cannot direct his thoughts to any other object." Dr. Carpenter's motto might be, "Ruat cœlum fiat vaccinia." Let small-pox after vaccination abound, but vaccination is right, nevertheless! There is one point on which Dr. Carpenter has the advantage of his opponents: he is to have the last word. But, sir, I am quite prepared to concede that advantage. I have no fear of the result, for, in my humble opinion, all the ability which Dr. Carpenter can bring to bear, and all the eloquence for which he is so widely famed, will not be able to bring forward one single fact in favour of compulsory vaccination which cannot be fairly, fully, and entirely overthrown.

Dr. E. HAUGHTON.-As in other questions, Professor Carpenter has shown candour of mind, and a disposition to consult the public good, I do not think he will be slow to give attention to any trustworthy evidence that may be brought | before him. I have always respected Professor Carpenter, and one of the oldest books in my possession was given me as a prize for anatomy and physiology, at the University of Dublin, namely, Carpenter's "Physiology." It therefore fills me with surprise that he should not have made himself acquainted with certain facts, which anyone who chooses to go to a right source may obtain. Certainly you will not get them in the Times, or in the medical journals. It is not the policy of the medical journals to publish both sides of the question. You have an advantage in attending this meeting which you would not have even at a medical society. When the question of the introduction of heifer-lymph was brought before that great British Medical Association, the chairman, Mr. Ernest Hart, declined to allow a motion to be put to the meeting. Why? Because there was not sufficient unanimity as to what vaccination was, to frame a reasonable resolution. At the last annual meeting at Ryde, great difficulty was experienced in formulating conclusions that would not seem to give encouragement to "those wicked anti-vaccinators who are the cause of so much trouble." The first idea was that a motion should be carried, appealing to the Local Government Board to provide a new supply of lymph, several speakers having shown that there were reasons for not having any great confidence in the lymph in present use; but I think our friend Dr. Drysdale interposed, and said that if such a motion were carried, it would give encouragement to those troublesome anti-vaccinators, who would consider it a kind of triumph to have a doubt thrown upon the current issue of lymph. A motion was therefore devised to this effect-that, although the profession has the fullest confidence in the ordinary supply of vaccine lymph, and considers it to be very good, nevertheless, the Government ought, as soon as possible, to provide a different supply-a supply of heifer lymph. And although it had been stated at the meeting that there were several distinct sources of supply of the said heifer-lymph, all differing more or less from one another, yet no one ventured to indicate which one of these supplies ought to be resorted to. The result is that any reasonable person can perceive that the whole question is in doubt and abeyance. We do not know what we mean when we use the word "vaccination." How, then, is it possible to frame

a resolution, or to predicate anything respecting it? We must have some definite conception of what we are speaking about before we can say whether it is good, bad, or indifferent. With regard to the Nineteenth Century, I think Dr. Carpenter made an observation to the effect that, if we chose, we could get our views expressed in such journals. Now, that is a mistake. A good many gentlemen have written to the Nineteenth Century, but the Editor will only permit vaccination to be vindicated, not impugned. Nevertheless, the last number of the British Medical Journal says vaccination is a "vexed question," in referring to this meeting. Anyone who had said as much ten years ago at a medical meeting would have been laughed to scorn. Vaccination is now admitted to be a vexed question. Again, when Dr. Carpenter wrote to the Spectator, the Editor of that journal told me himself that he would not insert any reply whatever, these antivaccinators being people who wished to make out that two and two make five. We have heard tonight something of the manner in which argument is met by the said anti-vaccinators, and we see they are as able to calculate as some other people. With regard to Scotland, I recollect some years ago an article appearing in the Lancet as to the low mortality from small-pox in that country. As to that, there are two ways of looking at it. It so happened that a friend having referred to the Registrar-General's Report as to the total Scottish mortality, this singular fact came forth, namely, that when small-pox was least in Scotland, then the general death-rate was highest. Thus vaccination might be no more than a means of killing people to save them from dying! I do not say so merely in jest. The converse of the proposition is just as remarkable. My friend Dr. Pearce has tabulated a variety of statistics relating to the rate of the general mortality when small-pox is prevalent; and what does he find? That, whenever small-pox is prevalent, in almost every instance, and in every country in Europe, there is a low general death-rate. You can verify that statement for yourselves. The epidemic of 1871-2 was the greatest that any man in this room can recollect, even including our venerable friend, Dr. Carpenter. It prevailed not only in England, but in almost every wellvaccinated country in Europe. Spain, I believe, escaped, Spain not having adopted compulsory vaccination. In Holland, Belgium, France, Prussia, and other European countries, the variolous death-rate was very high. In Berlin, almost all the population are re-vaccinated; certainly every adult is re-vaccinated; all the males are re-vaccinated when they enter the army, and all children when they go to school; and, I believe, in the event of marriage, men and women have to give some evidence of having undergone the operation. What was the result? That whereas in London the small-pox death-rate was so high as to surprise us, in Berlin the mortality was six times as great as in London. Then, again, Mr. W. E. H. Lecky, the historian, told us that vaccination had abolished small-pox in Ireland. He took so much for granted on the strength of other people's statements. Yet before the ink was dry upon his paper, the Belfast smallpox epidemic had broken out! About the same

time an article appeared in the Standard, saying that small-pox was abolished in Ireland as the effect of good vaccination. But at that very time there were seventy cases in the Belfast infirmary! When Ireland had the epidemic, it| had it in earnest. Dr. Carpenter says there is no anti-vaccination in Scotland, but the assertion is premature. Professor M'Call Anderson delivered a lecture before the Glasgow Young Men's Christian Association, and picked out a particular decade to prove how small-pox had abated under the influence of vaccination. He judiciously avoided the subsequent decade, which proved just the contrary, and a friend of mine, a canny Scotsman, looked up the facts, and published them in the newspapers, and the truth being manifest, we may look for the consequences in due season in the public opinion of Scotland. Statistics are valuable when they are taken upon a sufficiently large scale; and in the case of small-pox, it is essential to have the ages as well as the numbers of the sufferers. If not studied in a liberal and intelligent spirit, statistics may become, as Mr. Spurgeon says, a new mode of lying by figures.

Dr. CARPENTER, in reply.-At this late hour, I shall not attempt to go over the various remarks that have been made. With regard to Mr. Robinson's address, I really cannot find anything to answer, because I entirely agree with him as to the benefits of oxygen. The only question is how we are to bring about that which he recommends. I believe that the special malignity of small-pox in the present epidemic is due to the manufacture, so to speak, of a specially malignant virus by overcrowding in the Franco-German War. We have had plenty of instances of the same kind. I could go back to last century, and tell you how a mild remittent fever was converted into a most malignant typhus, that spread along the coast of England, by means of soldiers battened under the hatches in stormy weather, in a six weeks' passage from the Low Countries to Scotland. No one who has studied the history of epidemics has the smallest doubt as to such facts. But, then, how are we to sweep away London and reconstruct it? How are we to sweep away Glasgow and reconstruct it, and bring oxygen to bear upon everybody? No doubt, if we could, it would be an excellent thing. I have expressed as strong an opinion upon that point as anyone; but Mr. Collins did not lay stress upon the little word mostly. I spoke of a large proportion of epidemic diseases, or nearly all epidemic diseases. I had small-pox and scarlatina expressly in my mind as exceptions, when I wrote that paragraph; because they are diseases of all others peculiarly communicable by direct personal contact or contact with something that has touched the person. I do not believe that any sanitation will utterly extinguish them-at least, I cannot look forward to the time within any reasonable period at which that should be the case; therefore if we can get something else in the meantime, surely that something else should be used. Mr. Collins accuses me of having "fixed ideas;" well, I have had this idea for fifty years, ever since I began to think about such matters. No doubt it is a fixed idea, but I am not above learning; and I have applied for the best information attainable to the superintendents of small-pox hospitals in London.

I did not think of writing to the superintendent of the old Small-Pox Hospital; but I wrote to the Medical Superintendents of the four Asylum Boards Hospitals; and what facts do I get? Dr. Drysdale told you that in the Small-Pox Hospital they had very few cases of unvaccinated persons; but what are the facts here? In the Fulham Hospital, the total number of cases last year was 1,782; the total number of deaths was 250. The total number of vaccinated admissions was 1,378; putting aside 189 “doubtful," the certainly unvaccinated were 215. Taking the mortality in the whole number of vaccinated of all shades-good, bad, and indifferent, all those with any marks at all-the percentage of mortality was 7:22; of the 215 unvaccinated, there were 92 who died, giving a percentage of very nearly 43 per cent. It seems to me that anybody must be possessed of a very fixed idea, who cannot see the protective influence of vaccination in that.

Mr. EMERY.-I wish those figures had been quoted before the other speakers had sat down. I could answer them myself.

Dr. CARPENTER.-I stated as a general fact that among the unvaccinated, according to the experience of the last ten years in the hospitals, the mortality had been from 40 to 45 per cent., and stated it distinctly. I said that it was a mortality higher than had been known in modern times.

Mr. EMERY.-You say there is a greater mortality among the unvaccinated than there is among the vaccinated; but, if you put vaccinated and unvaccinated together, what is the difference between the total mortality from small-pox at this date and in the years prior to vaccination? The greater mortality in the unvaccinated (supposing they are unvaccinated) is to be accounted for by the age and surroundings of each case. If circumstances are not taken into account, we merely deceive ourselves by such statements.

Dr. CARPENTER.-The greater mortality of the unvaccinated at the present time in these hospitals is explained by this simple fact-the enormous proportion of the excessively severe cases which we have not seen in the present generation till the year 1871. During 1881 there were in the Fulham Hospital no less than 113 cases of the severest form of the malady (46 hæmorrhagic and 67 petechial), and 108 deaths. Not a single case of this number was "well" vaccinated. In the reports from the other hospitals also, there was a large number of these hæmorrhagic cases, and not one of these patients had been "well" vaccinated. At the Deptford Hospital, the total number of vaccinated admissions in 1881 was 2,263, and of deaths in this class 173, giving a percentage mortality of 76; while of the unvaccinated, the admissions were 539, and deaths 254, giving a death-rate of 471. At this hospital there were no fewer than 140 cases of the "malignant" type. At the Stockwell Hospital, the total number of vaccinated admissions in 1881 was 716, and the deaths were 47, or at the rate of 6.7 per cent.; while out of 197 unvaccinated, 93 died, making their death-rate 47.2. It is clear, therefore, from the extraordinarily high death-rate among the unvaccinated, that the epidemic, which last year returned upon us, has lost none of its

deadliness. These are facts which, I repeat, seem to me to require a very fixed idea indeed not to see the bearing of.-As to the Scotch mortality, set forth by Dr. Pearce, I distinctly said that the epidemic of 1871 affected Scotland most severely; and that it lasted for three years subsequently, instead of dying out the ne year, as in London. I said that it was since that epidemic, that small-pox had undergone an extraordinary reduction.-I fully recognise the fact that in last century there were a great many places where there was no small-pox for years and years; but why? What were the communications then between one place and other. In the days of the old slow-going coaches there was very little communication and migration. What is it now? I fully admitted that the increased small-pox mortality produced by inoculation did not show itself so much in London as in the country; and that inoculation did a great deal more harm in the country, by introducing the disease into places it would not otherwise have visited, than in London. I entirely believe that the progress of sanitary miprovement has affected a great change. But has any body been able to give any other account than I have given, of the increased mortality during the decade 1871-80? What other hypothesis is there to account for the extraordinary severity of that type of small-pox, when our general sanitary condition is improving? If the general sanitary condition has so much improved as speakers have said, how is it that we had this sudden outbreak-this most severe and terrible outbreak-terrible, not so much in the number attacked, as in its fearful mortality? There is the fact that the non-vaccinated population has shown a susceptibility to the most fearful form of small-pox, such as has never before been known in this generation. It was a most malignant type of disease, and everybody who has studied the history of epidemics knows that these malignant types are the most infectious. They give off doses of poison far greater than the ordinary forms of small-pox. Can anybody account for this extraordinary development in the decade 1871-80, in any other way than by admitting that it is a thing that has been bred elsewhere, imported and carried to every country all over the world. I say that the whole smallpox experience from 1871 to 1880 and 1881 is clearly a continuance of the same epidemic, an exceptional phenomenon, which should not be taken into account in the table. I did not hear Mr. Robinson, or Dr. Pearce, or Dr. Haughton, or Mr. Collins give any account of the peculiar characters of this epidemic. I am reproached for not paying attention to the facts that the anti-vaccinators bring forward; but I have gone to the best sources of information I could. I do not swear by every word that Mr. Ernest Hart, or anybody else, has said; I form my own conclusions. With regard to what was said by Pasteur, that answer of his was taken out of its connection. True; he said it was an open question." It was considered to have been settled by the Lyons Commission that small-pox and cowpox were entirely different diseases. I asked M. Chauveau, the head of that Commisssion, and M. Pasteur, what they now thought; and they both

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agreed that Pasteur's discoveries had re-opened the question-re-opening a thing that had been considered to be settled in an opposite sense.

I am much obliged for the courtesy with which every speaker has treated me personally, and for the kind attention that you have given to me. I feel sure that you are satisfied of my honesty in this matter. If I have, as Mr. Collins said, a "fixed idea," it is an "idea" which has become "fixed" just because I have the same belief in it, as honestly deducible from the collection of facts I have taken the greatest pains to obtain, as I have in any scientific fact whatever.

The CHAIRMAN: There may be some grounds of difference of opinion between us on the subject discussed, but there can be no ground for difference of opinion as to the debt that we owe to Dr. Carpenter for having come amongst us tonight, and given us his time and the results of his thought; I therefore ask you to testify your obligation to him by a hearty vote of thanks.

The vote of thanks was carried by acclamation. Mr. TEBB: May I also ask you for another round of applause to testify your thanks to Dr. Andrew Clark for so ably presiding.

Dr. CARPENTER: Allow me to support the motion. Dr. Andrew Clark's_time is pecuniarily of greater value than mine. It was at my special request that he came here to-night. Originally, Mr. Young suggested his name as a possible chairman, and I was extremely glad to secure his kind

1. Thus, the vaccinated admissions were nearly three times as many as the unvaccinated.

2. But the total vaccinated deaths were (almost exactly) half the unvaccinated deaths.

The table itself, as far as 1878, has been already published in the Report of the Metropolitan Asylums Board. All cases are ranked as vaccinated, which presented any distinct vaccination-mark. All cases are ranked as unvaccinated, in which the statement to that effect was confirmed by the entire absence of vaccination-marks; and all cases are ranked as doubtful in which either no evidence whatever could be obtained in regard to vaccination, or as to which the entire absence of vaccination-marks did not confirm the statement that they had been vaccinated. These marks were all looked for and recorded (wherever possible) on the admission of the patient, and the record was never subsequently altered.

3. The proportion of deaths to admissions was thus nearly six times as great among the unvaccinated as among the vaccinated. [The general death-rate of the unvaccinated is slightly above the 440 per cent. stated by Dr. Carpenter last year on the authority of the Vice-Chairman of the Metropolitan Asylums Board, and deemed "incredible by the Vaccination Inquirer, who was ignorant of the fact that a large part of the mortality of this epidemic is due to the prevalence of the "malignant" type of small-pox peculiar to it.] 4. Of the total of vaccinated admissions, less than one-seventh consisted of children under ten years of age; and of the total vaccinated deaths, those of children constituted little more than oneninth, making their death-rate only 6 per cent.

5. Of the total of unvaccinated admissions, nearly 55 per cent. consisted of children under ten years of age; and of the total of unvaccinated deaths, nearly 59 per cent. occurred among children, raising their death-rate to nearly 48 per cent.

6. Of the total of vaccinated admissions, more than six-sevenths were above ten years of age, and very few, if any, of them had been re-vaccinated; and though nearly eight-ninths of the deaths among the vaccinated occurred above the age of ten years, yet the death-rate among these was only 8 per cent.

7. Of the total of unvaccinated admissions, those above ten years of age were only about 45 per cent.; and of the unvaccinated deaths, those above ten years of age constituted 41 per cent., their death-rate being 40.8 per cent.

The theories advanced by the anti-vaccinationists to account for the high death-rate of the unvaccinated as compared with the vaccinated, is that the former are for the most part cachectic subjects, drawn from the lowest class of the metropolitan population. But they have produced no evidence of this from the experience of the medical officers of the small-pox hospitals. And this theory, even if admitted to be true to a certain extent, can scarcely be "forced" so far as to account for such an enormous disproportion

as that of more than seven to one between the

death-rates in unvaccinated and vaccinated children. And it is obviously inapplicable altogether to the regular gradation in the death-rates of the "well," "fairly well," "indifferently," and "badly vaccinated, as shown-alike in those under and those above ten years of age-in the following table :

Armmarks.

3 Good. 2 Good.

1 Good.

4 Good.

56 247

Good.

44

388

12

41 528

19

43 422

20

4 Imper

fect.

OBSERVATIONS BY THE EDITOR. We print the foregoing Homerton Returns at Dr. Carpenter's request, desiring that he should establish his position to his complete satisfaction. It is hardly necessary for us to repeat once more the single word, Incredible! We know the mortality from small-pox in pre-vaccination times; it was about 18 per cent., or the same in the total of cases as at the present day. When, therefore, we are told that the unvaccinated die at Homerton at the rate of 44 per cent., we laugh the communication to scorn. It is in vain to multiply figures in proof. We say they are incorrect; that we know they are incorrect; and that, however sworn to, we should still reject them as incorrect. In this matter we are hardened and hopeless unbelievers.

We say, further, there is not an unvaccinated population in London to furnish the quota of unvaccinated patients asserted.

We also demand, Who are the unvaccinated? Where do they come from? What are their circumstances? In the nature of the case, they are of a lower grade, socially and physically, than the vaccinated; and unless that grade be defined and recognised with all it represents, it is mockery to institute a comparison between them, with the slightest pretence to scientific

accuracy.

The radical error in these Hospital Tables consists in the illusory classification of cases under the influence of a blinding prepossession in favour of vaccination. It is taken for granted that a severe case of small-pox is necessarily an unvaccinated case; and as in such cases the vaccination marks are invisible, they are unhesitatingly registered as unvaccinated. We do not say that such classification is fraudulent in intent. On the

contrary, we say it is honest with the honesty of inbred faith and fanaticism. Nor do we make this assertion lightly. Over and over again, where investigation has been possible, severe cases of small-pox in the vaccinated have been traced registered as unvaccinated. The defence on exposure has usually been that the severity of the small-pox was certain evidence of the absence of vaccination! For those who care to see how the vaccination oracle is worked, let us commend to their attention a three-penny pamphlet by Mr. John Pickering, entitled, The Statistics of the Leeds Small-Pox Hospital Exposed and Refuted, published at 114, Victoria-street. Mr. Pickering's experience represents a large mass of the same order.

Dr. Carpenter's vaccination faith is omnivorous. He believes in vaccination marks as representative of degrees of protection from small-pox. Why not, then, introduce vaccination as a substitute for tattooing with which so many lads are infatuated? Mr. Marson, the originator of the marks doctrine, communicated another of his discoveries to a committee of the House of Commons. It was that fathers objected to vaccination in order that their families might be kept low by small-pox, so that thus they might have the fewer children to work for. We scarcely suppose that Dr. Carpenter concurs with Marson in that homicidal imputation. If there is any vestige of reality in the marks doctrine, it is probably limited to the fact that a person of good constitution heals well and

exhibits sharply-defined vaccination marks, and that the same constitutional vigour tends to a good recovery from small-pox.

OBSERVATIONS BY MR. ALEXANDER WHEELER. Mr. Wheeler, who has given much attention to Small-pox Hospital reports has communicated the following observations :

It is a great pity that Dr. Carpenter, instead of following Dr. Gayton in his tabulation, does not do his tabulation himself. Here is a 66 great discovery," some say the " greatest discovery in medicine," placed on its trial. It is a question whether vaccination is a preventive-a prophylactic. To touch it scientifically, we must therefore be perfectly sure we are not reckoning vaccinated persons as unvaccinated in any statistics we use. Yet here is Dr. Carpenter taking the very opposite course. Every assumption is passed as correct, if it is only against the unvaccinated. Doubt must be driven to the last refinement in some cases; but, in trying the cases of post-vaccinal small-pox, doubt is only permissible if it is applied to the faded or obscured mark of vaccination. Before us lies the very worst death-rate of small-pox patients we have seen, as happening in pre-Jennerian times. It is the Statistical Abstract of the London Small-pox Hospital, 1746 to 1762. There were 6,456 cases of small-pox "taken in the natural way"; 1,634 died, or 25 per cent. of the whole. It is expressly stated in the report that most of them were adults, often admitted after great irregularities, and some when their cure was despaired of."

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There is here a mortality of 8 per cent. heavier than Dr. Jurin's, which was spread over six times the area as regards numbers, and is, therefore, more reliable; but the point is, that this 25 per cent. is the very heaviest unvaccinated hospital small-pox death-rate, before Jenner, and after Sydenham's treatment came into use. What have the gentlemen who, like Dr. Gayton and Dr. Carpenter, are claiming to kill 40 and 44 per cent., and even 50 per cent. of the unvaccinated, to say to this? Why do the modern unvaccinated die at 20 and at 26 per cent. in excess of the preJennerian times ? It is idle to talk of the malignant small-pox as anything new, or anything explanatory. The small-pox in the last ten years is just what it was in 1649, and in 1749, and in 1849. It has been during all this time an unchanged disorder. And the proof is to be found in the works of Sydenham, Jurin, Wagstaffe, Massey, Von Swieten, and others, and in our own hospital records. On an average, 18 per cent. of the cases during all this time may, from the existing evidence, be said to have succumbed. And, it will be observed, Dr. Carpenter shows 188 as the common overhead death-rate at Homerton at this day. Jurin's was less, and even when including the figures I have given from the old small-pox hospital, Duvillard, who uses Jurin's figures, does not make the deathrate of natural small-pox exceed the 18.8 per cent.

If scientific men will apply their research to the question without bias, they will find there is positively no ground whatsoever for glorying in any gain as regards the mortality of modern over pre-Jennerian small-pox.

It is of little use telling Dr. Carpenter or any

PRIMITIVE VACCINATION-1806. DR. DRYSDALE accounts for the failure of vaccination to prevent small-pox by asserting that the virus in use has suffered degradation. The answer is, that vaccination in Jenner's day was not a whit more efficacious. The failures (allowing for the smaller number of the vaccinated) were as positive and conspicuous, as will be discovered by whoever examines the contemporary literature of the period. The other day we had placed in our hands some extracts from a journal kept by the father of a large family of remarkable distinction and intelligence. There were fourteen in family, including the parents-eight daughters and four sons. In succession two sons and seven daughters were inoculated. The eighth daughter was vaccinated about 1802, and the next, a son, was also vaccinated; but when the last child was born, he was inoculated, on account of the parents' distrust in vaccination. The father writes:

"Mr. M. to-day inoculated J.-April, 1806. We have no faith in vaccination, which was tried on M. and F. We have had many proofs of its utter worthlessness, especially on our son F., who has been subject to glandular swellings in the throat, which we refer to his vaccination."

Of all these children, only one, as an adult, had small-pox-namely, vaccinated F., who, in 1830, as a clergyman in Hertfordshire, was infected by a friend, a clergyman, whom he visited when recovering from small-pox, without fear, confident in the protection of his vaccination!

The two clergymen mentioned, and two others, all of whom had been carefully vaccinated with virus undegenerate, according to Dr. Drysdale's fancy, living near Hemel Hempstead, had smallwithin five years, two of the cases being confluent.

Such was primitive vaccination! What a commentary on Jenner's assertion, in his petition to Parliament, that "cow-pox is attended with the singularly beneficial effect of rendering, through life, the persons inoculated there with perfectly secure from the infection of small-pox!"

MR. R. H. HUTTON, in an article in the Nine teenth Century against Vivisection, observes:-" I, for my part, have always thought that genuine inoculations-the only very fruitful experiments among those of recent times-should be included in the class of small pains, and sufferings, and risks such as we may fairly require of the creatures beneath us."-The credulity of men of letters in contact with men of science, so-called, is touching. Mr. Hutton, in saying that experiments in inoculalation have been "very fruitful," refers, of course, to M. Pasteur; but imagine his embarrassment if required to return a definite answer to the question-Very fruitful in what?