53^ 



NATURE 



[April 7, 1898 



•"vaccinated" class lo cases with 3 deaths; and (Jb) to the 

 " un vaccinated " class 79 cases with 24 deaths. 



Without checking Mr. Wheeler's figures by laboriously going 

 through pages 70-117 of the Report, it is simply necessary to 

 •deduct those " under- vaccinated " from his several lists. His 

 classes of "no marks "and "? marks" correspond with Dr. 

 •Coupland's groups of "alleged" and " doubtful " vaccination, 

 except that Dr. Coupland's figures give one case less and one 

 death more than Mr. Wheeler's. Although it is highly prob- 

 able that many of these uncertain and doubtful cases were really 

 unvaccinated, the Report includes them, as does Mr. Wheeler, 

 in the " vaccinated " class (see page 153, &c.). 



unvaccinated 255 ; this, too, in families of the same class, in the 

 same streets, and living under similar sanitary (or unsanitary) 

 surroundings as those in which every child was unvaccinated. 

 May we not legitimately infer that had all the Gloucester 

 children at these ages been vaccinated, only i/7th of those 

 that did suffer would have suffered, and the mortality would 

 have been less than i/6oth of that to which it did attain? 

 Vaccinators are said to be incapable of viewing this subject 

 impartially, but Dr. Coupland is most judicious in the handling 

 of his figures, and it is apparent that the evidence that he has 

 collected from careful observation weighs with him as much or 

 more than do the figures he has brought together ; and it is certain 



Mr. Wheeler's Figures distributed on Plan of Report. 



• Discrepancy due to inclusion by Mr. Wheeler of one death too many among 

 '? vaccinated." 



' vaccinated in infancy," and one case too many among the 



It is difficult to grasp Mr. Wheeler's point in presenting the 

 figures in this way. It might be useful if these questionable 

 cases had all been turned over to the " unvaccinated" class ; but 

 why does he detach them from the rest of the admittedly 

 vaccinated ? He could not have intended to show, as his own 

 figures do, that post-vaccinal fatality diminishes with a rise in 

 the presumed greater efficiency of vaccination as evidenced by 

 the number of scars. Dr. Coupland does not enter into the 

 •question of marks. It has been done over and over again, and 

 in both his Dewsbury and Leicester Reports Dr. Coupland 

 makes a most valuable contribution to this question. The main 

 object of the inquiry at Gloucester was to determine the broad 

 ■question of the occurrence and fatality of small-pox in the 

 vaccinated and unvaccinated. 



Perhaps the most important point that the Gloucester epidemic 

 illustrated is one that is passed over by Mr. Wheeler, and 

 one which unfortunately appears as though the opponents 

 of vaccination in their pursuit of a fad had become callous 

 to the fate, in this instance, of the Gloucester children, but 

 also of the children wherever there is an outbreak of small- 

 pox. 



About the effects of the vaccination or non-vaccination of 

 ■children there can be no di.spute. In this connection it is only 

 necessary to refer to the figures of those attacked between one 

 and ten years of age, and especially at the incidence rates given 

 near the end of the Report. Indeed, if only those households 

 are taken in which some vaccinated children are to be found, it ap- 

 pears that theincidence oi sma.W-'pox among the vaccinated children 

 was only 10 to TOO, though amongst their unvaccinated brothers 

 and sisters it was 10 to 14 ; whilst the death rate (per 1000 of those 

 exposed to infection) was for the vaccinated less than 4, for the 



NO. 1484, VOL. 57] 



that if those who deny the efficacy of vaccination could have the 

 experience that he has had, they would cease to hold the view 

 that he is prejudiced. Any one who considers his Report 

 judicially must confess that he has presented the facts extremely 

 fairly and impartially, and that he evinces far less bias than those 

 whc^ on very slight and shadowy information, are undoubtedly 

 unreasonably opposed to vaccination — the very people, in most 

 cases, who bring the charge of partiality. Every one knows that 

 where large numbers of statistics have to be collected, errors 

 of fact may creep into records, and that, with fuller knowledge, 

 slight modifications may have from time to time to be made. As 

 regards the main facts of Dr. Coupland's records, however, the 

 most exacting will find it difficult to trace any important in- 

 accuracy. In respect to the records concerning children the 

 facts are indisputable, and lead to the mournful conclusion 

 that amongst these there would have been vastly less suffering 

 and far fewer deaths in the Gloucester epidemic, had not infant 

 vaccination been so widely neglected. 



As regards re- vaccination it is difficult to see how Mr. Wheeler 

 obtains the figure 173. In the table (p. 46) there are given 190 who 

 were stated to have been re-vaccinated. Assuming that each of 

 these was really and efficiently re-vaccinated — a large assumption 

 — the fatality would be 47, or much below the general vaccin- 

 ation rate. There are, however, several difficulties to be sur- 

 mounted before a satisfactory demonstration of the relationship of 

 re-vaccination to small-pox can be arrived at ; and one of these 

 especially, that of the true interpretation of a failure " to take," 

 is a most important one. This failure " to take " does not 

 necessarily imply that the subject is immune. Then there is also 

 the fallacy of recent re-vaccination which, like recent primary 

 vaccination, may have been done too close to the date of the 



