century, 20 per cent. of the mortality of Glasgow was due to smallpox. Smallpox abated, but did mortality abate? Not in the least. Dr. Robert Watt in 1813 recorded the fact with amazement over it. And what was true of Glasgow was true of other cities and other populations. There may be a cessation of smallpox, but (unless the result of sanitary improvement) the work of death is merely transferred to cognate agencies. There is no saving of life. What was a mystery to Watt is less of a mystery since the development of sanitary science. Zymotic disease in its various forms is a definite evolution from definite insanitary conditions. It is not affected by medical repression, nor by the spontaneous substitution of one variety of fever for another. In the the words of Dr. Farr, "To save people from smallpox is "not enough whilst exposed to other forms of disease. "Thus in a garden where the flowers are neglected, to "keep off thistle-down merely leaves the ground open to "the world of surrounding weeds." To lower the zymotic death-rate it is necessary to reduce the conditions in which zymotic disease is generated. Citing Dr. Farr once more, "To operate on mortality, protection against every one of the fatal zymotic diseases is required; "otherwise the suppression of one disease-element opens "the way for others." Dr. Watt and Dr. Farr alike believed that vaccination stopped smallpox, and alike realised that the disappearance of smallpox was accompanied with no saving of life. Sir Spencer Wells is of a contrary opinion, which he shares with a number of people who prefer the free play of the prejudiced imagination to the sobriety of exact information.

WHO ARE THE UNVACCINATED?

III. Then we are asked to believe that though vaccination may not keep off smallpox, it makes it milder, and in proof we are entertained with low rates of mortality among the vaccinated and high rates among the unvaccinated.

We reply, to make a fair comparison between the vac

cinated and the unvaccinated, it would be necessary to compare class with class, physique with physique, age with age. In other words, the subjects of smallpox should be constitutionally equal, their difference being limited to vaccination present or vaccination absent. So much is obvious.

But when or where has such comparison been even attempted? Nor would it be easily practicable for the vaccinated comprise the best portion of the community, physically; but who are the unvaccinated? They are the waifs and strays of civilisation, the offspring of the miserable and the vagrant, who, without fixed domicile, escape the attention of the vaccination officer. These, whatever their ailment, whether measles, pneumonia, diarrhoea, would exhibit a higher rate of mortality than the vaccinated; but would it therefore be safe to argue that vaccination was not only good against smallpox, but against measles, pneumonia, and diarrhoea? Yet it is these, the lowest physically and most neglected of the population, who drift into smallpox hospitals, who are exhibited as fearful examples of the neglect of vaccination. It might be added, they are unbaptised as well as unvaccinated, and probably the one defect may be as prejudicial as the other.

UNVACCINATED DEATH-RATES.

Our contention does not end here. Such is the prejudice in favour of vaccination that a bad case of smallpox is assumed to be an unvaccinated case. Over and over again has it been proved that vaccinated patients dead of smallpox have been registered as unvaccinated, their death being taken as evidence of the absence of the sav ing rite. Again in severe smallpox, when vaccination marks are invisible, the sufferer is frequently set down as unvaccinated. Dr. Russell, of the Glasgow Hospital, relates that patients entered as unvaccinated, showed excellent marks when detained for convalescence Had they died, they would have gone to swell the ranks of fearful examples.

It is thus that the high death-rates of the unvaccinated are accounted for, the framers of hospital reports appearing to vie with each other in extravagance. We are continually adjured in the newspapers to confess our folly and repent, because 40 or 60 or 80 per cent. of the unvaccinated have perished in this or that hospital because unvaccinated. To us such statistics have fraud written on their face, and the more they are sworn to, the more unscrupulous do their vendors reveal themselves. When all were unvaccinated last century, the hospital death-rate of smallpox ranged about 18 per cent. we are asked to believe that death-rate has doubled, trebled, quadrupled, and for no other reason apparently than to make for the glory of vaccination.

NURSES EXEMPT FROM SMALLPOX.

Now

IV. It is further said that nurses in smallpox hospitals never contract smallpox because they are revaccinated. To establish this assertion, it would be necessary to prove that prior to the introduction of vaccination, or rather of revaccination, it was common for nurses to fall victims to the disease. The attempt is not made, and wisely, for failure would be conspicuous. Jenner never recommended vaccination as a protective for nurses. Their general immunity, along with that of physicians, is noted throughout our older medical literature; nor is the reason far to seek. Smallpox is predominantly an affection of the young, and it is no more surprising that a nurse should be proof against it than that she should be proof against measles, whooping cough, or scarlet fever. Nurses occasionally incur these maladies, and they occasionally incur smallpox.

If revaccination preserves nurses from smallpox, to which they are exposed in the intensest form, it should much more preserve soldiers, sailors, policemen and postmen, whose exposure is incomparably less intense; yet these servants of the state (as already observed) are as liable to smallpox as their unrevaccinated fellow citizens of correspondent ages.

To speak plainly, the selection of a vocation so arduous. and repulsive, marks off a smallpox nurse as unimpressionable, and little apt to catch anything. Smallpox, too, is like tobacco custom fortifies the constitution against its immediate effects. If the atmosphere of a smallpox hospital is endured for a fortnight, it is likely to continue endurable. On the other hand, if a volunteer sickens on probation, she is not reckoned among nurses. Lastly, many nurses have entered hospitals as patients, and have accepted service in default of other occupation. On these grounds, the nurse argument breaks down irretrievably. At first sight, it seems something, but on scrutiny it proves nothing.

POCK-MARKED FACES.

V.-Another favourite argument for vaccination is the disappearance of pock-marked faces. People say when they were young such faces were common, whilst now they are rare; and demand, What can have wrought the change if not vaccination?

A medical man at a public meeting tried to dispose of some statistics adverse to vaccination by saying that statistics could be made to prove anything; and presently went on to relate that when his mother was a girl every third person she met was pock-marked. She had told him so repeatedly, and there was no doubt about her accuracy. Thus statistics in general were untrustworthy, but his mother's statistic was unquestionable.

We need not hesitate to allow that when smallpox was common and cultivated pock-marked faces were more numerous: but we must not forget that whether a patient is marked or not marked is very much a matter of treatment. Many at this day pass through smallpox, and severe smallpox, and escape unmarked, simply because those who have care of them observe certain precautions. It was different in former times. The treatment of smallpox was atrocious. The sick-room was made pestiferous by the exclusion of air and the maintenance of high temperature. The patient sweltered

under bed-clothes. change his linen. He was drenched with physic and timulants. In hospitals, patients were stuck two or or three in a bed, and stewed together. If, under such circumstances, the sick were restored to life pock-marked, what wonder! Patients who were fortunate enough to be sufficiently let alone, stood the best chance of recovery. Besides smallpox was not equally diffused. In some places it was endemic; in others it appeared at intervals; and in others it was hardly known. The smallpox death-rate of Glasgow was double that of London; and we may therefore infer that pock-marked faces were twice as numerous in Glasgow as in London. Hence when recollections are appealed to, they should be localised. What might be true of one population might be grossly untrue of another.

He was neither allowed to wash nor

It has been observed that smallpox was falling_off toward the close of last century, and the decline accelerated in the present century, irrespective of vaccination. An excellent illustration of this reduction of smallpox is furnished by the reports of the National Vaccine Èstablishment for 1822, 1825, and 1837, where the disappearance of pock-marked faces from London is triumphantly recorded and claimed as a result of vaccination. În 1831 Dr. Epps, director of the Royal Jennerian Society, made the like observation and the like claim, saying, "Seldom "are persons now seen blind from smallpox. Seldom is the pitted and disfigured face now beheld" adding, but seldom do mankind inquire for the cause. It is "vaccination. It is vaccination which preserves the soft and rounded cheek of innocence, and the still more "captivating form of female loveliness." Inasmuch as not ten per cent, of the population were vaccinated in 1831, the claim made for vaccination was absurd, whilst the disappearance of pock-marked faces was sufficiently explicable by the reduced prevalence of smallpox.

Where then is the argument for vaccination from the disappearance of pock marked faces? When anyone under seventy proceeds to recite the legend, "There is