JACOBSON v. COM. OF
MASSACHUSETTS, (1905)
No. 70
Argued: December 6,
1904 Decided: February 20, 1905
[197 U.S.
11, 12] [Reporter’s Headnote] This case involves
the validity, under the Constitution of the United States, of certain
provisions in the statutes of Massachusetts relating to vaccination.
The
Revised Laws of that commonwealth, chap. 75, 137, provide that 'the board of
health of a city or town, if, in its opinion, it is necessary for the public
health or safety, shall require and enforce the vaccination and revaccination
of all the inhabitants thereof, and shall provide them with the means of free
vaccination. Whoever, being over twenty-one years of age and not under
guardianship, refuses or neglects to comply with such requirement shall forfeit
$5.'
An
exception is made in favor of 'children who present a certificate, signed by a
registered physician, that they are unfit subjects for vaccination.' 139.
Proceeding
under the above statutes, the board of health of the city of Cambridge, Massachusetts,
on the 27th day of February, 1902, adopted [regulations to require all city
residents to be vaccinated].
The above
regulations being in force, the plaintiff in error, Jacobson, was proceeded
against by a criminal complaint in one of the inferior courts of Massachusetts.
The complaint charged that on the 17th day of July, 1902, the board of health
of Cambridge, being of the opinion that it was necessary for the public health
and safety, required the vaccination and revaccination of all the inhabitants
thereof who had not been successfully vaccinated since the 1st day of March,
1897, and provided them with the means of free vaccination; and that the
defendant, being over twenty-one years of age and not under guardianship,
refused and neglected to comply with such requirement.
The
defendant, having been arraigned, pleaded not guilty. The government put in
evidence the above regulations adopted by the board of health, and made proof
tending to show that its chairman informed the defendant that, by refusing to
be vaccinated, he would incur the penalty provided by the statute, and would be
prosecuted therefor; that he offered to vaccinate the defendant without expense
to him; and that the offer was declined, and defendant refused to be
vaccinated.
The prosecution
having introduced no other evidence, the defendant made numerous offers of
proof. But the trial court ruled that each and all of the facts offered to be
proved by the defendant were immaterial, and excluded all proof of them.
The
defendant, standing upon his offers of proof, and introducing no evidence,
asked numerous instructions to the jury, among which were the following:
That 137
of chapter 75 of the Revised Laws of Massachusetts was in derogation of the
rights secured to the defendant by the preamble to the Constitution of the
United [197 U.S. 11, 14] States, and
tended to subvert and defeat the purposes of the Constitution as declared in
its preamble;
That the
section referred to was in derogation of the rights secured to the defendant by
the 14th Amendment of the Constitution of the United States, and especially of
the clauses of that amendment providing that no state shall make or enforce any
law abridging the privileges or immunities of citizens of the United States,
nor deprive any person of life, liberty, or property without due process of
law, nor deny to any person within its jurisdiction the equal protection of the
laws; and
That said
section was opposed to the spirit of the Constitution.
Each of
defendant's prayers for instructions was rejected, and he duly excepted. The
defendant requested the court, but the court refused, to instruct the jury to
return a verdict of not guilty. And the court instructed structed the jury, in
substance, that, if they believed the evidence introduced by the commonwealth,
and were satisfied beyond a reasonable doubt that the defendant was guilty of
the offense charged in the complaint, they would be warranted in finding a
verdict of guilty. A verdict of guilty was thereupon returned.
The case
was then continued for the opinion of the supreme judicial court of
Massachusetts. That court overruled all the defendant's
exceptions, sustained the action of the trial court, and thereafter,
pursuant to the verdict of the jury, he was sentenced by the court to pay a
fine of $5. And the court ordered that he stand committed until the fine was
paid.
Mr. Justice Harlan delivered the
opinion of the court:
We pass
without extended discussion the suggestion that the particular section of the
statute of Massachusetts now in question ( 137, chap.
75) is in derogation of rights secured by the preamble of the Constitution of
the United States. Although that preamble indicates the general purposes for
which the people ordained and established the Constitution, it has never been
regarded as the source of any substantive power conferred on the government of
the United States, or on any of its departments. Such powers embrace only those
expressly granted in the body of the Constitution, and such as may be implied
from those so granted. . . .
We also
pass without discussion the suggestion that the above section of the statute is
opposed to the spirit of the Constitution. Undoubtedly, as observed by Chief
Justice Marshall, speaking for the court in Sturges
v. Crowninshield, 4 Wheat. 122, 202, 4 L. ed.
529, 550, 'the spirit of an instrument, especially of a constitution, is to be
respected not less than its letter; yet the spirit is to be collected chiefly
from its words.' . . .
What,
according to the judgment of the state court, are the [197 U.S.
11, 23] scope and effect of the statute? What results were
intended to be accomplished by it? These questions must be answered.
* * *
While the
mere rejection of defendant's offers of proof does not strictly present a
Federal question, we may properly regard the exclusion of evidence upon the
ground of its incompetency or immateriality under the statute as showing what,
in the opinion of the state court, are the scope and meaning of the statute.
Taking the above observations of the state court as indicating the scope of the
statute,-and such is our duty. Leffingwell
v. Warren, 2 Black, 599, 603, 17 L. ed. 261. 262; Morley v. Lake Shore & M. S. R. Co. 146 U.S.
162, 167 , 36 S. L. ed. 925, 928, 13 Sup. Ct. Rep. 54; Tullis v. Lake Erie & W. R. Co. 175 U.S.
348 , 44 L. ed. 192, 20 Sup. Ct. Rep. 136; W. W. Cargill Co. v. Minnesota, 180 U.S.
452, 466 , 45 S. L. ed. 619, 625, 21 Sup. Ct. Rep. 423—we assume, for
the purposes of the present inquiry, that its provisions require, at least as a
general rule, that adults not under the guardianship and remaining within the
limits of the city of Cambridge must submit to the regulation adopted by the
board of health. Is the statute, so construed, therefore, inconsistent with the
liberty which the Constitution of the United States secures to every person
against deprivation by the state?
The
authority of the state to enact this statute is to be [197 U.S.
11, 25] referred to what is commonly called the
police power—a power which the state did not surrender when becoming a
member of the Union under the Constitution. [Emphasis added] Although this
court has refrained from any attempt to define the limits of that power, yet it
has distinctly recognized the authority of a state to enact quarantine laws and
'health laws of every description;' indeed, all laws that relate to matters
completely within its territory and which do not by their necessary operation
affect the people of other states. According to settled principles, the police
power of a state must be held to embrace, at least, such reasonable regulations
established directly by legislative enactment as will protect the public health
and the public safety. Gibbons v. Ogden,
9 Wheat. 1, 203, 6 L. ed. 23, 71; Hannibal
& St. J. R. Co. v. Husen, 95 U.S. 465,
470 , 24 S. L. ed. 527, 530; Boston
Beer Co. v. Massachusetts, 97 U.S. 25 ,
24 L. ed. 989; New Orleans Gaslight Co.
v. Louisiana Light & H. P. & Mfg. Co. 115 U.S.
650, 661 , 29 S. L. ed. 516, 520, 6 Sup. Ct. Rep. 252; Lawson v. Stecle, 152 U.S.
133 , 38 L. ed. 385, 14 Sup. Ct. Rep. 499. It is equally true that the
state may invest local bodies called into existence for purposes of local
administration with authority in some appropriate way to safeguard the public
health and the public safety. The mode or manner in which those results are to
be accomplished is within the discretion of the state, subject, of course, so
far as Federal power is concerned, only to the condition that no rule
prescribed by a state, nor any regulation adopted by a local governmental
agency acting under the sanction of state legislation, shall contravene the
Constitution of the United States, nor infringe any right granted or secured by
that instrument. A local enactment or regulation, even if based on the
acknowledged police powers of a state, must always yield in case of conflict
with the exercise by the general government of any power it possesses under the
Constitution, or with any right which that instrument gives or secures. Gibbons v. Ogden, 9 Wheat. 1, 210, 6 L.
ed. 23, 73; Sinnot v. Davenport, 22 How. 227, 243, 16 L.
ed. 243, 247; Missouri, K. & T. R.
Co. v. Haber, 169 U.S.
613, 626, 42 S. L. ed. 878, 882, 18 Sup. Ct. Rep. 488.
We come,
then, to inquire whether any right given or secured by the Constitution is
invaded by the statute as [197 U.S. 11, 26] interpreted by
the state court. The defendant insists that his liberty is invaded when the
state subjects him to fine or imprisonment for neglecting or refusing to submit
to vaccination; that a compulsory vaccination law is unreasonable, arbitrary,
and oppressive, and, therefore, hostile to the inherent right of every freeman
to care for his own body and health in such way as to him seems best; and that
the execution of such a law against one who objects to vaccination, no matter
for what reason, is nothing short of an assault upon his person. But the liberty
secured by the Constitution of the United States to every person within its
jurisdiction does not import an absolute right in each person to be, at all
times and in all circumstances, wholly freed from restraint. There are manifold
restraints to which every person is necessarily subject for the common good. On
any other basis organized society could not exist with safety to its members.
Society based on the rule that each one is a law unto himself would soon be
confronted with disorder and anarchy. Real liberty for all could not exist
under the operation of a principle which recognizes the right of each
individual person to use his own, whether in respect of his person or his
property, regardless of the injury that may be done to others. This court has
more than once recognized it as a fundamental principle that 'persons and
property are subjected to all kinds of restraints and burdens in order to
secure the general comfort, health, and prosperity of the state; of the perfect
right of the legislature to do which no question ever was, or upon acknowledged
general principles ever can be, made, so far as natural persons are concerned.'
Hannibal & St. J. R. Co. v. Husen, 95 U.S. 465,
471, 24 S. L. ed. 527, 530; Missouri,
K. & T. R. Co. v. Haber, 169 U.S.
613, 628 , 629 S., 42 L. ed. 878- 883, 18 Sup. Ct. Rep. 488; Thorpe v. Rutland & B. R. Co. 27 Vt.
148, 62 Am. Dec. 625. In Crowley v.
Christensen, 137 U.S. 86,
89 , 34 S. L. ed. 620, 621, 11 Sup. Ct. Rep. 13, we said: 'The
possession and enjoyment of all rights are subject to such reasonable
conditions as may be deemed by the governing authority of the country essential
to the safety, health, peace, good order, and morals of the community. Even
liberty [197 U.S. 11, 27] itself, the
greatest of all rights, is not unrestricted license to act according to one's
own will. It is only freedom from restraint under conditions essential to the
equal enjoyment of the same right by others. It is, then, liberty regulated by
law.' In the Constitution of Massachusetts adopted in 1780 it was laid down as
a fundamental principle of the social compact that the whole people covenants
with each citizen, and each citizen with the whole people, that all shall be
governed by certain laws for 'the common good,' and that government is
instituted 'for the common good, for the protection, safety, prosperity, and
happiness of the people, and not for the profit, honor, or private interests of
any one man, family, or class of men.' The good and welfare of the
commonwealth, of which the legislature is primarily the judge, is the basis on
which the police power rests in Massachusetts.
Com. v. Alger, 7 Cush. 84.
Applying
these principles to the present case, it is to be observed that the legislature
of Massachusetts required the inhabitants of a city or town to be vaccinated
only when, in the opinion of the board of health, that was necessary for the
public health or the public safety. The authority to determine for all what
ought to be done in such an emergency must have been lodged somewhere or in
some body; and surely it was appropriate for the legislature to refer that
question, in the first instance, to a board of health composed of persons
residing in the locality affected, and appointed, presumably, because of their
fitness to determine such questions. To invest such a body with authority over
such matters was not an unusual, nor an unreasonable or arbitrary, requirement.
Upon the principle of self-defense, of paramount necessity, a community has the
right to protect itself against an epidemic of disease which threatens the
safety of its members. It is to be observed that when the regulation in
question was adopted smallpox, according to the recitals in the regulation
adopted by the board of health, was prevalent to some extent in the city of
Cambridge, and the disease was increasing. If such was [197
U.S. 11, 28] the situation,-and
nothing is asserted or appears in the record to the contrary,-if we are to
attach, any value whatever to the knowledge which, it is safe to affirm, in
common to all civilized peoples touching smallpox and the methods most usually
employed to eradicate that disease, it cannot be adjudged that the present
regulation of the board of health was not necessary in order to protect the
public health and secure the public safety. Smallpox being prevalent and
increasing at Cambridge, the court would usurp the functions of another branch
of government if it adjudged, as matter of law, that the mode adopted under the
sanction of the state, to protect the people at large was arbitrary, and not justified
by the necessities of the case. We say necessities of the case, because it
might be that an acknowledged power of a local community to protect itself
against an epidemic threatening the safety of all might be exercised in
particular circumstances and in reference to particular persons in such an
arbitrary, unreasonable manner, or might go so far beyond what was reasonably
required for the safety of the public, as to authorize or compel the courts to
interfere for the protection of such persons. Wisconsin, M. & P. R. Co. v. Jacobson, 179 U.S.
287, 301 , 45 S. L. ed. 194, 201, 21 Sup. Ct. Rep. 115; 1 Dill. Mun. Corp. 4th ed. 319-325, and authorities in notes; Freurid, Police Power,
63 et seq. In Hannibal & St. J. R.
Co. v. Husen, 95 U.S.
465 , 471-473, 24 L. ed. 527, 530, 531, this court recognized the
right of a state to pass sanitary laws, laws for the protection of life,
liberty, health, or property within its limits, laws to prevent persons and
animals suffering under contagious or infectious diseases, or convicts, from
coming within its borders. But, as the laws there involved went beyond the necessity
of the case, and, under the guise of exerting a police power, invaded the
domain of Federal authority, and violated rights secured by the Constitution,
this court deemed it to be its duty to hold such laws invalid. If the mode
adopted by the commonwealth of Massachusetts for the protection of its local
communities against smallpox proved to be distressing, inconvenient, or
objectionable to some,-if nothing more could be reasonably [197
U.S. 11, 29] affirmed of the statute in question,-the answer is that
it was the duty of the constituted authorities primarily to keep in view the
welfare, comfort, and safety of the many, and not permit the interests of the
many to be subordinated to the wishes or convenience of the few. There is, of
course, a sphere within which the individual may assert the supremacy of his
own will, and rightfully dispute the authority of any human government,-
especially of any free government existing under a written constitution, to
interfere with the exercise of that will. But it is equally true that in every
well-ordered society charged with the duty of conserving the safety of its
members the rights of the individual in respect of his liberty may at times,
under the pressure of great dangers, be subjected to such restraint, to be
enforced by reasonable regulations, as the safety of the general public may
demand. An American citizen arriving at an American port on a vessel in which,
during the voyage, there had been cases of yellow fever or Asiatic cholera, he,
although apparently free from disease himself, may yet, in some circumstances,
be held in quarantine against his will on board of such vessel or in a
quarantine station, until it be ascertained by inspection, conducted with due
diligence, that the danger of the spread of the disease among the community at
large has disappeared. The liberty secured by the 14th Amendment, this court
has said, consists, in part, in the right of a person 'to live and work where
he will' (Allgeyer v. Louisiana, 165 U.S.
578 , 41 L. Ed. 832, 17 Sup. Ct. Rep. 427); and yet he may be
compelled, by force if need be, against his will and without regard to his
personal wishes or his pecuniary interests, or even his religious or political
convictions, to take his place in the ranks of the army of his country, and
risk the chance of being shot down in its defense. It is not, therefore, true
that the power of the public to guard itself against imminent danger depends in
every case involving the control of one's body upon his willingness to submit
to reasonable regulations established by the constituted authorities, under
the [197 U.S. 11, 30] sanction of the
state, for the purpose of protecting the public collectively against such danger.
It is
said, however, that the statute, as interpreted by the state court, although
making an exception in favor of children certified by a registered physician to
be unfit subjects for vaccination, makes no exception in case of adults in like
condition. But this cannot be deemed a denial of the equal protection of the
laws to adults; for the statute is applicable equally to all in like condition,
and there are obviously reasons why regulations may be appropriate for adults
which could not be safely applied to persons of tender years.
Looking at
the propositions embodied in the defendant's rejected offers of proof, it is
clear that they are more formidable by their number than by their inherent
value. Those offers in the main seem to have had no purpose except to state the
general theory of those of the medical profession who attach little or no value
to vaccination as a means of preventing the spread of smallpox, or who think
that vaccination causes other diseases of the body. What everybody knows the court
must know, and therefore the state court judicially knew, as this court knows,
that an opposite theory accords with the common belief, and is maintained by
high medical authority. We must assume that, when the statute in question was
passed, the legislature of Massachusetts was not unaware of these opposing
theories, and was compelled, of necessity, to choose between them. It was not
compelled to commit a matter involving the public health and safety to the
final decision of a court or jury. It is no part of the function of a court or
a jury to determine which one of two modes was likely to be the most effective
for the protection of the public against disease. That was for the legislative
department to determine in the light of all the information it had or could
obtain. It could not properly abdicate its function to guard the public health
and safety. The state legislature proceeded upon the theory which recognized
vaccination as at least an effective, if not the best-known, way in which to
meet and suppress the [197 U.S. 11, 31] evils
of a smallpox epidemic that imperiled an entire population. Upon what sound
principles as to the relations existing between the different departments of
government can the court review this action of the legislature? If there is any
such power in the judiciary to review legislative action in respect of a matter
affecting the general welfare, it can only be when that which the legislature
has done comes within the rule that, if a statute purporting to have been
enacted to protect the public health, the public morals, or the public safety,
has no real or substantial relation to those objects, or is, beyond all
question, a plain, palpable invasion of rights secured by the fundamental law,
it is the duty of the courts to so adjudge, and thereby give effect to the
Constitution. Mugler v. Kansas, 123 U.S.
623, 661 , 31 S. L. ed. 205, 210, 8 Sup. Ct. Rep. 273; Minnesota v. Barber, 136 U.S.
313, 320 , 34 S. L. ed. 455, 458, 3 Inters. Com. Rep. 185, 10 Sup. Ct.
Rep. 862; Atkin v. Kansas, 191 U.S.
207, 223 , 48 S. L. ed. 148, 158, 24 Sup. Ct. Rep. 124.
Whatever
may be thought of the expediency of this statute, it cannot be affirmed to be,
beyond question, in palpable conflict with the Constitution. Nor, in view of
the methods employed to stamp out the disease of smallpox, can anyone
confidently assert that the means prescribed by the state to that end has no
real or substantial relation to the protection of the public health and the
public safety. Such an assertion would not be consistent with the experience of
this and other countries whose authorities have dealt with the disease of
smallpox. And the principle of vaccination as a means to [197
U.S. 11, 32] prevent the spread of smallpox has been
enforced in many states by statutes making the vaccination of children a
condition of their right to enter or remain in public schools.
. . . It must be conceded that some laymen, both learned and unlearned,
and some physicians of great skill and repute, do not believe that vaccination
is a preventive of smallpox. The common belief, however, is that it has a
decided tendency to prevent the spread of this fearful disease, and to render
it less dangerous to those who contract it. While not accepted by all, it is
accepted by the mass of the people, as well as by most members of the medical
profession. It has been general in our state, and in most civilized nations for
generations. It is [197 U.S. 11, 35] generally
accepted in theory, and generally applied in practice, both by the voluntary
action of the people, and in obedience to the command of law. Nearly every
state in the Union has statutes to encourage, or directly or indirectly to
require, vaccination; and this is true of most nations of Europe. . . . A common belief, like common knowledge, does not
require evidence to establish its existence, but may be acted upon without
proof by the legislature and the courts.. . . The fact
that the belief is not universal is not controlling, for there is scarcely any
belief that is accepted by everyone. The possibility that the belief may be
wrong, and that science may yet show it to be wrong, is not conclusive; for the
legislature has the right to pass laws which, according to the common belief of
the people, are adapted to prevent the spread of contagious diseases. In a free
country, where the government is by the people, through their chosen
representatives, practical legislation admits of no other standard of action,
for what the people believe is for the common welfare must be accepted as
tending to promote the common welfare, whether it does in fact or not. Any
other basis would conflict with the spirit of the Constitution, and would
sanction measures opposed to a Republican form of government. While we do not
decide, and cannot decide, that vaccination is a preventive of smallpox, we
take judicial notice of the fact that this is the common belief of the people
of the state, and, with this fact as a foundation, we hold that the statute in
question is a health law, enacted in a reasonable and proper exercise of the
police power.' 179 N. Y. 235, 72 N. E. 97.
Since,
then, vaccination, as a means of protecting a community against smallpox, finds
strong support in the experience of this and other countries, no court, much
less a jury, is justified in disregarding the action of the legislature simply
because in its or their opinion that particular method was—perhaps, or possibly—not
the best either for children or adults.
* * *
We now
decide only that the statute covers the present case, and that nothing clearly
appears that would justify this court in holding it to be unconstitutional and
inoperative in its application to the plaintiff in error.
The judgment of the court below
must be affirmed.
It is so ordered.
Mr. Justice Brewer and Mr. Justice Peckham dissent.
Footnotes
'State-supported facilities for vaccination began in
England in 1808 with the National Vaccine Establishment. In 1840 vaccination
fees were made payable out of the rates. The first compulsory act was passed in
1853, the guardians of the poor being intrusted with
the carrying out of the law; in 1854 the public vaccinations under one year of
age were 408,824 as against an average of 180,960 for several years before. In
1867 a new act was passed, rather to remove some technical difficulties than to
enlarge the scope of the former act; and in 1871 the act was passed which
compelled the boards of guardians to appoint vaccination officers. The
guardians also appoint a public vaccinator, who must be duly qualified to practise medicine, and whose duty it is to vaccinate (for a
fee of one shilling and sixpence) any child resident within his district
brought to him for that purpose, to examine the same a week after, to give a
certificate, and to certify to the vaccination officer the fact of vaccination
or of insusceptibility. . . .
Vaccination was made compulsory in Bavarla
in 1807, and subsequently in the following countries: Denmark (1810), Sweden
(1814), Wurttemberg, Hesse, and other German states (1818), Prussia (1835), Roumania (1874), Hungary (1876), and Servia (1881). It is
compulsory by cantonal law in 10 out of the 22 Swiss cantons; an attempt to
pass a Federal compulsory law was defeated by a plebiscite in 1881. In the
following countries there is no compulsory law, but governmental facilities and
compulsion on various classes more or less directly under governmental control,
such as soldiers, state employees, apprentices, school pupils, etc.: France,
Italy, Spain, Portugal, Belgium. Norway, Austria, Turkey. . .
.
Vaccination has been compulsory in South Australia
since 1872, in Victoria since 1874, and in Western Australia since 1878. In
Tasmania a compulsory act was passed in 1882. In New South Wales there is no
compulsion, but free facilities for vaccination. Compulsion was adopted at
Calcutta in 1880, and since then at 80 other towns of Bengal, at Madras in
1884, and at Bombay and elsewhere in the presidency a few years earlier. Revaccination
was made compulsory in Denmark in 1871, and in Roumania
in 1874; in Holland it was enacted for all school pupils in 1872. The various
laws and administrative orders which had been for many years in force as to
vaccination and revaccination in the several German states were consolidated in
an imperial statute of 1874.' 24 Encyclopaedia
Britannica (1894), “Vaccination.”
'In 1857 the British Parliament received answers from
552 physicians to questions which were asked them in reference to the utility
of vaccination, and only two of these spoke against it. Nothing proves this
utility more clearly than the statistics obtained. Especially instructive are
those which Flinzer compiled respecting the epidemic
in Chemnitz which prevailed in 1870-71. At this time in the town there were
64,255 inhabitants, of whom 53,891, or 83.87 per cent, were vaccinated, 5,712,
or 8.89 per cent were unvaccinated, and 4,652, or 7.24 per cent, had had the
smallpox before. Of those vaccinated 953, or 1.77 per cent, became affected
with smallpox, and of the uninocculated 2,643, or
46.3 per cent, had the disease. In the vaccinated the mortality from the
disease was 0.73 per cent, and in the unprotected it was 9.16 per cent. In
general, the danger of infection is six times as great, and the mortality 68
times as great, in the unvaccinated, as in the vaccinated. Statistics derived
from the civil population are in general not so instructive as those derived
from armies, where vaccination is usually more carefully performed, and where
statistics can be more accurately collected. During the Franco- German war
(1870-71) there was in France a widespread epidemic of smallpox, but the German
army lost during the campaign only 450 cases, or 58 men to the 100,000; in the
French army, however, where vaccination was not carefully carried out, the
number of deaths from smallpox was 23,400.' , Johnson's Universal Cyclopaedia
(1897), “Vaccination.”
'The degree of protection afforded by vaccination thus
became a question of great interest. Its extreme value was easily demonstrated
by statistical researches. In England, in the last half of the eighteenth
century, out of every 1,000 deaths, 96 occurred from smallpox; in the first
half of the present century, out of every 1,000 deaths, but 35 were caused by
that disease. The amount of mortality in a country by smallpox seems to bear a
fixed relation to the extent to which vaccination is carried out In all England and Wales, for some years previous to 1853,
the proportional mortality by smallpox was 21.9 to 1,000 deaths from all
causes; in London it was but 16 to 1,000; in Ireland, where vaccination was
much less general, it was 49 to 1,000, while in Connaught it was 60 to 1,000.
On the other hand, in a number of European countries where vaccination was more
or less compulsory, the proportionate number of deaths from smallpox about the
same time varied from 2 per 1,000 of all causes in Bohemia, Lombardy, Venice,
and Sweden, to 8.33 per 1,000 in Saxony. Although in many instances persons who
had been vaccinated were attacked with smallpox in a more or less modified
form, it was noticed that the persons so attacked had been commonly vaccinated
many years previously. 16 American
Cyclopedia, “Vaccination” (1883).
'Dr Buchanan, the medical
officer of the London Government Board, reported [197 U.S.
11, 1881] as the result of statistics that the smallpox
death rate among adult persons vaccinated was 90 to a million; whereas among
those unvaccinated it was 3,350 to a million; whereas among vaccinated children
under five years of age, 42 1/2 per million; whereas among unvaccinated
children of the same age it was 5,950 per million.' Hardway,
Essentials of Vaccination (1882). The same author reports that, among other
conclusions reached by the Academie de Medicine of France,
was one that, 'without vaccination, hygienic measures (isolation, disinfection,
etc.) are of themselves insufficient for preservation from smallpox.' Ibid.
The Belgian Academy of Medicine appointed a committee
to make an exhaustive examination of the whole subject, and among the
conclusions reported by them were: 1. 'Without vaccination, hygienic measures
and means, whether public or private, are powerless in preserving mankind from
smallpox. . . . 3. Vaccination is always an
inoffensive operation when practised with proper care
on healthy subjects. . . . 4. It is highly desirable,
in the interests of the health and lives of our countrymen, that vaccination
should be rendered compulsory.' Edwards, Vaccination
( 1882.)
The English Royal Commission, appointed with Lord Herschell, the Lord Chancellor of England, at its head, to
inquire, among other things, as to the effect of vaccination in reducing the
prevalence of, and mortality from, smallpox, reported, after several years of
investigation: 'We think that it diminishes the liability to be attacked by the
disease; that it modifies the character of the disease and renders it less
fatal,-of a milder and less severe type; that the protection it affords against
attacks of the disease is greatest during the years immediately succeeding the
operation of vaccination.'