He who knows only his own side of the case, knows little of that.-J. STUART MILL. The Vaccination Inquirer VOL. III., No. 36.] And Health Review. MARCH, 1882. NOTES OF THE MONTH. STUART MILL taught that a doctrine is never judged truly until it is judged in its best form an admirable maxim, but difficult, like so many other admirable maxims, to reduce to practice; for who shall determine what is the best form of any doctrine? The doctrine of vaccination, for instance, has several forms, and the variety is constantly increasing; and with all goodwill to discover the best, it is possible to be told of any selection that it is obsolete, or exploded, or questionable. The Committee of the London Society for the Abolition of Compulsory Vaccination, intent on bringing Vaccination to judgment, were, therefore, at a loss how to comply with Mill's chivalrous maxim; and feeling their incompetence to arrest the doctrine in its best form, took another course, and resolved to invite the most prominent representative and champion of the practice, namely, Dr. W. B. Carpenter, C.B., to the Society's monthly conference, so that he might set his form of the doctrine plainly before the members, with a view to discussion and the formation of sound opinion. Dr. Carpenter kindly assented, and in Steinway Hall, Marylebone, on February 3, under the impartial presidency of Dr. Andrew Clark, the end desired was accomplished, as the ample report in the following pages attests. That the Committee did not resort to Dr. Carpenter unwisely is proved by a critic so competent as Dr. Drysdale, who was pleased to say that he had never heard the case for vaccination expounded with more cogency and accuracy. It is no small matter to have achieved so much to have our adversaries' case set fairly before us with such consummate ability and authority. If we answer Dr. Carpenter, it cannot be said that we are dealing with figments of our own fancy. We know how hard it is for us to obtain attention and impartial consideration, and we cannot act more wisely than by exhibiting in our own conduct that virtue, the absence of which we have so frequently to deplore in our opponents. [PRICE 1d. DR. CARPENTER commenced by replying to Mr. Tebb's eloquent protest against the iniquity of compulsory vaccination. Since we compel parents to have their children educated, why should we not compel them to have them vaccinated? This reasoning is by no means uncommon, and appears to be thought forcible, but it is based on a fallacious analogy, for which Dr. Carpenter himself provided the means of exposure in saying, "Nobody doubts, or scarcely anybody, the desireableness of compulsion in the matter of education." Just so and therein is the difference. As nobody pretends that reading, writing, and arithmetic can harm a child, or maintains that it is right that a child should grow up in ignorance of these elementary arts, so no conscience is offended by their compulsory acquisition. It is far otherwise with compulsory vaccination. Whereas nobody doubts the desirableness of education, thousands not only question the efficacy of vaccination against small-pox, but are persuaded that it is a most pernicious practice. Here, then, a conflict is set up with parents whose intelligence, sincerity, and affections are vitally involved. If they defy the law, they are subject to fine or imprisonment; if they yield, it is with a sense of outraged conviction that does not make for loyalty and peace. To compare, therefore, a non-existent resistance to education with an active and scientific resistance to vaccination, is to conjure up an odious dummy in order to discredit a sentient adversary. As soon as a Society for the Abolition of Compulsory Education is established, it will be time enough to deal with its arguments. When a philosopher like Mr. Herbert Spencer puts on record his strong opposition to compulsory vaccination, and a statesman like Mr. Bright stigmatises the compulsory law as monstrous, which ought to be repealed, it is easy to see that the suggested analogy between opposition to vaccination and opposition to education is what is known as drawing a red herring across the scent. BUT Dr. Carpenter's argument, such as it is, is still more grossly at fault. If the question as to thank Heaven for a fictitious cause would be impious. Vaccination was introduced in 1800, and "See," cries Dr. Carpenter, "the small-pox mortality in the succeeding decade dropped to less than half! Dear Friend, we reply, the introduction of vaccination did not imply its application. If we concede that 50,000 Londoners submitted to vaccination between 1801 and 1810, we make a liberal concession, and we ask how the what is most precious in education were submitted to the House of Commons, the judgment of the vast majority would go for religion. If a choice had to be made, many would say it would be better far for a child to be well instructed in religious truth than to be informed with any quantity of secular knowledge. And yet it is just here, in that portion of education which is confessed of supreme importance, that compulsion is withdrawn, and the parent recog-vaccination of, say, 100,000, could have affected nised as the plenary representative of his the yield of small-pox mortality from a populachild. The conscience of the parent, whether tion of 1,000,000, in the course, too, of ten years ? Conformist or Nonconformist, Catholic or Does Dr. Carpenter believe in Vicarious VaccinaJew, is treated with absolute respect. Nay, tion?-that the vaccination of a few propitiates more the teaching of any religion whatever is the god of small-pox in favour of the many? If not insisted upon, and the children of agnostics and he does, let him say so, and then we shall begin atheists may grow up exempt. It is in the preto understand him. For ourselves, we recognise cedent thus established that we claim a similar in the fall of small-pox between 1801 and 1810 liberty for conscience in the matter of vaccination. simply a continuation of the fall that had set in Those who believe it can fortify them against twenty years before, assisted, we daresay, by the small-pox, cannot at the same time assume to decrease in variolous inoculation by the rumoured suffer harm from those who refuse it as an in- magic of cow-pox. For these reasons we therejurious superstition. As Mr. John Morley says, fore hold that we have no call to be thankful for "Where the law comes into conflict with the con- vaccination. sciences of men, it is the law that should be altered, and not conscience that should be forced." DR. PEARCE has elsewhere dealt with the chronological Table of London Mortality, exhibited by Dr. Carpenter with judicious omissions. The intention of the recital of these statistics is to appal the imagination. "See," it is said, "what havoc small-pox formerly wrought in London, and thank God for vaccination; " but before dropping on our knees for that special mercy, we have a few remarks to make. Smallpox, we allow, was bad-very bad; but considering the insanitary condition of eighteenth-century London, the wonder is that it was not much worse. But Dr. Farr, to whom we owe the Table, makes a noteworthy observation. He says: ANOTHER trick is to spread the terror of London small-pox over the country. The year of extreme metropolitan mortality is selected, rounded as 4,000, multiplied by the population of the United Kingdom, and the result set forth as the constant variolous death-rate of the entire land! Thus the National Health Society scatters tracts like snow-flakes, wherein it is asserted that 40,000 persons died annually of small-pox in Great Britain prior to Jenner's advent. A statement so demonstrably untrue is only to be characterised by one word. London small-pox is not, and never has been, the standard of provincial small-pox. In London the disease is endemic, waxing and waning: in the country it has been, and is, sporadic and epidemic. In a letter to the Echo, Dr. Carpenter admits that as the London death-rate of last century greatly exceeded the birth-rate, the population could only have been maintained by continual drafts from the country. London last century consumed its inhabitants-slaying more than it bred. It is of great importance to bear this fact in mind, and to refuse to convert London mortality into national mortality. Dr. Carpenter appears to think that Thus a fall in small-pox had set in before vacci- he adduces overwhelming evidence in favour of nation was introduced-a decline, too, that was vaccination, when he shows that in certain coincident with the most extensive culture of the cities there has been no small-pox for a numdisease by variolous inoculation. Before budging ber of years, whilst the disease continues an inch, therefore, in the way of thanksgiving," to smoulder among the unvaccinated resiwe insist on having this fall accounted for. It cannot be ascribed to vaccination, and to "Small-pox attained its maximum mortality after inoculation was introduced. The annual deaths from small-pox in London, 1760-79 were 2,323; in the next twenty years they declined to 1,740; this disease, therefore, began to grow less fatal before vaccination was discovered; indicating, together with the diminution of fever, the general improvement in health then taking-place." duum of London." We reply that the same before vaccination was ever dreamt of. Norwich was formerly, after Bristol, the chief city in England outside the metropolis, but in Norwich year sometimes followed year without a death from small-pox; and what was true of Norwich was true of many smaller towns, and still more of the rural population, which then constituted a much larger relative proportion of the people than at this day. Wherefore we hold that the absence of small-pox from Plymouth or Manchester or Newcastle or Glasgow or Aberdeen is no proof whatever of the prophylaxy of vaccination, but is simply the continuance of well-recognised phenomena from pre-vaccination times. To say that small-pox is stamped out anywhere because it happens to be absent, is to forget its epidemic character. It was stamped out in Sweden, "the best vaccinated country in Europe," and Sweden was used to stop every unbeliever's mouth. But, by-and-by, small-pox reappeared in Sweden with its ancient vigour and venom, to the utter confusion of the vaccination prophets. When Dr. Carpenter, therefore, asks us to consider and account for the disappearance of small-pox from this place and from that, we ask him to remember Sweden, and to moderate his tone. DR. CARPENTER's historic survey covered wellknown ground, and was relieved with sundry touches of amusing naïveté. Still we have to ask, to what purpose is the recital? Admitting in full the horrors of London and Parisian smallpox in high life, what then? They were the appropriate consequences of modes of life, which, however brilliant on the surface, were foul beneath. Queen Mary died of small-pox, but would Queen Victoria, asked Dr. Carpenter, keep away from Buckingham Palace if small-pox were prevalent in Pimlico? We expect she would; for with the profession of unbounded confidence in the protection of vaccination, there is nowhere any living faith in its security, and were it nonexistent, the dread of the disease could hardly be more intense. As for Queen Mary, we shall not attempt to describe her domestic arrangements. She lived in a palace; but such an atmosphere as pervaded her apartments would revolt the stomach of a modern chambermaid. "Anybody who knows Evelyn," remarked Dr. Carpenter," knows that he was not a man to be living under bad sanitary conditions, yet his daughter died of small-pox." Where is the warrant for the assumption? A century intervened between Evelyn and Jenner, and Dr. Carpenter might as reasonably aver that Jenner was not a man to live under bad sanitary conditions, and yet his house at Berkeley was haunted with typhus, and deadly as a Liverpool cellar, or a flat in an Edinburgh close; and yet Jenner had no suspicion that the situation was capable of amendment, but accepted the frequent fever as a dispensation of an inscrutable Providence. Let us beware of anachronisms in sanitary history. Dr. Carpenter is never so piquant as when positive, and positively wrong. Anxious to establish the London Bills of Mortality as veracious registers of small-pox, he had the temerity to adventure this assertion:: "There is this peculiarity about London and its records of small-pox-everybody knows that there were bills of mortality furnished by the parish clerks, collected together, and published weekly. There was a great deal of mistake about the various diseases. Small-pox was, however, universally known and recognised. There was no disease about which there could be such entire absence of any mistake whatever." So far from small-pox being thus unmistakably recognised, it is classified with measles in a series of the Bills for the latter part of the seventeenth century, as if which was which was beyond recognition, or matter of indifference. To come, however, within closer range of experience, let us inquire to whom was committed the definition of the causes of death. Dr. Carpenter is surely not unaware that physicians in the times under discussion were a luxury of the rich, and that the great majority entered and departed this life without professional assistance, whilst the causes of death were left to the definition of the women in attendance upon the sick. To prove this assertion, we cite the contemporary testimony of Isaac Massey, apothecary to Christ's Hospital, who, writing in 1723, observed: "These London Bills of Mortality are founded on the ignorance or skill of old women, who are the searchers in every parish, and their reports (very often what they are bid to say) must necessarily be very erroneous. Many distempers which prove mortal are mistaken for the small-poxnamely, scarlet and malignant fevers, with eruptions, swine-pox, measles, St. Anthony's fire, and three or four days (as frequently happeneth), the such-like appearances, which, if they destroy in distemper can only be guessed at, yet it is generally put down by the searchers as small-pox, especially if they are told the deceased never had them." In the light of this perspicuous bit of evidence, it is discovered (if hitherto unknown) how very sure Dr. Carpenter can be when he and matterof-fact are widely at variance. LEAVING these antiquarian considerations, we are brought to a present-day question in the ascription of exceptional malignity to the small This consideration is the rule whereby in hos vaccinated are discriminated. The existence of the rule had long been suspected and suggested, but, so far as we know, it was for the first time cynically avowed by Mr. Francis Vacher, in his report of the Birkenhead Hospital. It is stated thus: pox that has prevailed since 1871, with its derivation from the Franco-German War. We under-pital and parochial cases the vaccinated and unstand this pretty theory originated in the Medical Department of the Local Government Board, and was devised to account for the conspicuous failure of vaccination to resist the epidemic. Dr. Ballard argued plaintively before the Cow-Pox Conference that the Jennerian rite should not be charged with impotence because it broke down under the terrible French onslaught. When small-pox was absent, vaccination kept it away; and when present, it didn't; but what else could reasonable vaccinationists expect? What indeed! As for the importation of the French pox, it is conveniently forgotten that, as Mr. Marston told a committee of the House of Commons, small-pox was raging in the east of London before the French War broke out. The freaks of small-pox are infinite, and it is possible that the French variety came over, jumped on the back of the English, and intensified it. Dr. Drysdale is, however, of a different mind. He attributes the recent virulence of the disease to the degeneration of the virus used for vaccination-a degeneration which many vaccinators say is the fruit of his own active fancy. To decide where doctors differ is well known to be Quixotic, and we would merely point out that whatever character small-pox may have acquired, the returns plainly show that the ratio of mortality to cases is unchanged; that is to say, 1,000 cases of small-pox at this day practically result in the same number of deaths as a century ago. Dr. Carpenter, however, presents us with this crux, and defies us to offer a solution that does not concede the efficacy of vaccination; namely, that during the past year there was not a single death in the Small-Pox Hospitals of a well-vaccinated subject from the hæmorrhagic or petechial form of the disease. This we merely take as the last flagrant instance of the statistics with which we are continually assailed, to the effect that the death-rate from small-pox of vaccinated Londoners is 8 per cent., whilst the unvaccinated die at the rate of 44 per cent. Were such statistics true, our case would be bad indeed, We shall ask in vain for a definition of what Dr. Carpenter styles, "a well-vaccinated subject," and for an answer to the question, Who are the unvaccinated? The unvaccinated in hospitals are necessarily the miserable and homeless, who, with whatever disease afflicted, would exhibit a larger mortality than the vaccinated. Beyond this weighty consideration, however, there is another, which reduces to absolute insignificance the awful examples which Dr. Carpenter produces for our confusion. We do not mind what a patient says, nor what his friends say, of his vaccination. We look at his arms, and if we see vaccination marks, he is entered as vaccinated; but if we see no vaccination marks, he is entered as unvaccinated. Under this rule, the consequence is obvious. All severe cases of small-pox are entered as unvaccinated, the eruption rendering the marks indiscernible. And it is under this rule that the Munchausen statistics we have referred to are ever and anon shot forth upon a credulous public. To discuss them is waste of breath. They are beneath contempt. The cards are marked, the dice are loaded, the balance is false. We exempt Dr. Carpenter from knowledge of the imposture, though a life-time spent in scientific pursuits should have taught him circumspection. His zeal for vaccination has betrayed him, else his honoured name would never have been inscribed on the flash notes of the Vaccination Ring. WHAT Dr. Carpenter hoped to achieve by his reference to San Francisco was not apparent. The Chinese colony attached to that city, described as unvaccinated and pigging together, do not seem to come to deadly harm even with small-pox "smouldering among them." Any outbreak of the disease among the American citizens is, of course, ascribed to them, whilst its presence is used to terrorise and drive the trade in "heifer-lymph." It is very droll-an entire community in healthy circumstances consenting to be corrupted and sickened in order to escape from a disease which, at the worst, could only "catch" an inconsiderable minority. It is pretended that the general vaccination keeps off the small-pox, but that is precisely what we dispute. We challenge Dr. Carpenter to bring forward any population existing anywhere, at any time, under fair sanitary conditions, to whom small-pox has proved a serious affliction. On the one hand, it is idle to point out cases of zymotic disease in what he calls "the upper crust," as at Nahant; for it is possible to live in a very fine house and be no better off in sanitary respects than a resident in a slum. On the other hand, we have to recognise the possibility of even prolonged existence in unsanitary circumstances with impunity; for not until an epidemic supervenes may the peril of the situation be revealed. There are mysteries in the generation and propagation of fevers, but this is clear, that in the maintenance of health in the conditions of health, or, in a word, sanitation, there is a universal and benign prophylaxy, by the side of which vaccination is a vain and disgusting superstition. FINALLY, let us say, Dr. Carpenter's discourse will go far to confirm our friends in their opposition to vaccination, and will lend fresh energy to their exposure and denunciation of the practice. They have seen what the foremost English physiologist can advance in its defence, and they see, with all his ability and resources, how inadequate that defence is. Still, it is for us to bear in mind the caution of Coleridge, "Measure not the strength of your own cause by the weakness of your adversary's." It may be that there is more and better to be said for vaccination than even Dr. Carpenter was able to advance. If it be so, it is for us to give the superior argument our careful attention; and speaking for the Executive Committee of the London Society, we may unhesitatingly promise that if any champion of vaccination feels that the case may be established on better grounds, or in a different light, they will gladly hear from him and arrange to give him audience. It is the truth they seek, and the truth they would establish; and the means to truth consist in free and fair discussion. If, unfortunately, we have had to write of some points in Dr. Carpenter's contention with acerbity, it has been with no personal dislike. On the contrary, we entertain a vivid admiration of the courage with which, in the phrase of Dr. Andrew Clark, he entered the lions' den, nor failed to command the lions' respect. VIEWED at large, this vaccination agitation is an educational work-a training in accurate observation, accurate thought, and accurate speech. Any working-man, for instance, who enters into the discussion cannot fail to acquire a new sense of the distinction between fact and fancy, which he will bring to bear in other affairs-social, political, and religious. Nor is it working-men Nor is it working-men alone who will be affected. Mr. Samuel Whitbread for an M.P. of more than average passes intelligence, and in addressing his constituents at Bedford the other day, he said, in refusing to vote for Mr. P. A. Taylor's motion for the repeal of compulsory vaccination: "I feel convinced that vaccination properly carried out, not improperly carried out, properly performed, with proper skill [A Voice: By Whom?], and with proper materials, has been the saving of millions of lives in this country." Observe the nice derangement of conditions. He prescribes vaccination of an ideal character, and then asserts that the said impracticable vaccination has saved millions of lives in this country! The early vaccinators, who were prone to romance, were pleased to conceive the annual mortality from small-pox in the United Kingdom as ranging from thirty to fifty thousand, which by their magic they proposed to abolish. 40,000 was the favourite figure, and 40,000 passes current in vaccination literature to the present day. Vaccination did not, however, exterminate small-pox as predicted, and a large portion of the imaginary 40,000 continued to perish. But supposing the imaginary 40,000 had been saved, how many years would the salvation have had to run ere Mr. Whitbread's imaginary millions were attained? Mr. Whitbread is equal to the calculation, and when accomplished, he may possibly exclaim, "Confound it! Have I been making an ass of myself? There ZYMOTIC DISEASES, while they are not confined to any age, affect specially persons of tender years. Thus, in 1879, there were recorded 81,274 deaths from these affections; and of these, no fewer than 71,016, or 87 per cent., oceurred among children and persons under thirty-five years of age. can be no doubt that any saving effected in the rates of mortality from zymotic diseases must mainly affect young lives; and therefore, no doubt, it is that the improvement in the rate of mortality from these affections, and the saving of young There is, lives, have gone on simultaneously. however, still very much room for improvement in both these directions; for in all England there still die 293 5 children out of every 1,000 born, In the before they attain the age of five years. towns, the numbers are even larger; for in London about 370 children, out of every 1,000 born, die before they reach the age of five years, and in Bradford 441.-A. RABAGLIATI, M.D., Surgeon, Bradford Infirmary. |