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SCIENCE. 



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



per cent, of those who died from other dis- 

 eases than smallpox and 81 per cent, of 

 those who died from smallpox. Obviously 

 it was the lack of vaccination which was at 

 fault here, not feeble health nor unsanitary 

 conditions. In opposition to these figures 

 the anti-vaccinationists quote the experi- 

 ence of the city of Leicester, where since 

 1882 the number of vaccinations has 

 steadily decreased, falling to less than two 

 per cent, of the births in some recent years. 

 Smallpox has been introduced a number of 

 times (38 cases in 1892, 308 in 1893, 8 in 

 1894, 4 in 1895, 4 in 1901), but has not 

 spread extensively, and the death rate has 

 remained very low. The opponents of vac- 

 cination also quote, by way of contrast, 

 statistics showing that an increasingly large 

 proportion of hospital cases of smallpox 

 occur among the vaccinated,* and that in 

 epidemics the attack of an unvaccinated 

 person is often not recorded for some time.f 

 Facts of the last two classes have, of course, 

 no special significance except to indicate 

 the need for revaccination. No one now 

 supposes that a single vaccination affords 

 absolute permanent protection, and with 

 the increase of vaccination there must 

 naturally come an increase of cases among 

 the vaccinated. The experience of Leices- 

 ter, on the other hand, is certainly of in- 

 terest. It shows that under certain condi- 

 tions the dangers of neglected vaccination 

 may for a time be braved with impunity 

 by a considerable portion of the community. 

 This has been so far accomplished by 

 prompt reporting and strict isolation of 

 cases, and, according to the chairman of the 

 public health committee of the town by 

 the fact that 'a handful of the population, 

 including the medical men, sanitary staff, 



* London smallpox hospital, 40 per cent, in 1838, 

 94Vjo per cent, in 1879 — Wallace. 



t The first unvaccinated ease was the 174tli at 

 Cologne in 1870, the 42d at Bonn in the same year, 

 and the 225th at Lieenitz in 1871— Creighton. 



smallpox nurses, etc., are as well vaccinated 

 in Leicester as in any other town, so that 

 a cordon of protected persons can at once 

 be drawn around any case of smallpox 

 which may occur.'* It should be remem- 

 bered, however, that the population of 

 Leicester is still to some extent protected 

 by the vaccinations carried out prior to the 

 anti-vaccinationist agitation. Thus of the 

 358 persons attacked in 1892-5, 198 were 

 returned as having been at some time vac- 

 cinated. The experience of Gloucester is 

 ominous for the future of the 'Leicester 

 experiment.' Prior to 1892-3, according 

 to Dr. Edwardes, 'vaccination had been 

 almost in abeyance, in Gloucester, and the 

 inhabitants lived in a fools' paradise. ' The 

 result was an epidemic of 1,979 cases, with 

 434 deaths in a population of about 40,000, 

 giving a death rate of 10,000 per million! 

 With regard to the smallpox occurring 

 in persons once vaccinated, there are two 

 points to notice. In the first place, the 

 ratio of deaths to cases is far lower than 

 among the unvaccinated. Thus at the 

 Leipsic city hospital in 1870-2 99 died 

 among 139 unvaccinated cases, 116 died 

 among 1,504 vaccinated eases, and none 

 among 13 revaccinated cases. Creighton 

 and Wallace object to these statistics on 

 the ground that the death rate thus ap- 

 parent among the unvaccinated is obviously 

 too high, because 'in pre- vaccination times 

 the death rate (18.8 per cent.) was almost 

 the same as it is now in the vaccinated and 

 unvaccinated together' (Creighton. Now 

 it is quite impossible to fix any such general 

 fatality rate; the ratio of deaths to cases 

 has varied within wide limits both in the 

 eighteenth century and recently. In the 

 second place, it has been claimed that the 

 'unvaccinated' death rate is swollen by the 

 inclusion in that class, of children who 

 escaped vaccination on account of feeble 



* Windley, 'Leicester and Smallpox,' Joiinial 

 of State Medicine, January, 1903, p. 21. 



