104 



SCIENCE. 



[N. S. Vol. XVIII. No. 447. 



temberg after vaccination began, 18.4 per 

 cent, only were under 10, and 42 per cent, 

 over twenty years. So it is shown by Dr. 

 Creighton in his article on 'Vaccination' 

 in the 'Encyclopedia Bx-itannica, ' that, in 

 England and Wales, about 1847, three 

 fourths of the deaths occurred under five 

 years, while in the eighties less than a 

 quarter of the decedents were of this age. 

 In the second place, beside this shifting of 

 incidence, smallpox among the vaccinated 

 proved much less fatal, even when it was 

 contracted, than among the unvaccinated. 



Although minor epidemics began to re- 

 cur, smallpox in vaccinated countries was 

 insignificant in amount until 1870-5, when 

 a 'pandemic' swept over Europe which 

 recalled the normal conditions of the pre- 

 vaccination period. Considering the vary- 

 ing vii-ulence of disease at different periods, 

 and the fact that the importance of re- 

 vaccination was not at all realized, such 

 an epidemic was to be expected. The 

 statistics for the early seventies have been 

 used most dishonestly by the anti-vaccina- 

 tionists in comparison with selected years 

 of low mortality immediately after the 

 introduction of vaccination in the attempt 

 to show that no progress has been made. 

 The worst year of this period in England 

 and Sweden, however, showed a death rate 

 about half the average yearly rate for the 

 last quarter of the eighteenth century. 



A comparison of the incidence of small- 

 pox in this pandemic of 1870-5 upon dif- 

 ferent countries introduces the second class 

 of evidence as to the value of vaccination. 

 Thus Dr. Edwardes shows that for four 

 countries having compulsory vaccination 

 the average yearly smallpox death rate per 

 million inhabitants was as follows : Eng- 

 land, 361; Scotland, 314; Bavaria, 346; 

 Sweden, 333. On the other hand, the rate 

 for the same period was 953 in Prussia, 

 1,360 in Austria, 1,293 in Belgium and 958 

 in the Netherlands. All these countries 



had at this time no compulsory vaccina- 

 tion. The reverse has been affirmed in the 

 case of Prussia, and Creighton, in the 

 'Encyclopedia Britannica, ' states that re- 

 vaccination 'has been more or less the law 

 in Prussia since 1835,' and that 'Prussia 

 was the best revaccinated country in 

 Europe' in 1871. Dr. Edwardes discusses 

 this question in some detail and quotes the 

 official documents, which show explicitly 

 that thei'e existed in Prussia 'kein gesetz- 

 licher Zwang zur Impfung. ' Further- 

 more, the actual ratio of vaccination to 

 births in Berlin is on record, and the per- 

 centage ranged from 29 to 58 between 1865 

 and 1870. In this city there were 6,326 

 smallpox deaths per million living in 1871 ! 



The 'great pandemic' taught the lesson 

 that both vaccination and revaccination 

 were essential. In 1874 Germany enacted 

 a law providing for compulsory vaccina- 

 tion within the second year and revaccina- 

 tion within the twelfth year. In Prussia the 

 death rate, which had ranged from 95 to 

 2,624 per million from 1866 to 1874, drop- 

 ped to 36 in 1875 and has been under 10 

 since 1885. For the empire as a whole, 

 statistics, available only since 1886, show 

 a rate of 4.2 in that year, decreasing to .5 

 in 1895 since which there has been annually 

 less than one death per million. A com- 

 parison with the statistics of Austria 

 graphically made by Dr. Edwardes fur- 

 nishes as striking a proof that vaccination 

 is the only kind of sanitation which affects 

 smallpox as could well be desired. Before 

 1870 the two countries had about the same 

 amount of smallpox; since 1875 that in 

 Austria has increased and that in Prussia 

 has practically disappeared. The only dif- 

 ference in conditions lies in the law of 

 1874. 



Army statistics furnish striking confirm- 

 atory evidence. Thus Burridge* compares 



