|||SUPREME COURT OF THE UNITED STATES
197 U.S. 11, 49 L. Ed. 643, 25 S. Ct. 358
|||February 20, 1905
|||ERROR TO THE SUPREME COURT OF THE STATE OF MASSACHUSETTS
|||Mr. George Fred Williams, with whom Mr. James A. Halloran was on the brief,
for plaintiff in error:
|||The right of the State under police power to enforce vaccination upon
its inhabitants has not yet been determined, or more than remotely considered
by this court; references are made to it in Lawton v. Steele, 152. U.s.
133; Hammibal & St. J.r.r. Co. v. Husen, 95 U.s. 465; Am School of Healing
v. McAnnulty, 187 U.s. 94. The plaintiff in error knows of no other cases
in which the subject of vaccination has been considered by this court. From
a summary of vaccination laws and vaccination statutes in the United States
it appears that thirty-four States of the Union have no compulsory vaccination
law, as follows: Alabama, Arkansas, California, Colorado, Delaware, Florida,
Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Minnesota,
Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York,
North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Tennessee, Texas,
Utah, Vermont, Washington, West Virginia and Wisconsin.
|||Compulsory vaccination exists in eleven States, as follows: Connecticut,
Georgia, Kentucky, Maryland (of children), Massachusetts, Mississippi, North,
North Carolina, Pennsylvania (in second class cities), South Carolina, Virginia
and Wyoming. In thirteen States exclusion of unvaccinated children from
the public schools is provided, as follows: California, Georgia, Iowa, Maine,
Massachusetts, New Hampshire, New Jersey, New York, Oregon, Pennsylvania,
Rhode Island, South Dakota and Virginia.
|||Three-quarters of the States have not entered upon the policy of enforcing
vaccination by legal penalty. Not one of the States undertakes forcible
vaccination, while Utah and West Virginia expressly provide that no such
compulsion shall be used.
|||Smallpox has ceased to be the scourge which it once was, and there is
a growing tendency to resort to sanitation and isolation rather than vaccination.
The States which make no provision for vaccination are not any more afflicted
with smallpox than those which compel vaccination. Even New York, which
imports the major part of the immigrants who annually enter this country,
has not undertaken to force it upon the people. As to other countries, the
Queen of Holland has recently recommended the repeal of the compulsory vaccination
laws. There are no vaccination laws in New Zealand, and Switzerland has
by plebiscite abolished all compulsory vaccination.
|||The English Law, 61 & 62 Vict., ch. 49, provides only for the vaccination
of children, under a penalty, and furnishes to the people a special vaccinator.
|||See ch. 299, Laws of Minnesota of 1903, abolishing vaccination, and veto
in 1901 of Governor La Follette of vaccination law of Wisconsin. In 1904
there were riots in Brazil arising from attempts to enforce vaccination.
|||For decisions of state courts involving vaccination laws which have mainly
been decided upon statutes relating to the exclusion of children from the
public schools see Bissell v. Davison, 65 Connecticut, 183; Abell v. Clark,
84 California, 226; State v. Zimmerman, 86 Minnesota, 353; Osborn v. Russell,
64 Kansas, 507; Potts v. Breem, 167 Illinois, 67; Duffield v. Williamsport
School District, 162 Pa. St. 476; State v. Burdge, 95 Wisconsin, 390; Re
Rebenack, 62 Mo. App. 8; Blue v. Beach, 155 Indiana, 121. The only cases
which have considered general compulsory vaccination laws are State v. Hay,
126 N. Car. 999; Morris v. Columbus, 102 Georgia, 792; Re William H. Smith,
146 N.y. 68.
|||None of these cases are as extreme as the decision in the case at bar
and the laws providing that unvaccinated children shall not attend the public
schools are widely variant from laws compelling the vaccination of adult
|||As to admitted functions of the police power, see 4 Blackstone, 162; Cooley's
Const. Lim. 704; Ham. & St. Jo. R.r. Co. v. Husen, 95 U.s. 465, 470;
but the power is for the security of liberty and not for oppression. Barbier
v. Connelly, 113 U.s. 27; Lawton v. Steele, 152 U.s. 133.
|||A compulsory vaccination law is unreasonable, arbitrary and oppressive;
it is only effective in the protection of lawbreakers; the legal penalty
is illogical and unjust. See under English Act, 30 & 31 Vict., ch. 84,
extent of penalties. Regina v. Justice, L.r. 17 Q.b.d. 191; Dutton v. Atkinson,
L.r. 6 Q.b. 373; Pitcher v. Stafford, 4 Vest. & S. 775; Allen v. Worthy,
L.r. 5. Q.b. 163; Tebb v. Jones, 37 L.t. (n.s.) 576. The law is not of general
application as children are exempted. Compulsion to introduce disease into
a healthy system is a violation of liberty. The right to preserve life is
the most sacred right of man, Slaughter House Cases, 16 Wall. 36, and is
specially provided for in the Preamble of the Federal Constitution. If injured
the person vaccinated is damaged without compensation. Miller v. Horton,
152 Massachusetts, 546. The law is not within any cognizable principle of
. 1 Bishop, §§ 204, 230, 490, 513; Commonwealth v. Thompson, 6 Massachusetts,
134. The exemptions are unconstitutional. Minors are exempt while adults
are penalized. The classification in not a reasonable one. M., K. &
T. Ry. Co. v. May, 194 U.s. 267; Gulf, Colo. & S.r. v. Ellis, 165 U.s.
|||Plaintiff in error offered to show that he had suffered seriously from
previous vaccination, thus indicating that his system was sensitive to the
poison of vaccination virus. The like illness of his son indicated that
a hereditary condition existed which would cause the system to rebel against
the introduction of the vaccine matter. If the plaintiff in error had offered
the opinion of a physician that vaccination might even be deadly in its
effects upon the plaintiff, the law recognized no such defense, and the
evidence must have been excluded. The law itself testifies to its own oppressive
and unreasonable character. It is not due process of law, when such defense
is excluded. It is not equal protection of the laws, when such defense is
open to parents for the protection of children and is not open to parents
themselves. The right is of such an important and fundamental character
as to deprive plaintiff of his liberty without due process of law. West
v. Louisiana, 194 U.s. 258, 262.
|||The Board of Health is entrusted with arbitrary powers, and determines
the necessity for, and methods of, vaccination and plaintiff's rights in
regard thereto without a hearing, thus depriving him of his liberty without
due process of law. Chi., M. & St. P. v. Minnesota, 134 U.s. 418; Hagan
v. Reclamation Dist., 111 U.s. 701.
|||The law is not justified by necessity. Miller v. Horton, 152 Massachusetts,
546; Am. School of Healing v. McAnnulty, 187 U.s. 94.
|||Plaintiff in error was entitled to show the facts as they existed about
vaccination and its effects.
|||Mr. Frederick H. Nash, with whom Mr. Herbert Parker, Attorney General
of the State of Massachusetts, was on the brief, for defendant in error:
|||It is no argument that the conviction was repugnant to the spirit or to
the Preamble of the Constitution. An act of the legislature of a State and
regular proceedings under it are to be overthrown only by virtue of some
specific prohibition in the paramount law. Forsythe v. City of Hammond,
68 Fed. Rep. 774; Walker v. Cincinnati, 21 Ohio St. 14, 41; State v. Staten,
6 Coldwell, 233, 252; State v. Gerhardt, 145 Indiana, 439, 450; State v.
Smith, 44 Ohio St. 348, 374; People v. Fisher, 24 Wend 214, 219; Redell
v. Moores, 63 Nebraska, 219, overruling State v. Moores, 55 Nebraska, 480.
The Fifth Amendment does not apply to action by a State. Barron v. Baltimore,
7 Pet. 243, 247; Eilenbecker v. Plymouth Co., 134 U.s. 31; McElvaine v.
Brush, 142 U.s. 155, 158; Brown v. New Jersey, 175 U.s. 172; Capital City
Dairy Co. v. Ohio, 183 U.s. 238; Lloyd v. Dollison, 194 U.s. 445.
|||It is now too late to argue that the provisions of the Fifth Amendment,
securing the fundamental rights of the individual as against the exercise
of Federal power, are by virtue of the Fourteenth Amendment to be regarded
as privileges and immunities of a citizen of the United States. Slaughter
House Cases, 16 Wall. 36; Maxwell v. Dow. 176 U.s. 581.
|||The privileges and immunities of the plaintiff in error except where he
comes in contact with the machinery of the Federal Government, are those
which his own State gives him. In his relations with his State he takes
no benefit from the Fifth Amendment or from the Preamble of the United States
|||In its unquestioned power to preserve and protect the public health, it
is for the legislature of each State to determine whether vaccination is
effective in preventing the spread of smallpox or not, and deciding in the
affirmative to require doubting individuals to yield for the welfare of
the community. In re Smith, 146 N.y. 68, 77; Powell v. Pennsylvania, 127
U.s. 678, 683.
|||The s tatute in the present case was enacted as a health measure, and
has a real and substantial relation to that object.
|||Compare, by contrast, the statute forbidding the manufacture of cigars
in tenement-houses, In re Jacobs, 98 N.y. 98, the statute forbidding people
to give away articles in connection with a sale of food, People v. Gillson,
109 N.y. 389, and the statute forbidding bakers' employes to work more than
ten hours a day, People v. Lochner, 177 N.y. 145. Dissenting opinion.
|||Only in such cases of legislative dissimulation is it held that a law,
apparently looking to the protection of the public health and working without
undue classification, is a violation of the Fourteenth Amendment. Mugler
v. Kansas, 123 U.s. 623; Sentell v. New Orleans &c. Ry. Co., 166 U.s.
698, 704, 705; Hawker v. New York, 170 U.s. 189, 192; Holden v. Hardy, 169
|||In Lawton v. Steele, 152 U.s. 133, 136, it is said, by way of illustration,
that compulsory vaccination in a proper exercise of the police power, see
also Morris v. City of Columbus, 102 Georgia, 792, and State v. Hay, 126
N. Car. 999.
|||The courts may not listen to conflicting expert testimony as to the efficacy
or hurtfulness of vaccination in general. The legislature is the only body
which has power to determine whether the anti-vaccinationists or the majority
of the medical profession are in the right.
|||That the legislature has large discretion to determine what personal sacrifice
the public health, morals and safety require from individuals is elementary.
Cases cited (supra) , and Booth v. Illinois, 184 U.s. 425; Austin v. Tennessee,
179 U.s. 343; Fertilizing Co. v. Hyde Park, 97 U.s. 659.
|||The legislature of Massachusetts has power to require the vaccination
of its inhabitants and fix appropriate penalties for refusal. As to the
form of the legislation and its application to the plaintiff in error, the
exception of minors and wards from the provisions of the statute, rests
upon a reasonable basis of classification and denies to nobody the equal
protection of the laws. The advantage of uniform and general laws is best
attained by vesting discretionary power in local administrative bodies.
Wilson v. Eureka City, 173 U.s. 32; Health Department v. Rector of Trinity
Church, 145 N.y. 32.
|||A perfectly equal law may easily be the most unjust. A statute requiring
the vaccination of all the inhabitants of a State at a specified time irrespective
of the presence of smallpox and without regard to individual conditions
of health, or a set of rules and regulations made by the legislature itself,
which must necessarily be more or less inelastic, would be far less just
than this stature which delegates discretion to local public officials.
It is wise legislation which leaves the necessity for general vaccination
and the decision as to the time for vaccination of each individual to the
local boards of health. If they act in an arbitrary manner, depriving any
individual of a right protected by the Fourteenth Amendment, their action
in such individual case is void. Thus the law in general stands, but particular
cases of oppression may be prevented. Compare Yick Wo v. Hopkins, 118 U.s.
356, and Jew Ho v. Williamson, 103 Fed. Rep. 10, with Williams v. Mississippi,
170 U.s. 213; Ex parte Virginia, 100 U.s. 339; Carter v. Texas, 177 U.s.
442; Tarrence v. Florida, 188 U.s. 519.
|||The order of the Board of Health is clearly within the authority of the
statute. Matthews v. Board of Education, 127 Michigan, 530; Potts v. Breen,
167 Illinois, 67; State v. Burdge, 95 Wisconsin, 390; Lawbaugh v. Board
of Education, 177 Illinois, 572; In re Smith, 146 N.y. 68; Wong Wai v. Williamson,
103 Fed. Rep. 1; Wilson v. Alabama &c. R.r. Co., 77 Mississippi, 714;
Hurst v. Warner, 102 Michigan, 238, distinguished, as the rules were held
to be broader than the statute. And see where regulations were sustained,
Field v. Robinson, 198 Pa. St. 638; State v. Board of Education, 21 Utah,
401; Blue v. Beach, 155 Indiana, 121; Bissell v. Davidson, 65 Connecticut,
183; Morris v. City of Columbus, 102 Georgia, 792. In State v. Hay, 126
N. Car. 999, the court observed that if the jury had found that the defendant's
health made it unsafe for him to be vaccinated that would be a sufficient
excuse for his non-compliance, since to vaccinate him under such conditions
would be an arbitrary and unreasonable enforcement of the statute. See also
Abeel v. Clark, 84 California, 226; State v. Bell, 157 Indiana, 25; State
v. Zimmerman, 86 Minnesota, 353; Matter of Walters, 84 Hun, 457.
|||The action taken by the Board of Health in the case of the plaintiff in
error did not infringe his rights under the Federal Constitution. Arbitrary
action by the Board of Health, "with evil mind," might result
in a denial of due process of law. If they picked out one class of persons
arbitrarily for immediate vaccination, while indefinitely postponing action
toward all others, or if they otherwise abused their discretion their action
might be in violation of the Fourteenth Amendment, cases cited (supra) ,
but there is no suggestion of arbitrary conduct. It is not even hinted that
in the exercise of their discretion they failed to make proper discrimination
as to temporary conditions. If there were special reasons why the plaintiff
in error could not be vaccinated at the time required by the Board of Health,
he should have made them a ground of his refusal; and, if the Board neglected
to consider them, a defense to his prosecution. Penn. R.r. Co. v. Jersey
City, 47 N.j.l. 286. The statute did not require the vaccination and revaccination
of all the inhabitants, without discrimination, but left the matter to the
discretion of the local authorities. This was an unobjectionable method
of legislation. Field v. Clark, 143 U.s. 649, 693, 694.
|||Fuller, Harlan, Brewer, Brown, White, Peckham, McKenna, Holmes, Day
|||The opinion of the court was delivered by: Harlan
|||The United States does not derive any of its substantive powers from the
Preamble of the Constitution. It cannot exert any power to secure the declared
objects of the Constitution unless, apart from the Preamble such power be
found in, or can properly be implied from, some express delegation in the
|||While the spirit of the Constitution is to be respected not less than
its letter, the spirit is to be collected chiefly from its words.
|||While the exclusion of evidence in the state court in a case involving
the constitutionality of a state statute may not strictly present a Federal
question, this court may consider the rejection of such evidence upon the
ground of incompetency or immateriality under the statute as showing its
scope and meaning in the opinion of the state court.
|||The police of a State embraces such reasonable regulations relating to
matters completely within its territory, and not affecting the people of
other States, established directly by legislative enactment, as will protect
the public health and safety.
|||While a local regulation, even if based on the acknowledged power 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, the mode or
manner of exercising its police power is wholly within the discretion of
the State so long as the Constitution of the United States is not contravened,
or any right granted or secured thereby is not infringed, or not exercised
in such an arbitrary and oppressive manner as to justify the interference
of the courts to prevent wrong and oppression.
|||The liberty secured by the Constitution of the United States does not
import an absolute right in each person to be at all times, and in all circumstances
wholly freed from restraint, nor is it an element in such liberty that one
person, or a minority of persons residing in any community and enjoying
the benefits of its local government, should have power to dominate the
majority when supported in their action by the authority of the State.
|||It is within the police power of a State to enact a compulsory vaccination
law, and it is for the legislature, and not for the courts, to determine
in the first instance whether vaccination is or is not the best mode for
the prevention of smallpox and the protection of the public health.
|||There being obvious reasons for such exception, the fact that children,
under certain circumstances, are excepted from the operation of the law
does not deny the equal protection of the laws to adults if the statute
is applicable equally to all adults in like condition.
|||The highest court of Massachusetts not having held that the compulsory
vaccination law of that State establishes the absolute rule that an adult
must be vaccinated even if he is not a fit subject at the time or that vaccination
would seriously injure his health or cause his death, this court holds that
as to an adult residing in the community, and a fit subject of vaccination,
the statute is not invalid as in derogation of any of the rights of such
person under the Fourteenth Amendment.
|||THIS case involves the validity, under the Constitution of the United
States, of certain provisions in the statutes of Massachusetts relating
|||The Revised Laws of that Commonwealth, c. 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 five dollars."
|||An exception is made in favor of "children who present a certificate,
signed by a registered physician that they are unfit subjects for vaccination."
|||Proceeding under the above statutes, the Board of Health of the city of
Cambridge, Massachusetts, on the twenty-seventh day of February, 1902, adopted
the following regulation: "Whereas, smallpox has been prevalent to
some extent in the city of Cambridge and still continues to increase; and
whereas, it is necessary for the speedy extermination of the disease, that
all persons not protected by vaccination should be vaccinated; and whereas,
in the opinion of the board, the public health and safety require the vaccination
or revaccination of all the inhabitants of Cambridge; be it ordered, that
all the inhabitants of the city who have not been successfully vaccinated
since March, 1, 1897, be vaccinated or revaccinated."
|||Subsequently, the Board adopted an additional regulation empowering a
named physician to enforce the vaccination of persons as directed by the
Board at its special meeting of February 27.
|||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 seventeenth 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 first day 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
|||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 section 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 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 Fourteenth 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 the 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
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 five dollars. And
the court ordered that he stand committed until the fine was paid.
|||MR. JUSTICE HARLAN, after making the foregoing statement, 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, c. 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. Although, therefore, one of the declared
objects of the Constitution was to secure the blessings of liberty to all
under the sovereign jurisdiction and authority of the United States, no
power can be exerted to that end by the United States unless, apart from
the Preamble, it be found in some express delegation of power or in some
power to be properly implied therefrom. 1 Story's Const. § 462.
|||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, "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." We have
no need in this case to go beyond the plain, obvious meaning of the words
in those provisions of the Constitution which, it is contended, must control
|||What, according to the judgment of the state court, is the scope and effect
of the statute? What results were intended to be accomplished by it? These
questions must be answered.
|||The Supreme Judicial Court of Massachusetts said in the present case:
"Let us consider the offer of evidence which was made by the defendant
Jacobson. The ninth of the propositions which he offered to prove, as to
what vaccination consists of, is nothing more than a fact of common knowledge,
upon which the statute is founded, and proof of it was unnecessary and immaterial.
The thirteenth and fourteenth involved matters depending upon his personal
opinion, which could not be taken as correct, or given effect, merely because
he made it a ground of refusal to comply with the requirement. Moreover,
his views could not affect the validity of the statute, nor entitle him
to be excepted from its provisions. Commonwealth v. Connelly, 163 Massachusetts,
539; Commonwealth v. Has, 122 Massachusetts, 40; Reynolds v. United States,
98 U.S. 145; Regina v. Downes, 13 Cox C.C. 111. The other eleven propositions
all relate to alleged injurious or dangerous effects of vaccination. The
defendant 'offered to prove and show by competent evidence' these so-called
facts. Each of them, in its nature, is such that it cannot be stated as
a truth, otherwise than as a matter of opinion. The only 'competent evidence'
that could be presented to the court to prove these propositions was the
testimony of experts, giving their opinions. It would not have been competent
to introduce the medical history of individual cases. Assuming that medical
experts could have been found who would have testified in support of these
propositions, and that it had become the duty of the Judge, in accordance
with the law as stated in Commonwealth v. Anthes, 5 Gray, 185, to instruct
the jury as to whether or not the statute is constitutional, he would have
been obliged to consider the evidence in connection with facts of common
knowledge, which the court will always regard in passing upon the constitutionality
of a statute. He would have considered this testimony of experts in connection
with the facts that for nearly a century most of the members of the medical
profession have regarded vaccination, repeated after intervals, as a preventive
of smallpox; that while they have recognized the possibility of injury to
an individual from carelessness in the performance of it, or even in a conceivable
case without carelessness, they generally have considered the risk of such
an injury too small to be seriously weighed as against the benefits coming
from the discreet and proper use of the preventive; and that not only the
medical profession and the people generally have for a long time entertained
these opinions, but legislatures and courts have acted upon them with general
unanimity. If the defendant had been permitted to introduce such expert
testimony as he had in support of these several propositions, it could not
have changed the result. It would not have justified the court in holding
that the legislature had transcended its power in enacting this statute
on their judgment of what the welfare of the people demands." Commonwealth
v. Jacobson, 183 Massachusetts, 242.
|||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, is 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, Morley v. Lake Shore Railway Co., 146 U.S. 162, 167,
Tullis v. L.E. & W.R.R. Co., 175 U.S. 348, W.W. Cargill Co. v. Minnesota,
180 U.S. 452, 466 -- we assume for the purposes of the present inquiry that
its provisions require, at least as a general rule, that adults not under
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
|||The authority of the State to enact this statute is to be 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.
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; Railroad Company v. Husen, 95
U.S. 465, 470; Beer Company v. Massachusetts, 97 U.S. 25; New Orleans Gas
Co. v. Louisiana Light Co., 115 U.S. 650, 661; Lawton v. Steele, 152 U.S.
133. 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 or infringe
any right granted or secured by that instrument. A local enactment or regulation,
even if based on the acknowledged police power 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; Sinnot v. Davenport,
22 How. 227, 243; Missouri, Kansas & Texas Ry. Co. v. Haber, 169 U.S.
|||We come, then, to inquire whether any right given, or secured by the Constitution,
is invaded by the statute as 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." Railroad Co. v. Husen, 95 U.S. 465,
471; Missouri, Kansas & Texas Ry. Co. v. Haber, 169 U.S. 613, 628, 629;
Thorpe v. Rutland & Burlington R.R., 27 Vermont, 140, 148. In Crowley
v. Christensen, 137 U.S. 86, 89, 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 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.
Commonwealth v. Alger, 7 Cush. 53, 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 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, is 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 &c. R.R. Co. v. Jacobson, 179
U.S. 287, 301; 1 Dillon Mun. Corp., 4th ed.,§§ 319 to 325, and authorities
in notes; Freund's Police Power, § 63 et seq. In Railroad Company v. Husen,
95 U.S. 465, 471-473, 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 when 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 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, 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 Fourteenth 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; 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 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 the
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 evils of a smallpox epidemic that imperilled 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; Minnesota v. Barber, 136 U.S. 313, 320; Atkin v. Kansas,
191 U.S. 207, 223.
|||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. *fn1
And the principle of vaccination as a means to 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. Blue v.
Beach, 155 Indiana, 121; Morris v. City of Columbus, 102 Georgia, 792; State
v. Hay, 126 N. Car. 999; Abeel v. Clark, 84 California, 226, Bissell v.
Davidson, 65 Connecticut, 183; Hazen v. Strong, 2 Vermont, 427; Duffield
v. Williamsport School District, 162 Pa. St. 476.
|||The latest case upon the subject of which we are aware is Viemeister v.
White, President &c., decided very recently by the Court of Appeals
of New York, and the opinion in which has not yet appeared in the regular
reports. That case involved the validity of a statute excluding from the
public schools all children who had not been vaccinated. One contention
was that the statute and the regulation adopted in exercise of its provisions
was inconsistent with the rights, privileges and liberties of the citizen.
The contention was overruled, the court saying, among other things: "Smallpox
is known of all to be a dangerous and contagious disease. If vaccination
strongly tends to prevent the transmission or spread of this disease, it
logically follows that children may be refused admission to the public schools
until they have been vaccinated. The appellant claims that vaccination does
not tend to prevent smallpox, but tends to bring about other diseases, and
that it does much harm, with no good.
|||"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 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 of 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." 72 N.E. Rep.
|||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.
|||Did the offers of proof made by the defendant present a case which entitled
him, while remaining in Cambridge, to claim exemption from the operation
of the statute and of the regulation adopted by the Board of Health? We
have already said that his rejected offers, in the main, only set forth
the theory of those who had no faith in vaccination as a means of preventing
the spread of smallpox, or who thought that vaccination, without benefiting
the public, put in peril the health of the person vaccinated. But there
were some offers which it is contended embodied distinct facts that might
properly have been considered, Let us see how this is.
|||The defendant offered to prove that vaccination "quite often"
caused serious and permanent injury to the health of the person vaccinated;
that the operation "occasionally" resulted in death; that it was
"impossible" to tell "in any particular case" what the
results of vaccination would be or whether it would injure the health or
result in death; that "quite often" one's blood is in a certain
condition of impurity when it is not prudent or safe to vaccinate him; that
there is no practical test by which to determine "with any degree of
certainty" whether one's blood is in such condition of impurity as
to render vaccination necessarily unsafe or dangerous; that vaccine matter
is "quite often" impure and dangerous to be used, but whether
impure or not cannot be ascertained by any known practical test; that the
defendant refused to submit to vaccination for the reason that he had, "when
a child," been caused great and extreme suffering for a long period
by a disease produced by vaccination; and that he had witnessed a similar
result of vaccination not only in the case of his son, but in the case of
|||These offers, in effect, invited the court and jury to go over the whole
ground gone over by the legislature when it enacted the statute in question.
The legislature assumed that some children, by reason of their condition
at the time, might not be fit subjects of vaccination; and it is suggested
-- and we will not say without reason -- that such is the case with some
adults. But the defendant did not offer to prove that, by reason of his
then condition, he was in fact not a fit subject of vaccination at the time
he was informed of the requirement of the regulation adopted by the Board
of Health. It is entirely consistent with his offer of proof that, after
reaching full age he had become, so far as medical skill could discover,
and when informed of the regulation of the Board of Health was, a fit subject
of vaccination, and that the vaccine matter to be used in his case was such
as any medical practitioner of good standing would regard as proper to be
used. The matured opinions of medical men everywhere, and the experience
of mankind, as all must know, negative the suggestion that it is not possible
in any case to determine whether vaccination is safe. Was defendant exempted
from the operation of the statute simply because of this dread of the same
evil results experienced by him when a child and had observed in the cases
of his son and other children? Could he reasonably claim such an exemption
because "quite often" or "occasionally" injury had resulted
from vaccination, or because it was impossible, in the opinion of some,
by any practical test, to determine with absolute certainty whether a particular
person could be safely vaccinated?
|||It seems to the court that an affirmative answer to these questions would
practically strip the legislative department of its function to care for
the public health and the public safety when endangered by epidemics of
disease. Such an answer would mean that compulsory vaccination could not,
in any conceivable case, be legally enforced in a community, even at the
command of the legislature, however widespread the epidemic of smallpox,
and however deep and universal was the belief of the community and of its
medical advisers, that a system of general vaccination was vital to the
safety of all.
|||We are not prepared to hold that a minority, residing or remaining in
any city or town where smallpox is prevalent, and enjoying the general protection
afforded by an organized local government, may thus defy the will of its
constituted authorities, acting in good faith for all, under the legislative
sanction of the State. If such be the privilege of a minority then a like
privilege would belong to each individual of the community, and the spectacle
would be presented of the welfare and safety of an entire population being
subordinated to the notions of a single individual who chooses to remain
a part of that population. We are unwilling to hold it to be an element
in the liberty secured by the Constitution of the United States that one
person, or a minority of persons, residing in any community and enjoying
the benefits of its local government, should have the power thus to dominate
the majority when supported in their action by the authority of the State.
While this court should guard with firmness every right appertaining to
life, liberty or property as secured to the individual by the Supreme Law
of the Land, it is of the last importance that it should not invade the
domain of local authority except when it is plainly necessary to do so in
order to enforce that law. The safety and the health of the people of Massachusetts
are, in the first instance, for that Commonwealth to guard and protect.
They are matters that do not ordinarily concern the National Government.
So far as they can be reached by any government, they depend, primarily,
upon such action as the State in its wisdom may take; and we do not perceive
that this legislation has invaded by right secured by the Federal Constitution.
|||Before closing this opinion we deem it appropriate, in order to prevent
misapprehension as to our views, to observe -- perhaps to repeat a thought
already sufficiently expressed, namely -- that the police power of a State,
whether exercised by the legislature, or by a local body acting under its
authority, may be exerted in such circumstances or by regulations so arbitrary
and oppressive in particular cases as to justify the interference of the
courts to prevent wrong and oppression. Extreme cases can be readily suggested.
Ordinarily such cases are not safe guides in the administration of the law.
It is easy, for instance, to suppose the case of an adult who is embraced
by the mere words of the act, but yet to subject whom to vaccination in
a particular condition of his health or body, would be cruel and inhuman
in the last degree. We are not to be understood as holding that the statute
was intended to be applied to such a case, or, if it was so intended, that
the judiciary would not be competent to interfere and protect the health
and life of the individual concerned. "All laws," this court has
said, "should receive a sensible construction. General terms should
be so limited in their application as not to lead to inJustice, oppression
or absurd consequence. It will always, therefore, be presumed that the legislature
intended exceptions to its language which would avoid results of that character.
The reason of the law in such cases should prevail over its letter."
United States v. Kirby, 7 Wall. 482; Lau Ow Bew v. United States, 144 U.S.
47, 58. Until otherwise informed by the highest court of Massachusetts we
are not inclined to hold that the statute establishes the absolute rule
that an adult must be vaccinated if it be apparent or can be shown with
reasonable certainty that he is not at the time a fit subject of vaccination
or that vaccination, by reason of his then condition, would seriously impair
his health or probably cause his death. No such case is here presented.
It is the case of an adult who, for aught that appears, was himself in perfect
health and a fit subject of vaccination, and yet, while remaining in the
community, refused to obey the statute and the regulation adopted in execution
of its provisions for the protection of the public health and the public
safety, confessedly endangered by the presence of a dangerous disease.
|||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
|||The judgment of the court below must be affirmed.
|||It is so ordered.
|||JUSTICE BREWER and MR. JUSTICE PECKHAM Dissent.
"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 entrusted with the carrying out of the law;
in 1854 the public vaccinations under one year of age were 408,825 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 practice 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 Bavaria in 1807, and subsequently in the following
countries: Denmark (1810), Sweden (1814), Wurtemburg, Hesse, and other German
states (1818), Prussia (1835), Roumania (1874), Hungary (1876), and Servia
(1881). It is compulsory by cantonal law in ten out of the twenty-two Swis
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 Government
facilities and compulsion on various classes more or less directly under
Government control, such as soldiers, state employes, 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 eighty 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 Encyclopoedia 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 Chemitz 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."
8 Johnson's Universal Cyclopoedia (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 or 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 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 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  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 5 years of age, 42 1/2 per million; whereas among unvaccinated children
of the same age it was 5,950 per million.' Hardway's 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.'" Ib.
|||"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 practiced 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
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