THE FACTS AGAINSTCOMPULSORY VACCINATION

By H. B. Anderson

CITIZENS MEDICAL REFERENCE BUREAU226 West 47th Street New York

PRICE $1.00

THE FACTS AGAINST

COMPULSORY VACCINATION

By H. B. ANDERSON

PUBLISHED BYCITIZENS MEDICAL REFERENCE BUREAU

226 W. 47th STREET, NEW YORK, N. Y.

COPYRIGHT 1929BY

H. B. ANDERSON

Manufactured in the United States of America

P R E F A C E

This book has been prepared especially for the busyman or woman to read.

The entire story is contained in the headlines whilethe proof is given in light face type.

It is not necessary, therefore, to read the light facetype except where questions arise regarding the accuracyof any assertion contained in the headlines, in whichcase the facts are readily available.

This book points out the fallacy of community vacci-nation, involving compulsory measures, but does not at-tempt to advise anyone whether he should or should notbe vaccinated for his own protection.

The data contained herein is compiled entirely fromboard of health bulletins, medical journals and otherauthoritative publications.

It represents findings and concessions of the most out-standing advocates of vaccination. Hence, the data is ofa most conservative character which understates, ratherthan overstates, the actual facts.

Nevertheless, the findings here given, revealing the im-position and enormity of the outrage of the vaccinationrequirement, are of a most startling character.

No institutions have wider facilities for acquaintingthemselves with the facts referred to in this book thanfederal, state and local boards of health. Why then, dothey continue the policy of showing frankness in discuss-ing vaccination in technical publications and pursue thepolicy of assuring the public in the press, on the radioand on the public platform that vaccination is harmlessand that it constitutes a sure protection against small-pox?

iii

Health boards know the truth of the facts containedherein. They also know the strength of the politicalmedical machine which is ever striving to prevent in-formation of this kind from reaching the public. Butwhat they apparently fail to take into consideration isthat information may be suppressed for a time, buteventually avenues are opened up for bringing the factsto the public.

We appeal to all friends of free speech, to all friendsof a free press, and to all friends of medical liberty toassist in acquainting the public with the facts containedin this publication.

Compulsory vaccination as used in this book has refer-ence to making vaccination a requirement by denyingeducation, food, or employment to persons not vaccinated.The exercise of force to compel vaccination would subjectthe physician or health officer to possible damages forassault upon the body. (See Journal American MedicalAssociation, December 6, 1924, p. 1865). Hence it wasnot considered necessary to discuss forcible inoculation.

Grateful appreciation is extended by the author toReverend William Whitehead of Bryn Athyn, Pennsyl-vania for his invaluable assistance in compiling andassembling the data contained in this publication.

The Reverend Whitehead collaborated with the writerin the early stages of this treatise and the book wouldhave been published under joint authorship except forMr. Whitehead's absence abroad which necessitated itscompletion by the writer.

Reverend William Whitehead is Professor of Historyand Head of the History Department, Academy of theNew Church, Bryn Athyn, Pennsylvania.

Note:—All bold face type used in the quotations inthis publication are ours.

IV

CONTENTS

PREFACE

PART I. THE VACCINATION REQUIREMENT ISSTRENUOUSLY OPPOSED BY AN ENLIGHTENEDPUBLIC SENTIMENT WITHIN AND WITHOUT THEMEDICAL PROFESSION: IT IS UN-AMERICAN ANDIS SPONSORED BY CLASS INTERESTS WHICHWOULD PROFIT FINANCIALLY BY THE RETEN-TION OF THIS LEGISLATION.

In Very Few States Is Vaccination Compulsory ByLaw and Of the States Which Have Had Such aRequirement One After Another Have EnactedLegislation to Make This Form of Treatment Op-tional.England Has Repudiated Compulsory VaccinationBy the Acts of 1898 and 1907 Providing for a Con-science Clause.Holland Has Suspended Its Vaccination Require-ment Because of Cases of Serious Illness FollowingVaccination.Australia Has Repudiated Compulsory Vaccina-tion.The Vaccination Law In Germany Is BreakingDown.Opposition to Compulsory Vaccination Is So Over-whelming That an Increasing Number of Medical,Public Health and School Authorities Are FindingFault With the Vaccination Requirement.The London, Lancet, England's Leading MedicalJournal, Raises the Question of the Desirabilityof Abandoning Universal Vaccination As a PublicHealth Measure.v

Parental Right to Determine Form of TreatmentFor Children Is Fundamentally Sound.Compulsory Vaccination Is un-American.Typical Instances of Attempts By Advocates ofCompulsory Vaccination to Withhold Education,Employment or Food From Persons As a Means ofForcing Them to Be Vaccinated.Physicians Do Not Want Compulsion For Them-selves.Organized Regular or Allopathic Physicians andVaccine Companies Have a Commercial InterestIn Making It Appear That Compulsory Vaccina-tion Is Necessary.Two Health Boards Are Officially Engaged In theBusiness of Manufacturing, Creating a DemandFor and Selling Vaccines and Serums.Medical Politics Stands In the Way of An Im-partial Consideration of Vaccination Laws.Facts Showing That Organized Medicine Has theMachinery For Popularizing Vaccination Regard-less of Its Merits or Demerits.Extortion By Terrorism.

PART II. THERE IS NO RELATION BETWEENTHE VACCINATION REQUIREMENT AND THEPRESENCE OR ABSENCE OF SMALLPOX.

The United States Public Health Service ConcedesThat Unvaccinated Persons May Be Exposed toSmallpox Without Contracting It and That Small-pox of a Fatal Character May Occur In PersonsWith a Fairly Good Vaccination History.Organized Physicians Were Just As Sure That theInoculation of People With Smallpox Was a GoodThing As They Now Are That Vaccination IsNecessary But Smallpox Inoculation Resulted In

vi

Actually Spreading the Disease and Was Made aPenal Offence In England In 1840.Jenner, the So-called Discoverer of Vaccination,Was Just As Sure That a Single VaccinationWould Protect For Life As Organized MedicineToday Is That Vaccination Affords TemporaryProtection Against Smallpox.Smallpox Has Gone the Way of Cholera and OtherFilth Diseases Before the Onward March of Sani-tation and Improved Living Conditions.Smallpox Is Only One of Several Diseases WhichHave Shown a Substantial Reduction.There Has Been No Increase In Smallpox Follow-ing the Repeal of the Vaccination Requirement inMaine and a Number of Other States.In England Smallpox Mortality Has Greatly De-clined Following Virtual Repeal Of VaccinationRequirement By Passage of Acts of 1898 and 1907Providing For a "Conscience Clause" As ShownBy the Following Tables. No Other Country HasGiven Vaccination So Good a Tryout As England.Here Are the Facts.Smallpox Record of United States Where Vacci-nation Is Optional For Most Part ComparesFavorably With That of Italy, Japan and thePhilippines, Each of Which Make Vaccinationand Revaccination Compulsory.Unvaccinated Australia Free From Smallpox.The Case Reports of Alleged Smallpox In theUnited States And England, About Which Advo-cates Of Compulsion Are Seeking to Create SoMuch Alarm, Are the Result of a Practice InThese Countries Of Reporting a Variety of MildComplaints As Actual Cases Of Smallpox WhereasIn Other Countries They Would Be Designated As

vii

"Alastrim," "Cuban Itch," "Chickenpox" or UnderSome Other Name.Fallacy of Statistics Comparing Smallpox CasesAmong the Vaccinated And Unvaccinated.The Misuse of Statistics.How Statistics May Be Interpreted to Mean Any-thing the Advocates of Vaccines Want Them toMean.The Menace of Wholesale Serumization.Serum Craze Has Now Reached the Stage WherePersons Are Being Inoculated With PreparationsRanging From Extracts Of Newspapers to Dan-druff, Blonde and Brunette Hair and House Dust.

PART III. THE VACCINATION REQUIREMENT,INVOLVING AS IT DOES, WHOLESALE INOCULA-TION OF THE POPULATION OR AN IMPORTANTPART THEREOF, CONSTITUTES A MORE SERIOUSMENACE TO PUBLIC HEALTH THAN SMALLPOX.

More Than 10,000 Soldiers Were Made Sick ByVaccination.Articles In Medical Journals Refer to Lockjaw(or Tetanus) Following Vaccination As Alwaysto Be Feared and An Ever-Present Possibility.Bibliography Of Articles In Medical and PublicHealth Journals Referring to Cases Of Lockjaw(or Tetanus) Following Vaccination.Specific Cases Of Fatalities Following Vaccina-tion. The Following News Items Are Typical Ofthe Clippings Received Each Year Prior to theOpening Of the Schools. Health Boards In theUnited States Are Not Required to Make Publicthe Actual Number of Such Cases Which Occur.Hence, While One News Item May Over-Empha-size the Part Played By Vaccination the Majorityof Cases Would Not Be Reported At All.

viii

Says Deaths From Vaccination Outnumber ThoseFrom Smallpox.

Disclosures of Serious Illness and Fatalities Re-sulting From Vaccination Contained in theReports of Two Official Investigations JustIssued.New and Startling Dangers.—Recent Reports OfCases of Encephalitis Following Vaccination.Medical Authorities Concede That VaccinationMay Light Up Or Transmit Various Diseases.Epidemics Of Foot-and-Mouth Disease Of 1902and 1908 Among Cattle Traced By United StatesDepartment Of Agriculture to Vaccine Virus.How Vaccine Virus Is Prepared.—Method UsedIn England; Method Recommended by Dr. Park.No Physician Or Health Officer Can Be AbsolutelyCertain That Any Batch Of Vaccine Virus Is FreeFrom Impurities.

ix

This book is dedicated to the lateMr. John Pitcairn of Bryn Athyn,Pennsylvania who was one of the mostoutstanding opponents of compulsory-vaccination in the United States.

"Will a nonimmunized person contract smallpoxif exposed to the disease? By no means uniformly.Exposure to smallpox, especially to the milderforms, without contracting the disease frequentlyoccurs and is no definite evidence of immunity.The number of cases of smallpox among the unpro-tected persons in contact with patients sufferingfrom the disease is very much less than 100 percent. . . .

"The purpuric, uniformly fatal, form of smallpoxis the most difficult to prevent by vaccination, andcases of this form, without a true smallpox erup-tion, may occur in persons with a fairly good vacci-nation history ..." Extracts from article by Sur-geon J. P. Leake, published in "Public HealthReports," the weekly bulletin of the United StatesPublic Health Service, January 28, 1927.

PART IThe Vaccination Requirement Is Strenuously Op-

posed by an Enlightened Public Sentiment Withinand Without the Medical Profession: It is un-American and is Sponsored by Class InterestsWhich Would Profit Financially by the Retentionof this Legislation.

1

IN VERY FEW STATES IS VACCINATIONCOMPULSORY BY LAW AND OF THE STATESWHICH HAVE HAD SUCH A REQUIREMENTONE AFTER ANOTHER HAVE ENACTEDLEGISLATION TO MAKE THIS FORM OF

TREATMENT OPTIONAL.

(Note:—Only nine states have laws making this form oftreatment a requirement for admission to the public schools:the District of Columbia, Maryland, Massachusetts, NewHampshire, New Mexico, New York (in cities of the firstand second classes only), Pennsylvania, Rhode Island andSouth Carolina. Vaccination of children during infancy isrequired by law in Kentucky and Maryland. It is optionalwith local authorities whether or not they shall require vac-cination for admission to the public schools in Connecticut,Georgia, New Jersey, North Carolina, Ohio and Oregon. Inthe absence of legislation specifically authorizing State orlocal authorities to make vaccination a requirement for ad-mission to the public schools, the state or local boards ofhealth in Arkansas, Kentucky, and a few other states haveattempted to require vaccination by means of health boardregulations. This action has been upheld by the courts insome states but in most cases the exclusion of unvaccinatedchildren from the public schools, except during times of epi-demic, without specific authority from the legislature, hasbeen held illegal. H. B. A.)

2

Extract from Public Health Bulletin No. 52 by J. W.Kerr, issued by the United States Public Health Service,

January 1912."The provisions relative to vaccination in the United

States are many and varied. In very few States is thisprophylactic measure at all compulsory by law. Insome it can be made a provision of state-wide applicationat the discretion of the State board of health. In others,the majority, its adoption is optional with the local healthauthorities. Still in others, rules of the State board ofhealth require its practice, and in several, its obligatoryenforcement is absolutely forbidden.

"As to the practical enforcement of the existing provi-sions, no opinion can be expressed. Health authorities ofvarious States admit that, owing to general apathy orlack of funds, vaccination is seldom systematically en-forced, except perhaps in the case of school children."

Compulsory Vaccination Prohibited in Four States.From Supplement No. 60 to the Public Health Reportsentitled, "Smallpox Vaccination Laws, Regulations, andCourt Decisions," issued by the United States Public

Health Service, 1927."Compulsory vaccination prohibited.—In four States,

Arizona, Minnesota, North Dakota, and Utah, there arestatutory provisions against compulsory vaccination.

"The Arizona law provides that no minor child shall besubjected to compulsory vaccination without the consentof the child's parent or guardian. This law, however,has a proviso prohibiting the school attendance in aschool district of unvaccinated children when a smallpoxepidemic prevails in such district.

"In Minnesota the statute reads, 'no rule of the Stateboard [of health] or of any public board or officer shallat any time compel the vaccination of a child, or shallexclude, except during epidemics of smallpox and whenapproved by the local board of education, a child from

3

the public schools for the reason that such child has notbeen vaccinated.'

"The North Dakota law forbids making any form ofvaccination or inoculation a condition precedent for theadmission of any person to any public or private schoolor college, or for the exercise of any right, the perform-ance of any duty, or the enjoyment of any privilege, byany person.

"By the Utah" law it is made unlawful for any board ofhealth, board of education, or any other public board tocompel the vaccination of any person, or to make vacci-nation a condition precedent to school attendance.

"Compelling vaccination by physical force.—A pro-vision of the South Dakota statutes makes it unlawfulfor any board, physician, or person to compel another bythe use of physical force to submit to vaccination."

Arizona Repealed Law by Referendum Vote.Prior to the year 1918 Arizona had the following com-

pulsory vaccination law:"Sec. 28. Each parent or guardian having the care,

custody or control of any minor or other person shallcause such minor or other person to be vaccinated.

"Sec. 35. * * * Any person who fails to comply withor violates any of the provisions of this act * * * shallbe guilty of a misdemeanor, and upon conviction thereofshall be punished by a fine of not less than ten nor morethan fifty dollars, or by imprisonment in the county jailnot exceeding thirty days, or by both.—(Acts of 1903,ch. 65)."

In 1918 the following law was passed by referendumvote:

"Section 1. Children, compulsory vaccination prohib-ited; school attendance during smallpox epidemic.—Nominor child shall be subjected to compulsory vaccinationwithout the consent of the parent or guardian having thecare, custody, or control of such minor: Provided, how-ever, That no minor child shall be permitted to attend

4

any public school in any school district in the State ofArizona during the period in which a smallpox epidemicmay be prevalent in said school district unless said minorchild shall have first been vaccinated.

"Sec. 2. Repeal.—That paragraph 4396, chapter 1,title 41, of the Revised Statutes of Arizona, 1913, civilcode, be, and the same is hereby, repealed.— (Initiativemeasure approved by voters November 5, 1918; effectiveDecember 5, 1918)."

North Dakota Abolished Law in 1919.Prior to the year 1919 North Dakota had the following

law for the control of smallpox:"279. Each parent or guardian having the care, cus-

tody or control of any minor or other person shall causesuch minor or other person to be vaccinated.

"9038. Every person who wilfully violates any provi-sion of the health laws * * * is punishable by imprison-ment in a county jail not exceeding one year, or by a finenot exceeding two thousand dollars, or both.—(RevisedCodes, 1905)."

The following law abolishing compulsory vaccinationin North Dakota was passed by the North Dakota Legis-lature and approved February 14, 1919:

"Sec. 425al. Vaccination not to be made a conditionprecedent..—No form of vaccination or inoculation shallhereafter be made a condition precedent, in this State,for the admission to any public or private school or col-lege, of any person, or for the exercise of any right, theperformance of any duty, or the enjoyment of any privi-lege by any person.

"425a2. Repeal..—Section 425 of the Compiled Laws ofNorth Dakota is hereby repealed, as well as are all actsand parts of acts in conflict with the provisions of thisact—(1913-1925 Supplement to 1913 Compiled Laws)."

California Repealed Law in 1921.Two acts were passed by the California legislature be-

fore the vaccination law in California was completely

5

abolished. In 1911 the requirement that children be vac-cinated for admission to the public schools was modifiedin such a manner as to exempt children who presented asigned statement from the parent requesting that thechild be permitted to attend school without vaccination.

In 1921 another act was passed which repealed the vac-cination requirement altogether. It provides as follows:

"Section 1. Smallpox, control; vaccination rules, adop-tion.—The control of smallpox shall be under the direc-tion of the State board of health, and no rule or regula-tion on the subject of vaccination shall be adopted byschool or local health authorities. (Section 2 repeals ch.134, acts of 1911.) —(Acts of 1921, ch. 370)."

Maine Abolished Law in 1921.The State of Maine had, until the year 1921, a law

authorizing superintending school committees to requirevaccination. for admission to the public schools. It pro-vided as follows:

"Section 35. Superintending school committees shall—VII. Exclude, if they deem it expedient, any person notvaccinated, although otherwise entitled to admission.—(Rev. Stats. 1903, ch. 15)."

In 1921 this law was amended so as to make vaccina-tion optional with parents, regardless of the wishes ofthe superintending school committees. The law asamended reads as follows:

"Sec. 38 (as amended by ch. 41, acts of 1921). Ex-clusion of unvaccinated persons from school.—Superin-tending school committees shall perform the followingduties:

V. Exclude, if they deem it expedient, any person notvaccinated, although otherwise entitled to admission, un-less a parent or guardian of such person shall presenta signed statement that such parent or guardian is op-posed to vaccination, in which event such person mayonly be excluded in the event of an epidemic of smallpox.— (Revised Statutes, 1916, ch. 16)."

6

Massachusetts Abolished Compulsory Vaccination ofInfants in 1908.

Extract from a Communication by Mr. Henry D. Nunnin the Boston, (Mass.) Post, January 22, 1924.

"The first compulsory vaccination law was passed byMassachusetts in 1855. It required that every infantmust be vaccinated before reaching the age of two years;that no child should be admitted to any public school un-less vaccinated; that all inmates of public institutionsmust be vaccinated; that the employees of all manufac-turing corporations must be vaccinated as a prerequisiteto employment and to cap the climax, everyone must bevaccinated every five years. What was the result? Inthe 20 years following the enactment of this law therewere 4221 deaths from smallpox in Massachusetts. Theprotection afforded by this law did not highly recom-mend itself to the people, and in time it was pretty muchignored, so that finally in 1908 the infant vaccinationrequirement was repealed without protest by anybodyand without any bad results."

CHICAGO CITY COUNCIL IN 1926 ADOPTED ANORDINANCE PROHIBITING COMPULSORY VACCI-

NATION.Copy of ordinance passed by the Chicago City Council

January 13, 1926."The Board of Health shall pass no rule or regulation

which shall compel any person to submit to vaccination,or injection of any virus, or medication, against his willor without his consent, or, in the case of a minor or otherperson under disability, the consent of his or her parent,guardian, or conservator, and nothing in this ordinancecontained, or in any other ordinance heretofore passedand in force in this city, shall be construed to authorizeor empower any person or officer to so vaccinate, inject,or medicate, without such consent, or to authorize or em-power the said board of health to adopt any rule or regu-7

lation requiring or authorizing any such vaccination, in-jection or medication."

A measure was also passed by referendum vote of thepeople in Colorado Springs several years ago making vac-cination optional in that city.

ENGLAND HAS REPUDIATED COMPULSORYVACCINATION BY THE ACTS OF 1898 AND1907 PROVIDING FOR A CONSCIENCE CLAUSE.

This Action Came As a Result of the Findings of TheRoyal Commission on Vaccination in 1898 Which Con-ducted the Most Exhaustive Investigation That Has

Ever Been Made on This Subject.Extracts from book by C. Killick Milliard, M.D., entitled,"The Vaccination Question In the Light of ModernExperience," 1914, directing attention to the repudiationof compulsory vaccination in England and the findingsof the Royal Commission on Vaccination in favor of a

modification of the vaccination law.p. 1. "The Vaccination Question undoubtedly consti-

tutes one of the most remarkable controversies of the age.In many ways it is unique. Beginning in the early daysof last century when vaccination was first introduced, itonly became a popular question when vaccination wasmade compulsory in 1853. It attained its most acutephase after the Vaccination Act of 1872, which, passedwith the object of securing the more efficient enforce-ment of the Vaccination Laws by the appointment ofVaccination Officers, may be regarded as representing thehigh-water mark of compulsion. Since the VaccinationAct of 1898 with the note-worthy Conscience Clause, andstill more since the Act of 1907 permitting the father tomake a statutory declaration before a Justice of thePeace in place of having to go into Court, real compul-sion has been very largely abolished. * * *8

p. 27. "The Royal Commission on Vaccinationcertainly represents by far the most exhaustive inquiryever held in connection with the subject of vaccinationand constitutes a landmark in the history of our subject.It was, indeed, one of the most remarkable inquiries everheld in connection with any subject. Appointed in theyear 1889, the Final Report was not published until 1898,seven years later. This delay is not surprising, consider-ing the enormous volume of evidence recorded. The Com-missioners held 136 meetings, and examined 187 wit-nesses. In addition, they caused important investigationsto be made for their assistance. The examination of cer-tain individual witnesses occupied several whole days.The total number of questions put and answered was over18,000. Some idea of the mere bulk of the reports issuedis obtained from the fact that the five principal reports,consisting of closely printed matter, together with theeight bulky appendices, weigh altogether over 14 lb.avoirdupois! The Commissioners, under the able chair-manship of Lord Herschell, certainly did their work withcommendable thoroughness, and their reports constitutea veritable storehouse of facts relating to vaccination;but, unfortunately, much valuable evidence is virtuallyburied in this great mass of material. * * *

p. 38. "Reference 5. The Question of Compulsion.—As regards the important question of compulsion, theCommissioners recommended a modified and much lessstringent form of compulsion by recognizing andexempting the 'Conscientious Objector' on certain con-ditions. Two of those who signed the Majority Report,however, dissented from this concession; but, on the otherhand, two other Commissioners joined the Minority Com-missioners in objecting to the retention of the principleof compulsion in any form. There were thus two infavor of unrelaxed compulsion; seven in favor of agreatly modified and reduced form of compulsion; andfour in favor of compulsion being abandoned altogether.

9

It would only have required the transfer of three votes,therefore, to have secured a majority in favor of the en-tire abolition of compulsion." * * *

HOLLAND HAS SUSPENDED ITS VACCI-NATION REQUIREMENT BECAUSE OF CASESOF SERIOUS ILLNESS FOLLOWING VACCI-

NATION.

Extracts from item entitled, "Vaccination In Holland,"translated from the Dutch official document suspendingvaccination for one year, and published in the "Vacci-

nation Inquirer" April 2nd, 1928."Vaccination against smallpox is not compulsory in

Holland. By the Infectious Diseases Act, however, it hasbeen laid down as a rule that teachers and pupils are notallowed to enter a school unless they have been vaccinatedagainst smallpox, in a prescribed manner and with lymphprepared in laboratories approved of by the State. * * *

"In 1923 and following years, cases of encephalitisafter vaccination have occurred. As in most cases thisencephalitis has shown itself 10 to 13 days after vacci-nation, one has been led to suppose that there must besome connection between vaccination and the divergenceof the central nerve system as stated from the diagnosis.

"One could therefore not maintain any longer thatvaccination against smallpox has to be considered asentirely harmless, although the danger may be said tobe very slight.

"Comparing the possible harm caused by vaccination,the risk of smallpox cases is in this country consideredgreater, if the indirect compulsion to be vaccinated shouldbe entirely abolished.

"The Government, with a view to the present dangerof causing encephalitis after vaccination, for whichthere are no decisive remedies yet, have thought it ex-pedient to suspend the indirect compulsion for one year.

10

It is hoped that during that period, by means of officialscientific investigations and searches, the cause of thecomplication may be discovered, so that measures can betaken to prevent it.

"Should this step have no satisfactory result after oneyear, then it will be for the Government, either to extendthe suspension for another year, or if the danger of en-cephalitis is considered less than a threatened smallpoxepidemic, to revert to the old regime.

"In political circles there is a strong current to retainthe indirect compulsion of vaccination, even when ad-mitting that some risk is attached to vaccination. Aftera year the Government will take a decision as to thefuture. When in some community a case of smallpox isreported, teachers and pupils, who are not vaccinated,are prevented from attending school until all danger ofthe disease spreading has disappeared.

"At present the work of investigation into the natureof the post-vaccination encephalitis is rigorously pushedon, not only in Holland itself, but also in conjunction withforeign governments, institutions and persons.

"The Hague, February, 1928."

AUSTRALIA HAS REPUDIATED COMPUL-SORY VACCINATION.

The complete repudiation of compulsory vaccination inAustralia and the small number of persons vaccinatedis shown by the following extracts from the article in"Public Health Reports," August 14, 1925, page 1691:

"In 1909 compulsory vaccination was in force only inthe States of Victoria and Western Australia. In 1911 a'conscientious objection' clause was inserted in the healthact of Western Australia and in that of Victoria in 1919.in South Australia an act to suspend compulsory vacci-nation was passed in 1917.

11

"New South Wales has never had any statutory provi-sion for compulsory vaccination, but public vaccinatorsare appointed and receive a fee for each vaccination per-formed and reported. In this State, excepting for theyears 1913-1917 (period of smallpox outbreak), the vac-cinations per 100 births varied from 0.02 to 0.7. In 1913the proportion was 19.5 and in 1914, it was 12.4.

"Infantile vaccination in Victoria continued up to 1919.From 1909 to 1919 the vaccinations in Victoria variedbetween 69 and 44 per 100 births; but in 1920, the yearin which the 'conscientious objection' clause went intoeffect, they dropped to 12 and in 1923 to 6.

"The compulsory vaccination provision of the healthact of Queensland has never been proclaimed and vacci-nation has been voluntary. As medical practitioners donot notify vaccinations, no exact data on the proportionof the population vaccinated are available.

"Compulsory vaccination in South Australia practicallyended in 1901 by the inclusion of a 'conscientious objec-tion' clause, and was abolished by an act of 1917. Thenumber of vaccinations per 100 births dropped from 14.7in 1909 to an annual average of 5 for the years 1918-1922.No vaccinations were reported in 1923.

"In 1909 a bill revising the compulsory vaccination actof 1878 failed of passage in Western Australia, in whichyear it was stated that 'only about 10 per cent. of thoseborn in recent years in Western Australia had been vac-cinated.' In the health act of 1911 a 'conscientious ob-jection' clause was adopted.

"In Tasmania, under the vaccination act of 1898, allinfants are nominally required to be vaccinated beforethe age of 12 months unless either (a) a statutorydeclaration of conscientious objection is made, or (b) amedical certificate of unfitness is received. No informa-tion regarding vaccination in recent years is available forTasmania. No cases of smallpox occurred in Tasmaniaduring the period 1903-1923.

12

"For practical purposes, it is stated, the Common-wealth, as a whole, has been unprotected by vaccinationduring the period under study; and at the present timesome concern is expressed because of this fact. It is diffi-cult to estimate the proportion of vaccinated persons,even in terms of infantile vaccination, without any con-sideration of the revaccination necessary to insure im-munity. In the first volume of this study it was esti-mated that in 1910 about 30 per cent of all persons inAustralia had been vaccinated, and the best estimate fromall figures available places the present proportion at aboutthe same figure."

THE VACCINATION LAW IN GERMANY ISBREAKING DOWN.

Extract from communication in the Journal of theAmerican Medical Association, January 30, 1926, from

its Berlin Correspondent.

"Since the introduction of compulsory vaccination byfederal enactment back in the seventies of last century,there has been constant agitation in favor of either re-pealing or modifying the law. Some of the opponentshold that the law is superfluous and useless; others thinkthat vaccination should be compulsory only when an epi-demic is threatened. Both parties make use of the pleathat they are conscientious objectors, especially since inEngland conscientious scruples are recognized as an ex-cuse for noncompliance with the law. . . . Professor Grot-jahn, who occupies the chair of hygiene at the Universityof Berlin and who has performed meritorious service, isin favor of the admission of conscientious objections asa valid excuse for failing to comply with the compulsoryvaccination law."

13

DUTCH SUSPENSION OF VACCINATION HASEFFECT IN PRUSSIA.

Special to The Christian Science Monitor.

THE HAGUE—The suspension of the legal enforce-ment of vaccination in Holland, temporarily for one year,is having a marked influence abroad. In Prussia, wherethis law was just enforced, the state Minister of PublicHealth recently issued a decree stating that vaccinationwould for some months not be enforced in territorieswhere cases of encephalitis had appeared.

The reason for this decision, as stated by the PrussianMinister, was that in Holland after vaccination, and ap-parently as a result of it, this disease had occurred orhad taken a more serious form.

The medical editor of De Nieuwe Rotterdamsche Cour-ant, writing on this subject in a recent issue, states thatevidently the Prussian Minister had followed the adviceof four medical professors who had investigated thismatter in Holland. He points to the importance of thisdecision as taking place in the country where the legalenforcement of vaccination had its most staunch andnumerous supporters in the past.—From the Christian Science Monitor, April 18, 1928.

14

OPPOSITION TO COMPULSORY VACCI-NATION IS SO OVERWHELMING THAT ANINCREASING NUMBER OF MEDICAL, PUBLICHEALTH AND SCHOOL AUTHORITIES AREFINDING FAULT WITH THE VACCINATION

REQUIREMENT.

Declaration by Dr. Wm. F. King, State Commissioner ofHealth of Indiana in Public Health Bulletin No. 149issued by the United States Public Health Service, 1925.

p. 53. "I know of nothing that causes more uselessantagonism and more difficulty and trouble to the healthdepartment than the more or less grand-stand ordersissued by health departments requiring the vaccinationof school children whenever a few cases of smallpoxoccur. I have never been able to see wherein a healthdepartment is justified in issuing an order requiring thevaccination of school children as a measure to controlan outbreak of smallpox when the adult portion of thecommunity is at the same time permitted to go and comeas they may please. It seems to me that if a health de-partment is to be consistent it should issue an order ap-plying to every unvaccinated person regardless of age,and not be continually attempting to show an authorityover the school children of the community, who, as a rule,are.less responsible for the spread of the disease."

Declaration by Dr. John E. Monger, State Health Com-missioner of Ohio, in the monthly bulletin of the Indiana

State Board of Health, December, 1927."We are not German. We are not English. We are

Americans, and you simply cannot tell an American thathe must do thus and so. If you do, he will not do it justto show you he is an American. The history of compul-sory vaccination shows this . . . America has it in spots,and it fails."

15

Declaration by Dr. Walter N. Dickie, Secretary of theCalifornia State Board of Health, as published in thebulletin of the Public School Protective League, Los

Angeles, California, May, 1923.

"There is no doubt that many doctors in the medicalprofession would like a strict compulsory vaccination lawfor California, but the tendency now is to accept theundeniable rights of the individual to choose for himselfand for his children that particular mode of treatmentwhich in his judgment will best promote health andhappiness."

Copy of editorial published in the weekly bulletin of theCalifornia State Board of Health, January 6, 1923.

"There is apparently some confusion and misunder-standing relative to the present status of smallpox controlin California. Smallpox is now controlled under theregulations of the State Board of Health, the same asother communicable diseases. There is no special legis-lation with regard to smallpox, with the exception ofChapter 370 of the 1921 Statutes, which repeals the oldVaccination Act of 1911, and provides that no rule orregulation on the subject of vaccination shall be adoptedby school or local health boards.

"This measure does away with the cumbersome andunpopular Vaccination Act which provided for the ex-clusion of all unvaccinated persons from attendanceupon the school whenever smallpox existed within theschool district.

"The complex conditions which arose in connectionwith this act led to many embarrassing and difficult situ-ations. Under the present law the regulations of theState Board of Health provide a uniform method of regu-lation and thus the possibilities for confusion and mis-understanding should be eliminated."

16

Extract from editorial in the California State Journalof Medicine, February 1921, advocating the passage ofthe bill which resulted in the repeal of the vaccination

law in California.

"Senate Bill 408 is an act to repeal the general vacci-nation act for public and private schools. This act hasbeen the source of confusion and useless expense. Itdoes not seem practical of administration without muchfriction. The law requires that a child must be vacci-nated or present a conscientious objector's card beforehe or she can be admitted to school. Many children whoseparents recognized the efficacy of vaccination presentedobjector's cards and thereby created false statistics andincreased the work and expense of City and State healthdepartments. The establishment of exclusive districtsfor unvaccinated children created more work and ex-pense. The repeal of the law will in no way interferewith the present powers of health officers."

Declaration by Dr. W. J. Breeding, Director, Division ofHealth Education, and E. A. Lane, Epidemiologist, Ten-nessee State Department of Health, in an article pub-

lished in "Public Health Reports," July 23, 1926.

"Although the percentage of persons vaccinated inTennessee is extremely low, it is believed that the Statelaw empowering local boards to enact such vaccinationmeasures as may be deemed necessary for the protectionof the public is adequate for the time being. A Statecompulsory vaccination law, unenforceable in rural sec-tions, might stir up such opposition as to hinder otherhealth programs."

17

Extract from communication by former Commissionerof Education, Andrew S. Draper, to the President of theBoard of Education, Olean, New York, January 24,1912,published in the Ninth Annual Report of the EducationDepartment, State of New York, for the School YearEnding July 31, 1912, in which he pointed out that therewas a discrepancy between the law requiring that chil-dren receive an education and the law requiring them tobe vaccinated, and that it was the duty of the legislature

to correct this discrepancy.

"While the health law declares that all children ad-mitted to the schools must be vaccinated, and thereforewould exclude children who are not, the Education Lawrequires that all children of school age shall be requiredto attend the schools. In other words, there is an incon-sistency between the provisions of the health law andthose of the Education Law bearing upon this subject.Both of these statutes cannot be strictly enforced. It isa matter of common knowledge and it is within myofficial knowledge that the health law requiring allchildren to be vaccinated as a condition to their admis-sion to the schools is not strictly enforced, for the suffi-cient reason that it is not enforceable in the absence ofa real menace to the health of the school; and it is morethan doubtful if the Legislature, in an act concerningpublic health alone, actually intended to limit the in-herent American right of attendance upon the freeschools to those who would yield that freedom of judg-ment concerning their physical health or its treatment,which they might have to do if required to be vaccinated.To say the very least, there are natural rights heldsacred by our political system which are either not to beinvaded at all or only when absolutely necessary toprotect society and give safety to the institutions of thecountry."

18

Declaration by Dr. William Brady, in a syndicated arti-cle published in the Ohio State Journal, Columbus,

Ohio, October 21, 1923."Although I like this comfortable feeling of being well

vaccinated, still I should vote a positive no on any propo-sition of compulsory vaccination for any group of peopleor even for all the people. I should vote no on anyproposition which, through interlocking ordinances,would make vaccination virtually compulsory—such asthe compulsory school attendance law and the law whichpermits the authorities to exclude children not properlyvaccinated. . .

"Compulsory vaccination is an institution which a com-munity, and particularly, the health guardians of thecommunity, should be ashamed to countenance today. Itis tantamount to a confession that the community is back-ward and unenlightened upon the elementary principlesof hygiene and sanitation. . .

"Anything resembling compulsory vaccination seemsout of joint with the times. I am my brother's keeperonly with his consent. Any citizen should have the rightto suit his own taste in his choice of religions, healersand health insurance, provided his preference in suchmatters does not endanger or encroach upon the rights ofhis neighbors. If vaccination is as efficacious as webelieve it to be then those of us who do believe in it arereasonably well protected and therefore we cannot beendangered by those who are not vaccinated."

Declaration by "American Medicine" in an editorialMarch, 1914,

"The growing opposition to vaccination is a matter ofgrave concern. This new movement . . . is not the il-logical and absurd anti-vaccinationist crusade, but is theconviction on the part of very intelligent men, that it isuseless to protect against an infection which they maynever encounter This attitude is not confined to

19

laymen, but is taken by those leading men in the medicalprofession who postpone vaccination of their own kithand kin until the last moment. Two world renowned menhave confessed to us that they have had their childrenvaccinated only in obedience to public opinion in and outof the profession. The worst of the matter is that theprofession as a whole uses exactly the same argumentsin advising patients not to take any other prophylacticuntil the necessity arises—anti-toxin of diphtheria, forinstance. Doubtless we could immunize everyone againstplague and cholera, but what's the use if plague andcholera never come here? So we hear men saying thatthere is not one chance in a million of their children be-ing infected with smallpox, but that there is far morechance of a pus infection or tetanus from the vaccine."

THE LONDON, LANCET, ENGLAND'S LEAD-ING MEDICAL JOURNAL, RAISES THEQUESTION OF THE DESIRABILITY OFABANDONING UNIVERSAL VACCINATION AS

A PUBLIC HEALTH MEASURE.

Startling Admissions Contained in an Editorial of theLondon, Lancet, January 29, 1927, page 239.

"Failure to control smallpox in the North of Englandhas brought the policy of universal pseudo-compulsoryvaccination of infants into further disrepute

"It is a mistake to suppose that all the opposition isdue to lack of imagination or crankiness.

"Vaccination at the age of six months inflicts an in-fectious disease on the child at a time when its digestivemechanism is being rapidly modified, and many reason-able people, although convinced that vaccination willprevent smallpox, think that the advantages of immun-ity do not outweigh the disadvantages of its production.

* * * * * *20

"There is enough sense in the opinion . . . . to makeuniversal and full vaccination of infants (as theoreticallyenforced by Parliament) impracticable in this countryat the present time

"All that happens is that WHEN AN EPIDEMIC OFSMALLPOX BREAKS OUT THE MEDICAL OFFICEROF HEALTH DOES HIS BEST TO FRIGHTEN THEPUBLIC INTO WHOLESALE VACCINATION, hissuccess depending partly on his personality and partlyon whether the disease itself seems dangerous to thepeople of the district. This is an unsatisfactory wayof meeting" smallpox in a civilized community, and it istime that the alternatives were fully discussed.

"The first alternative is to let smallpox take its course,offering vaccination to those who prefer i t . . . .

"The second alternative is to modify our methods ofvaccinating infants, so that sensible people will have noreason to fear and dislike them

"The next, or third, alternative is to abandon univer-sal vaccination altogether in favor of the effective treat-ment of contacts in the face of an epidemic

"It is likely that even if compulsory vaccination ofinfants were sacrificed, Parliament would still be unwill-ing to give power to the Ministry of Health to makevaccination compulsory within 'an infected area.'

"Criticism might be lessened, however, if such vac-cination aimed at conferring only brief and temporaryimmunity, and it is theoretically possible to check theprogress of an epidemic by using an antigen producingsymptoms so far negligible that popular prejudice wouldsoon fade away. . . . The measure would be reserved forcontacts only. For them however, it must be compulsoryto be effective.

'It may be that we have not yet achieved sufficientaccuracy in vaccine standardization or in measuring in-dividual response to enable us to estimate either the doseor the probable amount and duration of any immunitywhich might thus be conferred."

21

Extracts From Presidential Address By Dr. J. W.Carr Before the Medical Society of London, Pub-lished in The Lancet (London) October 13, 1928,

p. 753.

"Another difficulty to be faced under the rule ofa medical bureaucracy would be that if once anyofficial procedure were established by law it wouldbe a long and difficult process to get any alterationmade to suit different circumstances.

"Take, for instance, the case of vaccinationagainst small-pox. Are we adapting ourselves tothe marked changes in type of that disease whichhave developed during the last few years? At pres-ent the one endeavour of our medical hierarchy isto get the maximal number of people vaccinated andprotected as completely as possible. Let it be grant-ed at once that vaccination does (for a certain num-ber of years) protect against small-pox, the ques-tion which arises is whether the present form ofsmall-pox is worth being protected against. Sup-posing some vaccine were discovered which, for acertain number of years, entirely prevented chicken-pox or mumps, would anyone seriously suggest itsuniversal use? I doubt it, yet both these diseasesare responsible for no inconsiderable inconvenienceand loss of time during school-life, and for the lastten years chicken-pox has been credited with from40 to 83 deaths, and mumps with from 14 to 41deaths annually in England and Wales. Is the pre-sent form of small-pox really more serious thanchicken-pox? I have no personal acquaintance withit, but so far as I can gather, it very rarely givesrise to pitting and hardly makes those suffering fromit feel ill—not so ill as vaccination often does.

22

CIRCUMSTANCES VERSUS CREEDS

"An exceedingly mild form of small-pox has nowbeen epidemic in this country for several years;ought we not seriously to consider whether a dis-ease which causes such slight constitutional dis-turbance, such an almost inappreciable number ofdeaths, and so few—if any—after-results, reallycalls for the elaborate and most expensive systemof hospital isolation which we maintain for it, es-pecially as we are told that in some districts it isconsidered preferable to have a pleasant threeweeks in hospital with small-pox than to sufferfrom vaccination at home. Also, if the disease isreally not more serious than chicken-pox, let ustreat it accordingly and not try to prevent it bygiving another disease which may cause as much,or more, constitutional disturbance, and in somecases as long, or even a longer period of incapacityfor work.

"The results of vaccinia are not absolutely neg-ligible and, unfortunately, whilst the number ofdeaths from small-pox is now certainly much over-stated, there is a possibility that those from vac-cinia may be understated. Moreover, it is now rec-ognized that in a certain number of cases recentlythe vaccination of children previously perfectlyhealthy has been followed by an obscure conditionof encephalomyelitis which not uncommonly provesfatal.

23

PARENTAL RIGHT TO DETERMINE FORM OFTREATMENT FOR CHILDREN IS FUNDA-

MENTALLY SOUND.

GOVERNOR BAXTER SAYS IT IS FUNDAMENTALTHAT EACH PERSON IS ENTITLED TO CHOOSE

HIS OWN TREATMENT.

Extract from inaugural address of former GovernorPercival P. Baxter of Maine, January 4, 1923.

"It is fundamental that each person is entitled tochoose his own school of medicine or of treatment justas he may choose his politics or religion."

The Proposition That Parents Should Determine theForm of Treatment For Their Children is Laid Down inNumerous State and Federal Laws, of Which the Follow-

ing Are a Few Examples.Copy of provision contained in the Federal "Maternity

and Infancy Act," approved November 24, 1921."Nothing in this Act shall be construed as limiting

the power of a parent or guardian or person standingin loco parentis to determine what treatment or correc-tion shall be provided for a child or the agency or agen-cies to be employed for such purpose."

Copy of Section 577-c amending the education law inNew York State, effective April 17, 1926.

"Whenever affected by the requirements of this article,the teacher, janitor or other person so affected and inthe case of a child, the parent or guardian of such childshall have the right to determine the form or manner oftreatment or remedial care to be prescribed or applied,but the treatment or remedial care must be in accordancewith and as allowed under article eight of the publichealth law, known as 'The Medical Practice Act.' "

24

Copy of Amendment to the School Law of the State ofIndiana.

"Provided that no pupil or minor shall be compelledto submit to medical examination or treatment underauthority of this section whose parent or guardian ob-jects to the same. Such objection shall be made by awritten and signed statement delivered to the pupil'steacher or to any person who might conduct such exam-ination or treatment in the absence of such objection."

DR. GREEN SAYS TENDENCY TO REGARD MEDI-CAL PROFESSION AS A DIVINELY AUTHORIZED

CLASS IS ERRONEOUS.Declaration by Dr. Frederick R. Green, former Secre-tary, Council on Health and Public Instruction, Ameri-can Medical Association, in an address before the UtahState Medical Association, September 30, 1914, and re-printed by the American Medical Association fromNorth West Medicine, December, 1914 and January, 1915.

"Another error into which we have fallen as a pro-fession is the tendency to regard the medical professionas a divinely authorized class, whose sacred and dis-tinctive function is the protection of the people eitherwith or without their consent. It is difficult to under-stand on what rational basis such a belief can rest in ascientific profession like ours. The medical professionis recruited from the same class as that which furnishesthe lawyers, judges, ministers, teachers and business menof our country. The men who go into medicine areneither wiser, more unselfish, more upright or more in-fallible in their judgment than those who make up anyother class of professional men. Why should we regardourselves as of superior mold, or why expect our opinionsor views to be accepted on any different basis from thoseof other men of equal intelligence, except in so far as weare able to justify our judgment? Yet too often medicalorganizations, as well as individual physicians, have

25

taken the position that they were the courts of last re-sort; that it was their special function to dictate theterms of public health legislation, and that it was theduty of the public to accept their decisions and acquiescein their judgment."

Extract from Presidential Address by W. S. Thayer,M. D. Before the Annual Meeting of the AmericanMedical Association, June 12, 1928, Published in theJournal of the American Medical Association, June 16,

1928.

"In the broader matters of public health the public hasthe same right, after seeking what advice it will, to takejust what action it chooses. It is our privilege to be ina position where individually and collectively we are es-pecially qualified to advise the public in these matters.This privilege implies a heavy responsibility. We mustseek to direct the public toward sane and efficient action.But we must remember that neither as individuals noras an association have we the right to demand that thepublic accept our views.

"As an association we are placed in a peculiarly deli-cate position. Do what we will we shall be accused bythose who disagree with us of selfishness, of attemptingto protect our own personal interests, of using our poweras an organization to oppress others. We must be exceed-ingly careful to see that such reproaches are wholly un-justified. We must not expect that we can go our waywithout adapting ourselves to circumstances beyond ourimmediate control. A well balanced life is one long com-promise. We must compromise as best we can with ex-isting conditions while we seek to direct events towardthat which we think the wisest course. We cannot stopthe general tendencies of the day by violence or heatedopposition. The late King Canute was not successful incontrolling the rising tide."

26

Declaration by the Journal of the American MedicalAssociation in an Editorial, February 15, 1919.

"It is not the function of the medical profession tomaintain lobbies or to endeavor to secure public healthmeasures by political methods. The true function of themedical profession is to advise the people, to show themhow to protect themselves. The doctor's mission is to bea teacher and not a political manipulator. The responsi-bility for public health conditions must rest with thepeople and not with any special class or profession. Thesooner these general principles are recognized, the betterit will be for the medical profession and for public healthadvancement."

COMPULSORY VACCINATION IS UNAMERI-CAN.

Extract from the "Declaration of Independence," madeby the Original Thirteen United States of America, on

July 4, 1776."We hold these truths to be self-evident, that all men

are created equal, that they are endowed, by their Crea-tor, with certain inalienable rights, that among these arelife, liberty, and the pursuit of happiness. That to securethese rights, governments are instituted among men, de-riving their just powers from the consent of the gov-erned, that whenever any form of government becomesdestructive of these ends, it is the right of the people toalter or to abolish it, and to institute new government,laying its foundation on such principles, and organizingits powers in such form as to them shall seem most likelyto effect their safety and happiness."

Extracts from the Constitution of the United States ofAmerica.

"We, the people of the United States, in order to forma more perfect union, establish justice, insure domestic

27

tranquillity, provide for the common defense, promotethe general welfare, and secure the blessings of libertyto ourselves and our posterity, do ordain and establishthis constitution for the United States of America."

Amendments to the Constitution of the United States.Article I—"Congress shall make no law respecting an

establishment of religion, or prohibiting the free exer-cise thereof, or abridging the freedom of speech or ofthe press, or the right of the people peaceably to assem-ble, and to petition the government for a redress ofgrievances. . . .

Article IV—"The right of the people to be secure intheir persons, houses, paper and effects, against unrea-sonable searches and seizures shall not be violated; andno warrants shall issue but upon probable cause, sup-ported by oath or affirmation, and particularly describingthe place to be searched, and the persons or things to beseized. . ..

Article V—"No person shall. . . . be deprived of life,liberty or property, without due process of law; nor shallprivate property be taken for public use without justcompensation. . . .

Article XIII—Section 1—"Neither slavery nor invol-untary servitude, except as a punishment for crime,whereof the party shall have been duly convicted, shallexist within the United States, or any place subject totheir jurisdiction. . . .

Article XIV—Section 1—"All persons born or natur-alized in the United States, and subject to the jurisdic-tion thereof, are citizens of the United States and of thestate wherein they reside. No state shall make or enforceany law which shall abridge the privileges or immunitiesof citizens of the United States; nor shall any state de-prive any person of life, liberty or property, without dueprocess of law, nor deny to any person within its juris-diction the equal protection of the laws."

28

TYPICAL INSTANCES OF ATTEMPTS BYADVOCATES OF COMPULSORY VACCINA-TION TO WITHHOLD EDUCATION, EMPLOY-MENT OR FOOD FROM PERSONS AS A MEANS

OF FORCING THEM TO BE VACCINATED.

Copy of editorial from the St. Louis (Mo.) Star, May24, 1926.

"Be Vaccinated or Get Fired."A new form of compulsory vaccination has come to

light in that vaccination has begun of about 1200 em-ployes of the Chicago & Eastern Illinois Railroad, andit is announced that employes who refuse to be vacci-nated will be the first laid off when forces are reduced.It is hard to conceive of a big successful corporationtaking such a narrow-minded action. Vaccination num-bers among its opponents hundreds and thousands oflaymen and many doctors of unquestioned standing. Itis bad enough for School Boards and other civic agen-cies to force those that do not believe in vaccination tosubmit to it, but for a private corporation to take uponitself such duties is incompatible with the American ideaof liberty."

"Recommendations" by Dr. C. C. Pierce, Senior Surgeon,U. S. Public Health Service, while investigating an epi-demic of smallpox in St. Paul and Minneapolis in 1925,published in the Minneapolis Morning Tribune and Even-

ing Tribune, January 14, 1925."(1) That the boards of education of the Twin Cities

require all teachers, employees and pupils of the publicschools to be vaccinated or exclude them.

"(2) That all employment agencies refuse to registerapplicants unless vaccinated.

"(3) That all merchants be requested to have all em-ployees vaccinated.

29

"(4) That all hotels and lodging houses have all em-ployees vaccinated.

"(5) That the Salvation Army, Union City Missionand other shelters and lodging houses refuse to feed orlodge persons not vaccinated.

"(6) That all hospitals refuse to admit visitors notvaccinated.

"(7) That all newspapers be urged to join in a pub-licity campaign to attain prompt 100 percent vaccina-tion."

Extracts from discussion at a conference of healthofficers at Lansing, Michigan, December 12, 1923, pub-lished in "Public Health," April, 1924 issued by the

Michigan Department of Health."Dr. Slemons: . . . 'The children in our schools are

given slips—you will find one of them in the exhibit, inthe auditorium—notifying the parents that the child isnot vaccinated. While the slip does not exactly demandvaccination, as you will find upon reading it, most peoplethink that it does and by using it we get a very high per-centage of vaccinations because our people have gottento believe that this is compulsory.'

* * *

'. ,. ,. On any slight pretense of exposure we demandvaccination. How far do we go? We go just as far aswe can.'

* * *'By taking advantage of any secondary exposure youwill be able to keep 100 per cent of the children in yourschools vaccinated. Here is a point that we have foundextremely beneficial—we penalize the non-vaccinated per-son every opportunity we get. I mean by this that anynon-vaccinated person exposed to smallpox is looked uponas a potential case of smallpox and that person goes homeand stays there for sixteen days, while a direct exposure

30

when vaccinated gets every consideration, and at the endof a seventy-two hour period goes back to the public.It has a very wholesome effect.'

* * *"Dr. Godfrey: 'In our city unvaccinated children even

though they are not exposed to contagious disease, can-not come to school until they are vaccinated.

'Unvaccinated children are turned over to the schoolboard, and excluded from school and then as soon as therecords show that they are not in attendance at schoolthey are arrested for non-attendance. In other words,we get them going and coming.'

* * *"Dr. Town: 'Penalize the fellow who refuses to co-

operate, you will find this is pretty good medicine.'In Jackson we have not gone into any factory or school

and put on a program of vaccination unless prettydefinite report of exposure has come in, because whenwe do go we go the limit, and interpret 'exposure' in itsloosest term. We have railroad shops where we vac-cinated 1500 men as soon as it was reported that oneman had worked five days with an eruption. We inter-preted this as wholesale exposure, and secured authorityfrom their Detroit office to do the work. Incidentally,we were very glad to have their regularly employedphysician and surgeon handle the vaccinations.' "Extract from syndicated article by Harris Dickson,

published in Savannah (Ga.) News, June 14, 1927."A drag net, drawn at random through the flooded

area, catches queer fish. The Baton Rouge haul recentlypulled in eighteen members of a certain small sect whorefused to be vaccinated or take the typhoid serum, be-cause, they insisted, it was against their religion. Sur-geons attempted to persuade them.

" 'Do this for your own protection, as well as for thesafety of a generous city that shelters you.'

31

"Not much. Altruistic arguments never touched them." 'Well,' the Red Cross man was trying not to become

a very cross man, 'Does your religion forbid you to eat?'"Eat? Free rations? Oh, dear, no. Breakfast, dinner

and supper constitute Articles One, Two, Three of theircreed. They believe in substantial food.

"'Fine!' the Red Cross official snapped, 'From now onyour meal tickets are cancelled until you can show yourvaccination scars.'"

32

PHYSICIANS DO NOT WANT COMPULSIONFOR THEMSELVES.

Extract from a copyrighted dispatch from Mexico City,to the Observer Dispatch and the Chicago Daily News,published in Utica, N. Y. Dispatch, April 22, 1926, re-ferring to the cancellation by 130 members of the DallasChamber of Commerce of their trips to Mexico rather

than submit to vaccination."Nearly 100 American medical men who were expected

in Mexico at the end of April after a conference inDallas have fared better than the commerce body. Ar-rangements have been made for allowing them to enterthe republic without vaccination."

Copy of an editorial in the "New York Medical Week,"June 16, 1923, in which the physician is told that he must

"woo" and "court" the germ to find vacation peace."A DIRGE TO WORK.

"The decisive onset of warm weather calls a halt tothe strenuous activities of colder days for the doctor.It is the signal for rest, and in the delights of fishingtackle and golf ball the medical man can find relief andsolace for the harassing memories of the winter's strain.

"It is true that the warm days of summer often bringa heat a little too extreme for comfort but, if we do notbear up well under them, it is a consolation to rememberthat neither do the microbes. And the nocturnal silenceof the telephone lends such harmony to the music of thespheres!

"We might append weighty warnings of the need forcare and hygienic vigilance in the pursuit of rusticpleasure, but according to Surgeon-General Cummins'counsels this will never do for the doctor's summer.Following out the official law of paradoxes, it is onlyby wooing the microbe and courting the germ that the

33

medico will find vacation peace. What food for contem-plation on the dangers of medical life!"

ORGANIZED REGULAR OR ALLOPATHICPHYSICIANS AND VACCINE COMPANIESHAVE A COMMERCIAL INTEREST IN MAK-ING IT APPEAR THAT COMPULSORY VACCI-

NATION IS NECESSARY.

Medical Society Official Announces that Less thanFifteen Percent are Prospects for Smallpox But One

Hundred Percent Are Prospects for Vaccination.Declaration by Dr. Mather Pfeiffenberger of Alton,Illinois, formerly President of the Illinois State MedicalSociety, in an address before a joint meeting of theSecond Annual Health Officers Conference and theSangamon County Medical Society, Springfield, Decem-ber 3, 1926, as reported in "Illinois Health News" for

January, 1927."Prevention practiced to its utmost will create more

work for the physician and not diminish it, for the full-time health officer will be educating his community con-stantly. There will be more vaccination, more immuniz-ing, more consulting and use of the physician. Hisservices will be increased many fold.

* * * *"I am informed that epidemic and endemic infections

cause only 12% of all deaths and that this percentageis declining very rapidly. Less than 15% of all childrenwould ever get diphtheria even under epidemic condi-tions, while 100% are prospects for toxin-antitoxin. Thepercentage who would ever get smallpox, under presenttime conditions, is even less; but 100% are prospects forvaccination. Scarlet fever will soon come in for its 100%also, as it may for measles, judging from the reports onthat disease. Typhoid fever is disappearing, due to sani-tation, but vaccination should be used when the indi-vidual travels into unknown territory and countries."

34

5 2 8 MICHIGAN'S DEPARTMENT OF HEALTH JOUR. M.S.M.S.

Marked Photographic Reprint of PageFrom The Journal of The Michigan State Medical society,

August, 1988.

MICHIGAN'S DEPARTMENT OF HEALTHGUY L. KIEFER, M. D., Commissioner

THE ECONOMIC SIDE OF IMMUNIZATION ORTREATMENT

At a recent meeting of physicians thesuggestion was made that if various im-munization programs sponsored by variouspublic health agencies were carried to theirlogical conclusion it would have the effectof curtailing the amount of medical prac-tice available to physicians. In this con-nection there are several well establishedfacts to be kept in mind.

No immunization program yet proposedin Michigan has been made sufficientlycomplete to reduce the sickness or deathrate of the state as a whole. Local im-munization in towns, schools or institu-tions have been the direct cause of the to-tal absence of smallpox and diphtheria inthese restricted areas. The county medi-cal societies of four counties sponsored theimmunization of all the school children oftheir respective counties. The result wasa reduction of one-half the diphtheriadeaths. In spite of the years of demon-stration of the effectiveness of vaccine vi-rus, over 500 cases of smallpox occur an-nually in this state; it is plain to see thatthe complete elimination of any of thesediseases from this state is not an end nearat hand.

The making of people immune to diseaseis the field of the private practitioner ofmedicine. Only in cases of indigency,emergency or for the demonstration of itsvalue to the public is it sound policy forpublic health departments to do this work.Therefore, when this desirable state of im-munity is conferred upon people it will bethe direct result of the services of theirown physicians.

Let us see, then, what the cold figuresconcerning this type of practice show.

In this state there are 100,000 peopleborn annually. They are practically allsusceptible to diphtheria from the momentthey are born. They are highly susceptiblefrom the age of six months until they areimmunized. If these infants were all im-munized, and for this service the physi-cians received from $5.00 to $10.00 pet-case, the net income would be from $500,-000 to $1,000,000. Michigan has 5,000cases of diphtheria annually. If the physi-cians received for their services, exclusive

of all other costs, an average of $50,000per case the income from this source would

be $250,000. The increase in physiciansincome from diphtheria would be from one-quarter to three-quarters of a million dol-lars, if we would immunize all childrenagainst this disease soon after they are sixmonths of age, instead of waiting untilthey are stricken with the disease and thenJtreating them.

Some maternity hospitals are vaccinat-. ing with vaccine virus all babies born intheir institutions. Babies under ten daysold very seldom have any general reactionand the immunity usually lasts for thewhole lifetime of the individual. It isestimated that. one-third of all births inthis state occur in hospitals. If all hos-

pitals were to establish this rule as part oftheir regular procedure, it would mean anaddition of 30,000 immunized people in thestate each year and an additional incomeof at. least $60,000 to the physicians or

hospitals.When the 100,000 people born every

year in Michigan are vaccinated againstsmallpox at birth, the income to the phy-sicians would approximate $200,000. The500 cases of smallpox that occur everyyear, treated at an average of $50.00_percase, bring physicians $25,0000. Thus thephysicians, by adopting the practice ofvaccination at birth, would increase their

income by nearly $200,000.We have taken diphtheria and smallpox

as_example's of_the economic advantage of.immunization, but the same conditionsapply to other diseases and to other publichealth measures.

With persistent educational work by thephysicians and the Micnigan..Departmentof Healthy these immunization programswill succeed in reducing the number ofthese preventable diseases and increasingthe earning of the physicians who activelysponsor this modern tvpe of.practice.

SUMMER RESORTSSummer restarts, and their proper sani-

tary supervision, have come to be a topic ofperennial interest to everyone concernedwith the public health. The increasingtendency to migrate during the warmweather—and the modern facility of mi-

35

Mr. Draper Says in Many Cases Physicians Become In-terested in Enforcement of Law Because of the Fees.

Declaration by Andrew S. Draper, former Commissionerof Education, in his fifth annual report of the New YorkState Education Department, for the year ending July

31, 1908."In many cases physicians become interested in the

strict enforcement of the law because of the fees result-ing therefrom. In some school districts a physician isappointed by the trustees and the entire expense of vac-cinating the children is borne by the district. In manyothers, parents are requested to have their childrenvaccinated and a physician is appointed who vaccinatesthose children only whose parents do not provide fortheir vaccination. In any event all the children arevaccinated and provision is made for prompt paymentfor such service. In the more populous districts themedical fees resulting from vaccination are an importantitem. It is not claimed that physicians as a rule aregoverned in this matter by a mercenary motive. On thecontrary in the great majority of cases their action inurging vaccination emanates from their professionalknowledge of the subject and their desire to render adistinct service to the people of the community in whichthey live. However, this mercenary motive has been thecontrolling factor in a sufficient number of cases whichhave come to the attention of this Department to justifythe above assertion."

Copy of a Washington dispatch published in the NewYork Evening World, October 31, 1924, announcing adop-tion of fee schedule for vaccination, ranging from two

to twenty-five dollars per person."Washington, Oct. 31—A scale of minimum and maxi-

mum fees for almost every ill a physician or surgeon isever called upon to treat has been fixed by the MedicalSociety of the District of Columbia.

36

"Minimum fees range from $2.00 for a minor officeconsultation or a word of advice over the telephone to$300 for certain major operations. Maximum fees forsimilar service range from $10 to $5,000.

"An example is the fee for a smallpox vaccination,where a minimum of $2, and a maximum of $25.00 isfixed. General visits range from $3 to $25, and theremoval of an appendix may cost from $100 to $5,000."[Note:—It is significant to note that the above schedulefixing a minimum fee of $2.00 and a maximum fee of$25.00 was adopted during the latter part of the year1924 and in the early part of the following year an ex-tensive vaccination campaign was carried on in Washing-ton, D. C. for the alleged prevention of smallpox.—H. B. A.]

Dr. Rankin Tells Physicians to Think of the Businessthe Physicians Receive in Keeping Up the Vaccination

Work.

Declaration by Dr. W. S. Rankin while Secretary of theNorth Carolina State Board of Health, as reported inthe Journal of the American Medical Association,

November 4, 1922."Last year we inoculated 70,000 persons against

typhoid fever, and 1,000 children between 6 and 12 yearsof age against diphtheria. The county commissioner paidthe local practitioners 25 cents for each complete inocula-tion and that was $20,000 which went to the professionlast year which otherwise would not have been received.

"The work of the medical profession with the stateboard of health does not stop when that $20,000 is paid.It goes on. In the dispensaries which were conductedin Union County, N. C, with 35,000 people, the physi-cians vaccinated 10,000 people in a campaign of fiveweeks. That was $2,500 paid to twenty physicians-only $125 each, but think of the effect on the businessof the profession in keeping up that work. It goes on."

37

Extract from editorial in the Boston Medical and Surgi-cal Journal, September 17, 1925, in which it takes theposition that vaccinations and inoculations are necessaryfor the young physician to have a practice that will be

considered successful."The young physician who believes that his life work

will consist in a daily round of house to house visits,watching the course of typhoid fever, of pneumonia andof inoperable cancer, is making a grave mistake. If heis to keep abreast of the times and enjoy a practice thatwill be considered successful his duties will consist ofvaccinations and inoculations, periodic health examina-tions and advice as to hygiene, diet and the maintenanceof health."

Extract from article by C. S. Nelson, M. D., entitled"Proper Relationship Between the State Department ofHealth, and the Medical Profession," published in the

Illinois Medical Journal, March 1928.I feel that it would be out of place to attempt to dis-

cuss preventive medicine from a monetary standpoint,for physicians as a rule have never been considered amercenary profession. Otherwise they never would have,as in the past, fallen in line so readily and given theircooperation toward preventive medicine that has hadsuch wonderful results in the past quarter of a century.If, however, this thought should ever enter the mind ofany physician, stop and consider what it would mean toyou, if the present health propaganda and the preventionof preventable diseases should be universally adopted—annual physical examinations, vaccination against small-pox, diphtheria and I think in the near future, scarletfever and measles. Would it not appear to you that therevenue from this source would far exceed the remuner-ation received from the comparatively few diseasestreated that would naturally occur in the families ofyour clientele? And besides it would be much moresatisfactory.

38

INTRODUCTION OF BIOLOGIC PRODUCTS HASINCREASED THE DANGER OF COMMERCIALIZED

THERAPEUTICS.

Extract from an editorial in the Journal of the Ameri-can Medical Association, February 14, 1920.

"The danger of commercialized therapeutics has beenenormously increased by the introduction of biologicproducts. These substances offer a rich field for thecommercially minded, first, because of the remarkableresults which seem to have followed the use of certainproducts of this type; second, because the field is newand the mode of action of these substances not readilyunderstood and, third—and most important—because,by the very nature of the problems involved, few physi-cians are well informed concerning them."

Item from the Journal of the American Medical Associa-tion, February 18, 1905.

"The Downfall of Therapeutics.—The following edi-torial from American Medicine shows clearly the presentstatus of therapeutics and materia medica: 'Before thedevelopment of the natural sciences placed medicine asan art among the applied sciences, therapeutics was themost important branch of medical study and practice.Among the medical sects the same observation holds trueat the present time. During the last half century medicalprogress, however, the pursuit of exact medical knowl-edge, has led students chiefly into surgery, diagnosis,pathology and bacteriology. Definite knowledge of theintimate reactions of the metabolic processes of ourbodies with foreign agents introduced as drugs is justcoming into sight with the growth of the new scienceof pharmacology, and so necessarily therapeutics atpresent lags behind. All of which is new to no one whosees, and is introduced simply to draw attention to anunfortunate practical result of this state of affairs.For some years progress in materia medica and thera-

39

peutics has seemed almost to lie in the hands of laymanufacturers. With their new compounds and theirdisguised old ones, the drug makers have kept the ma-teria medica expanding at an alarming rate. This con-dition is by no means wholly to be deplored, as thepharmaceutists have contributed much to the comfort ofphysician and patient. However, the tremendous pre-ponderance of commercialism in recent therapeutic prog-ress has brought with it some ill conditions. Money-making attracts the unscrupulous, and the medical pro-fession has difficulty in separating the wheat from thetares. Any good new laboratory product of therapeuticvalue is immediately imitated or attacked. There de-velops intense feeling between foreign and domesticmanufacturers, and all the while the poor doctor, as thebone of contention, is overwhelmed with "literature" and"medical journals" (sic) and agents. Contradictionsmultiply until mercury and quinin appear to be about theonly agents of whose qualities the physician may feelreasonably sure! The prize—the patronage of the pro-fession—being of great commercial value, many subter-fuges are employed by some to enable them to share init. Official positions in medical bodies at times are sought,and at other times are appropriated by not too nicestrategy. Medical journals are subsidized and new onesare published. A number of makers pay a regularstipend secretly to complaisant doctors here and thereover the country, who, in return, are expected to read"useful" papers and at every possible turn to uphold thewares of the benefactor. Thus it comes that therapeu-tics has reached its present low estate. Scientific physi-cians give their time to diagnosis and pathology, andlimit themselves to simplest measures of treatment.Others make a diagnosis and then choose the remedy thatthe maker says is best for that condition. Many amongus who love the study of means to alleviate suffering haveendeavored faithfully to recreate professional interest in

40

pure therapeutics, but the combat with intrenched wealthand monopoly is an unequal one in the face of generalprofessional lethargy. But hope is not to be abandoned.' "

TWO HEALTH BOARDS ARE OFFICIALLY EN-GAGED IN THE BUSINESS OF MANUFACTUR-ING, CREATING A DEMAND FOR AND SELL-

ING VACCINES AND SERUMS.

Extract from "Public Health Reports," May 29, 1925,giving a list of the products which the Bureau ofLaboratories of the New York City Department of

Health in 1925 was licensed to sell."Diphtheria antitoxin; tetanus antitoxin; antimenin-

gococcic serum; antipneumococcic serum; normal horseserum; vaccine virus; rabies vaccine (Pasteur); tuber-culin old; and bacterial vaccines made from gonococcus,paratyphoid bacillus A, paratyphoid bacillus B, pertussisbacillus, pneumococcus, staphylococcus albus, staphylococ-cus aureus, streptococcus, and typhoid bacillus; diph-theria toxin-antitoxin mixture; diphtheria toxin forSchick test."[Note:—The cash receipts of the New York City Depart-ment of Health from its "Sales of Virus" in 1924amounted to $16,051.98 and its receipts from "Sales ofAntitoxin" amounted to $53,277.41, making a total of$69,329.39, as brought out in the Annual Report of theNew York City Department of Health for the year 1924.—H. B. A.]Extract from article in "Public Health Reports," May29, 1925, giving a list of the products which the Massa-chusetts Department of Health in 1925 was licensed to

sell."Diphtheria antitoxin; antimeningococcus serum; anti-

pneumococcus serum; vaccine virus; bacterial vaccinesmade from paratyphoid bacillus A, paratyphoid bacillusB, and typhoid bacillus; diphtheria toxin-antitoxin mix-ture; diphtheria toxin for Schick test."

41

MEDICAL POLITICS STANDS IN THE WAYOF AN IMPARTIAL CONSIDERATION OF VAC-

CINATION LAWS.

Extract from address by Dr. W. A. Evans, formerlyCommissioner of Health of Chicago, published in theJournal of the American Medical Association, September

16, 1911."As I see it, the wise thing far the medical profession

to do is to get right into and man every great healthmovement; man health departments, tuberculosis socie-ties, child and infant welfare societies, housing societies,etc. The future of the profession depends on keepingmatters so that when the public mind thinks of thesethings, it automatically thinks of physicians, and not ofsociologists or sanitary engineers. The profession can-not afford to have these places occupied by others thanmedical men."

Copy of resolution adopted by the staff of the NorthCarolina State Board of Health, and published in The

Survey, New York, September 15, 1922."It is a fundamental purpose of this staff to seek to

enlarge and deepen the interest of the medical professionin public health work to the end that the profession inall public matters may assume the initiative and havethe chief credit for whatever there is of achievement indisease prevention and health promotion."

Dr. Woodward Tells How He Succeeded in Lining Up thePresident of the Massachusetts Senate.

Declaration by Dr. Samuel B. Woodward in a PaperPublished in the Boston Medical and Surgical Journal,

September 15, 1921."The so-called vaccination bills are, in common with

most health bills, referred to the Committee on Public

42

Health, and the composition of this Committee is of theutmost importance, for the legislature is naturally proneto follow its recommendations. It is, therefore, import-ant to get in touch with the President of the Senate andthe Speaker of the House, in whose hands the appoint-ments to this, as to every committee lie, and this, duringmy three years as your President, I always did, findingunderstanding and cooperation in my endeavor to havemen with medically sane minds, the majority appointees.The reason for this cooperation was not, however, al-ways a desire for the improvement of health conditionsin the Commonwealth.

"In 1919, a gentleman who afterwards became ratherconspicuous as a candidate for State Treasurer, on ac-count of the similarity of his name with that of thepresent occupant of the office, was the ranking Senatoron the Committee of Public Health. Unsuccessful effortshad been made by your legislative committee to preventhis re-election. He was a pronounced anti-vaccinationistand anti all good health measures, yet courtesy wouldhave made him chairman of his committee. The Presi-dent of the Senate, however, told me that he would ap-point as chairman, any Senator endorsed by the physi-cians of the State, and he kept his word.

"My successor in office, Dr. Worcester, was much cha-grined a year later when he failed to obtain what hedesired from the same gentlemen, and may be interestedto know why I may have succeeded while he failed. TheSenator in question was connected with a Boston bank.I am connected with a bank in Worcester and went tohim provided with a letter of introduction from thePresident of one of the largest banks in Boston.

"Country banks maintain deposits in city banks, andsome two months after our interview, the President ofthe Massachusetts Senate appeared in Worcester andsuggested that I should use his bank as my bank ofdeposit.

43

"I believe Dr. Worcester is not a banker. It may beunnecessary to say that no change in financial arrange-ments was made by me.

"But there are members of the legislature who aregreatly interested in public health and who give, or at anyrate gave me, good advice and abundant cooperation. Itmay be, and probably is, invidious to mention names inthis connection, but if one wishes to find a legislator whofrom the time of his first election has consistently andalways supported your legislative committee, he need notwander far from the chair of the present speaker of thehouse of representatives."

Declaration by Dr. Moore of Cadillac, Michigan in a Dis-cussion of Medical Legislation, Published in the Journalof the Michigan State Medical Society, June 1928, p. 428.

"I think it is within the power of every physician tomake a friend of his Senator and Representative. It isdone in business, and it is done socially. Get him outand take him on a fishing trip or a hunting trip, or gethim into a poker game. Get under his skin. Don't lethim know what you are doing when you are talking tohim, but get him so full of it that he is just all for you.

"I think it is a good suggestion for every physicianand County Secretary to take home to the local societiesto cultivate the acquaintance of the Senators and Kepre-sentatives and then your problems will be solved. Youhave to do it on the banks of a stream or in a huntingcamp or in a club room or a noonday luncheon club orsome such place as that where you can get right nextto the fellow."

44

Extracts from an article by John B. Hawes, 2nd, M. D.,published in the Boston Medical and Surgical Journal,October 7, 1920, giving a summary of the replies to aquestionnaire he had sent to the Secretaries of the State

Medical Societies."New York: The State Medical Society has a legisla-

tive committee which for many years has been veryefficient. It does not limit itself to attending hearings,but acts by personal interviews with the legislators. TheNew York County Medical Society also has a legislativecommittee, acting in unison with the State Society. Forseveral years, the President of the State Society hastaken an active hand in the legislative work. New Yorkhas adopted the principle of personal interviews and in-fluence with the Legislature. They also ascertain whois the family or personal physician of each Legislator.

"North Carolina: The committee, however, selects onedoctor in each county who can be called upon to conferwith, write or wire his representative or senator in theGeneral Assembly. There are 100 counties, and theAssociation has been able to turn in a telegram to thesenators and representatives in the General Assemblyfrom more than 75 per cent of these counties on a givenmorning. This has been of distinct influence.

* * * *"Pennsylvania: The President of the Society has a

desk in the Department of Public Health at the StateHouse. He is in harmony with this department. He isclosely affiliated with the medical members of the Houseand Senate, and attends committee meetings, not as alobbyist, but simply as an advisor. He lets it be under-stood that he represents 11,500 physicians in Pennsyl-vania. The results depend largely upon the personalityof the president of the society. Pennsylvania is to becongratulated in having as the president of its StateMedical Society a man who can devote so much time andwho is able to exert so much influence as is apparentlythe case here."

45

FACTS SHOWING THAT ORGANIZED MEDI-CINE HAS THE MACHINERY FOR POPU-LARIZING VACCINATION REGARDLESS OF

ITS MERITS OR DEMERITS.

Declaration by Dr. William H. Park, Director of Labora-tories, New York City Department of Health, at aFederal Hearing on a bill to regulate the Sale of Viruses,

March 24, 1924."I remember meeting a physician who was, I thought,

doing some very disreputable things, and I asked him whyhe did it, and he said it was the economic urge that causedhim to do it. The economic urge does change our opin-ions, and we all know the advertising of a business isvery apt to be an art in itself, and the advertiser mayhave very little knowledge of the thing.

"I remember some time ago I was asked to make avaccine for a certain party, years ago, and I told himI did not have the facilities. He said:

"I don't care at all whether you have the facilities ornot, because I can advertise the sale of the product, andeven if you give me stone dust, if you will put your nameon it, I can sell it."

Extract from editorial in New York State Journal ofMedicine, June 1, 1928.

"The task of educating the people along medical lineswould be hopeless if it had been done entirely by physi-cians ; but fortunately the medical profession has the aidof the departments of health, the public schools, and layorganizations to such an extent that health educationis invoked as justifying organized sports and the promo-tion of artificial beauty and comeliness.

* * * *"The essential element in public health and popular

health education is publicity, especially through the news-

46

papers. Physicians formerly avoided publicity, and evenmade their codes of ethics demand its suppression, be-cause it was used By quacks for their personal gain.The physicians now recognize two kinds of publicity:1, that of the individual doctors, and 2, that of the scien-tific movements which the doctors represent.

* * * *

"The medical society is a collection of individualdoctors, one of whom writes and speaks for all the others.It is the individual doctors rather than the organizationsthat speak or write.

"Lay organizations engaged in public health work arenot subject to the strict code of ethics of the medicalprofession, but they depend on wide publicity for theirvery existence. They must show results in order to holdthe support of the people who patronize them and themoney givers who support them. They must transmuteinformation of their activities into emotion and actionon the part of their followers. They live by means ofpublicity of their aims and actions."

Extract from an editorial in the Journal of the Ameri-can Medical Association, May 5, 1928.

"The Bureau of Health and Public Instruction is reach-ing a tremendous public through radio lectures, healthtalks and direct correspondence. Much of its effort dur-ing the past year has been devoted to the promotion ofperiodic physical examination. Of special significanceis its cooperation with the National Education Associa-tion in bringing health education directly to children inthe schools. The great philosopher Leibnitz said that hecould change the nature of the world if permitted toeducate the children for two years."

47

Extract from Editorial in the New York State Journalof Medicine, May 15, 1928.

"Arousing favorable public opinion toward the scien-tific work of the doctors is the peculiar field of lay healthorganizations.

"The practice of public health and civic medicine re-quires a combination of three conditions:

" 1 . Scientific knowledge made available by a few re-search workers.

"2. Physicians ready to apply the knowledge."3. People ready to receive it."A movement in public health starts from a center of

discovery and spreads through a community in ever-widening waves. The center is usually a research labora-tory where the discoveries, such as toxin-antitoxin andinsulin are developed. As the waves advance theydiminish in intensity. While the research worker isfamiliar with all the phases of the subject, the familyphysician needs to be familiar with only the applicationof the product or method; while the layman needs toknow only that it exists, and is valuable as a healthmeasure and is available at the office of physicians.

"The speed of propagation of waves of medical knowl-edge from a center is usually in direct proportion to theneed of a community. Physicians apply a preventivemeasure according to the demand which the people makefor it. A case of smallpox, for example, speeds up thedistribution of knowledge of vaccination, and a desirefor its application as a preventive measure; but the de-mand for the procedure often changes to opposition whenthe epidemic passes by.

"The function of a lay organization is to create ademand for public health where none has previouslyexisted. It seeks to transform knowledge into strongdesire and finally into action."

48

EXTORTION BY TERRORISM

How the Milwaukee Health Board Caused City to Be-come Panic-Stricken in Order to Promote a Dangerous

and Questionable Vaccine.Health Official Tells How He Used Fright and Pres-

sure to Have People Vaccinated.

Declaration by Dr. John P. Koehler, Commissioner ofHealth of Milwaukee, Wisconsin, in an article in The

"Wisconsin Medical Journal, November, 1925."Since people cannot be vaccinated against their will,

the biggest job of a health department has always been,and always will be, to persuade the unprotected peopleto get vaccinated. This we attempted to do in three ways:first, by education; second, by fright; and third, bypressure.

"We dislike very much to mention fright and pressure,yet they accomplish more than education, because theywork faster than education, which is normally a slowprocess.

* * *

"During the months of March and April we tried edu-cation, and vaccinated only 62,000. During May we madeuse of fright and pressure, and vaccinated 223,000 people.

"Our educational program consisted of warnings inthe daily papers, smallpox posters on the streets, instores and factories, special smallpox bulletins for alllarge places of employment, and special letters to alllarge employers from the health department and theassociation of commerce, calling their attention to athreatening smallpox epidemic. The radio was alsomade use of in this work.

"As the conditions grew worse, we felt justified inusing stronger measures. We had some good picturestaken of patients suffering from the confluent type of

49

smallpox, and had posters, showing these pictures, dis-tributed all over the city. The moving picture theaterscooperated at this time by issuing warnings on thescreen.

"The newspapers published daily the names and ad-dresses of people dying from smallpox. A second letterwas sent to all factories, stores, and other places of busi-ness, informing them of a rapidly approaching smallpoxepidemic, and advising them to have their employees vac-cinated immediately, and thereby prevent a seriousfinancial loss to the city, which might occur if a realepidemic developed.

"At this time the department was vaccinating thou-sands of people daily, but there were still too many whocould neither be educated nor frightened into vaccina-tion. Cases and deaths each amounted to a considerablenumber, and we now felt justified in using all of thepower a health officer has, and if that was not enough,to get more.

"We sent out a third letter to all employers requestingthem to have all of their employees vaccinated and atthe same time informing them that if a smallpox casedeveloped in their place of employment in the futurewe would consider their place of business a menace tothe health of the community and very likely place theentire establishment under quarantine until it could becleaned up and made safe for the public. Putting thisresponsibility on the employer drove in thousands ofanti-vaccinationists who could better afford to get vacci-nated than lose their jobs. All employers co-operatedvery bravely with this last request, although in a fewinstances it was necessary to lay off old, reliable andvaluable employees."

50

PART IIThere is no relation between the vaccination re-

quirement and the presence or absence of smallpox.

51

THE UNITED STATES PUBLIC HEALTHSERVICE CONCEDES THAT UNVACCINATEDPERSONS MAY BE EXPOSED TO SMALLPOXWITHOUT CONTRACTING IT AND THATSMALLPOX OF A FATAL CHARACTER MAYOCCUR IN PERSONS WITH A FAIRLY GOOD

VACCINATION HISTORY.

Extracts from Article by Surgeon J. P. Leake, Publishedin "Public Health Reports," the Weekly Bulletin of theUnited States Public Health Service, January 28, 1927.

"Will a nonimmunized person contract smallpox ifexposed to the disease? By no means uniformly. Ex-posure to smallpox, especially to the milder forms, with-out contracting the disease frequently occurs and is nodefinite evidence of immunity. The number of cases ofsmallpox among the unprotected persons in contact withpatients suffering from the disease is very much less than100 per cent. . . .

"Though smallpox is unquestionably many times morefrequent in the unvaccinated than in those who have hadeven a single vaccination, it is believed that neither thevaccination history nor the presence of scars should begiven diagnostic weight. The unreliability of such acriterion is especially evident in virulent outbreaks ofthe disease. . . .

"The purpuric, uniformly fatal, form of smallpox isthe most difficult to prevent by vaccination, and cases ofthis form, without a true smallpox eruption, may occurin persons with a fairly good vaccination history. . .

"The mildness of the form of smallpox commonest atpresent is one reason for endeavoring to make preventivevaccination as harmless and as mild as possible. . . . .

"Cases, and even fatalities, occur in every severe epi-demic among persons who were vaccinated in good timebut with vaccine found, too late, to be of insufficientpotency; such cases and fatalities also occur among per-sons thought to be protected by successful vaccinationperformed years previously."

52

ORGANIZED PHYSICIANS IN ENGLANDWERE JUST AS SURE THAT THE INOCULA-TION OF PEOPLE WITH SMALLPOX WAS AGOOD THING AS THEY NOW ARE THAT VAC-CINATION IS NECESSARY, BUT SMALLPOXINOCULATION RESULTED IN ACTUALLYSPREADING THE DISEASE AND WAS MADE

A PENAL OFFENCE IN ENGLAND IN 1840.

Extract from the Minority Report by Dr. W. J. Collinsand Mr. J. Allanson Picton, of the Royal Commissionon Vaccination, August, 1896 Calling Attention to aResolution Passed by the Royal College of Physicians

of London in 1754 Defending Smallpox Inoculation."In 1746 an inoculation hospital was started in London,

and in most of the large provincial towns the new prac-tice was encouraged by the clergy, as well as the lead-ing medical practitioners, 'and in 1754 the Royal Collegeof Physicians of London pronounced its authoritativesanction of what was no longer a speculative novelty.'The resolution of the college was: 'The College, havingbeen informed that false reports concerning the successof inoculation in England have been published in foreigncountries, think proper to declare their sentiments inthe following manner, viz: That the arguments which atthe commencement of this practice were urged againstit have been refuted by experience; that it is now heldby the English in greater esteem, and practiced amongthem more extensively than ever it was before; and thatthe College thinks it to be highly salutary to the humanrace.' From this date to the end of the century inocula-tion was widely diffused, though to varying degrees, indifferent districts; the practice doubtless paved the wayfor the later acceptance of vaccination. The latter cameto replace the former method, and by the Act of 1840,sec. 8, the practice of inoculation became a penal offence.

53

"Inoculation is still practiced in India, in many places,and in association with religious observances, in honorof Sitla, the goddess of smallpox."Extract from book entitled "Smallpox and Vaccination"by Benjamin White, Ph.D., Director of the Division ofBiologic Laboratories, Department of Public Health ofMassachusetts, in Which He States that Inoculated Per-sons Frequently Served to Spread the Disease to Others,

p. 28. "Inoculation, or variolation, consisted in trans-ferring matter from a true smallpox pustule to theabraded skin of the person to be protected. This pro-cedure usually produced a mild form of the disease,which, anticipated and controlled, was preferable to afortuitous and virulent attack, but it had serious disad-vantages. Infections other than smallpox were trans-mitted along with the variolous matter. Further, theinduced disease was true smallpox, and, therefore, in-oculated persons frequently served to spread the diseaseto others. Then, too, the infection sometimes ran atypical and fatal course."

Extract from Article by Dr. J. H. Dempster in the Jour-nal of the Michigan State Medical Society, July, 1926.

"The method of prevention of smallpox that prevailedup to Jenner's time was that of 'inoculation,' the effectsof which were often as bad as the disease itself. Theprocedure consisted in producing in the person an arti-ficial attack of smallpox, and seeing the patient safelythrough the infection. Several doctors became noted fortheir skill in inoculation and the operation became a sortof specialty with them. The operation of inoculation wasattended by risks through the danger of introducingother infective agents into the system. The only advan-tage of this old method of prevention consisted in thefact that the patient could select the time and place whenhe wished to have smallpox, but there was no guaranteethat the induced disease might prove less dangerous thanthat accidentally acquired."

54

JENNER, THE SO-CALLED DISCOVERER OFVACCINATION, WAS JUST AS SURE THAT ASINGLE VACCINATION WOULD PROTECTFOR LIFE AS ORGANIZED MEDICINE TODAYIS THAT VACCINATION AFFORDS TEMPO-

RARY PROTECTION AGAINST SMALLPOX.

Extract from the Minority Report by Dr. W. J. Collinsand Mr. J. Allanson Picton, of the Royal Commission onVaccination, Calling Attention to the Persistence ofEdward Jenner in maintaining that a Single Vaccination

Offered Protection Against Smallpox For Life:"Jenner's first writing on the cowpox was a com-

munication intended for the Royal Society in 1797, theoriginal of which, it would appear, exists in manuscriptin the library of the Royal College of Surgeons. Thecommunication was not printed in the PhilosophicalTransactions, but was returned to Jenner, and, with addi-tions, was published in 1798 as 'An inquiry into thecauses and effects of the Variolae Vaccinae.' The originalpaper asserted that 'matter of various kinds when ab-sorbed into the system may produce effects in somedegree similar; but what renders the cowpox virus soextremely singular is, that the person who has been thusaffected is for ever after secure from the infection ofthe smallpox; neither exposure to the variolous effluvianor the insertion of the matter into the skin producingthis malady.'

* * * *"Cases in which smallpox had occurred after cowpox

had frequently been pressed upon Jenner's attention(Gregory's 'Eruptive Fevers,' p. 208), and in his thirdpublication in 1801 Jenner thus alludes to these objec-tors: 'Some there are who suppose the security fromsmallpox obtained through the cowpox will be of a tem-porary nature only. This supposition is refuted, notonly by analogy with respect to the habits of diseases

55

of a similar nature, but by incontrovertible facts, whichappear in great number against it.' . . . In his petitionto the House of Commons he states that he had dis-covered that 'the cowpox admits of being inoculated onthe human frame with the most perfect ease and safety,and is attended with the singularly beneficial effect ofrendering through life the persons so inoculated per-fectly secure from the infection of the smallpox.' (Baron.1., 490)."

SMALLPOX HAS GONE THE WAY OF CHOL-ERA AND OTHER FILTH DISEASES BEFORETHE ONWARD MARCH OF SANITATION AND

IMPROVED LIVING CONDITIONS.

Extracts from Book Entitled "The Vaccination Ques-tion" by Dr. C. Killick Millard, Medical Officer of Healthfor Leicester, England, Issued in 1914, Directing Atten-tion to the Decline in Smallpox Along With the Plague,

Cholera and Typhus.p. viii. Preface. "For forty years, corresponding

roughly with the advent of the 'sanitary era,' smallpoxhas gradually but steadily been leaving this country[England]. For the past ten years the disease hasceased to have any appreciable effect upon our mortalitystatistics. For most of that period it has been entirelyabsent except for a few isolated outbreaks here and there.It is reasonable to believe that with the perfecting andmore general adoption of modern methods of control andwith improved sanitation (using the term in its widestsense) smallpox will be as completely banished from thiscountry as has been the case with plague, cholera, ortyphus fever. Accompanying this decline in smallpoxthere has been a notable diminution during the pastdecade in the amount of infantile vaccination. This fall-

56

ing off in vaccination is steadily increasing and is be-coming very widespread.

* * * *p. 185. "Undoubtedly, many have a genuine fear that

if smallpox once succeeded in obtaining a foothold in anunvaccinated community it would spread 'with, a rapidityof which we have in recent times had no experience.'I realize that any one who suggests that this view isunduly alarmist incurs a certain measure of responsi-bility, and I believe that this reflection has hitherto de-terred those who might otherwise have been inclined toexpress a more sanguine view. Personally, having beenMedical Officer of Health for thirteen years in a townwhich, for practical purposes, may be regarded as un-vaccinated; living and moving, as I do, amongst a childpopulation 90 per cent of which is unvaccinated, I feelunable to subscribe to this pessimistic view. I believethat the sanitary condition of the country has been sogreatly improved, and alternative measures for dealingwith smallpox have been so highly evolved, that we shallnever revert to the state of things which existed in thedays before vaccination was discovered."Extracts from Article by Dr. C. V. Craster, Health Of-ficer, Newark, N. J. In the American Journal of PublicHealth, May, 1925, Contrasting The Insanitary Condi-tions of the 19th Century With the Present High Stand-

ards of Living."The onset of the industrial era in Europe, and in

America too, changed to an immense degree the generalliving conditions of the populations. As a result ofeconomic demands for factory labor and also the lure ofbetter wages, a continuous drift of population took placefrom the rural districts to the towns.

"This would not have been important as a nationalchange had the cities been able to absorb and accommo-date the vast army of employed. As it was, the citieswere without sufficient dwellings and such as they had

57

were without a water supply, without sewerage, with-out even an available or clean food supply to provide forthe new citizens. These conditions brought about in thevast majority of city dwellings in America and abroadduring the middle of the nineteenth century overcrowd-ing, indescribable filth and generally a miserable livingstandard among the families of the poor. Disease andevery kind of infection ran riot, finding ideal conditionsin the foul homes and in the emaciated and under-nourished bodies of unfortunate victims.

"Speaking of the living conditions in the tenementbuildings of the City of London in the 19th centurySimon said: 'There are some places where the mortalityis yet high, where in fact the cloud of death is alwayshanging, where the vitality of the people is seriouslysapped and where disease makes an easy conquest. Itis not enough that these places are the continuous hauntsof such endemic maladies as phthisis, fever, and otherputrid classes, but often they become seats of strongerpestilences.'

"A parallel to this situation existed at the same timein the City of New York, where in 1864, according tothe City Inspector, 6,000 families comprising 18,000 in-dividuals were living in underground cellars. . . .

"It was evident that although routine enforcement ofsuch old established methods as isolation and quarantinewere administration methods of some value in the con-trol of epidemics, they would in the end be useless asmere gestures unless there was possible an improvementin the actual living conditions of the people. The de-mand for reform brought about the great national effortsto insure a good water supply for cities and the pro-vision of adequate sewerage and refuse collection sys-tems, as well as a general improvement in the type ofcity dwelling used by the worker.

58

"The greater number of epidemic diseases which sweptover enormous continental areas were strictly diseaseswhere possibilities of spread were directly questions ofenvironment. This class would include smallpox, yellowfever, dysentery, typhoid fever, bubonic plague, cholera,malaria, typhus fever, meningitis and tuberculosis. Allof these with the exception of tuberculosis have ceasedto be widely prevalent except in countries where famine,destitution and filth exist as a result of war or economicrevolution."

SMALLPOX IS ONLY ONE OF SEVERAL DIS-EASES WHICH HAVE SHOWN A SUBSTAN-

TIAL REDUCTION.

The Following is a Photographic Copy of Chart byStatistician's Department, The Prudential InsuranceCompany of America, Showing Comparative Reductionin Mortality from Scarlet Fever, Diphtheria and Croup,

Whooping Cough and Measles.

Comparative Reduction in Mortality from Measles

59

THERE HAS BEEN NO INCREASE IN SMALL-POX FOLLOWING REPEAL OF VACCINATIONREQUIREMENT IN MAINE AND A NUMBER

OF OTHER STATES.

MAINETable Showing the Number of Cases and Fatalities fromSmallpox in Maine Before and After the Year 1921When the Law Authorizing Superintending School Com-mittees to Exclude Unvaccinated Children Was Virtually

Repealed by Passage of "Conscience Clause."

Year Cases Deaths1920 256 01921 96 01922 85 01923 118 21924 19 01925 1 01926 12 01927 1 0

MASSACHUSETTSExtract from Communication by the Late Mr. HenryD. Nunn, in the Boston, Mass. Post, January 22, 1924Directing Attention to the Repeal of the VaccinationRequirement of Infants in 1908. (It still requires vac-

cination for admission to Public Schools)."The first compulsory vaccination law was passed by

Massachusetts in 1855. It required that every infantmust be vaccinated before reaching the age of two years;that no child should be admitted to any public school un-less vaccinated; that all inmates of public institutionsmust be vaccinated; that the employes of all manufactur-ing corporations must be vaccinated as a prerequisite toemployment and to cap the climax, everyone must be vac-cinated every five years. What was the result? In the

60

20 years following the enactment of this law there were4221 deaths from smallpox in Massachusetts. The pro-tection afforded by this law did not highly recommenditself to the people, and in time it was pretty muchignored, so that finally in 1908 the infant vaccinationrequirement was repealed without protest by anybodyand without any bad results."

ARIZONATable Showing Number of Cases and Deaths from Small-pox in Arizona Following Repeal of Vaccination Re-

quirement by Referendum Vote in December, 1918.

Year Cases Deaths1919 69 01920 172 51921 192 41922 468 1341923 100 261924 160 201925 117 11926 18 61927 10 0

NORTH DAKOTATable Showing Number of Cases and Fatalities FromSmallpox in North Dakota Since 1919 When the Law

to Require the Vaccination of Minors Was Repealed.

Year Cases Deaths1920 533 01921 1777 21922 657 21923 444 21924 575 11925 204 71926 276 01927 208 0

61

CALIFORNIATable Showing Number of Cases and Fatalities fromSmallpox in California Since 1921 when the Vaccination

Law Was Entirely Repealed.Year Cases Deaths1921 5581 211922 2129 201923 2025 11924 9445 561925 4921 581926 2794 2361927 984 5

IN ENGLAND SMALLPOX MORTALITY HASGREATLY DECLINED FOLLOWING VIRTUALREPEAL OF VACCINATION REQUIREMENTBY PASSAGE OF ACTS OF 1898 AND 1907 PRO-VIDING FOR A "CONSCIENCE CLAUSE" ASSHOWN BY THE FOLLOWING TABLES. NOOTHER COUNTRY HAS GIVEN VACCINATIONSO GOOD A TRYOUT AS ENGLAND. HERE

ARE THE FACTS.

18721873187418751876187718781879

ENGLAND AND WALESPercentage of Births Vaccinated

and Number1872-1881Percent

of BirthsVaccinated

85.085.285.0584.986.086.385.386.0

of Smallpox Deaths Registered.

SmallpoxDeaths19,0222,3032,084

8492,4084,2781,856

536

1882..1883..1884..1885..1886..1887..1888..1889..

1882-1891Percentof Births

Vaccinated85.985.684.484.783.482.881.779.8

SmallpoxDeaths1,317

9572,2342,827

275506

1,02623

62

1880. .1881..

85.186.6

Totals

6483,098

37,082Average per annum

1892..1893..1894..1895..1896..1897..1898..1899..1900..1901..

85.5

1892-1901Percent

of BirthsVaccinated

74.572.370.467.866.062.461.066.468.771.4

3,708

SmallpoxDeaths

4311,457

820223541

2525317485

356

1890..1891..

1902..1903..1904..1905..1906..1907..1908..1909..1910..1911..

78.075.8

82.1

1902-1911Percentof Births

Vaccinated74.875.475.375.873.470.963.259.855.952.3

1649

9,230

923

SmallpoxDeaths2,464

760507116211012211923

Totals 4,365Average per annum

67.9 436 67.6

3,953

395

191219131914191519161917191819191920

1912-1921Percent of Births

Vaccinated50.146.544.645.544.743.341.540.639.5

Deaths9

104

1318

32

2830

1921 38.3 5

Totals 122

Average per annum 43.4 12Commenting on the above statistics, the "National Anti-

Vaccination League," of London, England, remarks:—"So in the 10 years 1872-1881 when an average of

85.5% of the births were vaccinated, we had an averageof 3,708 Smallpox Deaths every year. In 1882-1891,when an average of 82.1% of the births were vaccinated,we had an average of 923 Smallpox Deaths every year.In 1892-1901, when the vaccinations had declined to anaverage of 67.9% of the births, the Smallpox Deathsdropped to an average of 436 per annum. In 1902-1911,when the average number of vaccinations was 67.6% ofthe births, the Smallpox deaths averaged 395 per annum,but in 1912-1921, when the vaccinations had dropped to43.4% of the births, there was an average of only 12Smallpox Deaths per annum.

"How can any person who claims to understand statis-tics and to have a logical brain declare that it is vaccina-tion that has stamped out Smallpox, in the face of theabove official figures?"

(Note:—A discussion of the alleged increase in casesin England during recent years is given on pages 73-79).

SMALLPOX RECORD OF UNITED STATESWHERE VACCINATION IS OPTIONAL FORMOST PART COMPARES FAVORABLY WITHTHAT OF ITALY, JAPAN AND THE PHILIP-PINES, EACH OF WHICH MAKE VACCINA-TION AND REVACCINATION COMPULSORY.

UNITED STATESDeclaration by United States Census Bureau in "Mor-

tality Statistics," 1917.p. 28. "It has been many years since smallpox was the

64

cause of high mortality, and data are now presented onlyto show how few deaths have been due to this disease inrecent years."

Table Showing the Number of Fatalities from Smallpoxin the United States During the Years 1902 to 1927

Inclusive.

19021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927 (40 States)

Deaths2111138270930895749279202130165125212169114204339358508641628170900709377138

(The number of fatalities from smallpox fades into in-significance when it is realized that the total number offatalities from all diseases in the United States amount

65

to more than a million per year and the number of per-sons killed by automobiles amount to approximately six-teen thousand per year.)

JAPANExtracts from an Article by S. Kitasato, M.D., Director,Institute for Research in Infectious Diseases, Tokyo,Japan, Published in the Journal of the American Medi-cal Association, March 25, 1911, Directing Attention toOutbreaks of Smallpox in Japan and its Vigorous Vac-

cination Laws."One of the greatest epidemics of smallpox during the

past forty years broke out in 1885 and lasted three years,with 125,315 cases and 31,960 deaths. The epidemic be-gan to decline in 1888. It reappeared in 1892 and againlasted three years. During this second outbreak 88,095cases were recorded, of which 23,603 patients died. Thethird outbreak extended over two years, 1896-1897, with52,650 cases and 15,664 deaths. During the next tenyears, a few cases were imported from China every nowand then, without any ensuing serious outbreak. Since1900, the cases in the whole empire were remarkablyfew, until in 1907, when the disease reappeared at Kobe.This caused an uncommonly severe epidemic, whichspread all through the empire. It began to die out in thespring of 1908. During this fourth epidemic 19,101 casesand 6,273 deaths were reported. This outbreak, however,completely subsided by July of the same year, withoutany trace left.

* * *"In 1874 the first vaccination law was enacted, and in

1876 the regulations for the prevention of smallpox werepromulgated, which provided for compulsory vaccina-tion. In 1885 a revised law concerning vaccination wasenacted. It comprised all the data included in the for-mer two regulations. It provided that every baby shouldbe vaccinated within the first year of its age, and revac-cinated every five or seven years. The violation of this

66

regulation was punished with a fine not less than 5 andnot exceeding 50 sen (or approximately from 2-1/2 to 25cents in U. S. currency). It was in the same year, justafter the enactment of these regulations, that the greatepidemic broke out which is mentioned above. Thisregulation remained unchanged during twenty-fouryears; a new revision took effect in the year 1909. Thisnew law provides that each new-born baby shall be vac-cinated within ninety days after birth and before Juneof the next year. Revaccination shall be made at thetenth year from birth (including the year in which thechild was born). If either the primary or the secondaryvaccination is unsuccessful, the child shall be revacci-nated before December of the next year."

ITALYCopy of Communication by the Citizens Medical Refer-ence Bureau Addressed to Dr. Hugh S. Cumming, Sur-geon General of the United States Public Health Service,May 25, 1927, Directing Attention to a Severe Epidemicof Smallpox in Italy Where Vaccination and Revaccina-

tion Are Compulsory."We fail to find a comprehensive discussion of the dis-

astrous epidemic of smallpox in Italy in any of the issuesof 'Public Health Reports' or in any of the annual re-ports issued by your Department.

"We find that in 1912 there was an average mortalityfrom smallpox in Italy of 9.5 per 100,000 persons. In1918 there was a mortality of 2.6 per 100,000; in 1919it rose to 45.4; in 1920 it was 30.3 and in 1921 it was 3.7per 100,000 persons. This means that in Italy in 1919there were 18,213 fatalities from smallpox as comparedto only 358 fatalities in the United States, and in 1920there were 12,155 fatalities in Italy as compared to only508 fatalities in the United States.

"In view of the fact that the mortality from smallpoxin the United States has been less than one per 100,000

67

persons during each year for the past 20 years or more,and in view of the fact that the bulletins issued by theLeague of Nations, publications issued by health boardsthroughout the country, and publications issued by thevarious medical societies have done so much to picturethe United States as being a smallpox plague center,when the very reverse is true, it is disappointing to saythe least that your Department which is so closely intouch with the statistics throughout the world has failedto bring out the facts with regard to smallpox in Italy.

"I am sure you will agree that the record of theUnited States, which for the most part does not makevaccination compulsory, is very remarkable when com-pared with the record of Italy where the laws providefor compulsory vaccination of all infants below one yearof age, and for the revaccination of children before theyreach the age of 12 years. The brief reference to small-pox in Italy in your 1920 annual report does not revealeither the actual number of fatalities or cases of small-pox in Italy.

"Will you kindly advise if you contemplate issuing areport in the near future dealing with the epidemics ofsmallpox in vaccinated and revaccinated Italy?"

(Note:—Over a year has elapsed since the above com-munication was forwarded to the United States PublicHealth Service, and more than seven years have elapsedsince the disastrous smallpox epidemic in Italy, and yetno medical or public health journal in the United States,to our knowledge, has yet published a comprehensive dis-cussion of the facts about this epidemic in Italy. H. B. A.)

68

PHILIPPINE ISLANDSDisastrous Epidemic of Smallpox in the Philippine Is-lands in 1918 and 1919 Where Vaccination and Revaccin-

ation Are Compulsory.Table Showing Number of Vaccinations and the Numberof Fatalities From Smallpox During the Ten Years,

1911-1920.(The total population of the Philippine Islands is only

approximately ten million persons.)

Year1911191219131914191519161917191819191920

Total of

10 years

No. of Vaccinations1,472,7491,216,0801,524,1691,635,8571,265,107

839,363817,170

3,877,9697,976,5283,811,897

24,436,889

No. of DeathsFrom Smallpox

1,192567903438273554403

16,44747,368

7,194

75,339

Extracts from Communication by the Philippine HealthService to the Citizens Medical Reference Bureau, Sep-tember 25, 1922, denying the charge raised in the UnitedStates as an explanation for the large number of fatal-ities from smallpox in the Philippines that vaccinationmeasures were in the hands of inefficient Filipino man-

agement."We admit that our sanitary inspectors have not been

infallible; yet, our consciences are clear that since we hadassumed the full responsibility of the health administra-tion, our sanitary personnel have been performing theirduties to the best of their ability.

* * *

69

"Regarding the question of general administration, anyscientific man would admit that three or four years ob-servation is not enough to justify a criticism of successor failure. Experiments either technical or administra-tive, require a considerable length of time to prove cer-tain definite conclusions and results. And even at pres-ent, statistical facts indicate that, under similar existingconditions and circumstances, the American and FilipinoHealth Administrations in the Islands, as far as the re-straint of smallpox is concerned, show no great discrep-ancy. In fact, it should be recalled that way back in 1911,1912 and 1913, i. e., during the American Health Admin-istration, there have been similar outbreaks of smallpox,particularly in Southern Islands and among the non-Christian population of Mindanao and Sulu. It shouldnot also be lost sight of that, from the beginning ofhealth administration in the Islands, the personnel ofthe vaccinating parties who have been partly, if not intoto, instrumental in checking such epidemics, have allbeen Filipinos."

Extracts from the Report of the Chief of the Divisionof Sanitation, City of Manila, in the Annual Report ofthe Philippine Health Service for 1920, in Which theExcuse is Offered That the Hundreds of Thousands ofYearly Vaccinations in Manila Proved a Failure BecauseInfants Under One Year of Age Had Been Allowed to

Escape Compulsory Vaccination."From the time in which the smallpox was practically

eradicated in the city of Manila to the year 1918 (about9 years) in which the epidemic reappeared certainly inone of its severest forms, hundred after hundred ofthousands of people were yearly vaccinated and revac-cinated with the most unfortunate result that the 1918epidemic looks prima facie as a flagrant failure of theclassic immunization towards future epidemics.

"Obviously, the epidemic moment called for a revisionof the classic methods of vaccination, and it was through

70

a painstaking study and consideration of our records ascompared with the situation that the fact was plainlydisclosed that our hundred of thousands of yearly vac-cinations were nothing but a fruitless attempt since avery important group of such population was overlookedand in fact unwisely spared in the immunization scheme.Through a combination of circumstances among whichhad gained undue prominence the country-wide fear ofaccepting antivariolic vaccination for children of lessthan six months to one year age, there was thus formedan aggregate numerous group of unprotected people, toohardly, if at all possible, to trace and identify aftermonths or years have elapsed since first seen when nearlynew-born. Just on the occasion of the 1918 epidemic,cases were on records of children of 40 to 43 days of agewho contracted, and certainly died from, virulent (con-fluent) smallpox. It was then the moment for a generalalarm, and rush orders were accordingly issued for the'immediate compulsory vaccination of all children fromnot less than 30 days age on, or earlier, if the children'sfamily so desire.'"

UNVACCINATED AUSTRALIA FREE FROMSMALLPOX.

Extract from Service Publication Number 29, Issued bythe Australia Department of Health, 1925, Stating That

for Practical Purposes Australia is Unvaccinated.P. 109. "Consideration of the extent to which vaccina-

tion has been carried out in the several States duringthis period indicates that for practical purposes theAustralian community is, as a whole, unprotected byvaccination. It is difficult to assess the proportion ofvaccinated persons in the community, even in terms ofinfantile vaccination, without any consideration of therevacciraations necessary to ensure a more complete im-munity. In the previous volume, page 132, an approxi-

71

mate estimation was given that, in 1910, some 30 per cent,of all persons in Australia had been vaccinated."

Table Showing Number of Cases and Fatalities fromSmallpox in Australia During the Fifteen Year Period

1909-1923.

New South Wales

VictoriaQueenslandSouth AustraliaWestern AustraliaTasmania

Deaths fromSmallpox.

4

20000

(In 3 ofsmallpox

Cases ofSmallpox

2400these caseswas only a

contributing cause.)95170

The Extremely Mild Character of the So-called Casesof Smallpox in Australia During the Fifteen Year Period1909-1923 May be Gained from the Following Extractsfrom Service Publication Number 29 Issued by theAustralia Department of Health, 1925, Referring to theOnset of the Epidemic Among Employees in a Factory

in Sydney, Australia."The precedent illness, in all the cases, appeared to

have been of a very mild type, and while some of thegirls had stayed away from business for a few days, somehad not considered it necessary to do so at all. Not morethan two of the girls affected had consulted a medicalpractitioner, and in those cases they stated they hadbeen told that there was nothing much the matter.Further inquiries elicited that the first case had occurredon or about 25th April, at which date a girl, E. D.,.aged22, had been attacked by 'influenza.' Three days latershe developed a 'pimply' rash on the face. She had beenabsent from work for a week, and had returned to dutyfeeling well before the eruption appeared,"

72

THE CASE REPORTS OF ALLEGED SMALL-POX IN THE UNITED STATES AND ENGLAND,ABOUT WHICH ADVOCATES OF COMPULSIONARE SEEKING TO CREATE SO MUCH ALARM,ARE THE RESULT OF A PRACTICE IN THESECOUNTRIES OF REPORTING A VARIETY OFMILD COMPLAINTS AS ACTUAL CASES OFSMALLPOX WHEREAS IN OTHER COUNTRIESTHEY WOULD BE DESIGNATED AS "ALAS-TRIM," "CUBAN ITCH," "CHICKENPOX" OR

UNDER SOME OTHER NAME.

Extract from Annual Report of the United States PublicHealth Service for the Fiscal Year 1924, Referring toSmallpox as Being Much Better Reported Here Than

in Other Countries.p. 5. "Reports of 149,550 cases [of smallpox] with

22,346 deaths were received during the year. The factthat more than one-fifth of the cases reported occurredin the United States should not be taken to mean thatthis disease is more prevalent here than anywhere else,but that it is much better reported in the United Statesthan in most other countries."

Table Showing Number of Alleged Cases of Smallpox inthe United States by Years from 1919 to 1927, Inclusive.

Year191919201921192219231924192519261927 (40 States and

D. of C.)

Cases56,33296,684102,78732,80029,96851,42939,63930,45032,102

73

Extracts from London Letter to the Journal of theAmerican Medical Association, Published in the Journal,June 30, 1928, Showing the Alarm Being Created ThereOver an Alleged Increase of "A Mild Form of Smallpox."

"The report of the smallpox and vaccination committeeof the League of Nations draws attention to the remark-able decrease in smallpox in European countries duringrecent years. To this England and Wales offer the soleexception, owing to the increasing prevalence of a mildform of smallpox, from which, however, the mortalityis almost negligible The alarming increase in small-pox in England was emphasized by Major G. S. Parkin-son of the army medical corps, in an address at the publichealth conference recently held in London. He gave thefollowing figures: 1918, 63 cases; 1921, 336; 1927, morethan 9,000."

United States Public Health Service in "Public HealthReports," December 9, 1921 Recommended ReportingCases of So-called "Cuban Itch," "Philippine Itch,""Alastrim," etc. as Actual Cases of Smallpox, as shown

by the Following Extracts."It should be borne in mind that while alastrim, from

a scientific viewpoint, may possibly be a separate diseaseentity, it has all the public health aspects of smallpoxand, in the present state of our knowledge of its exactclassification, should always be reported and combated assmallpox.

"Synonyms. Varioloid-varicella, amaas, Kaffir milk-pox, Sanaga smallpox, West Indian modified smallpox,pseudo smallpox, weisse pocken.

* * *"It is probable that the so-called 'Cuban Itch' and

'Philippine Itch' observed after the War with Spain, themild form of smallpox prevalent in America, and alas-trim are identical."

74

Doctors Unable to Distinguish Between So-called"Smallpox" and "Poison-Ivy" as Brought Out in the Fol-lowing Extracts from an Editorial in the New York

Times, July 1, 1926."This Smallpox Was Poison Ivy.—From Peekskill

comes the report that the smallpox 'scare' recently re-ported at the National Guard camp was due to a numberof serious cases of ivy poisoning. The doctors must havebeen able to distinguish between the effects of poison ivyand incipient smallpox, but the story is another indica-tion that the poison ivy season is already at its height."Extracts from an Article by Assistant Surgeon-GeneralJohn W. Trask of the United States Public Health Serv-ice, in "Public Health Reports," June 23, 1911, in WhichHe Directs Attention to the Extreme Mildness and theSmall Number of Deaths from Smallpox in the United

States."One of the most notable features of the smallpox

which has been more or less prevalent in the UnitedStates for at least ten years is its extreme mildness andthe small number of deaths which it has caused. In 1909the combined states from which complete reports werereceived had 19,534 cases with 92 deaths, which was amortality rate of 0.471 for each 100 cases. In 1910 therate was considerably higher, but still remarkably lowwhen compared with the rates reported from other coun-tries.

* * *"That the community is protected by vaccination may

be true for certain localities, but that the protection thusafforded is general can hardly be maintained. Japan asa nation is probably as well or better protected byvaccination than is the United States, and yet in 1907-1903 there was an outbreak of smallpox in Japan inwhich 19,101 cases were reported with 6,273 deaths.Vaccination did not there modify the type of the diseaseto that found in America. * * * *

75

"If the non-virulence of the disease in this country isdue to protection by vaccination it would be expectedthat the mild cases would be found only in those so pro-tected. This may be assumed from the limited informa-tion available not to be the case. Records of the vacci-nation history of all patients would undoubtedly addmuch to our knowledge of the subject.

"That the type of the disease as seen in the UnitedStates is due to the protective value of vaccination isshown not to be true for certain localities in which out-breaks of the virulent form of the disease have been re-ported. These outbreaks have occurred at widely separ-ated points extending from Virginia and South Carolinain 1909 to Michigan, Oklahoma, Texas and Oregon in1910. . . ."

Extracts from Service Publication Number 29, Issuedby the Department of Health of Australia, 1925 StatingThat There is a Division of Opinion Among HealthAuthorities as to Whether the Mild Type of So-called

Smallpox Is or Is Not A Distinct Disease.p. 20. "The striking feature of the world course of

smallpox, during the period under review, has been theepidemic extension in many countries of an exceptionallybenign form of the disease. Throughout the historicalrecords that relate to smallpox, there has been noted bysuch observers as Rhazes, van Swieten, Sydenham, andJenner, the occasional appearance of a form of smallpoxso mild that fatal results were rarely heard of, and theeruption was only occasionally confluent. Since 1898,however, particular attention has been focussed on thecontinuance of a benign type of the disease in manycountries and on its spread to, and extension and endemicestablishment in, other countries. Naturally, in each out-break of this type of disease there has been considerablediversity of opinion as regards diagnosis when the dis-ease first appeared. The specific identity of the diseasein each outbreak in its relationship to typical variola has

76

been freely questioned, and the nomenclature adoptedhas resulted in a new and confused nosology—'alastrim,''amaas,' 'varioloid,' 'variola-varicella/ 'para-variola,' and'mild smallpox' as distinct from 'variola vera,' 'classical'or 'Asiatic smallpox.' With the continuance of the mildtype or types of disease, and the accumulation of clini-cal, epidemiological and laboratory records, there havedeveloped two schools of opinion which have been calledby Professor Jorge the 'unicists' and 'dualists'—the uni-cists desire to see in alastrim merely an expression ofvariola; the dualists persist in believing it a species suigeneris, autonomous and independent.'"

Extract from Article on "Smallpox" in the 1925 Supple-ment to The New International Encyclopedia, Vol. II,pp. 1217-1218 Referring to Alastrim as Being Distinct

from the Severe Type."Smallpox. During the 10 years 1914-24, much infor-

mation was gained about this affection. The convictionis growing that there are different strains of the disease,one of which is naturally mild and the other severe.Should this dualistic view obtain a permanent footholdmany peculiarities of the disease may be explained. Asevere type of disease may, of course, have its virulencemodified and appear alternately in mild or severe form;but there may be a mild form which is never severeunder any circumstances. This appears to be the casewith the alastrim of the West Indies, which is believedto be the same as the mild smallpox of western Africa,from which it was originally derived. The latter haslong been regarded as distinct from the severe smallpoxof eastern Africa. The severity of the latter, as of othervirulent strains of the disease in the tropics, makes itdifficult to control by vaccination, to which must be addedthe great difficulty of obtaining fresh virus, and the dif-ficulty of enforcing vaccination decrees in primitive com-munities."

77

Extract from Lecture by Dr. Charles V. Chapin, Super-intendent of Health, Providence, R. I., Extracts fromWhich Were Published in "Public Health Reports,"

December 24, 1926."That vaccinia is derived from smallpox by animal

passage we know. That varicella is another offshootfrom smallpox is highly probable. That the mild typeof smallpox sometimes called alastrim, or amaas, isanother cleavage seems clear. That the two strains areclosely related is shown by complement fixation tests, byanimal inoculation, and by the immunity against bothproduced by vaccinia. Nevertheless the two types differclinically in a marked degree and to some extent inimmunity relations and in animal reactions.

"The history of the appearance and dispersion of themild type of smallpox shows that it is not to be explainedby changes in the host caused by vaccination, or other-wise. It is not possible that it is due to climate or anytelluric, or cosmic, or mystic epidemic influence. Thetheory that the disease is mild because the smallpox germhas parted company with a virulent streptococcus seemshighly improbable. The simple and wholly adequatetheory is that in Florida or in Africa the smallpox germsome thirty years ago, suddenly underwent a change,or mutation, just as many other species of plants andanimals, high and low, are constantly doing."

Extract from an Article Published in The CanadianMedical Association Journal, April, 1928.

"The history of medicine teaches us that most infec-tious diseases gradually change their character from onegeneration to another. The terrible plagues of theMiddle Ages are in many cases unrecognizable fromdescriptions which have come down to us. Diseases re-garded at one time as almost inevitably fatal becomecomparatively benign, while others become progressivelymore virulent. The factors concerned in this change are

78

largely unknown; whether it is due to a change in thecustoms and habits of mankind, to a gradual immuniza-tion of the population, or to an alteration in the excitingorganism is uncertain.

FALLACY OF STATISTICS COMPARINGSMALLPOX CASES AMONG THE VACCIN-

ATED AND UNVACCINATED.

(Note: As long as medical text books and medical jour-nals continue to advise physicians and students to regarda recent vaccination as a sign that any disease havingthe appearance of smallpox is probably some other dis-ease, the voluminous statistics compiled by health boardscomparing the number of cases of smallpox among thevaccinated and the unvaccinated are worthless. Thefollowing citations are given to show that it is the ac-cepted practice among physicians to practically rule outsmallpox as a possibility whenever the patient has beenrecently vaccinated:)

Extract from Article Entitled "Smallpox—Its Differen-tial Diagnosis," by Archibald L. Hoyne, M.D., Read Be-fore the Northwest Branch, Chicago Medical Society,and Published in the Illinois Medical Journal, June, 1923.

"In examining a case of suspected smallpox, close ob-servation is of the utmost importance. If the patientshows evidence of a typical vaccination scar of compara-tively recent date, variola may be almost absolutely ruledout."

In a book entitled "Modern Medicine," by William Osier,M.D, Volume 1, p. 853, William T. Councilman, M.D.,refers to the differential diagnosis of chickenpox andsmallpox and mentions the following as the first dif-

ferential point."The vaccinal condition of the patient."

79

HOW VACCINATION STATISTICS ARE MADE

(1) Health Departments tell physicians to look for thevaccination soar as of first consideration in deciding whethera case is or is not smallpox, as in reproduction given below.

(2) Then whan the statistics are compiled these sameHealth Departments announce to the world No Smallpox Among thePersons Successfully Vaccinated!

From The Journal of the Michigan State Medical Society.

MARCH, 1927 HEALTH DEPARTMENT 181

THE MISUSE OF STATISTICS.

An illustration of how statistics are being used by vac-cinationists to make it appear that compulsory vaccina-tion is necessary and that vaccine virus is not to blamefor the fatalities following vaccination is illustrated byan article by W. W. Keen, M.D., entitled, "Smallpox—ANational Disgrace," published in "The American Reviewof Reviews," February, 1927.

In parallel columns below we give extracts from thearticle by Dr. Keen and facts which he omitted to men-tion and which would have shown the fallacy of the con-clusions which he sought to bring before his readers:

Statements by Dr. Keen."Surgeon-General Cum-

ming, head of the PublicHealth Service, in his re-port for June 30, 1925stated that the increase inthe number of cases ofsmallpox in the previouscalendar year was 75 percent., and of deaths fromsmallpox was 628 per cent.,over the year 1923!

Facts Omitted in Articleby Dr. Keen.

Dr. Keen does not ex-plain that what appears tothe reader unfamiliar withsmallpox statistics as analarming increase in fatali-ties of 628 per cent wassimply the usual fluctuationthat takes place from oneyear to the next betweenone hundred to less than athousand fatalities.

He does not mention thatthis is a remarkably lowdeath rate, so low in fact,that the United States Cen-sus Bureau in its 1917 re-port of "Mortality Statis-tics" declares that smallpoxdata is now given "only toshow how few deaths have

81

Statements By Dr. Keen(Cont.)

"Approximately one-fifthof all the cases in the worldin 1923-24 occurred in theUnited States. India withits 319,000,000 p e o p l eheaded the list; then camethe United States with 55,-538 cases.

Facts Omitted By Dr.Keen (Cont.)

been due to this disease inrecent years."

Also Dr. Keen does notmention to what extentthese fatalities were duemainly or in part to otherdiseases from which the pa-tient had been ill.

Dr. Keen does not informhis readers that the UnitedStates Public Health Serv-ice in "Public Health Re-ports," December 9, 1921,recommended reporting allcases of "Cuban itch,""Philippine itch," alastrim,and a long list of com-plaints diagnosed in othercountries under a varietyof names as smallpox.

He does not tell his read-ers that because of lack ofuniformity in diagnosis arecord of thirty or fiftythousand cases may meannothing more than thatnumber of cases of chicken-pox, nor does he mentionas stated in the Annual Re-port of the U. S. PublicHealth Service, 1924, thatthe number of cases in thiscountry should not be takento mean that the disease ismore prevalent here than

82

Statements By Dr. Keen(Cont.)

"Smallpox not only killsmany of its victims, butwith very few exceptionsall who escape death arehorribly disfigured by thepockmarking or 'pitting' ofthe face, and a considerablepercentage are also blinded.Smallpox is especially a dis-ease of childhood. The pock-marking and blinding aretherefore for life.

"The 'Statistics of Noti-fiable Diseases' for 114countries, issued by theHealth Organization of theLeague of Nations, for1925, shows that in theUnited States for the sevenyears from 1919 to 1925, in-clusive, there were reported

Facts Omitted By Dr.Keen (Cont.)

anywhere else, but that itis much better reported inthe United States than inmost other countries.

Dr. Keen does not men-tion as brought out in anarticle entitled "Alastrim"in "Public Health Reports,"December 9, 1921 that "Itis probable that the so-c a l l e d 'Cuban-itch' and'Philippine itch' observedafter the War with Spain,the mild form of smallpoxprevalent in America, andalastrim are identical."

Also when Dr. Keen triesto make it appear that 350,-000 persons have beenpock-marked a n d s o m eblinded for life his state-ment is shown to be falla-cious by the description ofthe mild smallpox found inthe United States in the ar-ticle in "Public Health Re-ports" above referred towherein it is brought outthat "the skin is smooth,with scarcely a trace ofpitting or scarring" andthat "Usually the progressof the disease is uneventful,without complications orsequelae." It also bringsout that "Throughout its

83

Statements By Dr. Keen(Cont.)

409,649 cases of smallpox.The number of deaths isnot given. Though the epi-demic has usually beenmild, and therefore thenumber of deaths probablynot large, yet certainlymore than 350,000 personshave been pock-marked andsome blinded for life."

* * * *

"In the seventeenth cen-tury Bernouilli estimatedthat in Europe alone 60,-000,000 people died ofsmallpox."

* * * *

"The Franco - PrussianWar, 1870-1871: In theGerman army, 4,835 casesof smallpox developed, with276 deaths. In the Frencharmy, much smaller thanthe German, there were125,000 cases and 23,470deaths—i. e. in the Frencharmy there were 26 timesas many cases and 86 timesas many deaths as in theGerman army. (How ser-ious was the loss of mili-tary efficiency of theFrench army, through theneglect of vaccination!)The reason for this impres-sive difference in these two

Facts Omitted By Dr.Keen (Cont.)

course the disease is ex-ceedingly mild, and exceptfor the pains of onset andmaturation, the patient ex-periences relatively littlediscomfort. There is nodelirium, and patients arenot really very ill and re-tain their appetites."

The estimate of fatalitiesfrom smallpox in theseventeenth century mayhave been exaggerated ahundred times. However,in giving out this estimateDr. Keen says nothingabout the insanitary condi-tions in the seventeenthcentury.

The statistics used by Dr.Keen with reference to theFranco-Prussian war wereused by the London Lancet,one of the leading medicalmagazines of the world, inits issue June 1, 1901 butin its issue June 8, 1901 itpublished a communicationby Alexander Paul direct-ing attention to the fallacyof the statistics used andappended thereto the fol-lowing foot-note:

"The figures escaped our

84

Statements By Dr. Keen(Cont.)

armies is that vaccinationwas widely practiced inGermany though it was notenforced by law until 1874,when it was made compul-sory."

* * * *"After the Great War,

from 1919-1921, there wereabout 300 cases of smallpoxannually in England andWales. In 1923 the numberrose to 2,485, and in 1924to 3,765. During 1925 therewas a further increase to5,365 cases.. . Today thereis great concern in Englandon account of the increas-ing smallpox.

* * * *"In 1918 (in the Philip-

pine Islands) Death beganto reap his harvest, and by1921 there had been 130,-264 cases and 74,369 deathsfrom smallpox—the mostterrible epidemic in moderntimes. Coincident with thenew administration of Gen-eral Wood, in 1921, vacci-nation was again thorough-ly reestablished, and by1923 the scourge of small-pox was ended."

Facts Omitted By Dr.Keen (Cont.)

attention. We regret tohave published them astheir falsity has been es-tablished."Now after the lapse of

twenty-six years the sameerroneous statistics appearin the article by Dr. Keen.

Dr. Keen fails to mentionthat in England the aver-age number of fatalitiesfrom smallpox during thepast fifteen years has beenless than fifty per year.

Also Dr. Keen fails tocontrast the remarkablerecord in England wherevaccination has been madeoptional and where themajority of the populationis unvaccinated with therecord of Italy where vacci-nation and revaccination iscompulsory.

In Italy there were 18,213fatalities from smallpox in1919, 12,155 fatalities in1920 and 1,484 fatalitiesfrom smallpox in 1921.

Official reports from thePhilippine Health Serviceshow that a general vacci-nation of the populationwas carried out during theyears 1905 and 1910. Also

85

Statements By Dr. Keen(Cont.)

"In California, from1919 to 1924, there were26,651 cases of smallpox.In Massachusetts, by con-trast, there were in thesame years only 126 cases.

* * * *"The very short, upper

line represents 688 deathsfrom smallpox in the four

Facts Omitted By Dr.Keen (Cont.)

during the ten years from1911 to 1920, there were24,436,889 vaccinationsperformed.

The Philippine HealthService in a communicationaddressed to the CitizensMedical Reference Bureau,dated Manila, September25, 1922, said: "We admitthat our sanitary inspectorshave not been infallible;yet our consciences are clearthat since we had assumedthe full responsibility ofthe health administration,our sanitary personnel havebeen performing theirduties to the best of theirability."

The epidemic had comeand gone before GeneralWood had reached the Is-lands as shown by the factthat the number of fatali-ties had dropped from 47,-368 in 1919 to 7,194 in1920.

Dr. Keen does not men-tion the fact that there area number of eastern statessuch as Maine and Ver-mont, where vaccination isnot made a requirement,where geographical condi-

86

Statements By Dr. Keen(Cont.)

states of New York, NewJ e r s e y , Connecticut andMaryland, which enforcevaccination laws. The longline represents 9137 deaths—thirteen times as many—in the two states of Wash-ington and Oregon, whichhave only one-fourth thepopulation of the fourstates in the first group.

"What the Detroit HealthDepartment Found Afterthe 1924 Epidemic.

"(Of those successfullyv a c c i n a t e d within fiveyears, not one contractedsmallpox.)"

* * * *

Facts Omitted By Dr.Keen (Cont.)

tions are more nearly thesame as Massachusetts, andwhose absence of smallpoxcompares favorably withMassachusetts or any otherstate where it is a require-ment.

Dr. Keen fails to men-tion that Oregon has thesame kind of law making itoptional with local authori-ties whether or not theyshall require vaccination asConnecticut and New Jer-sey. New York only re-quires it in cities of the firstand second classes. Hence,the comparison is not basedupon a group having onekind of law and anothergroup having a differentlaw. Maryland is the onlyone out of the six statesmentioned which makesvaccination a requirementthroughout the state.

Dr. Keen fails to mentionthat the Michigan Depart-ment of Health recom-mends that "The absence ofany history of having hadsmallpox or a successfulvaccination within the pastfive years" be regarded by

87

Statements By Dr. Keen(Cont.)

"Since 1902 the manufac-ture of vaccine lymph hasbeen under Governmentcontrol. Every lot of vac-cine is tested before anycan be sold There havebeen 41 cases of lockjaw inmany millions of vaccina-tions. The most thoroughexamination in each casehas shown that the germ oflockjaw did not exist in thevaccine lymph."

Facts Omitted By Dr.Keen (Cont.)

physicians and health offi-cers as one of the primaryaids in the diagnosis ofsmallpox. (See Journal ofthe Michigan State MedicalSociety, March, 1927.)

Quite naturally therewould be no cases of small-pox among the recentlyvaccinated if physicians areadvised to look to seewhether or not the patienthas been recently vacci-nated before they diagnosethe case.

Dr. Keen does not men-tion the fact as brought outby Dr. M. J. Eosenau in theJournal of the AmericanMedical Association, Janu-ary 22, 1910 that "It wouldbe ideal if the governmentcould guarantee the purityand potency of each pack-age, but to do so would re-quire more than supervi-sion—it would almost meangovernment ownership."

Dr. Keen simply leavesthe reader to infer that thegovernment does guaranteethe purity of the vaccine.

Also Dr. Keen makes nomention of the many ar-ticles like that contained in

88

Statements By Dr. Keen Facts Omitted By Dr.(Cont.) Keen (Cont.)

the Journal of InfectiousDiseases, November, 1927that the utmost care andthe best scientific supervi-sion does not preclude thechance of serious conse-quence due to contaminat-ing bacteria and that thetetanus organism is an op-portunist in any wound andthat tetanus following vac-cination is always to befeared.

(Note:—On the strength of such misleading and er-roneous use of statistics as that referred to above Dr.Keen draws the conclusion that "The experience of cen-turies and the common sense of every community shouldinsist on universal vaccination." The article by Dr. Keenis typical of the nation-wide propaganda in favor ofcompulsory vaccination appearing in newspapers andpopular magazines, which for the most part these news-papers and magazines allow to go uncorrected. H. B. A.)

HOW STATISTICS MAY BE INTERPRETED TOMEAN ANYTHING THE ADVOCATES OF VAC-

CINES WANT THEM TO MEAN.

Extract from Paris Letter in the Journal of the Amer-ican Medical Association, April 16, 1927.

"THE INCONGRUITIES OF HEALTH STATISTICS"Dr Dequidt, formerly head of the Service central du

controle in the ministry of public health but who is nowthe manager of an independent special journal, theMouvement sanitaire, writes that health statistics as atpresent published are not fully reliable. While the law

89

of 1902 demands that the exact causes of deaths be regis-tered, the number of deaths from 'unknown causes' im-mediately increased. From 1911 to 1921, between 5 and6 per cent of the deaths were declared to be due to un-known causes. In 1925, the percentage increased to 26.7.However, in about fifteen departments of France thepercentage is above 50, and in the department of la Cor-reze it is nearly 70. Such figures render the statisticsof these departments practically useless. In a depart-ment adjacent to Paris, the mortality from pulmonarytuberculosis has fallen in five years from fifteen to tenper 10,000 inhabitants, which amounts to a decrease of83 per cent from the general average for France. But,at the same time, the number of deaths, in that samedepartment, from unknown causes has increased from5 per cent to 40 per cent. The question is, How manydeaths from tuberculosis may be included in that figure?One of the most important services that the Office na-tional d'hygiene sociale, recently created, will render willbe the establishment of uniform statistics in the depart-ments of France. At the present time, statistics may bemade to say anything that one wants them to say."

Extract from Article in the Statistical Bulletin of theMetropolitan Life Insurance Company, September, 1928:

A certain statistical office was making a study of theeffect of the great influenza pandemic of 1918 upon themortality from puerperal conditions in the United Statesand in England and Wales. In the former the figuresshow a rise from 6.6 deaths from puerperal causes, per1,000 live births, in 1917, to 9.2 in 1918; in the latter,there actually appeared to have been a slight decline,namely, from 3.9 in 1917 to 3.8 in 1918. On the faceof these figures, the investigator would have to concludethat while influenza was the cause of a big increase inthe mortality of pregnant and parturient women in theUnited States, such was not the case in England. What

90

actually happened was that in the United States alldeaths, in which the return showed both influenza andany puerperal cause, were charged to the latter, whereasin England they were charged to the former.

THE MENACE OF WHOLESALE SERUMIZA-TION.

As the United States Public Health Service AdvocatesSeventeen Visits to the Physician's Office for Inocula-tions as an Alleged Temporary Protection Against FourDiseases, Would a Hundred Visits and a Hundred Inocu-lations Be Necessary for Protection Against All theContagious Diseases When Vaccines or Serums for Allof Them Have Been Discovered and How Often WouldThese Hundred Inoculations Have to Be Repeated; HowWould Anyone Know When the So-called Immunity HadDisappeared, and Would Any Human Being Be Able toSubmit to Such Experimentation and Survive? TheseAre Questions Which Should Be Given Serious Con-sideration Before Making Vaccination a Requirement.Copy of Communication by J. P. Leake, M.D., U. S.Public Health Service, Published in the Journal of theAmerican Medical Association, January 28, 1928, givinga schedule of seventeen visits to the doctor's office forinoculations as an alleged temporary protection against

four diseases.

"AN IMMUNIZATION PROGRAM""To the Editor:—The problem offered by the query

from Pennsylvania (The Journal, January 7, p. 51) rela-tive to immunization of nurses is an interesting one inpractical immunology, and in part, at least, is not infre-quently presented to the physician. Carrying out thesame general order as that given in The Journal, andwith the same number of visits to the physician (seven-teen) , the following scheme would serve to give the most

91

favorable days for observation and for reading the vari-ous reactions:

"Day zero: Schick test on the right upper arm andcontrol on the left upper arm, using the flexor surface2 inches above the fold of the elbow.

"Day 2: (Two days later) : Smallpox vaccination onthe left upper arm over the insertion of the deltoidmuscle (not on the leg).

"Day 3: Dick test on the right forearm, control on theleft forearm, using the flexor surfaces at the juncturesof the upper and middle thirds.

"Day 4: Reading and recording of measurements ofthe reactions to the Dick and Schick tests and smallpoxvaccination. If the Dick test is positive, the first dosefor scarlet fever immunization is given in the upper partof the right arm.

"Day 11: Reading and recording the reaction tosmallpox vaccination; also recording the date of the maxi-mum diameter or redness as observed by the person vac-cinated. The second dose for scarlet fever immunizationis given in the upper part of the right arm.

"Day 18: Third dose for scarlet fever immunizationin the upper part of the right arm.

"Day 25: Fourth dose for scarlet fever immunization,in the upper part of the right arm. By this time, if theinsertion was small and the area kept dry, the smallpoxvaccination site should be entirely healed and the crustoff, even with primary vaccinia.

"Day 28: First dose of typhoid vaccine, in the upperpart of the left arm, below the site of the smallpox vac-cination.

"Day 32: Last scarlet fever dose, in the upper part ofthe right arm.

"Day 35: Second dose, typhoid vaccine, in the upperpart of the left arm.

"Day 39: First dose of diphtheria immunization (ifthe Schick test was positive) in the upper part of theright arm.

92

"Day 42: Last dose of typhoid vaccine, in the upperpart of the left arm.

"Day 46: Second dose of diphtheria immunization, inthe upper part of the right arm.

"Day 52: Second Dick test and control, in the rightand left forearms.

"Day 53: Reading and recording of the Dick test.Last dose of diphtheria immunization, in the upper partof the right arm.

"Seven months after the first Schick test, the secondSchick is given. It is read four days later.

"In case this course of treatment is judged to be over-strenuous, and some of the immunizations are accord-ingly omitted, the succeeding dates would be advanced.Of the different immunizations, that against smallpoxis the most efficacious and should under no circumstancesbe omitted for nurses entering training. Purpuric variolacan easily enter the wards of hospitals undiagnosed, andhas given rise to fatalities in the nursing corps morefrequently than appears in the literature. By allowingadequate observation of the reactions, opportunity shouldalso be given the vaccinating physician to see that hissmallpox vaccine is of full potency; i.e., giving vaccinoid(four to seven day maximum) in at least 50 per centof those vaccinated over ten years before, and a reactionof immunity (one to three day maximum) or typicalvaccinia (eight to fourteen day maximum) in all the re-mainder. A small series of successful primary vaccina-tions, though commonly so taken, is not sufficient evi-dence of full potency of a vaccine if reactions of immunityare to be observed.

"J. P. Leake, M.D., Washington, D. C."Surgeon, U. S. Public Health Service."

93

SERUM CRAZE HAS NOW REACHED THESTAGE WHERE PERSONS ARE BEING INOC-ULATED WITH PREPARATIONS RANGINGFROM EXTRACTS OF NEWSPAPERS TODANDRUFF, BLONDE AND BRUNETTE HAIR

AND HOUSE DUST.

Copy of an Article by Maximilian A. Ramirez and FredWise in the Medical Journal and Record, June 6, 1928.

"Interesting Cases of Protein Sensitization"Cases Reported by Dr. Ramirez

"Case I.—A boy, aged fourteen, gave a history of re-current attacks of asthma for the past five years. Hewas free of symptoms during the interval between at-tacks and was also free during most of the winter months.Symptoms had been more marked from spring to lateautumn. His mother had hay fever when a child, buthad not had any symptoms during the past few years.One uncle had asthma and hay fever.

"Careful investigation revealed the fact that this boy'ssymptoms came on whenever he went to a farm in thecountry, and that during his visit at the farm he in-variably slept in the same bed with an uncle (not theuncle having asthma). Thorough testing with a largevariety of epidermal, food, and pollen extracts, gave anegative result in every case. However, a strongly posi-tive reaction was obtained by testing with an extractof dandruff obtained from the uncle with whom this boyslept at the farm. It is interesting to note that extractsof hair gave only a very small reaction.

"This patient's symptoms completely disappeared byhaving him avoid close contact with this uncle. He hadonly had one or two slight attacks of asthma during thepast year associated with an acute bronchitis.

"Case II.—The patient, a female, aged forty-six, com-plained of attacks of severe sneezing and itching of the

94

eyes every morning, lasting for fifteen or twenty minutes.There was no difficulty in breathing and there were nosymptoms of asthma or hay fever at any other time.

"Investigation revealed that this patient had breakfastin bed every morning, after which she read the morn-ing paper, and that invariably the attacks of sneezingwould come on immediately upon opening the newspaper.An extract of newspaper was prepared for me by theArlington Chemical Company of Yonkers, N. Y., andtests by both the scratch and intradermal methods gavea strongly positive reaction. This patient's symptomscompletely disappeared upon removing exposure to news-paper at that time.

"It was interesting to note that reading at other timesof the day would cause a slight attack, but not the severesymptoms that were produced during early morningexposure. This patient was given a long series of treat-ments against extracts of newspaper, and was suffi-ciently protected so that she could read the paper in themorning as was her usual custom. Protection lasted forabout six months and then symptoms started returningand she is now receiving another series of inoculations.

"In arriving at the conclusion that newspaper orprinter's ink was the cause of this patient's symptoms,we must add that symptoms could be produced andstopped by allowing morning contact and eliminatingmorning contact with the newspaper. Some extract wasprepared of the paper before it had gone to press andalso of printer's ink. Skin tests with these two separateextracts were both negative.

"Sufficient work has not been done on this type of sen-sitization to justify particular comment other than thereport of an extremely interesting clinical history. Ihave recently been told of two other cases of sensitizationto newspaper, therefore, it seems worth while calling thistype of sensitization to general notice.

95

"Case Reported by Dr. Wise and Dr. Ramirez"Case.—A. R., male, aged thirty-six, complained of

periodical swelling of the face lasting from one to twodays, simulating the appearance of angioneurotic edema.Local treatments with lotions and X-ray were of no avail.Thorough testing with various proteins and investiga-tion along sensitization lines proved beyond peradven-ture of a doubt that this patient was hypersensitive tobrunette human hair. Skin test with an extract of bru-nette hair gave a strongly positive reaction. A skin testwith blonde human hair proved negative. It was possibleto show that if this man avoided contact with brunettes,he was free of symptoms and his symptoms returnedupon exposure to brunette hair, particularly, to one per-son. We have been unable to attempt immunization withextract of brunette hair in this case as the patient hadrefused further treatment."

96

Photographic Reproduction of Article in the Journal ofthe American Medical Association, November 7, 1925,Recommending the Preparation by Physicians of Prod-ucts for Inoculation Prepared from House Dust, Street

Dust, Glue, etc.The Propaganda for Reform

IN T H I S DEPARTMENT APPEAR REPORTS OF T H E JOURNAL'SBUREAU OF INVESTIGATION, OF THE COUNCIL ON PHARMACY ANDCHEMISTRY AND OF THE ASSOCIATION LABORATORY, TOGETHERWITH OTHER GENERAL MATERIAL OF AN INFORMATIVE NATURE

HORSE DUNG ALLERGEN-SQUIBB, HOUSE DUSTALLERGEN-SQUIBB, LE PAGE'S GLUE ALLER-

GEN-SQUIBB AND STREET DUST ALLER-GEN-SQUIBB NOT ACCEPTABLE

FOR N. N. R.Report of the Council on Pharmacy and Chemistry

The Council has authorized publication of the followingreport. W. A. PUCKNER, Secretary.

Among the allergic protein preparations of E. R. Squibb& Sons, offered as a means of determining specific hypersen-sitiveness, are the following: Horse Dung Allergen-Squibb,Stated to be the protein from the dung of the horse; HouseDust Allergen-Squibb, stated to be the protein from ordi-nary house dust; Le Page's Glue Allergen-Squibb, the proteinisolated from "Le Page's Glue"; Street Dust Allergen-Squibb,stated to be the protein from ordinary street dust.

The composition of house dust varies with the contents ofdifferent houses and with their location; therefore the proteinobtained from house dust must vary widely. Similarly, thecomposition of street dust is dependent on the material thatgoes to make up the dust on streets in different localities.Le Page's Glue is a product of unstandardized composition;hence there is no guarantee the protein isolated fromLe Page's glue is uniform. As the composition of horse dung,house dust, glue and street dust is indefinite, it is irrationalto test the hypersensitivity of a patient by means of a stockpreparation; instead, an extract should be prepared, frommaterial which is likely to correspond with that to whichthe patient is sensitive.

In consideration of their indefinite composition, the Councilfinds Horse Dung Allergen-Squibb, House ,Dust Allergen-Squibb, Le, Page's Glue Allergen-Squibb. and Street DustAllergen-Squibb unacceptable for New and NonofficialRemedies. 97

PART IIIThe Vaccination Requirement, Involving as It

Does, Wholesale Inoculation of the Population oran Important Part Thereof, Constitutes A MoreSerious Menace to Public Health Than Smallpox.

"With the greatest care . . . certain risks arepresent, and so it is unwise for the physician toforce the operation upon those who are unwilling,or to give assurances of absolute harmlessness."—George Dock, M.D., in the chapter on "Vaccina-tion," in "Modern Medicine," by Sir William Osier,M.D., 1913 edition, Vol. 1, p. 848.

MORE THAN 10,000 SOLDIERS WERE MADESICK BY VACCINATION.

The Report of the Surgeon General of the Army, 1919,Vol. 1, p. XXXVIII, gives the number of Admissions toHospitals during the year 1918 on account of vaccinia,the disease caused by vaccination, as 10,830.

The Report of the Surgeon General of the Army, 1918gives the number of Admissions to Hospitals during theyear 1917 on account of vaccinia and typhoid vaccinationcombined as 19,608.

98

ARTICLES IN MEDICAL JOURNALS REFERTO LOCKJAW (OR TETANUS) FOLLOWINGVACCINATION AS ALWAYS TO BE FEARED

AND AN EVER PRESENT POSSIBILITY.

Extract from Article by Stanley Thomas, from the La-boratory of Bacteriology, Lehigh University, Bethlehem,Pennsylvania, Published in the Journal of Infectious

Diseases, November, 1927."The dangers involved in its use [vaccine virus], how-

ever, cannot be denied. Its preparation, while conductedwith the utmost care and under the best scientific super-vision does not preclude the chance of serious conse-quence due to contaminating bacteria. The staphylococ-cus present in the ordinary commercial vaccine virus (inspite of the glycerol and phenol preservative) may notbe in itself pathogenic but by aiding anaerobic conditionsit certainly can, and does, prepare a favorable field forthe growth and toxin development of the tetanus bacillus.Although not in the vaccine itself, this organism is anopportunist in any wound, and tetanus following vac-cination is always to be feared.

* * *"Recently it has been observed in Holland, Switzerland

and elsewhere that the incidence of poliomyelitis andencephalitis apparently increased following vaccinationagainst smallpox. In the light of Levaditi's work show-ing the similarity between the virus of vaccinia and thatof encephalitis and as some doubt as to the safety ofthe neuro-vaccine has been suggested by Camus, Brunetand others, considerable skepticism would probably haveto be overcome by its users. Proof of the safety of anyproduct rests with its proponents. In the recent pastsyphilis has received considerable attention as a possiblecongener of vaccination. Papers by Winkler, Kolb,Krapelin and Plant, and others have controverted thistheory and the same line of arguments may be used in

99

defence of neurovaccine if it should prove to be an ef-ficacious prophylactic against smallpox."Extract from Editorial in the Journal of the American

Medical Association, May 12, 1928."Among the excuses that are offered against com-

pulsory vaccination is the alleged occurrence of post-vaccination tetanus. True, tetanus has been transmittedby infected vaccine. However, extensive tests at theHygienic Laboratory of the U. S. Public Health Servicehave failed to demonstrate the presence of the organismin modern commercial vaccine. The tetanus bacillus wasdetected more than a decade ago on 'bone point' scari-fiers by McCoy and Bengtson; and this organism has alsobeen found on bunion pads that were used as vaccina-tion dressings. The examination of other commercialdressings, of needles, of capillary tubes, and of mild anti-septics occasionally used on vaccination lesions has failedto reveal the presence of B. tetani. Consequently thegovernment experts conclude that the occasional casesof postvaccination tetanus which are not explainable onthe basis of the two positive observations mentioned mustbe due to the presence of the specific organism at the localsite at the time of vaccination, or to its subsequent intro-duction.

"The ever present possibility of accidental contamina-tion because of the ubiquity of the tetanus bacillus callsfor continued vigilance."Extract from Editorial in the New York Medical Jour-nal, December 11, 1915, Referring to Vaccination Wounds

as Unduly Prone to Tetanus."Tragic events, especially if preventable in any degree,

which jeopardize a procedure of such vast importance,should receive most earnest attention. Tetanus follow-ing vaccination is an event of just this character. Allavailable evidence, both clinical and experimental, justi-fies the belief that infections of this kind are not due tothe vaccine virus per se, but occur subsequently, and are

100

attributable to later contaminations of the vaccinationwound. In all justice, however, it must be admitted thatexperience also teaches, despite all contrary evidence,that vaccination wounds, at least in children of certainages, are unduly prone to such infections. The reasonsare not apparent."

Extract from Editorial Entitled "Pure Vaccine Virus"in the New York Medical Journal, New York, July 17,

1915.p. 149. "The next step, after cleansing the patient,

was the investigation of the virus. It was found thatbacteria of many sorts were present constantly. Theattempt was then made to decrease the number, and ex-periments showed that mixing the virus with concen-trated glycerine and keeping it in the refrigerator fortwo or three months caused a great reduction. Thespores that might be present, however, were not affected,while the activity of the virus was impaired considerably.This method of preparation, nevertheless, is what is com-monly employed today; infections are not numerous, butthe percentage of 'takes' may not be as great."

BIBLIOGRAPHY OP ARTICLES IN MEDICALAND PUBLIC HEALTH JOURNALS REFER-RING TO CASES OF LOCKJAW (OR TETANUS)

FOLLOWING VACCINATION.

Armstrong, Charles: Tetanus Following VaccinationAgainst Smallpox and Its Prevention, "Public Health Re-ports" December 16, 1927. (Refers to 98 cases of tetanusfollowing vaccination "over a period of several years.")

Armstrong, Charles: Tetanus Following the Use ofBunion Pads as a Vaccination Dressing, "Public HealthReports" June 26, 1925. (Refers to 11 cases of tetanusfollowing vaccination, of which 9 cases were fatal).

Sir William Osier, M.D. in "Principles and Practice ofMedicine," 1924 Edition. Dr. Osier says: "McFarland

101

collected 95 cases, practically all American. Sixty-threeoccurred in 1901, a majority of which could be tracedto one source of supply, in which R. W. Wilson demon-strated the tetanus bacillus. Most of the cases occurredabout Philadelphia. Since that date very few cases havebeen reported. The occurrence of this complication em-phasizes the necessity of the most scrupulous care in thepreparation of the virus, as the tetanus bacillus is almostconstantly present in the intestines of cattle."Anderson, John F.: Post-Vaccination Tetanus, "PublicHealth Reports," July 16, 1915.

Photographic extract from a page advertisement published innumerous medical and public health journals including the follow-ing: American Medicine, August, 1927; Medical Review of Re-views, August, 1927; American Journal of Public Health, Septem-ber, 1927; Medical Journal and Record, August 17, 1927; The Jour-nal Lancet, August 15, 1927 and September 1, 1927; The CanadianMedical Association Journal, September, 1927, and The Journal ofthe American Osteopathic Association, September, 1927.

Vaccinationcomplicationsyield to thistreatment

WHERE the vesicles inflame anddeep excavated ulcers result.

The bad arm does not manifest untilafter "the take," so that the antiseptic

102

SPECIFIC CASES OF FATALITIES FOLLOW-ING VACCINATION. THE FOLLOWING NEWSITEMS ARE TYPICAL OF THE CLIPPINGS RE-CEIVED EACH YEAR PRIOR TO THE OPENINGOF THE SCHOOLS. HEALTH BOARDS IN THEUNITED STATES ARE NOT REQUIRED TOMAKE PUBLIC THE ACTUAL NUMBER OFSUCH CASES WHICH OCCUR. HENCE, WHILEONE NEWS ITEM MAY OVER-EMPHASIZETHE PART PLAYED BY VACCINATION THEMAJORITY OF CASES WOULD NOT BE RE-

PORTED AT ALL,

News Item from the Scranton (Pa.) Times, September25, 1928.

CHILD DIES FROM LOCKJAW FOLLOWING VAC-CINATION

Wilkes-Barre, Sept. 25 (AP).—Mary Woytkwycz, six,died at a local hospital last night of lockjaw. The littlegirl started to school on Sept. 4 and was vaccinated by aphysician. Infection followed and on Friday her jawslocked. Several hundred thousand units of tetanus anti-toxin serum were used in efforts to save the child.

News Item from the Washington (Pa.) Observer, Sep-tember 26, 1928.

VACCINATION TETANUS FATAL TO 2 CHILDREN.York, Sept. 25.—Lockjaw, said to have developed from

vaccination, today caused the second death of a child inYork county in the last 36 hours.

Fairy Crone, 6, of York, died today, while Clair Draw-baugh, 7, of Dover, near here died late Sunday.

Both children had recently entered school and werevaccinated in compliance with the law. Tetanus set insuddenly in both cases and the children were in seriouscondition when physicians were called.

It was said no investigation is planned.103

Marked Photographic Reprint of Extracts From DeathCertificate of Dorothy Schmoyer, Allentown, Pa., WhoDied July 27, 1927 As a Result of Vaccination Prepara-

tory to Attending School.

104

News Item from the Philadelphia Record, July 28, 1927.Allentown, Pa. July 27—Dorothy, 5-year-oid daughter

of David Schmoyer, of Alburtis, died in the AllentownHospital today of tetanus. She was admitted yesterdayand, although surgeons made every effort to save thechild's life, their efforts were in vain. The little girlwas vaccinated several days ago, preparatory to attend-ing school in the fall.(Note:—The death certificate of Dorothy Schmoyerspecifically mentions Vaccination as a contributory causeof death. H. B. A.)News Item from the Scranton Republican (Pa.), October

5, 1927.Wilkes-Barre, Pa. Oct. 4. (AP).—Frank Shukowski,

[Franciszek Szumowski] aged 7, of Georgetown, a sub-urb, died at a hospital tonight of lockjaw. The boy wasindirectly a victim of a vaccination. He was vaccinatedthree weeks ago to enable him to go to school. Last weekin playing with other boys, the scab was knocked offand the wound became infected and tetanus set in.(Note:—The death certificate of Franciszek Szumowskigives Tetanus as the cause of death. No contributorycause is mentioned. H. B. A.)News Item from the Philadelphia Record (Pa.), Novem-

ber 3, 1927.Death Follows Vaccination. Special to "the Record."

Allentown, Pa. Nov. 2.—Margaret, 6-year-old daughterof John Montgomery, died today at the Allentown Hospi-tal of lockjaw.(Note:—The cause of death of Margaret Montgomery asstated in the death certificate was "Tetanus—Contribu-tory—Vaccination Against Smallpox."—H. B. A.)News Item from the Newburgh, N. Y. News, July 7, 1926.

Peekskill, July 7—Geraldine Creamer, aged 4 years,daughter of John and Mary Quinn Creamer, died inPeekskill Hospital from lockjaw. The girl had been vac-cinated on June 20 and it is believed that the lockjaw

105

germs entered the body through a vaccination woundwhile she was playing in the garden soil in the rear ofher home, 611 John Street.List of Fatalities Following Vaccination Contained in aReview of "Pittsburgh's Vaccination Scourge of 1924"Embodying the Results of a Special Investigation Un-

dertaken by the "Pittsburgh Health Club."Arthur Santoro, age five years, 1509 Belasco Avenue,

(Beechview), Pittsburgh, Pa., vaccinated at school Octo-ber 1, 1924, died October 17, 1924.

Blanche Jarmalowski, age ten months, 2741 MulberryStreet, Pittsburgh, Pa., vaccinated July 14, 1924, diedJuly 31, 1924.

Minnie A. Hill, 1000 Greenfield Avenue, Pittsburgh,Pa., vaccinated at the Court House Clinic, July 23, 1924,died August 8, 1924.

Agnes Bik, age two years and five months, 955 HerronAvenue, Pittsburgh, Pa., vaccinated about June 25, 1924,at Montefiore Hospital, died August 24, 1924.

Helen Schamming, age seven years, Grant Street(Wall) Pittsburgh, Pa., vaccinated about July 15, 1924,died August 16, 1924.

Antoinette Oleniacz, age one year and six months, 5112Carnegie Avenue, Pittsburgh, Pa., vaccinated July 10,1924, died July 28, 1924.

Hilda Fleishauer, age twelve years, 1564 Westmore-land Street, Pittsburgh, Pa., revaccinated July 9, 1924,died August 5, 1924.

Mary Florence McGovern, age three years and eightmonths, 529 North Euclid Avenue, Pittsburgh, Pa., vac-cinated July 21, 1924, at Lincoln School, died August 23,1924.

Ten months-old son, Victor, of Mrs. Robert Kozlowski,3114 Brereton Avenue, Pittsburgh, Pa., died July 22,1924.

Alice Welsh, age nineteen years, 2411 Westmar Street,North Side Pittsburgh, Pa., vaccinated July 8, 1924, diedJuly 14, 1924.

106

HEALTH OFFICIAL ADMITS THREE PROBA-BLE AND A FOURTH POSSIBLE FATAL IN-FECTION IN PITTSBURGH FOLLOWING VAC-

CINATION.

Extract from Article Entitled "The 1924 Smallpox andVaccination Situation in the City of Pittsburgh" by R. G.Burns, M.D., Superintendent Bureau of Infectious Dis-eases and T. F. Moore, M.D., School Physician, Publishedin the Pittsburgh Medical Bulletin, Issued by the Alle-

gheny County Medical Society, August 8, 1925:"With so many vaccinations being performed on peo-

ple living and working in places where the sanitary con-ditions are far from good, and who have practically noknowledge of personal hygiene, it is to be noted thatvery few serious and fatal secondary infections happened;three probable and a fourth possible case of this kinddid occur. Rumors of all kinds came into the Depart-ment of Public Health with claims of very many deathsdue to vaccination, and in all cases a thorough investiga-tion was made by a physician, and, except as stated, theserumors were found to be false."

Extract from a Pamphlet Entitled "Vaccination Resultsin New York State in 1914 Being a Study of Forty-nineCases With Portraits and Certain Conclusions," byJames A. Loyster, Cazenovia, N. Y., in Memory of HisSon Lewis Freeborn Loyster Who Died September 21,

1914, as a Sequence of Vaccination.p. 36-37. "As a result of the investigation of over fifty

vaccination disasters and the almost constant study ofvaccination literature for several months, it seems thatthe following conclusions are warranted and should befrankly stated:

"(1) Vaccination has been the cause, directly or indi-rectly, of the death of at least fifty children in New Yorkstate in 1914. The record herewith printed gives only

107

the cases occurring in rural or suburban districts.Neither the time nor means were at hand to make a can-vass of the cities. While only 27 fatalities are here re-corded, some of which are not clearly proven, it is be-lieved that were the figures from the cities obtainablepossible errors in the list would be more than offset andenough reported to swell the total to the number given.

"(2) In addition to the deaths an appalling trail ofillness has followed vaccination. It has been entirely be-yond the scope of this publication to print even a partialrecord of these cases.

"(3) The cost in illness and destruction of child lifeis entirely out of proportion to the amount of protectionagainst smallpox that is attained or needed. There werebut three deaths from smallpox in the entire state, includ-ing Greater New York, in 1914. In one rural districttwenty miles in diameter, where four children died fromvaccination, there has not been a single case of smallpoxwithin the memory of any person now living."

SAYS DEATHS FROM VACCINATION OUT-NUMBER THOSE FROM SMALLPOX.

Extract from Book Entitled, "The Vaccination Ques-tion," by C. Killick Millard, M.D., Medical Officer of

Health for Leicester, England, 1914.p. 22. "It cannot be denied that vaccination causes,

in the aggregate, very considerable injury to health,most of it only temporary, but some permanent. It istrue that the deaths certified as due to vaccination areless numerous now than they used to be, but some deathsstill occur every year. . . . During the last decade thedeaths from vaccinia have several times outnumberedthose from smallpox, whilst if we have regard to theamount of ill-health caused by the two diseases (andputting aside for the moment the question of the allegedeffect of vaccination in lessening smallpox) it looks as

108

if vaccinia were becoming, so far as the community isconcerned, the more serious disease of the two . . . . "

DISCLOSURES OF SERIOUS ILLNESS ANDFATALITIES RESULTING FROM VACCINA-TION CONTAINED IN THE REPORTS OF TWOOFFICIAL INVESTIGATIONS JUST ISSUED.

Report of Committee on Vaccination in England Com-pares the Dangers from Vaccination to Dangers from

Smallpox.

Extracts from Report of the Committee on VaccinationPresented by the Minister of Health to Parliament by

Command of His Majesty, July, 1928.p. 87.

'If London be excluded, the prevailing type of small-pox in England and Wales has been mild since the be-ginning of the century. Witnesses have appeared beforethe Committee who have held that there are now twodistinct types of smallpox—the mild and the severe.The Committee are not in a position to determine whetheror not these types constitute separate entities, or aremerely variations of one disease, or if the mild type andthe severe may. become transformed the one into theother. Whether or not these forms of smallpox aresimply variants or are separate entities, there is universalagreement that recent successful vaccination protectsagainst both. Witnesses affirmed that the bodily dis-turbance and discomfort produced by the vaccinationof an adult is as great, if not greater, than the disturb-ance and discomfort produced by an attack of smallpoxof the mild type.

"The deaths from smallpox and from vaccinia as givenin the Registrar-General's Returns during the last 10years have been as follows:—

109

TotalNumber of Deaths from

Year Smallpox Vaccinia1926 18 11925 9 31924 13 11923 7 81922 27 41921 5 31920 30 91919 28 11918 2 31917 3 6

"It is also true, as hereinafter recorded, that 93 casesof post-vaccinal nervous disease with 51 deaths havebeen reported in this country between November, 1922,and the end of September, 1927, during which periodapproximately 2,000,000 vaccinations and revaccinationswere performed at the cost of the rates; that 124 caseswith 38 deaths have been reported from Holland between1923 and August, 1927, and that a few similar cases havebeen reported in other countries. Nine English casesand one Dutch were under one year of age."

LEAGUE OF NATIONS FINDS THAT ENCEPH-ALITIS FOLLOWING VACCINATION HAS

BECOME A PROBLEM OF ITSELF.

Extracts from the Report of the Commission on Small-pox and Vaccination of the Health Organization of the

League of Nations, Geneva, August 27, 1928."5 The post-vaccinal encephalitis with which we are

dealing has become a problem of itself mainly in conse-quence of the events of the last few years in the Nether-lands and England and Wales. In each of these coun-tries the cases which have occurred have been sufficiently

110

numerous and similar to require them to be consideredcollectively. Their occurrence has led to the realizationthat a new, or at least a previously unsuspected or un-recognized, risk attaches to the practice of vaccination.This risk, when taken at its maximum value, is onlyminute in proportion to the vast numbers of normal vac-cinations to which the cases of post-vaccinal encephalitiscorrespond, and it is easy to exaggerate its importance.Nevertheless, it is one whose existence, in these two coun-tries at any rate, has to be recognised, and its meaning-considered. In fact, it has in the Netherlands been con-sidered of sufficient gravity to cause the temporary sus-pension of the administrative measures by which thevaccination of children is secured, while in England thesubject has already received the attention of two expertCommittees appointed by the Ministry of Health, thesecond of which (the Rolleston Committee) has now pre-sented a comprehensive report, embodying the informa-tion and conclusions arrived at by the first or AndrewesCommittee, whose work was described to this Commis-sion in 1926.

"6. In the Netherlands, 139 cases of disease of thecentral nervous system following vaccination were de-scribed during 1923 to 1927, of which 41 died. In Eng-land and Wales, taking the arbitrary periods dealt withrespectively by the Andrewes and Rolleston Committees,62 cases with 36 deaths occurred between November 14th,1922, and November 1st, 1923, while a further group of40 cases occurred between January 1st, 1926, andSeptember 30th, 1927. Of these 40 cases, however, 15were excluded by the Rolleston Committee on account oftheir doubtful nature, leaving for consideration 25 cases,of which 12 died, in the second period. The two com-bined, on this basis, gave a total of 87, of which 48 werefatal, for England and Wales during the two periodsunder investigation by these Committees.

111

"17. Conclusions: The facts and considerations whichhave been before the Smallpox and Vaccination Commis-sion at its present session seem to permit the followingconclusions:

"(a) The foremost of these is the rarity of cases ofpost-vaccinal encephalitis, even in the countries speciallyaffected, by contrast with the number of vaccinations.We are in fact concerned with a minimal proportion ofthem.

"(b) Apparently the matter is not one in which merecoincidence between vaccination and encephalitis can beinvoked; in other words, we are not dealing with a merelyfortuitous occurrence.

"(c) In our present state of knowledge we must con-clude that post-vaccinal encephalitis is a different dis-ease from encephalitis lethargica. The conditions underwhich post-vaccinal encephalitis has manifested itself inthe Netherlands and in England and Wales tend to showthat children between 3 and 13 years of age are par-ticularly susceptible, whilst infancy and adult ages arealmost wholly exempt. All observations point to the con-clusion that the appearance of encephalitis is not con-nected either with particular strains of lymph or withparticular accidents of lymph preparation.

" (d) Passing to the aetiologico-pathological side of theproblem, it would appear in our present state of knowl-edge that the virus of vaccinia of itself cannot be con-sidered responsible for the supervention of encephalitis.Rather it has to be supposed that some unknown factorexists—perhaps bacterial or a filter-passing virus, or alatent virus—which, by means of a reciprocal reaction,determines the occurrence of the accidents in question."

112

NEW AND STARTLING DANGERS.—RECENTREPORTS OF CASES OF ENCEPHALITIS FOL-

LOWING VACCINATION.

Extract from Report of J. A. Putto, M.D., of the Nether-lands in the International Health Year Book, 1925,Issued by the Health Organization of the League of

Nations.p. 354. "Post-vaccinal Encephalitis. As in 1924, a cer-

tain number of cases of post-vaccinal encephalitis wereregistered in 1925. Dr. van Bouwdijk Bastiaanse wasthe first to draw attention to the existence of this diseasein the Netherlands. He submitted the results of his in-vestigation to the Department of Public Health. He wasthen instructed, together with Dr. Terburgh, the Inspec-tor-General of Public Health, and Dr. Bijl, the head ofthe Bacteriological Section of the Central Public HealthLaboratory, to undertake an exhaustive enquiry, the re-sults of which were discussed at the Conference heldearly in January, 1926 at The Hague, under the chair-manship of Professor Ricardo Jorge. On the advice ofDr. van Bouwdijk Bastiaanse, the English methods wereadopted in 1926, and Professor Aldershoff, M.D., Direc-tor of the State Serological Institute, prepared a serumfor use in cases of post-vaccinal encephalitis."

Extract from Article on, "Smallpox and Vaccination,"in The New International Year Book for 1926.

"Beginning some time in 1925, physicians in Holland,Germany and Switzerland reported to the proper healthauthorities that scattered cases of cerebral disease haddeveloped during the first week after vaccination, andthat contaminated lymph could not be accused. The totalnumber was not large, not over fifty, and was scatteredover a very wide area. . . . Little chance was given fora study of the disease. Medical societies and health

113

boards began an investigation in the affected localities,and, pending reports, orders were issued to dilute thelymph considerably more than usual and to refrain, forthe time being, from vaccinating all ailing and delicatechildren.

"Thus far, no reports on these cases seem to havebeen made in the countries but in April, 1926, the atten-tion of the ministry of health of Great Britain was calledto the subject. Although no cases had been reportedfor that country, an investigation of past records wasordered. The report of this investigation is found in theLancet for September 4. All deaths following vaccina-tion were subjected to inquiry for years back. It wasfound that during the past 14 years 7 such cases hadcome to light in Great Britain. These are reported infull in the British Journal of Experimental Pathologyfor October. . . . A crucial point was the possibility thatthis affection may complicate smallpox; in such case thereis the greater likelihood of it as a result of vaccina-tion. . ..

"For the past ten years, lethargic encephalitis, or'Sleeping sickness,' has appeared in most of the coun-tries of the world, and is practically a new disease. This,in the opinion of many, indicates a lowered resistance ofthe brain tissues to certain infections. If the brain ofcivilized man is becoming more vulnerable in this respect,it may throw a little light on these cases."

Extract from Communication by Netherlands Corres-pondent, Journal of the American Medical Association,

January 22, 1927."Postvaccinal Encephalitis"

"The publication of the reports of several cases inwhich encephalitis is alleged to have been the result ofsmallpox vaccination has aroused considerable interest.The statistics of 1924 and 1925 make reference to thirty-five cases, fifteen of which resulted fatally. It should be

114

emphasized that these thirty-five cases developed out ofa total of more than 250,000 vaccinations, which makesthe percentage of cases very small indeed. Nevertheless,the observations prove that vaccination is not absolutelywithout danger and furnish arguments to those who op-pose making it obligatory. Dr. Terburgh, the generalinspector of public health, has addressed a circular tothe medical profession requesting that information besent to him in regard to any untoward consequences ofsmallpox vaccination be they never so slight, in orderthat statistics may be secured that will be valuable inconnection with this question which is of great import-ance for social medicine."

Extracts from London Letter to the American MedicalAssociation, Published in the Journal of the American

Medical Association, August 25, 1928.

"In the Section of Pathology and Bacteriology, Pro-fessor Mclntosh called attention to the fact that clinicalaccounts of smallpox contain frequent references to theappearance of symptoms which suggest involvement ofthe nervous system. In recent years a new type of en-cephalitis had been observed in relation to vaccination.Professor Turnbull had noticed the occurrence of thisparticular type so long ago as 1912. Altogether, somehundreds of similar cases had now been reported inEurope. Postvaccinal encephalitis bore a constant rela-tion to vaccination, as regards both time and place. Thecondition manifested itself on the average from ten tofourteen days after vaccination as headache, deliriumparesis, and ultimately coma and death in fatal cases.Some doubt had existed whether or not the conditionwas vaccinal in origin. Professor Mclntosh thought thatthe vaccine virus was the causal agent, and presenteda body of evidence in favor of this view."

115

MEDICAL AUTHORITIES CONCEDE THATVACCINATION MAY LIGHT UP OR TRANSMIT

VARIOUS DISEASES.

Extract from "A Layman's Handbook of Medicine," byRichard C. Cabot, M.D., 1916.

p. 403. "Certain things ought to be said about vac-cination, because questions are often raised as to thedangers of the process, arid as to the degree of protec-tion which it gives. In the first place, the reason thatthe antivaccinationists' propaganda gets so much poweris that people are afraid of having some disease put intotheir blood. I suppose the disease that they are afraid ofis syphilis. I do not know of any well-authenticated casewhere a person has had a syphilitic lesion on the site ofa vaccination, but one cannot deny the possibility of sucha lesion provided vaccination were done with criminalcarelessness. The other thing that bothers people isthe fact that vaccination sores get septic, sometimes whenthe vaccination is clumsily done, and sometimes whenit is correctly done. We need not necessarily blame thedoctor because the patient has a bad arm. In spite ofall precautions, if the patient is in bad condition, anybreak in the skin may become septic."Extract from Article by H. E. Hasseltine, Published in"Public Health Reports," the Weekly Bulletin of theUnited States Public Health Service, January 5, 1923:

"After observing this small series of cases, one can-not escape the conviction that vaccinia had somethingto do with the appearance of the leprous manifestationsin the successfully vaccinated cases. This phenomenonmay also explain some of the opinions held by the olderHawaiian laity, that in many cases vaccination was thecause, or at least the exciting cause, of leprosy. Duringthe days of arm-to-arm vaccination the possibility of thespread of leprosy by this procedure must be admitted.It is more probable, however, that the vaccination servedto bring to light latent or unrecognized leprosy."

116

Extracts from Book Entitled "The Principles and Prac-tice of Medicine" by The Late Sir William Osier, M.D.,Fellow of the Royal College of Physicians, London;Regius Professor of Medicine, Oxford University; Hon-orary Professor of Medicine, Johns Hopkins University,Baltimore; Formerly Professor of the Institute of Medi-cine, McGill University, Montreal, and Professor ofClinical Medicine in the University of Pennsylvania,Philadelphia, and Thomas McCrae, M.D., Professor ofMedicine, Jefferson Medical College, Philadelphia; Phy-sician to the Jefferson and Pennsylvania Hospitals,Philadelphia, and Formerly Associate Professor ofMedicine, Johns Hopkins University, Ninth Edition, 1924.

p. 338. "Generalized Vaccinia.—It is not uncommonto see vesicles in the vicinity of the primary sore. Lesscommon is a true generalized pustular rash, developingin different parts of the body, often beginning about thewrists and on the back. The secondary pocks may con-tinue to make their appearance for five or six weeksafter vaccination. In children the disease may provefatal. They may be most abundant on the vaccinatedlimb, and occur usually about the eighth to the tenthday.

"(c) Complications.—In unhealthy subjects, or as aresult of uncleanliness, or sometimes injury, the vesiclesinflame and deep excavated ulcers result. Sloughing anddeep cellulitis may follow. In debilitated children theremay be a purpuric rash with this. Acland thus arrangesthe dates at which the possible eruptions and complica-tions may be looked for:

"1 . During the first three days: Erythema, urticaria;vesicular and bullous eruptions; invaccinated erysipelas.

"2. After the third day and until the pock reachesmaturity; Urticaria; lichen urticatus, erythema multi-forme; accidental erysipelas.

"3. About the end of the first week: Generalized vac-cinia; impetigo; vaccinal ulceration; glandular abscess;septic infections; gangrene."

117

EPIDEMICS OF FOOT-AND-MOUTH DISEASEOF 1902 AND 1908 AMONG CATTLE TRACEDBY UNITED STATES DEPARTMENT OF AGRI-

CULTURE TO VACCINE VIRUS.

Declaration by the late Senator Dolliver, of Iowa, inthe United States Senate, February 25, 1909.

"The Department of Agriculture in its effort to sup-press the foot-and-mouth disease traced that disease tovirus imported into the United States by our manu-facturing chemists and sold to our people. The investi-gations revealed that this virus, used upon calves in theDistrict of Columbia, communicated the foot-and-mouthdisease to them. The investigations also showed thatthese diseases are almost universal in the countries ofEurope, in Asia, Japan, the Philippine Islands, and inpractically all the countries from which we import ourmedical viruses, including the vaccine for smallpox andkindred diseases."

Copy of Conclusions Contained in Circular 147, Issuedby the Bureau of Animal Industry of the United StatesDepartment of Agriculture, June 16, 1909, Giving theFindings of Drs. John R. Mohler and Milton J. Rosenauin an Investigation Conducted by them of "The Originof the 1908 Outbreak of Foot-and-Mouth Disease in the

United States.""(1) The recent outbreak of foot-and-mouth disease

in this country started from some calves used to propa-gate vaccine virus.

" (2) The vaccine virus used on these calves has beenproved to contain the infection of foot-and-mouth disease.

"(3) The outbreaks of foot-and-mouth disease in1902-3 probably had a similar origin.

" (4) It is probable that the foot-and-mouth infectiongot into the vaccine virus in some foreign country wherethe disease prevailed, and was introduced into the United

118

States through the importation of this contaminatedvaccine.

"(5) The symbiosis between the infections of vac-cinia and foot-and-mouth disease is especially interesting.Animals vaccinated with the mixed virus, as a rule, showonly the lesions of one of these diseases, namely, vaccinia;nevertheless the infectious principle of foot-and-mouthdisease remains in the vaccinal eruption."

Extract from "Farmers' Bulletin" No. 666, by John R.Mohler, V. M.D., Assistant Chief, Bureau of AnimalIndustry, in an Article Entitled "Foot-And-MouthDisease," published by the United States Department of

Agriculture, April 22, 1915.p. 15. "Foot-and-mouth disease is primarily and

principally a disease of cattle; secondarily and casually,a disease of man. . . . It is doubtful whether the dis-ease can be transmitted to man by cutaneous or subcu-taneous inoculation, though it is probable that the infec-tion may be communicated if the virus directly entersthe blood through wounds of any kind.... The symptomsin man resemble those observed in animals."

HOW VACCINE VIRUS IS PREPAREDMETHOD USED IN ENGLAND

Extract from "Epidemiology and Public Health," Vol-ume 1, 1922, by Dr. Victor C. Vaughan, former President

of the American Medical Association.p. 199. "At the present time the bovine virus is used

in most countries. However, Shera, writing in 1918,gives the following method for the preparation of vac-cine employed in England.

" 'Female calves from two to four months old are taken.They are sometimes tested with tuberculin and alwayskept under observation for a few days, then clipped andthoroughly cleansed. The belly is completely shaved and

119

prepared as for operation. About 100 small scarifica-tions are now made under strict asepsis. Slight bleed-ing occurs, which is mopped up. The virus, which isobtained from a human case and preserved on sterilebone "slips," is inoculated on each area. The lesionsare allowed to dry. Sterile gauze then covers the lesions.The animals are kept clean, excreta being promptly re-moved. The animal must not kick itself. Within 48hours a reaction occurs, and the animal is killed aftersix days. Strict asepsis, as for operation, is observed.The field of papules is cleansed and curetted. Aftercurettage serum exudes. "Slips" are charged with this,and the pulpy exudate is made up thus:

Glycerin 50%Water 49%Phenol 1%

"The glycerin pulp is left standing three to fourweeks, as it is always infected with bacteria. At theend of this time these should have undergone dissolution.The pulp is then triturated and put up in capillary tubes.The vaccine is tested bacteriologically and not put uptill sterile. Also it is tested for tetanus and its potencyestimated by the type of vesicle it produces.' "

METHOD RECOMMENDED BY DR. PARK.

Extract from "Epidemiology and Public Health," Vol-ume 1, 1922, by Dr. Victor C. Vaughan, former President

of the American Medical Association.p. 199. "According to Park, the most reliable seed

Virus is what he calls the human-calf-rabbit virus. Crustsfrom healthy children are collected on the nineteenthday after vaccination and worked into an emulsion withsterile water. With this material an area of about sixinches square on the prepared abdomen of a calf is inocu-

120

lated, while the remainder is planted with the ordinary-vaccine. The virus from the limited space is separately-collected and after being glycerinated is diluted with12-1/2 parts of a normal salt solution and planted on theproperly prepared, shaved skin of the backs of rabbits.The pulp from the rabbit vaccination is used for vac-cinating calves. Usually within 24 hours after vaccina-tion the scratches become pink, within another dayslightly raised and papular, and within from four to sixdays typical vaccinia vesicles are developed. In remov-ing the material the scarified surface is washed withwarm water and soap and then thoroughly with sterilewater. The crusts are carefully picked off with sterileforceps and the contents of the vesicles removed witha curette. The mass of material thus obtained is placed insterile beakers or tubes and treated with a mixture ofwater, glycerin, and carbolic acid, as given above in theEnglish formula. According to Park, one calf shouldyield about ten grams of pulp—enough to vaccinate about1,500 people. The efficiency of the virus is determinedby inoculation on the shaved backs of rabbits. Dilu-tions of the virus, 1 to 10 and 1 to 100, are made, and aproper virus should produce vesicles on the rabbit in adilution of 1 to 500 at least. The number of bacteria inthe glycerinated preparation can be determined by theplate method. Usually, practically all bacteria disap-pear from the glycerinated preparation within a month.However, in all instances white mice should be inocu-lated in order to prove the absence of the tetanusbacillus."

121

NO PHYSICIAN OR HEALTH OFFICER CANBE ABSOLUTELY CERTAIN THAT ANYBATCH OF VACCINE VIRUS IS FREE FROM

IMPURITIES.

Declaration by Dr. M. J. Rosenau in an article entitled"The Federal Control of Serums, Vaccines, Etc." in theJournal of the American Medical Association, January

22, 1910.

p. 249. "The government does not guarantee that eachvaccine point or each package of antitoxin will produceits full therapeutic effect and be free from all danger.This would be impracticable with the extent and varietyof the business in biologic products now carried on inthis country and abroad. It would be ideal if the govern-ment could guarantee the purity and potency of eachpackage, but to do so would require more than super-vision—it would almost mean government ownership."

Copy of item entitled "Bacteria in Vaccine" published inthe Encyclopedia Americana, Volume 27, stating thatall vaccine virus contains many varieties of bacteria,some of these may be pathogenic, but the majority are

harmless.

"The many investigations made of the bacteria foundin both the humanized and bovine virus are almost con-clusive that they are in no wise connected with the spe-cific cause of vaccinia. All vaccine virus contains manyvarieties of bacteria, some of these may be pathogenic,but the majority are harmless. Their origin may befrom several sources from an antecedent virus, from theskin, from the alimentary tract of the vaccinated animaland from external contamination. Bovine virus usually

122

contains the pus organisms, the staphylococcus aureusand albus, the streptococcus and in rare instances thetetanus bacillus. A vaccine virus may contain a greatnumber of bacteria and yet be harmless; on the otherhand only a few of the pathogenic varieties, and maycause serious consequences. As a rule the number ofbacteria may be taken as an index of impurity result-ing either from a faulty preparation, or not subjectedlong enough to the action of the glycerine. Any treat-ment to which the vaccine tissues are subjected, witha view to freeing it from the extraneous bacteria, in-fluences its potency to a more or less degree. If glycer-ine be added, the number will gradually diminish. Soin order to obtain the best results it usually follows thatthere arrives a time when such virus is free of bacteria,or nearly so, and when its potency is very little impaired.The Japanese have discovered that vaccine virus towhich glycerine has been added, can be made to with-stand considerable quantities of pure carbolic acid andin such strength as to kill the extraneous bacteria, andto do so without materially impairing its potency. Fur-ther, the vaccine virus can be produced bacteria free incertain animals, such as the male rabbit and calves, ashas been suggested by Noguchi, but as yet this is in theexperimental stage.

"The preservation of the virus in a highly potent stateis all important, it is quite sensitive to heat; the hotweather of the summer months causes it to deterioraterapidly. Low temperatures on the other hand preserveit, and particularly is this so if the temperature is be-low the freezing point. Elgin of this country was firstto discover this fact, which was confirmed by Green ofEngland. Vaccine virus when subjected to very lowtemperatures and maintained, thus with but little varia-tion will remain potent for months, even as much as twoyears."

123

Declaration by Dr. William Brady, in a syndicatedarticle in the Ohio State Journal, Columbus, Ohio,

October 21, 1923.

"No one knows what vaccinia is, whether a 'take' givesthe subject cowpox or a modified form of smallpox. Noone knows whether cowpox is a distinct disease orsmallpox modified by passing through the animal. No-body has discovered the germ or organism, which webelieve causes smallpox. Nobody has isolated a specificgerm or organism from the virus employed for vaccina-tion. No one can be absolutely certain that the virusemployed for vaccination will not convey to the subjectvaccinated some accidental infection as well as vaccinia."

124

INDEX

American Medicine 19Arizona 3, 4, 61Arkansas 2Australia 11, 71, 72, 76

Baxter, Governor PercivalP 24

Boston Medical & SurgicalJournal 38, 45

Brady, Dr. Wm 19, 124Breeding, Dr. W. J 17

Cabot, Richard C, M.D 116California 5, 16, 62Canadian Medical Associa-

tion Journal 78Cards to Parents, Mislead-

ing Wording Of 30Carr, Dr. J. W 22Chapin, Dr. Charles V 78Chicago 7Coercion, Examples of .. .29-32Commercialism Behind Vac-

cination Requirement . .34-41Connecticut 2Constitution, U. S 28Craster, Dr. C. V 57

Declaration of Independence 27Department of Agriculture,

U. S 118-119Dickie, Dr. Walter N 16Diphtheria 34, 35, 59District of Columbia 2Dolliver, Senator 118Draper, Andrew S 18, 36Dust Preparations 94-97

Education Law, Conflict With 18Employment, Vaccination A

Requirement for 29, 50Encephalitis .10, 14, 99, 110-115Encyclopedia Americana . . . 122England 8, 20, 22, 53, 56

62-64, 74, 108,109, 119Evans, Dr. W. A 42

Fees for Vaccination .36, 37, 38Food, Vaccination a Require-

ment for 32Foot and Mouth Disease.. .118Franco-Prussian War 84Freedom 15-20, 24-28, 33

Georgia 2Germany 13, 14, 113Germs, Doctors to Court and

Woo 33Green, Dr. Frederick R. .. 25

Hawes, John B., M.D 45Holland 10, 99, 110-115Hoyne, Archibald, M.D 79

Illinois Health News 34Illinois Medical Journal .38, 79Indiana 15, 25Italy 67, 85

Japan 66, 75Jenner, Edward 55Journal of the American

Medical Association27, 39, 47, 100, 115

Journal of Infectious Dis-eases 99

125

Keen, W. W., M.D 81Kentucky 2Kerr, J. W 3King, Dr. Wm. F 15Koehler, Dr. John P 49

Lancet (London) 20League of Nations 110-111Leake, Surgeon, J. P.. .1 , 52, 91Leprosy 116Loyster, James A 107

Mclntosh, Professor 115Maine 6, 60Maryland 2Massachusetts 2, 7, 42, 60Massachusetts Department

of Health 41Maternity and Infancy Act 24Medical Journal and Record 94Medical Politics.. .25-27, 42-48Metropolitan Life Insurance

Co 90Mexico, Waives Vaccination

Requirement for Physi-cians 33

Michigan 44Michigan Department of

Health 30, 35, 80, 87Millard, C. Killick 8, 56, 108Milwaukee Health Board... 49Minnesota 3Monger, Dr. John E 15Moore, Dr 44

National Anti-VaccinationLeague 64

National Education Ass'n.. 47Nelson, C. S., M.D 38New Hampshire 2New International Encyclo-

pedia 77New International Year

Book 113New Jersey 2

New Mexico 2New York

2, 18, 24, 36, 45, 105, 107New York City 58New York City, Department

of Health 41, 46New York Medical Journal

100,101New York Medical Week... 33New York State Journal of

Medicine 46, 48Newark, N. J 57Newspaper Publicity . . .46, 50North Carolina 2, 45North Carolina State Board

of Health 37, 42North Dakota 3, 5, 61

Ohio 2, 15Oregon 2Osier, William. .79, 98, 101, 117

Park, Dr. Wm. H 46Pennsylvania 2, 45, 103-107Pfeiffenberger, Dr. Mather. 34Philippine Islands . . . 69-71, 85Pierce, Dr. C. C 29Pittsburgh Health Club 106Poison Ivy 75Propaganda, Medical . . . .46-51

Rankin, Dr. W. S 37Red Cross 32Religion, Disregard for . . . 31Rhode Island 2Rosenau, Dr. M. J 122Royal Commission on Vacci-

nation 8, 53, 55

Sanitation 56-58Serumization, Wholesale. .91-97Smallpox Inoculation 53-54Smallpox, Mildness of

22,72-79,109

126

Smallpox, No Uniformity inDiagnosis of 73-79

Smallpox, Status Of20, 51, 56-87

Soldiers Made Sick By Vac-cination 98

South Carolina 2South Dakota 4Statistics, Fallacy Of 79-90Switzerland 113

Tennessee 17Terrorism, Extortion By.. .

49-51,74Tetanus Following Vaccina-

tion 99-109Thayer, Dr. W. S 26Trask, Dr. John W 75

United States, Smallpox In20, 51, 64-65, 73-78

Utah 3U. S. Public Health Service

1, 3, 15, 29 51,52, 67, 74, 91, 101, 116

Vaccination, Dangers Of...20, 23, 98-124

Vaccination, Laws RelatingTo 2-14,36

Vaccination, Uncertainty Of1, 21, 52-88

Vaccine Virus, Preparationof 119-121

Vaughan, Dr. Victor . .119, 120

White, Benjamin, Ph. D 54Woodward, Dr. Samuel B.. . 42

127

State Medicine A Menace toDemocracy

State Medicine A Menace To Democracy is the title of a128-page book by H. B. Anderson which presents a disinter-ested analysis of erroneous principles of public health policy.

It explains the seeming paradox that the larger the appro-priations for alleged public health work become the moreattention is diverted from sound public health activities andthe more the enjoyment of "life, liberty and the pursuit of hap-piness" is being taken away from the American people.

The book is based upon a painstaking study of the most im-portant official documents and periodicals issued by health de-partments, leading medical and sociological organizations andother publications bearing on the subject of public health.

Issued by

Citizens Medical Reference Bureau226 West 47th Street, New York CityPrice $1.00 per copy bound in cloth

Subscribe to the MonthlyBulletins

The Bulletins and News Letters Issued by the Citi-zens Medical Reference Bureau Contain ImportantFacts Revealing the Fallacy Behind, and the Enor-mity of the Outrage of, Measures for the CompulsoryMedical Supervision of Everybody.

Two Bulletins and a News Letter are Issuedeach month.

Send $1.00 for Six Months'Trial Subscription

Citizens Medical Reference Bureau226 West 47th St. New York

Subscribe to the MonthlyBulletins

The Bulletins and News Letters Issued by theCitizens Medical Reference Bureau Contain ImportantFacts Revealing the Fallacy Behind, and the Enormityof the Outrage of Measures for the Compulsory Med-ical Supervision of Everybody.

Two Bulletins and a News Letter are Issuedeach month.

Send $1.00 for Six Months'

Trial Subscription

CITIZENS MEDICAL REFERENCE BUREAU226 West 47th Street New York City

State Medicine A Menace toDemocracy

State Medicine A Menace To Democracy is the title of a128-page book by H. B. Anderson which presents a disinter-ested analysis of erroneous principles of public health policy.

It explains the seeming paradox that the larger the ap-propriations for alleged public health work become the moreattention is diverted from sound public health activities andthe more the enjoyment of "life liberty and the pursuit ofhappiness" is being taken away from the American people.

The book is based upon a painstaking study of the mostimportant official documents and periodicals issued by healthdepartments, leading medical and sociological organizationsand other publications bearing on the subject of public health.

Issued by

CITIZENS MEDICAL REFERENCE BUREAU226 West 47th Street New York City

Price $1.00 per copy bound in cloth