Statistics.— Some are inclined to criticise statistics concerning the protective effects of vaccination, and believe that these can be so manipulated that anything desired can be proven by them. When there is a death from smallpox, there can be but little doubt as to the cause of death, so if the deaths from smallpox be taken, a charge of manipulating statistics to suit the purpose would rest upon a slender foundation. The number of deaths caused by this disease, taken per million inhabitants, will, therefore, convey a very clear idea as to the rate among a population. London has records reaching as far back as 1629, and Geneva from 1580. In other countries, while the records are not so remote they are sufficient to give an idea of the prevalence of smallpox before vaccination. In England before vaccination, the rate was above 3,000 per million; in London it was over 4,000 per million. Now the rate is less than 20. In Prussia the rate before vaccination was slightly over 4,000, but on the adoption of vaccination it began to suddenly decline, and continued to do so until the vaccination law of 1874 was en forced, when the cases became fewer and fewer until now the rate is less than two per million. Sweden had a death rate from smallpox for 16 years prior to 1800, of 2,049 per million, while the rate from 1802 to 1811 fell to 623. In 1816 compulsory vaccination was enforced and for the next 10 years the rate was 133. From 1890 to 1889, 100 years after vaccination began to be practised, the death rate fell from 2,049 to 1.
Compulsory vaccination has been in force in France only since 1902, the rate of smallpox among the army being now four per 100,000, as compared with the experiences of 1870-71. Vaccination was introduced into Austria in 1808, and was optional until 1900, when all school children were required to be vaccinated before entering. Vaccination and revaccination are compulsory for the army and navy. Denmark since 1810 requires all Children to be vaccinated before the seventh year. Revaccination is compulsory for the soldier and inmates of public institutions, Italy has had compulsory vaccination since 1888. All children are required to be vaccinated within the first six months, and, if this is unsuccessful, to be revaccinated before, they are a year old. Before the law was in effect the death rate of smallpox was 610 per million; in 1902, 9.7 per million. In Belgium and Holland it is not compulsory, al though all public officials and the army are re quired to be vaccinated. In the latter, while not obligatory, all children must go to school and no child can attend without being vaccinated. The teachers also must be vaccinated. India prohib ited smallpox inoculations in 1880 and made vac cination compulsory. Similar laws are in effect in Australia, New Zealand and Cape Colony. Vaccination is only optional in Russia, except in the army and the public service. The great majority of the people do not avail themselves of vaccination, so epidemics are not uncommon. In Persia, Siam and China little vaccination is done; therefore, smallpox is endemic. Japan has enforced compulsory vaccination since whereby the greater portion of the population has been vaccinated and revaccinated. Especially is this true of the population of large cities and on the seacoast. No provisions are made in any of the cities for smallpox hospitals proper. When a case develops it is usually allowed to remain at home, or taken to a general hospital for treatment. No quarantine measures of any kind are enforced. Notwithstanding this fact smallpox has never been known to spread from any such cases. The same also may be said
with regard to the German empire, where no precautions are taken in the strict sense of the word against the spread of smallpox, the whole reliance being upon vaccination. It has been stated by those who opposed vaccination that the reason why the German empire was so free from smallpox was the superior facilities for the isolation and treatment of cases, and not vaccination. This was investigated by the Local Government Board to ascertain just what methods were employed by the government and municipalities for the prevention of smallpox. Accordingly, an agent was sent to make this investigation. He encountered serious difficul ties from the very first. In Berlin he was in formed by the Central Health Office that so far as it was known there were no smallpox cases in Germany. The principal cities of the four chief states of Prussia, Bavaria, Saxony and Wurtemburg were visited. In 10 cities of these states, containing a population of over five million, or one-tenth of the population of the German empire he did not find a single case. As a matter of history he ascertained that there had been 70 cases in seven years, 1895 to 1901 inclusive; in Coldgne one case in 10 years; in Frankfort nine cases in 10 years; in Wiesbaden 12 cases 11 years ago, but none since then; in Mainz none during 11 years; in Munich seven cases in eight years ; in Nuremberg none for about 11 years; in Dresden no deaths for the past 10 years; in Leipzig eight cases in eight years and in Stuttgart none in six years. Vaccination in the United States is not com pulsory to the whole population. In many of the States and the District of Columbia all children of school ageiraust be vaccinated, and those persons who have been exposed to small pox. While vaccination is generally practised in nearly all the States there are large numbers of the population, particularly in the Southern States, principally among the negroes, who do not vaccinate. Among these smallpox is a com mon occurrence. The government requires all alien immigrants to be vaccinated before being allowed to land; also all persons of the army and navy. Further instances in statistics could be cited to show the protective effects of vac cination against smallpox if they were con sidered necessary. The only thing which seems to be lacking in our country is a compulsory vaccination law and a strict governmental supervision of the production of vaccine virus.
Bibliography.— Baron,