of course my opinion may be of no value.
9626. (Chairman.) You have some addition to make to your answers to Questions 7700-7712 relating to the comparative mortality of medical men from small-pox and fevers?--Yes. That was put to me very strikingly; it was a new point altogether, and I was not aware of it. I want to remark upon that, as a matter of logic and the proper treatment of the subject, that the mortality of medical men as regards small-pox should be compared, not with that of the general population but with that in some strictly comparable profession, equally healthy, equally interesting, and pursued by persons in an equal position altogether with respect to exercise, and other important items, such for instance as civil engineers, the clergy, geologists, and people of that kind. Then again the most important point I think is this, that small-pox epidemics occur at long intervals. For years together the disease is so little prevalent that the majority of medical men hardly ever see a case, and a great part of the cases are treated in hospitals. I have here an extract from a periodical called "The Hospital" which touches upon that point--this is in the number for March 20th, and it says "These were days in which treatment in hospital was the exception, not the rule, and in which, therefore, the private practitioner had many opportuities of observing the doings of small-pox among both vaccinated and unvaccinated, opportunities which are now enjoyed only by the physicians of the great small-pox hospitals." That illustrates the point that the average medical man is not now likely to be more exposed than other persons in a similar class of life to the infection of small-pox. Then again, fevers, with which it was compared, are very much more generally prevalent. In the 13 years from 1876 to 1888, I find the average small-pox mortality to be 59 per million, the average scarlet fever mortality 450 per million, and the average mortality from other continued fevers 223 per million; so that you have fever altogether ten times as numerous as small-pox; and as fevers are not so universally or so very generally treated in hospital as small-pox, the ordinary medical man would in almost every year be subject to the contagion of fever, whereas only at long intervals would he be subject to the contagion of small-pox.
9627. But apart from that point as to the treatment of the one disease in hospital; if the medical man is ten times as much exposed to fever as to small-pox, so would the general public be ten times as much exposed to fever as to small-pox. How would it matter that the one is a disease prevailing more than the other. If there are but few epidemics of small-pox so that it will only slightly affect the general population, just in the same proportion will it affect the doctors, if they are all equally protected?--The principal point is of course, the treatment in hospitals, and also the question of epidemics. In an epidemic one medical man may of course attend many patients, but in the case of fevers each patient may have a chance of infecting a medical man. Therefore in the case of fevers medical men are very much more exposed to infection than the general population; whereas in the case of small-pox they are not more exposed than the general population.
9628. (Dr. Bristowe.) Do you know how small-pox patients get into hospital; do you think they are seen by medical men before they go in?--Yes, no doubt some of them are.
9629. Do not you think that all are?--Yes, perhaps they are seen once.
9630. (Chairman.) You would not say, I suppose, that all fevers were as contagious as small-pox?--I should have thought that scarlet fever was as contagious.
9631. I did not say any particular fever, but all fevers?--No doubt that might be so, but scarlet fever is the one that is most frequent, the one from which medical men are said most to suffer.
9632. (Mr. Hutchinson.) Should you not say that every patient who is sent to hospital is seen by a medical man more than once?--That I could not say.
9633. They are all sent by medical men?--Practically, I suppose they are.
9634. (Sir James Paget.) In fact, a person suffering from small-pox could not get in without being seen?--Probably; but he would not be treated throughout the course of the disease.
9635. (Mr. Hutchinson.) So that the medical man would expose himself to the risk of taking contagion for some little time before the diagnosis was established?--Then it was alleged that the reason why medical men escaped the contagion of small-pox was that they were more generally re-vaccinated. That, as it appears to me, requires to be proved, not merely to be alleged; because I find that in a discussion that took place on Dr. Ogle's paper in which these facts were given about medical men, one of the other facts stated was that medical men are greatly subject to death by enteric fever, to four times the extent of the general population, and it was suggested in the discussion that medical men lived in very badly-drained houses. Now, as medical men know better than anybody else the danger of living in badly-drained houses, it is reasonable to suppose that they would not be more careful about vaccination, even if they believed in it, than to have their houses well drained.
9636. (Chairman.) It is a simpler thing, is it not, to be vaccinated than to have your house well drained?--No, I beg your pardon, to be vaccinated involves a considerable amount of personal inconvenience.
9637. But to have your house well drained involves considerable expense, and with the possible result that when you have had it done you will find your house worse drained than before?--That is possible; but, as I was pointing out, vaccination involves a considerable amount of inconvenience and sometimes disability for a few days.
9638. (Sir William Savory.) Did I understand you on a previous occasion to say that it was only an inference that nurses were re-vaccinated in hospital?--No, I said it was only an inference that medical men were re-vaccinated more than other persons.
9639. But you know to what extent the nurses escape?--Yes. I would beg leave to read an extract I have come upon in a medical work in reference to that point. In Buck's Treatise of Hygiene and the Public Health, Vol. 2, I find an article by Drs. Hamilton and Emmett on small-pox and other contagious diseases in which occurs the following passage: "It is a fact fully appreciated by medical men, that persons constantly exposed to small-pox very rarely contract the disease. In the case of physicians, health-inspectors, nurses, sisters of charity. hospital orderlies, and some others, this is the rule; and of over 100 persons who have been to my knowledge constantly exposed, some of them seeing as many as 1,000 cases, I have never personally known of more than one who has contracted the disease; but there are many writers who believe perfect immunity to be extremely rare. In this connexion attention may be called to the exemption of certain persons who occupy the same room, and perhaps bed, with the patients, and though sometimes never vaccinated, altogether escape infection." Of course, the only point there is, first, that the fact is appreciated by medical men and stated, as a matter of common knowledge, that constant exposure to infection results in immunity, and next that there are persons, as I urged before, who are not subject to infection at all.
9640. (Mr. Hutchinson.) Do you doubt that any person who was going to be continually exposed, whether he be a hospital attendant, a medical man, or a nurse, would almost invariably take the precaution of being vac- [[p. 127]] cinated; he knows he is going to be exposed and would take that precaution?--I believe there are many exceptions, and the person who wrote this passage evidently thought that there were many exceptions, he implies that in his words.
9641. (Sir William Savory.) But where is the evidence of people constantly exposed independently of vaccination and yet not taking the infection?--I do not give that as my opinion, I give it as the opinion of a medical man.
9642. (Sir James Paget.) Mr. Wheeler mentioned a fact in regard to that that Dr. Huxham, who in his time was perhaps the greatest authority on fevers, and saw the largest number of them, mentioned that he knew one person who had been repeatedly exposed to the infection of small-pox and had never been infected; does not that bear upon it, that he mentioned only one person, he himself having larger experience than any one now living with regard to small-pox?
(Chairman.) Does not this allusion to the fact that in some cases persons sleeping in the same bed have not taken it, even though not vaccinated, rather point to the fact that he was speaking of the others as being as a rule vaccinated?
(Witness.) He says "and though sometimes never vaccinated;" he does not say "even."
9643. Does not that indicate that he is speaking of the vaccinated class in other cases and is putting these as the exceptional cases?--I really do not think that, he implies that constant exposure of itself leads to immunity.
9644. Do you know what precedes that in the article, he may have been talking about vaccination?--There is nothing that precedes that bearing upon this point.
(Mr. Hutchinson.) The constant exposure implies immunity, and the immunity has been tested and found safe.
9645-6. (Professor Michael Foster.) Now may I ask you with reference to small-pox in the Austrian and Prussian armies; you stated that you believed the regulations in the Austrian army were the same as in the Prussian army; you have no actual knowledge of that, I believe?--No.
9647. I find here at pages 7 and 8 of this German publication (Beitrage) vaccination in the Austrian army spoken of as being confessedly faulty:--"In May 1886 with reference to the Austro-Hungarian army in which, as we have said, the vaccination," that is to say, the re-vaccination, "had hitherto been imperfectly carried out, a new regulation for vaccination is instituted in the sense of a more complete carrying out of universal compulsory vaccination, above all, in the future all recruits must immediately upon their reception be vaccinated or re-vaccinated respectively as has been the case in the Prussian army in a similar manner ever since the year 1834?"--I presume, that is, a German, not an Austrian statement.
(Professor Michael Foster.) It is a Berlin statement, but it is official; it was issued by the Imperial Sanitary Office, the Gesundheits Ammte.
9648. (Chairman.) Then you wish to call attention to the report of the German Vaccination Commission upon the question of the comparative mortality of the vaccinated and unvaccinated?--It is a very small point, and I have not got it at first hand. But in the British Medical Journal for August 29th 1885, pages 408-9, there is an article on the German Vaccination Commission, and it is stated there that "in the view of Dr. Koch, no other statistical material than the mortality from small-pox can be relied upon, questions as to the vaccinated or unvaccinated condition of the patient leaving too much room for error," and it was implied that that was adopted by the Commission as the rule on which they reported.
9649. Do you mean that for the purpose of ascertaining whether vaccination was a protection by seeing what was the effect of small-pox upon the vaccinated and the unvaccinated he solved the problem by assuming that those had been vaccinated who died little, and that those were unvaccinated who died much?--I understand it to be that the uncertainty of determining the fact of vaccination was so great that they put that aside altogether, and trusted merely to the effect of vaccination on the general population that is what I understand was the meaning of it. At all events this Dr. Koch was an official and a vaccinator, and the fact that he at all events implied that such evidence was not trustworthy goes to support our contention also that it is not trustworthy. That is our great contention, the one thing upon which we most rely, that the evidence of mortality on the vaccinated and the unvaccinated untrustworthy.
9650. (Dr. Bristowe.) Who was the author of the article?--I do not know.
9651. In what form did it appear?--It is an editorial article upon the German Vaccination Commission. I presume it is an accurate report of what took place. I merely refer to it as indicating that at all events in Germany the Commission rejected that kind of evidence and trusted to the general evidence of small-pox mortality.
9652. (Chairman.) I find in an article upon the German Vaccination Commission read before the Epidemio logical Society, on the 9th of December 1885, what may perhaps explain the passage you have quoted. "Dr. Koch explained that for these statistics he had taken the small-pox mortality as the only reliable basis to go upon for the following reasons. To begin with it was well known that the mortality from all diseases was much greater during infancy than in the years next succeeding it, and that all small-pox statistics ought to be arranged in age classes, considering the great influence of age upon morbidity, lethality, and mortality. (By lethality is meant the degree of reaction of the organism towards an infectious disease.) Now, although some statistics in age classes appear to show that vaccination is useless, this was only because the same statistics brought in the 'vaccinated condition' of the patients. But all comparative statistics founded on this last, were ipso facto unreliable, 'usually worthless.' Directly the question of the vaccination or non-vaccination arose, room was made for a number of errors; in fact, this was why the original returns of the epidemic were not produced. To begin with, the information as to whether anyone who had died of small-pox had been vaccinated or not, had been given by the deceased's friends, and not (in the majority of instances) by medical men. Again such statistics did not state (1) whether the vaccination was successful or not; (2) the degree of success--the number of vesicles produced; (3) the date of the vaccination," and so on. I read from the Transactions of the Epidemiological Society, page 38. So that he is there not dealing with the division between the vaccinated and unvaccinated, where the medical man can examine the patient and form an opinion for himself, but he is dealing with the statistics of the vaccinated and unvaccinated, which related, not to the evidence of medical men, but to evidence taken from unreliable sources. Would not that be what Dr. Koch is alluding to in the passage which is summarised as you read it?--It may be so.
9653. Is there anything else which you desire to call the attention of the Commission to?--I have nothing else in the way of special points, except that I should like to make a few personal concluding remarks, and to be allowed to sum up my point of view.
9654. By all means do so.--During the course of my examination, I have been asked questions which implied that I had taken up this subject and written on it without the full and accurate information befitting a man of science. I admit that this is, to some extent, true; but my answer is that I did not take it up as a question of pure science. If it had remained a question of medical science and practice, I should not have troubled myself about it, and certainly not have written on it. But from the moment when, through the great influence of the medical profession, a medical dogma was enforced by penal law, it became a question of politics, a question of personal liberty. When almost every week I read of men fined or imprisoned for refusing to subject their children to a surgical operation which they (and I) believed to be, not only useless, but injurious and dangerous, I felt impelled to aid, if ever so little, in obtaining the repeal of a cruel and tyrannical law. I could not wait years to study the question in all its intricacies and obscurities while men were being daily punished, as I believed, unjustly. Liberty is in my mind a far greater and more important thing than science. I thought I could put a few of the more striking and best ascertained facts before the public and before Members of Parliament in a clearer way than they have yet been put, and I tried to do so. A few errors have been pointed out in my book, but I am glad to find that they are all unimportant, and do not at all affect the general arguments relied on. When I com- [[p. 128]] pare them with the mistakes made by men of far greater weight in this matter than myself (because they are listened to by legislators) they seem to me but as molehills compared with mountains. I should like to be allowed to give two or three examples, which I will do very briefly. For years the comparative small-pox mortalities of the French and German armies during the war were given in definite figures (23,469 French, 263 German), and used as a most powerful argument in favour of vaccination. Now it turns out that no statistics exist, and that the figures must have been invented by someone for the occasion. Then I would just mention that the late Dr. W. B. Carpenter, once in the Spectator and again in a little pamphlet he published, called "The Truth about Vaccination," said, that "100 years ago the small-pox mortality of London alone, with its then population of under a million, was often greater in a six months' epidemic than that of all England and Wales now, with their 25 millions, in any whole year." This is an amazing error. The facts well known are that the very highest small-pox mortality in London during the last century was 3,992 in 1772, while it was 7,912 in 1871, and in the same year in England and Wales over 23,000. This gross error was pointed out to him privately and acknowledged privately, but never withdrawn publicly; and he posed as "one who had studied the medical literature of the last century." Mr. Ernest Hart, a medical man and a candidate for Parliament, in his "Truth about Vaccination," surpasses even Dr. Carpenter. At page 35 he states that in the 40 years 1728-57 and 1771-80 the average annual small-pox mortality of London was about 18,000 per million living. He has taken the periods of greatest small-pox mortality, and has multiplied them by four to compare with the mortality of the present century. These gross errors, important as showing how untrustworthy are some medical men, how careless in a matter where accuracy is of vital importance, this carelessness and even recklessness of statement, extends to official publications. In a tract, "Facts concerning Vaccination," issued by the National Health Society, with revision and sanction of the Local Government Board, at page 4, we find: "Before its discovery" (vaccination) "the mortality from small-pox in London was 40 times greater than it is now." This is a gross error and misleading statement. If it means that in some years of the last century it was 40 times greater than in some years now, it is simply misleading, since within the last 20 years we have some years when the small-pox mortality was not only 40, but 80, 100, and even 200 times greater than others. If it means on an average of 10 or 20 years it is absolutely false, for the small-pox mortality of London for the 20 years 1861-80 was 367 per million; of London in the last 20 years of the 18th century it was about 2,364 per million, or six and a half times as much as that just given, while in the 10 years of the greatest small-pox mortality, compared with the population, in the last century, viz., 1710-19, it was 3,820 per million.
9655. (Professor Michael Foster.) I thought the mortality was greater in the succeeding decades, even proportionately to the population?--I think not. I have taken the greatest average of the 10 years in the last century. It ran somewhere about that. There are several decades in the last century in which it ran high, but I do not think it ever exceeds that. Then, again, in this same pamphlet it is stated at pages 2, 3, and 5 that vaccination protects against attacks of small-pox "in the great majority of cases," that it gives "an enormous protection" against attacks, and that vaccinated people "escape attack to immensely larger extent than unvaccinated people," statements which are opposed to well-known facts as to the proportions of vaccinated patients in our hospitals.
I would now ask permission to briefly summarise my evidence. In the first place, with reference to the small-pox mortality of London from 1780 to 1884, the diagram I have laid before the Commission shows a decrease from 1800 to 1822, far greater than can be attributed to the amount of vaccination then performed, and a decrease from 1822 to 1884 on the whole far less than it ought to have been from the great increase in the amount of vaccination. In the second place diagrams of Sweden and Prussia show very similar phenomena, while in Stockholm, Berlin, and Vienna modern epidemics have been as severe as those of the dreadfully insanitary London of the 18th century. Thirdly, I have adduced evidence to-day to show that at the end of the last century and the beginning of this one there was a great improvement in the sanitary condition of the population as indicated by a remarkable decrease, both of infant mortality and that from a number of other diseases besides--small-pox, fevers, consumption, dropsy &c. Fourthly, as a test case I refer to the Prussian and Austrian armies, both vaccinated and revaccinated but showing an enormous difference in small-pox mortality. But there is a corresponding difference both in the small-pox mortality and the general mortality of the two nations; so that the facts are accounted for independently of vaccination. Lastly, I submit that the fact that the incidence of small-pox on the vaccinated and unvaccinated is now approximably proportionate to the numbers of these two classes in the community, shows that vaccination has absolutely no effect in warding off attacks of small-pox; while the close agreement in the total per-centage of small-pox mortality to cases in the last century, and since vaccination was enforced, offers a strong presumption that it has not influenced the mortality from the disease. The apparent advantage of the vaccinated depends upon a combination of circumstances which have been often pointed out, the unvaccinated including three distinct groups of individuals on whom the disease is likely to be especially fatal. These are (a) all infants under vaccination age; (b) all those whose vaccination is postponed through ill-health or constitutional weakness; (c) all those who escape the vaccination officers, including the nomad populations--tramps, beggars, and criminals, living under the most unsanitary conditions.
From these five groups of facts, which lend mutual support to each other, I draw the conclusion that vaccination is absolutely powerless either in preventing attacks of small-pox or in diminishing small-pox mortality.
9656. (Chairman.) I think in the diagram you first put in you took as your starting point for the population, the computation in the year 1738, by Maitland, did you not?--Yes, I think it was.
9657. And since 1801 it was from the census?--Yes.
9658. So that your basis, as regards the earlier period, depends upon the accuracy of Maitland in 1738?--Yes.
9659. There seems to have been a very small increase of population, if that is correct. In 1738 he computes the number of persons within the Bills of Mortality at 725,903; in 1801 it is only 746,233, an addition of 20,000 in the 63 years. Do you know if there is any reason to suppose that the population was so stationary in the last century?--I think other authorities stated that it was not supposed to increase at all for a long time during the 18th century.
9660. But I observe that in the decennium between 1801 and 1811, there is an increase of 100,000. That was still during the time of the war, and one is a little surprised to find an increase from 746,000 to 856,000 in the decennium from 1805 to 1810 if there had been only 20,000 increase in the 62 years before?--Is not that partially explained by that remarkable decrease of mortality which Dr. Farr points out? Of course, the decrease of mortality would of itself necessarily lead to an increase of population.
9661. But that had begun, according to the table you have put in to-day, a little earlier?--It had, no doubt.
9662. (Professor Michael Foster.) I was struck with the words in the opening of your conclusion; therefore may I take the opportunity of asking, do you object to compulsory notification and isolation?--No.
9663. That you think is on a different footing from compulsory vaccination?--Yes.
9664. You do not agree with the writer in the "Vaccination Inquirer," that, "When that comes in force the agitation against it would be an agitation compared with which the present agitation against vaccination is as a ripple compared to a storm"?--Perhaps I do not understand what you mean by compulsory notification and isolation.
9665. When it shall be necessary that every infectious disease shall be made known to a public authority and the public authority shall have the power to isolate the sick individual, whether he will or not, from his fellow creatures; you were talking about liberty, and so on; you do not object to that infringement of liberty do you?--Isolation is a different thing; I should object to that under penalties to the parent. If it be necessary I had rather it be done as far as the simple isolation is concerned forcibly, if it is done at all; that is to say, done compulsorily.
9666. That is to say, take the patients away?--Or isolate them in their own homes. I take it that it would [[p. 129]] never be done in this country to the exclusion of isolation in one's own house; you would never, I take it, force a duke's son, or one of the Queen's children, for example, to go into a public hospital.
9667. (Chairman.) You would not be opposed to interference with individual liberty to this extent--that the State should take a person away if he could not be effectively isolated in his own house?--No, I should not.
9668. (Sir James Paget.) Would you object to isolate the rest of the family with him?--I thought it was the object of isolation to separate them.
9669. It is the practice in New South Wales and other Australian Colonies to send away the whole family with the person infected; would that be your view?--I would rather not give an opinion upon these points without considering them very carefully.
9670. (Mr. Picton.) Are you aware that it is done in Leicester; that they isolate the whole family with the patient?--But that is not done compulsorily; people may do it because they see the benefit of it.
9671. (Professor Michael Foster.) But that is not the point; do you object to that being enforced by the State?--We would all prefer its being done by the municipality.
9672. That, again, is not the point; you have no objection to substituting rigorous compulsory isolation for compulsory vaccination?--I should certainly very much prefer isolation, but still isolation carried out with the fullest consideration for the feelings of the persons concerned.
9673. (Mr. Hutchinson.) You have also stated very plainly that in your view vaccination does not prevent small-pox; may I ask if you have any large collection of facts as to individuals who having been recently vaccinated have been exposed to small-pox contagion, and have taken small-pox?--I have not collected them, but I have read plenty at different times.
9674. Could you refer me to any such collection of evidence?--I could not refer you to any such collection.
9675. Do not you think that would be the most important evidence of all?--It would.
9676. Do not you think it should be collected: take a nurse who gets herself vaccinated and successfully vaccinated before she goes into a hospital, would it not be valuable if you could collect evidence showing that such persons have to any extent taken small-pox?--I have not collected it, and I could not give the time or take the trouble to prepare it.
9677. You are quite aware that now the medical profession are beginning to think that vaccination is only protective for a short time, but that it is very strongly protective for that short time, do you think there is any evidence to shake that belief?--I believe there is. I have read a number of cases which would seem to do so.
9678. Of those who have recently been vaccinated and have taken small-pox?--Yes; you mean, I presume, within one year or two years.
9679. Yes; those who have gone into small-pox hospital trusting to their recent vaccination, and it having failed them?--Every case of a soldier having small-pox is a proof in that direction.
9680. But within what period of their re-vaccination?--I never heard it said that vaccination only protected for one year, but for five or six years.
9681. How many cases could you give the Commission of one year's vaccination not having protected?--The recruits are vaccinated.
9682. But they would not necessarily have taken it only within one year or within two years after they were vaccinated?--They do not remain long in the service, but the difficulty would be in any case to get at the proof. You would not take cases recorded at the time unless you could get actual proof.
9683. There would be no cases that would be so convincing to those who believe in vaccination, if those could be collected; we should be shaken somewhat?--No doubt.
9684. (Mr. Meadows White.) Is it the fact that the general rate of mortality has diminished?--Since when?
9685. Of late years?--I believe it has.
9686. The reports of the Registrar-General of late years appear to show that the rate of mortality has very much diminished?--I did not think it had very much of late years.
9687. Two or three points?--I daresay it has.
9688. Has that been concurrently with the increase of vaccination?--That again raises the question whether within the last few years vaccination has not considerably decreased, owing to the great opposition to it. I should say that within the last few years it had been decreasing.
9689. The general rate of mortality is better than it used to be, is it not?--That involves the whole question whether, because two things are concurrent, therefore one is the cause of the other, that is the thing we dispute, we deny altogether that post hoc propter hoc.
9690. (Chairman.) Is not that just what you rely upon for your connexion of the increase of cancer with vaccination?--Yes, to some extent, because it appears to be probable from other reasons.
9691. (Mr. Meadows White.) Is there any evidence that with the increase of vaccination there has been an increase of disease?--Disease is such a complex thing, and depends upon so many causes; certain diseases may increase without affecting the total diminution. There has been a diminution, but the question is how much diminution, and whether there ought not to be more.
9692. If you make a comparison between the general mortality statistics and the vaccination statistics, is there any evidence to show that concurrently with the increase of vaccination there has been an increase of disease generally?--Generally no; and I do not expect there to be at all, these things have no relation to general disease, why should they?
9693. (Mr. Picton.) With reference to the inoculation of cancer has your attention been drawn to an allegation by Dr. Hanau, of Zurich, that he has succeeded in inoculating cancer on animals?--I am not acquainted with medical literature. I have too much other literature to look at.
9694. It appeared in a periodical called The Hospital, which you happen to have quoted. Now, with reference to the statistics of London before registration, any uncertainty would tell equally in both directions, would it not?--I think so. I think there is a certain amount of harmony in the general results. I do not think there could be any very serious alteration produced by slight errors previous to registration in the last century.
9695. In your study of the subject you have found that the Bills of Mortality are constantly relied upon to show the prevalence of small-pox?--They are always relied upon, of course.
9696. They are not found untrustworthy in that case?--They are really absolutely the only authority.
9697. (Chairman.) There would be no danger of their showing (subject to the danger of error of diagnosis) more small-pox cases than there were, the error would be on the side of there being fewer cases returned than the actual number?--No doubt, but the question of error in diagnosis is an important point; no doubt there may have been many cases of measles classed as small-pox to account for the sudden apparent increase of measles after vaccination had been began in this century; it looks as if what has been before classed as small-pox was afterwards classed as measles.
9698. (Dr. Collins.) Are the figures from the Bills of Mortality that you have utilised in this way found on pages 9, 10, and 11 of the Medical Officer's Report of the Local Government Board for 1884?--Yes, that is where I got them from.
9699. In Question 7123 with respect to Scotland you were questioned as to the Act of 1867. I think as a matter of fact it was in 1863 that vaccination was made compulsory in Scotland, was it not?--That I really do not know.
9700. You directed our attention to Sweden, and several authorities including, I think, Körösi, give tables showing an enormous reduction of small-pox in Sweden at the beginning of this century; are you able to give any evidence as to the extent to which inoculation was practised in Sweden?--No.
9701. You do not happen to know whether it was compulsory?--I was not aware of it; do you mean compulsory until the time that vaccination was introduced?
9702. That is my impression; you directed our attention to a report that was prepared by Dr. Seaton, the [[p. 130]] secretary of the Epidemiological Society, which is rightly or wrongly thought to have influenced legislation in the year 1851, and I think he gives information as to the extent to which vaccination was compulsory in different countries of Europe; do you happen to know that he states in 1851, that "In the kingdoms last-named (Prussia and Bavaria) direct compulsion by fines is employed in addition to these (indirect) means"?--I have seen it stated, but it has been denied I think on reference to the law itself. I think the fines were only to come into force if the child had small-pox alleged to have occurred in consequence of the want of vaccination.
9703. Are you aware that he states that the information which the report contains was obtained by application to official sources in foreign countries, and that he adds: "On this point we have obtained most important and authentic information"?--I saw that stated.
9704. And that the first rule under the heading "Prussia" is: "Every child is required to be vaccinated before it is twelve months old; the magistrates and officers of health (Kreis-physicus) of every circle keep proper lists; parents of those children who do not obey are fined." That is taken from his Appendix A. "On Laws and Regulations in different countries connected with Vaccination"?--I have seen the report.
9704a. (Chairman.) Does any other point occur to you before your examination is concluded?--Might I be allowed to state one small point which I forgot, but which should I think be called to your attention. Since that re-vaccination law in Germany has been passed it is stated, and I believe it is the fact, that the age for primary vaccination has been altered from one year to two years; that being the case, and the period in England being three months, it would follow that there would be a very large number indeed of unvaccinated children in Germany compared with those in England; and as in unvaccinated children the period between three months and two years of age is the period of the greatest mortality from small-pox, that would show that in Germany they really should be more liable to small-pox than in England under this new law, yet we have almost a total absence of small-pox imputed to this new law.
9705. (Dr. Collins.) The reason I put these questions to you was because I understood your contention to be (in agreement with the statement made by Dr. Seaton to the Committee in 1871) that prior to that year Prussia was a well-vaccinated country?--Yes, I take it that the general assumption up to that time was that it was always quoted as a well-vaccinated community.
9706. And as to the alteration made in the law in 1874, Dr. Böing the authority to whom Dr. Hopkirk called attention, stated that "Before 1874 we had no vaccination law in Prussia; nevertheless I believe that the thorough vaccination of the population before the compulsory law of vaccination was promulgated was greater than at the present time." Then Dr. Hopkirk proceeds, reading the extract, "Because in former times children were vaccinated who, according to the present vaccination law, are not now required to be presented for vaccination," and are not vaccinated until a later period. Is that the statement you were anxious to make?--No, it was with reference to the vaccination age being two years.
9707. With reference to the fact you have mentioned to us to-day, and which appears somewhat surprising that the infantile mortality within registration years has not diminished, I find on page 52, of the 51st Report of the Registrar-General for England and Wales, figures giving the mortality of infants under one year of age to 1,000 births for England and Wales for the periods from 1838-42, 1847-50, 1851-60, 1861-70, and 1871-80, the figures for those several periods are 152, 154, 154, 154, and 149?--That is the table from which I got my information with reference to the one year, but with reference to the five years he gives no direct information.
9708. And apparently for London the figures are less satisfactory; for 1841-50 the infant mortality was 157, in the period 1851-60 it was 153; in 1861-70 it was 162; and in 1871-80 it was 158, are those the figures upon which you base your calcuation?--Yes, those are the figures which I have used.
9709. Our attention was called to the alleged neglect of vaccination in the French Army, and also to the fact that it was only in recent years, I think the date has been given as 1884-85, that the thorough re-vaccination of the French Army was carried out, are you able to give us any figures showing cases of or deaths from small-pox since the last regulations have been in force in the French Army?--I have seen them, but they are not very remarkable either way, there is a certain amount of small-pox mortality.
9710. I only wanted to ask whether as far as your information goes, the same immunity from small-pox has been experienced in the French Army in the last three or four years as is stated to have been the case in the Prussian army since the adoption of their improved regulations?--No, there is not nearly such a great immunity as there is in Prussia, but still there has been a considerable improvement in the last three or four years.
9711. (Professor Michael Foster.) But that is a comparison of three or four years with a whole series of years?--I have not paid any special attention to that, but it appears to me that the comparison of the German and Austrian armies was most striking on account of their vicinity and similar discipline.
9712. (Dr. Collins.) You have directed our attention to the paper entitled "Facts concerning Vaccination for Heads of Families. Revised by the Local Government Board, and 'issued with their sanction'." There is a statement on page 4, which appears to be important. "The fear that a foul disease may be implanted by vaccination is an unfounded one." Presuming that to apply to such a disease as syphilis, does that accord with the evidence you have come across in your reading?--I have always understood that it is universally admitted now that there have been very numerous cases of that disease conveyed.
9713. (Mr. Hutchinson.) What sort of quantity would you mean by such an expression as "very numerous"?--I would say several hundred cases have been recorded.
9714. Over how many years?--Over eight or ten years, I should say.
9715. Do you know whether any cases have been recorded in the last ten years?--I cannot say that; it is a point which I have not gone into.
9716. "Very numerous" is a strong expression if you cannot quote a single case in the last ten years?--How can I quote a single case when I have not paid special attention to it? I give my general impression. I cannot give more.
9717. (Mr. Meadows White.) Would you read that expression in the pamphlet as meaning that it is absolutely impossible that it could be inoculated or that with prudence and care the fear was unfounded?--I do not think it can be called "unfounded" when any cases are admitted.
9718. Is not the statement rather intended to repel a fear than to convey the idea of impossibility?--I do not think it should be put forward in such a way as to convey to the ignorant that no such cases have occurred.
9719. (Dr. Collins.) Do you happen to know that Monsieur Lancereaux published 258 cases in his work on syphilis?--I have heard that, but that is outside my province. I believe Mr. Tebb collected over 100 cases.
9720. (Chairman.) Attention has been called to the statement in the pamphlet headed "Facts concerning Vaccination," that "the fear that a foul disease may be implanted by vaccination is an unfounded one" as being inconsistent with the fact that there is evidence that syphilis has been communicated through vaccination. Have you observed that the words which I have read are followed in the pamphlet by these words "Such mischief could only happen through the most gross and culpable carelessness on the part of the vaccinator; and as all medical men now receive special training in vaccination, no risk of this kind need be at all apprehended. Of course, vaccination, like everything else, requires a reasonable amount of care in its performance," would not those words seem to qualify the first statement, if the first statement were to be understood as meaning that the communication of syphilis through vaccination is an impossibility?--They qualify it in one sense, but to my mind they almost make it worse in another, because they imply that care can prevent it and that it is always carelessness where it happens, whereas, so far as my knowledge goes, it has been the reverse.
9721. (Dr. Collins.) Could you give me any case in [[p. 131]] this country in which, where syphilis has been conveyed by vaccination, the fact has been the subject of prosecution for malpractice?--I never heard of such a case.
9722. (Chairman.) Have you studied those cases?--Whenever the cases have come in my way I have read them with interest. I have always read everything that came in my way in that direction, with interest.
9723. I understand your view to be that it would be a mis-statement or an over-statement to say that mischief could only happen through gross carelessness or negligence, because it may happen without?--Not only may happen but almost must happen without, under the conditions of public vaccination; it being practically impossible that a public vaccinator can make the necessary inquiry into all the antecedents of each of the children's parents.
9724. (Dr. Bristowe.) But there is a great deal of vaccination that is not public, is there not?--The bulk of it is public.
9725. (Chairman.) That would imply, would it not, that the disease could be conveyed through vaccination even though there were no indication of the disease upon the vaccinifer?--I thought that was admitted. Of course it would be gross negligence if the marks of the disease were visible, and they still used that child as a vaccinifer.
9726. (Dr. Collins.) Can you tell at all if the proportion of registered vaccinations to births has been increasing or decreasing since 1880?--I do not think I have the record beyond the year 1884; it decreases from 1880 to 1884.
9727. (Sir Edwin Galsworthy.) Do I understand you to admit that small-pox is a very contagious disease?--Certainly.
9728. Then how do you account for the fact that the hundreds of re-vaccinated nurses and attendants exposed to it in the hospitals never take the disease?--That is a point upon which I have been asked, I think, twice before. I do not account for it except upon the general principle that such persons become nurses as are insusceptible; and I should like to look at the comparative statistics with reference to other diseases which do not seem to be given to us. We do not hear of the number of cases with nurses in other diseases.
9729. (Sir William Savory.) Have you gone into the question of the Fever Hospital?--I daresay it would be instructive, but as I say, the subject would be so tremendously vast, and the time required to hunt up evidence would be so enormous that unless one lived in London one could not do it; and I live 120 miles off.
9730. But you have made your reputation by thoroughly sifting evidence before you came to a conclusion?--Some kind of evidence.
9731. (Sir Edwin Galsworthy.) How do you account for this, that nurses or attendants not re-vaccinated do take small-pox?--That is a disputable point. I have read a great many cases of the reverse; that those do not and that others who are re-vaccinated do--it is all a question of evidence.
9732. (Mr. Meadows White.) Have you seen the statement about fever hospitals compared with small-pox hospitals with reference to the immunity of nurses; if you refer to pages 105 and 106 of McVail's book you will see he extracts a statement by Dr. W. B. Carpenter?--I would not accept any statement of Dr. Carpenter's without confirmatory evidence.
The witness withdrew.
Adjourned till Wednesday, 11th June, at 1 o'clock.
* * *
1. The figures given in the Appendix to the First Report of the Commission, page 101, are 530,000 for the period 1681-90, and 653,900 for 1746-55. If, however, I have taken too high a figure for the population of London before 1800 it will tell against my argument by making the small-pox mortality per million less than it really was and reducing the difference between that mortality in the last 20 years of the 18th and the first 20 years of the 19th century.--A.R.W. [[on p. 8]]
* * *
Editor's Note: Appendix II at the end of the volume contained Wallace's tables and diagrams. The tables are reproduced below (but again, the diagrams were too fragile to copy). Note that the entire spread extends from numbered page 179 through numbered page 198. Also note that there is no Diagram or Table "I," and that although Diagram G/Table H was withdrawn, it was printed in the Report anyway.