Dissolving Illusions review



Part One: Smallpox and the First Vaccine

In the first three chapters of Dissolving Illusions S. Humphries and R. Bystrianyk give a history of infectious diseases and living conditions during the nineteenth and twentieth centuries. The authors say that “improved living conditions, more nutritious food, better obstetric care, and other non-vaccine elements were responsible for the decline in infectious disease death rates” in the twentieth century. It is their position that vaccines do nothing to prevent disease. They set about trying to prove this in chapter 4, Smallpox and the First Vaccine.

On pages 60 – 62 the authors talk about how, in the eighteenth century, smallpox inoculation led to an increase in smallpox cases, since it involved deliberately infecting people with the disease, but they do not here attempt to claim that it did not provide immunity to those inoculated.

On page 64 they quote from Charles Creighton’s 1889 book in which he disputed vaccine creator Edward Jenner’s claim that people who had had cowpox were immune to smallpox:

It is absurd to claim the dozen old cases of cowpoxed milkers, who were subsequently inoculated with smallpox, as experiments; there were many cowpoxed milkers… who submitted to inoculation along with others, whenever a general inoculation was afoot; [1]

Jenner had included in a 1798 publication [2] the cases of sixteen farm workers who, when he inoculated them with smallpox, had not developed the disease, who had in common the fact that they had previously had cowpox. Jenner used these cases as evidence that cowpox provided immunity from smallpox. Creighton is correct that Jenner’s cases were not scientific experiments and therefore could not be treated as evidence, but he does seem to have overlooked Jenner’s assertion that the subjects had never had smallpox (and had therefore never been inoculated):

It is necessary to observe, that the utmost care was taken to ascertain, with the most scrupulous precision, that no one whose case is here adduced had gone through the Small Pox previous to these attempts to produce that disease. [3]

Also on page 64, the authors of Dissolving Illusions say:

Since the late 1700s, the medical profession has supported vaccination, even though there was never a trial where one group was vaccinated and compared to another group of the same size that was not vaccinated. [4]

Whilst it is true that controlled trials of the smallpox vaccine have never been carried out, the authors must be aware that there have been epidemiologic studies demonstrating its effectiveness. The reason they must be aware of this is that these studies are discussed in the very source they cite for the lack of controlled trials, the CDC’s Morbidity and Mortality Weekly Report of June 22, 2001. In fact, the studies are mentioned in the very same sentence where the lack of trials is mentioned:

Although the efficacy of vaccinia vaccine has never been measured precisely during controlled trials, epidemiologic studies demonstrate that an increased level of protection against smallpox persists for <5 years after primary vaccination and substantial but waning immunity can persist for >10 years. [5]

The epidemiologic studies referred to in the CDC report provide compelling evidence for the effectiveness of the smallpox vaccine. The report cites the second report of the WHO Expert Committee on Smallpox Eradication, which summarises the studies. According to the WHO report, smallpox was endemic in Brazil in 1967 [6]. There were 4,514 cases reported [7]. Over the next four years, 83.3 million people were vaccinated [8], and in 1971, only 19 cases were reported [9].

The WHO report also states that most African countries undertook eradication (vaccination) programmes starting in 1967. In 1967, in the 20 countries of western and west central Africa, there were 11,069 reported smallpox cases [10]. In 1971, after four years of the vaccination programme, there were none [11].

During this time total world cases decreased from 131,418 to 51,924 [12]. Ethiopia, however, saw an increase in reported cases from 466 to 25,976 [13]. This was due to the establishment of systematic surveillance in 1971 [14]. Ethiopia’s organised vaccination programme began in the same year, and smallpox was eradicated there by 1976 [15].

It is also worth noting that a controlled trial of the smallpox vaccine at any point after it became freely available and widely accepted as effective would have been unethical, since it would have meant withholding what was believed to be an effective preventive treatment from a random group of people and potentially allowing deaths to occur for the purposes of the study.

On page 65, the authors say:

The CDC admits that, even now, the level of antibody that protects against smallpox infection is unknown. [16]

This is true, however the CDC report where this is stated goes on to say that:

…after percutaneous administration of a standard dose of vaccinia vaccine, >95% of primary vaccinees (i.e., persons receiving their first dose of vaccine) will experience neutralizing or hemagglutination inhibition antibody at a titer of >1:10. [17]

So while the amount of antibody which provides protection is not known, it is known how much antibody is present after vaccination, and it is known that this amount provides “an increased level of protection” [18] for up to five years, and that “substantial but waning immunity can persist” [19] for over ten years.

On pages 65 – 69, the authors discuss the production and viral content of early smallpox vaccines. These pages do not directly contest whether or not the vaccine was effective, but discuss what it consisted of and discuss methods of production and application.

On page 70, the authors discuss vaccinations carried out in early 1799 by a Dr Drake, using Jenner’s cowpox-derived vaccine, which did not prevent smallpox:

Dr Hughes, another doctor from Stroud, reported that the children subsequently developed smallpox and suggested that the vaccination technique failed. Jenner received the report but decided to ignore the results. [20]

However, Jenner did address cases where smallpox was reported to have followed cowpox:

Some other instances have likewise been represented to me of the appearance of the disease [cowpox], apparently marked with its characteristic symptoms, and yet that the patients have afterwards had the smallpox. On these cases I shall, for the present, suspend any particular remarks, but hope that the general observations I have to offer… will prove of sufficient weight to render the idea of their ever having had existence, but as cases of spurious cow-pox, extremely doubtful. [21]

Jenner’s explanation was that there were various other diseases which were easy to confuse with cowpox, and also that matter taken from cowpox sores may not necessarily contain the virus itself, if it was allowed to decompose:

I shall proceed to enumerate the sources, or what appear to me as such, of a spurious cow-pox.

1st. That arising from pustules on the nipples or udder of the cow; which pustules contain no specific virus.

2dly. From matter (although originally possessing the specific virus) which has suffered a decomposition, either from putrefaction or from any other cause less obvious to the senses.

3dly. From matter taken from an ulcer in an advanced stage, which ulcer arose from a true cow-pock.

4thly. From matter produced on the human skin from contact with some peculiar morbid matter generated by a horse. [22]

The authors report the cases where smallpox apparently followed cowpox, but neglect to mention that Jenner provided a possible explanation for this.

On page 70 the authors mention that Dr Woodville, director of the Smallpox Inoculation Hospital in London, raised concerns in 1799 about cowpox inoculation, reporting that it could produce a severe disease and had in one case proven fatal. The authors fail to mention, however, that in 1800, after further experience with cowpox inoculation, Dr Woodville concluded that these cases were the result of contamination in the hospital, since he never observed any severe disease when carrying out cowpox inoculation elsewhere:

…I readily admit that they have been and still continue to be the effect of some adventitious cause, independent of the Cow-pox… as these different effects of the disease between the patients in, and those out of the Hospital did not depend upon any difference or alteration of the matter with which the inoculations were performed, the only cause remaining to which the frequent occurrence of pustules on the former can be rationally referred, is the variolated atmosphere of the Hospital… [23]

On page 71 the authors quote a series of reports that people who had had cowpox, or cowpox vaccination, later developed smallpox, and on page 72 they mention how, in the nineteenth century, “medical article after medical article pointed out clearly that exposure to cowpox providing lifelong immunity to smallpox was an unproven theory”. On page 73, the following quote appears:

…where the smallpox contagion has access to operate upon vaccinated cases of upwards of six years standing, and the contagion applied in a concentrated and lasting form, nearly the whole of such cases will yield to the influence of the small-pox contagion. [24]

The authors are correct that cowpox vaccination did not provide lifelong immunity to smallpox – Jenner was wrong about this – but they give the misleading impression that this was never admitted by the medical establishment and that it was only anti-vaccinators who were saying it. In fact, by the second half of the nineteenth century, it was generally accepted that the protection from vaccination was not permanent. As Noel A. Humphreys wrote in the Journal of the Royal Statistical Society in 1897:

It is much to be regretted that the medical profession so long hesitated to admit that Jenner was over sanguine and mistaken in declaring that infant vaccination conferred life long protection from an attack of small-pox… No one now really questions the fact that the protective influence of infant vaccination diminishes with the lapse of years. [25]

Writing in the British Medical Journal in 1863, George Budd gave the length of protection afforded by vaccination as seven years:

The protection given by cow-pox is, however, practically effectual for about seven years. Within this time small-pox seldom, if ever, occurs… After the lapse of seven years, cases of small-pox begin to appear among the vaccinated… [26]

Edward Daniell, writing in the Provincial Medical and Surgical Journal in 1850, described the level of protection being reduced over time:

I look upon vaccination as filling the system with protection against variolous infection, and compare it to a measure full to the brim… Time… deprives the system of a certain modicum of protecting power… Thus at the end of seven years a third of the protection may be gone; at the end of fourteen years two-thirds; and at the end of twenty-one all protection has passed away. [27]

F. Smith, writing in the Journal of Comparative Pathology and Therapeutics in 1892, estimated the susceptibility of previously-vaccinated people to smallpox by observing their reaction to revaccination. It was his opinion that “a person who develops a perfect vesicle [following revaccination] is one who would have contracted small-pox if exposed to the contagion” [28]. Smith suggested that the immunity from vaccination might start to decrease after only a year:

I can, however, go a step further than this, and affirm that after a successful primary vaccination, it is possible to successfully re-vaccinate a person twelve months later, the only difference between the first and second vaccinations being that the latter will run a more rapid course; excepting for this fact, the character of the vesicle produced is nearly indistinguishable from a primary inoculation. [29]

And Edward H. Janes, City Sanitary Inspector of New York, wrote in 1873:

…we shall find nothing more fallacious than the attempt to establish an invariable rule, that vaccination will protect the system from the variolous poison during a certain number of years… Here we have a number of cases [337], thirty-three per cent. of which were supposed to have been protected, and yet that protection did not extend over a period of five years. [30]

All of these writers were supporters of vaccination. Janes called it “Jenner’s splendid discovery” [31] in the article quoted above.

On page 73, the authors say, “Numerous other medical journals detailed how smallpox could still infect those who previously had smallpox…” [32]. Citing numerous medical journals on this point is unnecessary, since Jenner himself acknowledged such cases:

Certain then it is that variolous matter may undergo such a change from the putrefactive process, as well as from some of the more obscure and latent processes of nature, as will render it incapable of giving the smallpox in such a manner as to secure the human constitution from future infection, although we see at the same time it is capable of exciting a disease which bears so strong a resemblance to it as to produce inflammation and matter in the incised skin (frequently, indeed, more violent than when it produces its effects perfectly), swelling of the axillary glands, general indisposition, and eruptions. [33]

Whether or not Jenner was correct, the authors of Dissolving Illusions should have attempted to disprove his argument, rather than ignoring it.

On page 74 the authors quote William Cobbett, who reported that people vaccinated by Jenner had subsequently contracted smallpox. This could be explained by the fact that Jenner was wrong about vaccination offering lifelong protection.

On page 75 the authors have used wording which is at best ambiguous and could easily be misleading. They say that “In the 1844 smallpox epidemic, about one-third of the vaccinated contracted a mild form of smallpox…” [34]. This could be read as meaning that one third of the total vaccinated population caught a mild form of smallpox, when in fact it means that, amongst patients in the London Small-pox Hospital who had caught smallpox despite being vaccinated, one third had a mild form of the disease [35]. The authors use the same wording again the next clause, stating that “roughly 8 percent of those vaccinated still died…” [36]. This does not mean that eight percent of the vaccinated population died, it means eight percent of patients in the Small-pox Hospital who had caught smallpox despite being vaccinated died [37]. The authors of Dissolving Illusions completely fail to mention that the statistics they are discussing here relate to people who were admitted to hospital with smallpox.

The actual statistics they are referring to are as follows: during the 1844 smallpox epidemic in England, 647 people were admitted to the Small-pox Hospital in London. 312 were confirmed to have been vaccinated, leaving 335 unvaccinated. 24 of the vaccinated patients – roughly eight percent – died, and 127 of the unvaccinated patients – roughly thirty-seven percent – died [38]. Despite the fact that these statistics show that unvaccinated patients died at more than four times the rate of vaccinated patients, the authors of Dissolving Illusions have taken from these statistics the fact that “roughly 8 percent of those vaccinated still died”, making no mention of the fact that thirty-seven percent of those not vaccinated died, and that “nearly two-thirds had severe disease” [39], despite having no evidence of how many unvaccinated patients had “severe disease”. They point out that vaccinated people were not immune to smallpox, never mentioning that most medical professionals, from the late nineteenth century onwards, would explain this by saying that the protection from vaccination was not permanent.

On page 75 the authors quote a letter in the Hampshire Telegraph and Sussex Chronicle of March 2, 1850, which said that vaccination was not working: “I shall also select the Registrar’s returns of one of the country districts (Bradford) to show how little protection vaccination afforded in the last quarter of that year…” [40]. What the authors do not mention is that the person who wrote the letter was in fact a supporter of vaccination who simply felt that vaccine stocks had lost their potency:

The first question that suggests itself to my mind is, what is that virus now supplied to the public for vaccination… I can only say I am one of the many who have no confidence in it, and would wish it got rid of and a fresh stock introduced. Is it not probable that the protective power of vaccine might be worn out or impaired by age, or, what is worse, might it not be affected by the contaminating influences of the diseased constitutions it has passed through… [41]

On page 76 the authors mention a number of cases where people died of erysipelas due to contaminated vaccine or contamination during vaccination. If it was the case that these people died as a result of being given a treatment that did nothing, that would of course be a travesty. However, the only thing the authors have so far proven is that vaccination did not provide lifelong immunity. This does not imply that it did not work at all. In addition to this, it is illogical to discredit a medical procedure because it was sometimes carried out improperly (which must have been the case for contamination to have occurred).

On page 76 the authors also say “Often a vaccinated person was recorded as having died from another condition such as chicken pox…” [42] but they give no evidence of this having happened and do not offer a supporting citation. They also question the validity of nineteenth century statistics, suggesting that deaths from vaccination, and smallpox deaths of people who had been vaccinated, were covered up. In support of this they quote a letter which appeared in The Ipswich Journal in 1876. The letter contained quotes from two doctors admitting they had concealed vaccination as a cause of death. The authors of Dissolving Illusions say that such concealment “must have had a considerable impact on the validity of the statistics of the day.” [43] They say this despite the fact that between them the two doctors only mention three cases where information was suppressed. The impact may have been considerable, but more evidence would be needed to show this. It’s also the case that vaccination was sometimes mistakenly blamed for unrelated conditions, as suggested by the following two letters which appeared in the British Medical Journal in 1887:

SIR,– I should like to record what I cannot but consider a lucky escape which occurred in my practice a short time since. I was asked by a lady, whom I had attended in her confinement two months before, to vaccinate her baby, as she was going into the country. I thought it preferable to await her return, and postponed the operation. It was well I did so, for within three or four days the child developed a violent attack of desquamative dermatitis, and for a week or two presented a most pitiable appearance… The child recovered in the course of two or three weeks, but it can easily be imagined what would have been the verdict had I been unfortunate enough to have vaccinated the child. As it was, the mother asked me, “Was I sure I had not vaccinated the child?” [44]

A child was brought for vaccination late on the first morning of the usual quarterly vaccination. My stock of lymph having been, luckily, exhausted, I told the mother to bring her child again at the proper time a week hence. This she did, but for the purpose of procuring a postponement, for the child was suffering from a severe attack of eczema capitis. Having frequently heard uncomplimentary remarks made respecting vaccination and vaccinators whilst performing my duties as public vaccinator, I availed myself of this opportunity to afford of number of the fair sex present an ocular demonstration of the liability to condemn vaccination unjustly… Had vaccination been performed in this instance when the child was first brought, the feelings of exasperation on the part of the women, and of humiliation of myself, at its [the child’s] second appearance, can be better imagined than described.[45]

A tendency to ascribe unrelated diseases to vaccination when they occurred shortly after it could have had an opposite impact on statistics to the one the authors of Dissolving Illusions write about.

Also on page 76, still on the subject of statistics, the authors give a quote from a Lieutenant-General A. Phelps. Phelps was commenting on a paper by Noel A. Humphreys, which was presented to the Royal Statistical Society in 1897 (the comments of audience members were recorded and published with the paper in the society’s journal). Phelps said:

…the Gloucester statistics ought to be very carefully examined by the Society. Dr. Bond stated in that wonderful story of his, which was referred to in the paper as exceedingly valuable, that not one vaccinated child under the age of 10 had died; but that result was obtained by excluding all those children who had been vaccinated within a certain limited period. One child, Elizabeth Sabin, 4 years of age, with six good marks of successful vaccination, caught small-pox three weeks and three days after being vaccinated, and died. Her case was excluded from the list of the vaccinated in Dr. Bond’s statistics. Statistics cooked in that way could not be accepted as accurate. [46]

Phelps was incorrect that a claim was made that no vaccinated children under the age of 10 had died – at least, this was not claimed in the unqualified way which Phelps alleges. He was probably referring to the following remark which appears on page 535 of Humphreys’ paper, and which echoes a similar remark on page 39 of Francis Bond’s report on the Gloucester epidemic [47], which Humphreys took his figures from:

It should, moreover, be noted that the 2,036 cases of attack during the Gloucester epidemic did not include a single death of a person who had been successfully re-vaccinated within ten years, and not less than one month previous to exposure to infection. [48]

By looking at people vaccinated within a certain range (less than ten years ago and more than one month before exposure to smallpox), Bond and Humphreys do exclude the death of the vaccinated child. But this does not represent “cooking” statistics, since they make it clear what range they are looking at. Phelps may have felt that they were being dishonest by highlighting this range, but the underlying statistics were not doctored and nothing was concealed – a table on page 37 of Bond’s report clearly showed that one vaccinated child under the age of ten died (along with 279 unvaccinated children under the age of ten) [49]. And on page 39 of his report, Bond said “If we take children under 10 years of age, we find that out of 25 cases of the ‘vaccinated’ class there was only one death…” [50]. Humphreys also acknowledged that not all children under ten who died were unvaccinated:

The case mortality of all cases under 10 years of age (all but one of the 280 deaths being unvaccinated children) was 39.2 per cent. [51]

On page 77 the authors quote Alexander Wilder, who says of the smallpox epidemic of 1871-1872:

..many vaccinated persons in almost every place were attacked by small-pox before any unvaccinated persons took the disease. [52]

Wilder does not give any evidence for this claim that vaccinated people caught smallpox before unvaccinated people, but in the next paragraph he provides figures which show the majority of those affected in England had been vaccinated (11,174 of 14,808). This can be explained by the fact that vaccination did not provide lifelong immunity, and so people who had not been vaccinated recently enough were not protected (an 1867 law “encouraged” revaccination [53], but did not make it compulsory). This explanation is borne out by the fact that, while smallpox deaths amongst most age groups increased as a result of the epidemic, deaths of children under five (in whom vaccination had had less time to wear off) did not increase:

In the next ten years, 1865-74, the rate was governed by the epidemic of 1871-72, and showed a marked increase, compared with that in the preceding decennium, at each age-period above 5 years, but under 5 years there was a slight decline, notwithstanding the effect of the epidemic. [54]

It is also worth quoting here a point made by Francis Bond in his report on the Gloucester smallpox epidemic of 1895-6:

…the expression “vaccinated” is uncertain, and may mean anything, from the fleeting protection given by a single poor vesicle, to the almost perfect and long-protracted immunity which is conferred, as a general rule, by not less than four good ones. The fallacy of assuming that the word “vaccinated” has in all cases a precise and uniform meaning is one which is commonly exhibited by anti-vaccinators in dealing with vaccination statistics… For, so long as persons who have been vaccinated in infancy fail to renew the protection which they have thus obtained, by re-vaccination at least once in after life, so long will they be exposed to the risk of catching small-pox, with a severity proportionate to their ages, and so long also will all epidemics… be swollen by cases of so-called “vaccinated” persons. [55]

On page 78 the authors discuss the strict compulsory vaccination laws passed in Massachusetts in 1855, and on page 79 they say “These repeat smallpox epidemics showed that the strict vaccination laws instituted by Massachusetts had no beneficial effects”. This may have been to do with a lack of revaccination, but may also have been to do with the fact that, despite the laws, large numbers of people were not vaccinated at all:

By 1872, any optimism about [the extent of] vaccination was wiped out as smallpox reached epidemic levels not seen in a generation. Towns and cities throughout Massachusetts relayed disquieting evidence of inadequate vaccination. Worcester authorities found “large numbers of persons of all ages… unprotected by vaccination,” and Holyoke reported “indifference and neglect of the people in regard to vaccination.” Town officials all over the state complained that large percentages of their residents “have not been vaccinated since childhood,” that “there have been many unvaccinated children attending school,” and that “there is criminal indifference to the subject.” …in 1874, the Massachusetts State Board of Health deplored the insufficiency of the 1855 law: “The protection of the community from so dreadful a disease as small-pox requires something more than the imposition of the trifling fine of five dollars.” [56]

On page 82 the authors include a quote from an editorial in the Boston Medical and Surgical Journal of February 10, 1881:

The latest epidemic, that of 1872-1873, having proved fatal to 1040 persons, was the most severe that has been experienced in Boston since the introduction of vaccination. [57]

This is another example of the authors quoting a source as if the writer they are quoting was against vaccination, when in fact they supported it. The editorial here quoted goes on to explain that children of school age were least affected by the epidemic, since they were the best protected by vaccination, which was a requirement of school attendance:

We here see that children until five, although constituting only 12.5 per cent. of the population, contributed 26.5 per cent. of all deaths by small-pox; while youths between 5 and 15, making 18.5 per cent. of the living, contributed only 5.8 per cent. of the decedents. The contrast between these two sets of figures is very striking, and shows, in the most peremptory manner, the deficiency of protection in the first years of life, and the efficacy of vaccination practiced later on, at the ages of school attendance. The relative degree of exemption enjoyed during adolescence and resulting from the postponed vaccination, undergone in obedience to the requirements of school-attendance, is seen to disappear gradually, so that we find again, between the ages of 20 and 30, a marked liability to fatal small-pox, which can bear but one interpretation: we here see evidence of an insufficient practice of revaccination, which measure of prevention is shown to become necessary within a space of 8, 10 or 12 years after the first vaccination usually undergone in children. [58]

On page 82, the authors say “By the end of 1868, more than 95 percent of the inhabitants of Chicago had been vaccinated,” [59], and go on to remark that the city was “hit with a devastating smallpox epidemic in 1872” [60]. The 95 per cent figure is accurate. However, for the five wards where revaccination figures were reported, the average proportion of people who had been revaccinated was less than 19 percent [61], meaning that vaccination may have had time to wear off in some people. Additionally, although only five percent of the population had never been vaccinated, this still amounted to 11,324 people [62]. Another factor is the speed of population growth in Chicago during this period. The population in 1860 was 109,260 [63]. By 1880, it was 503,185 [64], more than four times larger — an average increase of more than 1,600 per month. Allowing for 1,300 births per month and 500 deaths [65], the city must have been receiving over 800 potentially unvaccinated immigrants per month, on average. Some immigrants even had smallpox when they arrived:

During the months of May, June and July the disease [smallpox] was almost daily brought here by immigrants, making it necessary to examine all trains that arrived here with immigrants. In the autumn it was again introduced by persons coming from the neighboring cities and towns, showing that constant vigilance is necessary to protect the city from the inroads of this disease. [66]

On page 83 the authors list more reports of vaccinated people catching smallpox, but there is no mention of how recently these people had been vaccinated, meaning the protection from vaccination could have worn off.

On page 84 the authors quote from a letter written by a Dr Ruata to the New York Medical Journal in 1899. Dr Ruata gave smallpox statistics for several Italian villages where large proportions of the populations caught the disease, despite being “perfectly vaccinated” [67]. No details were given as to how recently the people in the villages had been vaccinated, however. Dr Ruata did address the question of revaccination in his letter, though, in a section not quoted by the authors of Dissolving Illusions:

Vaccinationists were not puzzled by these facts, and with the greatest certainty they asserted that this enormous number of deaths was due to want of revaccination. Happily, in Italy we are able to prove that revaccination has not the least preventive power. I only give a few figures : During the sixteen years 1882-’97 our army had 1,273 cases of small-pox, with 31 deaths; 692 cases, with 17 deaths, happened in soldiers vaccinated with good result, and 581 cases, with 14 deaths, happened in soldiers vaccinated with bad result. [68]

Dr Ruata appears to have taken these figures from an article which was in the British Medical Journal in April 1899 [69]. What Dr Ruata does not mention in his letter is that the article his figures were taken from concluded that vaccination was extremely effective since, while vaccinated soldiers did contract smallpox, the rate was much lower than among unvaccinated soldiers. Dr Ruata mentions that 1,273 vaccinated soldiers caught smallpox, but does not mention that during the same period 225 unvaccinated soldiers also caught smallpox [70]. According to the author of the paper the figures are taken from, soldiers were vaccinated within fifteen days of recruitment [71]. Since they were in the army for three years, their fifteen days unvaccinated represented only 1.4 per cent of their time in the army. And yet this group accounted for fifteen percent of smallpox cases (amongst soldiers whose vaccination status was known [72]).

On page 85 the authors quote Charles Creighton’s 1888 review of vaccination in the Encyclopedia Britannica, which stated that “The practice of re-vaccination was first recommended in England by G. Gregory… It has been more or less the law in Prussia since 1835” [73]. Creighton’s suggestion that revaccination was compulsory in Prussia since 1835 was directly refuted by Edward J. Edwardes in his 1902 book, A Concise History of Small-Pox and Vaccination in Europe, in which he says:

At last we come to the Sanitary Directions (Regulations) of 1835, August 8, 1835… By these Regulations there was no direct legal compulsion for anyone to be vaccinated, or to have his children vaccinated. Vaccination is “urgently recommended,” and “all intelligent persons are expected to further it by example and precept.” All officials to whom it may concern are to further Vaccination “on every occasion that offers.” Compulsory measures are to be adopted when epidemic outbreaks occur, if necessary… No punishment was provided for the neglect of vaccination where small-pox was not present… As to revaccination, it was merely recommended for those who had been (successfully) vaccinated long previously, “on account of the greater security thereby effected.” [74]

Revaccination was, however, made compulsory for Prussian Army recruits in 1834 [75]. This seems to have had a pronounced effect: in the ten years up to 1834, an average of 49 Prussian soldiers died every year of smallpox [76], but in the thirty-five years following, the average number of smallpox deaths per year was less than three [77].

On page 85, the authors discuss vaccination in Japan. They say “From 1885 to 1892, there were more than 25,000,000 recorded vaccinations and revaccinations [in Japan], yet smallpox epidemics still wreaked havoc upon the Japanese” [78]. The average population of Japan during this period was approximately 39,600,000 [79]. If there were 25,000,000 vaccinations over the eight years, this means 3,125,000 people, or 7.9 percent of the population was vaccinated per year on average. At this rate, it would take over twelve years for the entire population to be vaccinated. Assuming vaccination became ineffective after five years, less than half of the population would have been protected at any one time.

Also on page 85, the authors include the following quote from Simon L. Katzoff:

Another act passed in 1896 made repetition of vaccination every five years compulsory on every subject regardless of station; yet in the very next year, 1897, they had 41,946 cases of smallpox and 12,276 deaths. [80]

Katzoff does not give any indication of how well the law was implemented. However, given that we know how many people were vaccinated in total that year and during the previous four years, an analysis similar to the one above can tell us the percentage of the population which would have been protected, assuming that vaccination became ineffective after five years. The following table shows the results.

Table 1: Number of vaccinations [81] and population [82] of Japan 1890 – 1898.

The figures in column B are produced by adding the number of people vaccinated that year and the numbers vaccinated in the four preceding years. This assumes that nobody was vaccinated more than once in a five-year period. If they were, the correct figures in column B would be lower than shown, as some people would have been counted twice. Therefore the figures represent the maximum number of people who could have been protected, i.e. vaccinated no more than five years ago, each year. It can be seen that in 1897, 34.5 million people were protected, leaving 7.8 million, or more than one in six, who had not been vaccinated within the last five years.

On page 88 the authors point out that there were more than 1,600 deaths related to vaccination between 1859 and 1922 in England and Wales, and that from 1906 to 1922, “the number of deaths recorded from vaccination and from smallpox were approximately the same” [83]. This is because the number of deaths from smallpox during those years was lower than it had been during the nineteenth century. Over the whole period, 1859 to 1922, there were 119,597 deaths from smallpox in England and Wales [84], more than seventy times the number of vaccination-related deaths. Also, it seems that many of the vaccination-related deaths could have been avoided by improving hygiene:

There is conclusive evidence that most of the deaths assigned to “the effects of vaccination” occur among the lower grades of the working classes, and are frequently attributed by the certifying practitioner to neglect, want of cleanliness, and in fact to the filthy surroundings of the infant. It may be noted that of the 43 deaths referred to “cow pox and the effects of vaccination” in 1891, 36 were of the infant children of mechanics, artizans, or labourers, or of the illegitimate children of domestic servants; 4 were described as the children of shopkeepers or of shop assistants, 2 as children of commercial clerks, and 1 as the child of a farmer. Not one occurred among those classes in which due and intelligent care of infants can, as a rule, be assured. [85]

Doubtless improved sanitation would have also reduced the incidence of smallpox during this period, but this fact alone does not imply that vaccination does not provide some immunity.

To determine whether vaccination during the nineteenth century in England and Wales helped prevent smallpox, we can look at the numbers of those vaccinated and those unvaccinated who died from the disease. These figures were recorded in the annual reports of the Registrar-General, available from the University of Essex’s Histpop website [86]. According to these reports, between 1881 and 1910, 3,895 vaccinated people died of smallpox, and 5,419 unvaccinated people died of smallpox (these figures do not represent everyone who died of smallpox during this time, as not everyone’s vaccination status was known). While the number of vaccinated people who died of smallpox is lower than the number of unvaccinated people who died of it, the difference is perhaps not large enough to seem statistically significant. Fortunately, however, the Registrar-General’s reports classify smallpox deaths by the age of the victim. Seeing as compulsory vaccinations had to be carried out on children within three months of their birth being registered, and seeing as vaccination wore off over time, if we look at the statistics for children under five, the age group in whom vaccination was least likely to have worn off, we should find a significant difference in susceptibility between those vaccinated and those not. And we do. Between 1881 and 1910, only 158 children under the age of five who were known to be vaccinated died of smallpox in England and Wales [87]. During the same period, 2,176 children under the age of five who were known to be unvaccinated died of it [88].

The vaccination statuses of the remaining 2,356 children under five who died during these years were unknown, but assuming the proportion of vaccinated and unvaccinated deaths amongst this group was the same as amongst the group whose statuses were known, we can estimate that a further 159 vaccinated children died of smallpox and a further 2,197 unvaccinated children died of it, giving a total for vaccinated children of 317, and a total for unvaccinated children of 4,373.

Taking these figures as percentages of the numbers of newborns who were vaccinated (20,155,816 [89]) and not vaccinated (7,187,948 [90]) during these years, we can estimate that the chance of a vaccinated child under five dying from smallpox was 0.0015 percent, and the chance of an unvaccinated child under five dying of smallpox was 0.06 percent. So it was about thirty-eight times more likely that an unvaccinated child would die from smallpox than that a vaccinated child would die. This is excellent evidence that vaccination was effective. The chance of dying from vaccination was about 0.008 percent (most of these deaths were children under five) [91]. So the combined chance of a vaccinated child dying, either from the effects of vaccination or from smallpox, was 0.0095 percent, less than a sixth of the chance of dying from smallpox if not vaccinated.

On pages 88 – 92 the authors cover the risks associated with vaccination in more detail. It can’t be disputed that smallpox vaccination carried a risk. The question is whether the risk was justified. According to the figures just discussed, between 1881 and 1910 vaccinating a child reduced their risk of death significantly enough to make it justifiable.

On page 92 the authors make the following claim: “The death rate for smallpox declined after 1872, but there is no evidence that vaccination had anything at all to do with it” [92]. This is not true. The figures just discussed from the Registrar-General’s reports from 1881 to 1910 show the stark difference in the death rates of vaccinated and unvaccinated children. This is good evidence that vaccination was effective at preventing smallpox.

On pages 93 and 94, there are graphs showing that scarlet fever declined along with smallpox, and that even after the prevalence of vaccination went down in the early twentieth century, the number of smallpox cases did not increase. The authors say that people “began asking the question as to whether better sanitation, hygiene, improved housing, nutrition and isolation of cases were the best ways to deal with smallpox” [93]. That improved hygiene and sanitation and isolation were good ideas and good ways to reduce the incidence of infectious diseases seems beyond question, and it seems plausible that these measures helped reduce the number of smallpox cases in the early twentieth century. But this does not prove that vaccination did not also limit the spread of smallpox, and the authors have not shown that it did not.

Notes.

[1] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 64.

[2] Jenner, E, An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ, Or Cow-Pox, 1798.

[3] Ibid, p. 10.

[4] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 64.

[5] Centers for Disease Control and Prevention, MMWR, vol 50, no. RR-10, June 22, 2001, p. 4.

[6] World Health Organization, WHO Expert Committee on Smallpox Eradication [meeting held in Geneva from 22 to 29 November 1971]: second report, 1972, p. 15.

[7] Ibid, p. 11.

[8] Ibid, p. 15.

[9] Ibid, p. 11.

[10] Ibid, p. 11.

[11] Ibid.

[12] Ibid.

[13] Ibid.

[14] Ibid, p. 17.

[15] Centers for Disease Control and Prevention, MMWR, vol 46, no. 42, October 24, 1997, p. 991.

[16] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 65.

[17] Centers for Disease Control, MMWR, vol 50, no. RR-10, June 22, 2001, p4.

[18] Ibid.

[19] Ibid.

[20] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 70.

[21] Jenner, E, Further Observations on the Variolæ Vaccinæ, or Cow-Pox, 1799, p. 3.

[22] Ibid, p. 4.

[23] Woodville, W, Observations on the cow-pox, 1800, p. 18, p. 21.

[24] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 73.

[25] Humphreys, N A, “English Vaccination and Small-Pox Statistics…”, Journal of the Royal Statistical Society, September 1897, pp. 515-516.

[26] Budd, G, Remarks on the Present Prevalence of Small-Pox, British Medical Journal, May 2, 1863, p. 445.

[27] Daniell, E, Observations Suggested by Mr. Newnham’s “Cursory Remarks on Vaccination”, Provincial Medical and Surgical Journal, June 12, 1850, p. 320.

[28] Smith, F, For How Long Does Vaccination Confer Immunity Against Small-Pox?, Journal of Comparative Pathology and Therapeutics, 1892, p. 341.

[29] Ibid, pp. 341-342.

[30] Janes, E H, Report on the Practical Lessons of the Recent Prevalence of Small-Pox, with Reference to its Prevention in the Future, Public Health Papers and Reports, 1873;1:173-183.

[31] Ibid. p. 173.

[32] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 73.

[33] Jenner, E, Further Observations on the Variolæ Vaccinæ, or Cow-Pox, 1799, p. 14.

[34] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 75.

[35] Gregory, G, Brief Notices of the Variolous Epidemic of 1844, Royal Medical and Chirurgical Society, January 28, 1845, p. 163.

[36] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 75.

[37] Gregory, G, Brief Notices of the Variolous Epidemic of 1844, Royal Medical and Chirurgical Society, January 28, 1845, p. 163.

[38] Ibid.

[39] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 75.

[40] “Small Pox and Vaccination”, Hampshire Telegraph and Sussex Chronicle, March 2, 1850.

[41] Ibid.

[42] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 76.

[43] Ibid.

[44] Gubb, A S, Not Due to Vaccination, British Medical Journal, vol. 2, issue1401, November 5, 1887, p. 1023.

[45] Knight T F, Not Due to Vaccination, British Medical Journal, vol. 2, issue 1404, November 26, 1887, p. 1186.

[46] Humphreys, N A, English Vaccination and Small-Pox Statistics, Journal of the Royal Statistical Society, September 1897, pp. 544-545. This is a longer version of the quote than is given in Dissolving Illusions.

[47] Gloucester epidemic of small-pox, 1895-6 : report of the committee appointed by the Board of Guardians to organise and carry out the general vaccination of the city and district, 1896.

[48] Humphreys, N A, English Vaccination and Small-Pox Statistics, Journal of the Royal Statistical Society, September 1897, p. 535.

[49] Gloucester epidemic of small-pox, 1895-6 : report of the committee appointed by the Board of Guardians to organise and carry out the general vaccination of the city and district, 1896, p. 37

[50] Ibid, p. 39

[51] Humphreys, N A, English Vaccination and Small-Pox Statistics, Journal of the Royal Statistical Society, September 1897, p. 535.

[52] Wilder, A, The Fallacy of Vaccination, 1899, p. 10.

[53] Humphreys, N A, English Vaccination and Small-Pox Statistics, Journal of the Royal Statistical Society, September 1897, p. 505.

[54] Ibid, p. 510.

[55] Gloucester epidemic of small-pox, 1895-6 : report of the committee appointed by the Board of Guardians to organise and carry out the general vaccination of the city and district, 1896, p. 38.

[56] Walloch, K L, The Antivaccine Heresy, 2015, p. 22.

[57] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 82.

[58] Small-Pox and Revaccination, Boston Medical and Surgical Journal, vol. 104, no. 6, February 10, 1881.

[59] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 82.

[60] Ibid, p. 83.

[61] Report of the Department of Health of the City of Chicago, 1871, p. 196.

[62] Ibid.

[63] United States Census, 1860.

[64] United States Census, 1880.

[65] According to the US Census Bureau’s Historical Statistics of the United States, Chapter B, there were around 50 births per 1,000 people every year in the US at this time, and, for the states where figures are given, around 20 deaths. Taking the average population of Chicago to be 306,223, this would give 15,311 births and 6,124 deaths per year.

[66] Report of the Department of Health of the City of Chicago, 1871, pp. 190-191.

[67] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 84.

[68] Ruata, C, “Vaccination in Italy”, The New York Medical Journal, July 22, 1899, pp. 188-189.

[69] Livi, R, On Vaccination and Small-Pox in the Italian Army, British Medical Journal, April 29, 1899, p. 1017.

[70] Ibid, p. 1019.

[71] Ibid.

[72] There were a further 90 cases during this period amongst soldiers whose vaccination status was not known (ibid).

[73] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 85.

[74] Edwardes, E J, A Concise History of Small-Pox and Vaccination in Europe, 1902, p. 75-76.

[75] Ibid, p. 59.

[76] Ibid.

[77] Ibid.

[78] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 85.

[79] Imperial Japan Static Population Statistics as of December 31, 1908, Kindai Digital Library at the National Diet Library of Japan.

[80] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 85.

[81] Irwin, F, Smallpox in Japan, Public Health Reports (1896-1970), Vol. 25, No. 35 (Sep. 2, 1910), pp. 1205-1208.

[82] Imperial Japan Static Population Statistics as of December 31, 1908, Kindai Digital Library at the National Diet Library of Japan.

[83] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 88.

[84] The Annual Reports of the Registrar-General of Births, Deaths and Marriages in England, 1859 – 1920, and The Registrar-General’s Statistical Review of England and Wales, 1921 and 1923.

[85] Humphreys, N A, English Vaccination and Small-Pox Statistics, Journal of the Royal Statistical Society, September 1897, p. 531.

[86] http://www.histpop.org

[87] The Annual Reports of the Registrar-General of Births, Death and Marriages in England, 1881 – 1910.

[88] Ibid.

[89] Ibid. Number of children vaccinated was calculated using the percentages given in the written answer by Lord E. Percy to a Parliamentary Question addressed by Mr. March, MP, to the Minister to Health on July 16, 1923.

[90] Ibid.

[91] The Annual Reports of the Registrar-General of Births, Death and Marriages in England, 1881 – 1910.

[92] Humphries, S and Bystrianyk, R, Dissolving Illusions, 2015, p. 92.

[93] Ibid, p95.