I asked ChatGPT to transcribe the text of my link as it is very densely printed.
Transcription
July 5, 1902.
SANITATION OR VACCINATION.
[The British Medical Journal] 69
SANITATION OR VACCINATION.
In endeavouring to explain away the manifold proofs that vaccination prevents small-pox, perhaps no line is now so frequently followed by anti-vaccinationists as that which attributes to sanitation all the good effects of vaccination. Medical men are told that they are ignorant of the real facts, but they are aware that sanitary conditions materially affect health; but when the contention is advanced briefly to tax within prove the worthlessness of the anti-vaccinationist contention.
Sanitation is a term of varied meaning. A man with a clean skin, clean clothes, clean hands, clean breath, pure air, taking proper exercise and proper rest, is a better position to resist disease of any kind, including small-pox, than another man living under the opposite conditions. But the same sanitary measures which are powerful against one disease are not necessarily effective against another. The means which control enteric fever are not at all identical with those which check or greatly diminish the incidence and make and havoc caused by measles and whooping-cough; with the lessons which science has gleaned in the case of diphtheria or diarrhoea. Similar considerations apply to small-pox prevention. That disease is not known to have any special relationship to water supply or milk supply, or sewage, or soil pollution. In so far as overcrowding enables the infection to be carried more readily from individual to individual, the prevention of overcrowding is naturally regarded of value against small-pox; but the disease through which small-pox can be transmitted is so much greater than in the case of typhus, that the same results from prevention of overcrowding cannot be looked for in the two cases, and experience proves that as a matter of fact they have not been obtained. The value of sanitation is so abundantly proved in many directions that it is quite unnecessary for even its antagonists to advocate or record its beneficent effects for the promotion—vaccination would give sanitation the credit for results which are clearly due to vaccination.
Much of what is set down here has already been pointed out in the British Medical Journal or elsewhere, but the disregard of these facts calls for special reference to the one question of sanitation.
Vaccination Without Sanitation.
The City of Glasgow in its experience of small-pox a century ago proved that vaccination in the entire absence of sanitation had an immediate and direct effect in reducing the prevalence of small-pox. The population of Glasgow increased very rapidly from about 1780 onwards. In that year it was 42,832. In 1791 it was 65,578; in 1801 it was 77,385; in 1804 it was 102,000. The area occupied was very small, the people living layer upon layer in high tenement houses closely built together. Reports made in 1818, 1837, 1838, etc., show its sanitary condition to have been extremely bad—perhaps worse than that of any large town in Britain. Before vaccination was practised, in the earlier years due to small-pox in every two deaths from that disease. Under vaccination the deaths were reduced in six years to less than one in thirty-six years to less than one in seventy-six; and in eight years to less than one in ninety-three. In 1814, out of 800 cases, there was not a single death. At the same time overcrowding became no less prevalent and no less insanitary; and there was still quite insufficient small-pox in hospital, and the hospital accommodation for the treatment of ordinary diseases. But as a matter of fact in Glasgow, with sanitation going from bad to worse, with the population increasing as above shown, with measles deaths multiplying and small-pox increasing, vaccination diminished by leaps and bounds.
A similar experience, indeed, is found elsewhere. In pre-vaccination times, small-pox, measles, and whooping-cough were in proportion to all causes of death. When, from about 1800 onwards, all small-pox deaths were included in registers, and the large majority were under seven years of age. Since vaccination began small-pox has in great measure disappeared from childhood, and has transferred itself to later years. Measles and whooping-cough, on the other hand, are still diseases of childhood as they were before. Sanitation cannot possibly explain this difference between small-pox on the one hand and measles and whooping-cough on the other. The practice of vaccination at once gives the necessary explanation.
Small-pox Age-incidence.
Among the vaccinated, small-pox, as has just been said, has largely transferred itself from childhood to later life; but among the unvaccinated it still largely prevails among children, though owing to the comparative infrequency of vaccination in fairly vaccinated populations, the unvaccinated are made, as it were, so rarely, and vaccination has had an indirect control of small-pox among the unvaccinated, finding no large percentage of its victims among children, while in the vaccinated it attacks a much less proportion of children than of adults.
Small-pox Age-incidence in Scotland.
It has been suggested that sanitation has a special beneficial effect on the young, and that would account for the altered age-incidence of small-pox in a vaccinated population. But that cannot be the case, owing to the ages at which the cough has not been altered, and the measles and whooping-cough have not been altered, and the measles and whooping-cough have not been altered. This is clearly shown in the statistics of the Edinburgh epidemic of 1871. The population of Edinburgh was 180,000, and the deaths from small-pox during that epidemic were 512. Of these, 386 were unvaccinated, 84 vaccinated, and 42 doubtful. Of the unvaccinated 216 were under five years of age, 43 between five and ten, 29 between ten and fifteen, 39 between fifteen and twenty-five, 37 between twenty-five and forty-five, 22 over forty-five. Of the vaccinated, only 5 were under five years of age, 9 between five and ten, 7 between ten and fifteen, 17 between fifteen and twenty-five, 22 between twenty-five and forty-five, 24 over forty-five. Of the doubtful, 3 were under five, 5 between five and ten, 4 between ten and fifteen, 12 between fifteen and twenty-five, 8 between twenty-five and forty-five, 10 over forty-five. These figures show that sanitation cannot explain the altered age-incidence of small-pox, and that vaccination alone accounts for it.
Small-pox—Incidence and Revaccination.
In Germany both vaccination and revaccination are compulsory, and small-pox has greatly diminished, but anti-vaccinationists in this country attribute the diminution to sanitation. In Germany primary vaccination is not compulsory before the age of one year, and in some places not till the age of two. The same has been the result of vaccination in England, where the practice of revaccination has also had a beneficial effect. In Germany the incidence of small-pox death at all ages is much lower than in England, and the proportion of deaths in childhood is very small. In England, where vaccination is not compulsory, and revaccination is not compulsory, small-pox among the unvaccinated is more prevalent.
Small-pox—Age-incidence in Sheffield, Leicester, Warrington, etc.
When small-pox came to Sheffield in 1887–8 the town was well vaccinated as far as primary vaccination was concerned. When it came to Leicester in 1892 vaccination was at a low ebb, and Leicester was almost entirely unvaccinated. But in Sheffield children under ten years old were attacked much less frequently than in Leicester, where vaccination was neglected. In Leicester, out of 361 cases, 236 were in children under ten years of age; in Sheffield, out of 1,277 cases, only 12 were in children under ten years of age. The difference cannot be explained by sanitation, as sanitation in Leicester was not worse than in Sheffield. The difference is entirely due to vaccination. The same result was observed in Warrington, where vaccination was carried out, and in Gloucester, where vaccination was neglected
See Jenner Number of Public Health, May, 1896.