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CHAPTER 97: Inoculable Diseases—England and Wales.

In 1880, the late Mr. Ghas. H. Hopwood, Q.C., M.P., moved in the House of Commons for a return showing the percentage of deaths from small-pox, at certain ages, to the total deaths from that disease ; and also for the number of deaths of infants under one year of age per million births from a number of specified inoculable diseases and all other causes. This was granted, and gave the information for England and Wales, from 1847 to 1878 inclusive. The specified diseases were :—Syphilis, scrofula, tuberculous peritonitis, skin diseases, erysipelas, pyaemia,  bronchitis,  diarrhoea,  and  atrophy.

These returns show an increase in the death-rate from syphilis from 472 per million births in 1847 to 1,851 per million births in 1878. The combined death-rate from the nine enumerated causes, including syphilis, increased from 55,213 per million births in 1847 to 81,280 per million births in 1878.

In 1888, Mr. Francis Channing (now Lord Channing) moved for a similar return for the years 1879 to 1886 inclusive, which also was granted and published.

This second return  shows that the death-rate from syphilis more than maintained its high level, and in the last year (1886) was 1,882 per million births. The combined death-rate from the nine enumerated causes likewise remained at a high level, and increased from 71,013 per million births in 1879 to 84,177 per million births in 1886.

Many things have happened to affect the mortality during the thirty years which have elapsed since the second return appeared, and, in the course of that long period, there has been a marked decrease of vaccination, which set in soon after the great small-pox epidemic of 1871-73, and the passing of the great and beneficent Public Health Act of 1875. In addition to this, the sittings of the Royal Commission covered seven years, during which time prosecutions were largely suspended. Then came the successive Acts of Parliament, in 1898 and 1907, both not only moderating the severity of the compulsory law, but also bringing in the " Conscience Clause," with its army of exemptions, and consequent reduction in the number of defaulters who would otherwise have been liable to be proceeded against. Then, the extension of the age for vaccination from three to six months must have produced some tangible result in reducing the infantile death-rate from all causes.

The consideration of all these circumstances made me feel anxious to know what the actual effect has been, so that I might publish it in this work. I, therefore, asked Mr. J. Ramsay Macdonald, M.P. for Leicester, if he would undertake to move in the House of Commons for the  further return,  from  1887 to  1910.     To this Mr. Macdonald kindly and promptly assented. He moved for the return on 6th March, 1912 ; it was ordered to be printed, and on 22nd March was ready to be issued to the public.

As I fully expected, and the facts warranted, we find a substantial reduction, both for syphilis and for the total of the nine enumerated inoculable diseases. There is a considerable decrease in the death-rate from each of these diseases, with the exception of pyaemia and phlegmon, which are taken together, and show a slight increase -from 153 per million births in 1887 to 212 per million births in 1910. Syphilis has gone down from 1,787 per million births in 1887 to 1,150 per million births in 1910, whilst the combined death-rate of the nine inoculable diseases has declined from 80,411 per million births in 1887 to 53,014 per million births in 1910. (For the full Parliamentary returns, see Tables 54, 55, and 56, Appendix.)

I now give a summary, showing the average annual death-rate from syphilis, and from the combined group of the nine inoculable diseases, with the average annual percentage of vaccina­tions to births, for the different periods, as specified :—

The Small Dark Pyramids show the actual death-rate from syphilis per million births.
The Large Pyramids show the death-rate from nine inoculable diseases, including syphilis, per million births.
                                 (One-tenth only shown to accommodate size of diagram.)
The Black Dotted Curve
shows the death-pate from all other causes per million births.
(One-tenth only shown to accommodate size of diagram.)
The Red Curve shows the percentage of vaccinations to births.
                                (Proportionally increased to accommodate size of diagram.)

Table showing, for ENGLAND AND WALES, the death-rate per million births from Syphilis; from the total of nine inoculable diseases (including Syphilis) ; from all other causes; the percentage of vaccinations to births; and the conditions as to vaccination prevailing during the several groups of years. (See Parliamentary Returns, Tables 54, 55, and 56, Appendix.)



 Average Annual Death-rate per Million Births. 

 Percentage of vaccinations to births 

 Prevailing  Conditions


 Nine Inoculable Diseases including Syphilis

 All other causes

(7 years)





 Vaccination Optional

(14 years)





 Vaccination Obligatory

(31 years) 





 Vaccination Compulsory and enforced by penalties.

(10 years)





 Vaccination acts relaxed and 'Conscience Clause' started

(2 years) 





 Vaccination Acts amended ; exemptions at work

It will be seen that as the practice of vaccination lessens, the mortality from all these diseases also decreases. That from syphilis is falling rapidly, and in 1909-10 is less than any other of the periods, excepting the first, whilst the death-rate from the nine inoculable diseases combined   (including   syphilis),   after   rising   by   an increase of nearly 26 per cent, to a maximum of close upon 80,000 per million in the period of highest vaccination, is now plunging downward with decreased vaccination, and has reached the lowest recorded mortality since registration began in 1847.

The fall is a very remarkable one, being nearly 32 per cent.—from 79,336 per million to only 54,124 per million.

No unbiased mind can examine these figures and resist the conclusion that the synchrony between enforced vaccination and the increased death-rate, and also that between the decline and less rigorous enforcement of vaccination and the lessened death-rate, is much more than a coincidence—is, indeed, direct cause and effect.