DR. W. B. CARPENTER, C.B., F.R.S., At the Monthly Conference of the London Society for the Abolition of Compulsory Vaccination. By the invitation of the Executive Committee of the London Society, Dr. W. B. Carpenter kindly consented to lead off the debate at the Monthly Conference with a paper entitled, "The Increase of Small-pox Mortality in London during the year 1880, without any corresponding increase in other parts of the Kingdom, a reason-not for a repeal of the Compulsory Vaccination Act-but for increasing the efficiency of its operation." The meeting was held in Steinway Hall, Portmansquare, on Friday evening, February 3. The chair was occupied by Andrew Clark, Esq., M.D.,

LL.D.

The CHAIRMAN: Ladies and gentlemen, The subject which we have assembled to discuss-that of compulsory and non-compulsory vaccinationis among the most important that at present engages the minds of thoughtful men. It is a very difficult subject; there are difficulties which are inherent to the subject; there are difficulties surrounding it and inseparable from it; and, worst of all, there have arisen difficulties which we ourselves on both sides of the question have added to the inseparable difficulties. We have permitted the element of emotion to enter into the discussion: and whenever that element does enter into the discussion of purely intellectual questions, it always disturbs the discussion; it blunts our perceptions; it lessens our charity; it alters our judgment; and, do what we will, whenever this element is largely present, it is almost impossible to get at the truth. Now, there is no shirking the fact that on both sides of this question that element has been permitted to enter too largely. I do not say which side is the worse. I am not here to speak on that matter; but I do say that both sides have erred; and if now and again one hears vaccinators talk of antivaccinators as fanatical and foolish, why then we see the anti-vaccinators repay them in kind by saying that the ground for their opinions is the money they get for vaccination. Now that is not the attitude of mind which we should present to this question; that is not the attitude of mind in which we can have any hope of getting at the truth; and I hope that all who are assembled here this evening for the purpose of discussing a very important part of the subject, will address themselves to it in that quiet, calm, even temper which every man who knows anything about scientific inquiry knows to be necessary for success. One thing I do askbecause you do not all know Dr. Carpenter as I know him-and that is to give him the credit which you claim for yourselves. That is a very small matter. You believe yourselves to be sincere, and I believe you to be sincere-you who are on the opposite side of the question; and I pray you to give to the other side that same credit for sincerity which you claim for yourselves. It is peculiarly happy that I should be here to-night, for I look upon Dr. Carpenter as one of the most valuable teachers that I ever had in my life. He does not know it, but I owe him a great deal; and I look back to-night to twenty years ago, when I

used to have the privilege of walking with him from the London Hospital, where he was our great teacher of physiology, to the West-end, and well did we enjoy it. Therefore it is an extreme pleasure to me to come here to-night after such a long time to hear him speak upon this important English physiology. He is known throughout subject. He is, you all know, the father of Europe as a man of varied and of profound knowledge, a man of a judicial temper of mind, and a genuine lover of truth. These are qualifications which it is almost impertinent in me to allude to in his presence, but they are known, and I venture to allude to them that you may remember them in listening to him. And now, that the discussion may able bounds, I will, with your permission, read a be kept within reasonable and profitletter which Dr. Carpenter has handed to me in order to show precisely the lines which he takes in his paper to-night; and I trust that these will be kept to in the course of the replies which you may see fit to make. He writes:

This has

"I think it well that you should know that I intend this evening to confine myself to the London experience of small-pox and vaccination, as shown-first, in the progressive reduction of the small-pox death-rate just in proportion to the spread of vaccination, which brought it down from more than 4,000 per million (leaving out the increase attributable to inoculation in the last and at the beginning of the past present century) to 276 in the decade 1861-70. Secondly, I shall then show that the decade 1871 to 1880 has been altogether exceptional, in the malignant character of the small-pox imported from France after the war. spread over Europe and the United States, everywhere showing the like severity; and the London outbreak of last year retained, as I learn from the medical superintendents of the small-pox hospitals, the like character, a considerable number of fatal hæmorrhagic cases still occurring, and running up the mortality of the unvaccinated. (3.) But, notwithstanding this, in the latter part of the decade the small-pox mortality of Scotland, where vaccination is well enforced, has been almost nil; and this is true also of Provincial England, including our great towns. No general outbreak took place anywhere last year, the small-pox mortality being somewhat augmented in the southern metropolitan area. (4.) I affirm, then, that the exceptional condition of London is mainly due to the Antivaccination propaganda. (5.) I cite a most interesting recent outbreak of small-pox in San Francisco; showing that general sanitation, or position in society, has little or no influence on the propagation of small-pox, and evidencing, most remarkably, the protective influence of vaccination. (6.) And lastly, I shall finish with some particulars of the epidemic of 1881, replying to some objections raised to former statistics."

Before calling upon Dr. Carpenter to read his paper, I shall ask Mr. Tebb to explain the aim and objects of the London Society for the Abolition of Compulsory Vaccination.

Mr. TEBB.-Mr. Chairman, ladies and gentlemer, it is customary at these monthly conferences of the London Society, to give an account of the progress of our agitation. On the last occasion, some information was given relative to the recent International Congress at Cologne, and also the result of the Congress held in the previous year

at Paris, in inducing the withdrawal of Dr. Liouville's Bill for compulsory vaccination and revaccination. This evening, I shall confine myself to a brief statement of the aims and objects of this Association and of our monthly conferences. The grounds of our contention are, we think, very strong; but I hope the chairman will not consider that in stating them I import passion into the case. Perhaps I cannot do better than refer to the Articles of our Association. One of them runs thus:-"In times when the laws of health were imperfectly understood, the fanciful discovery was made that by poisoning the blood with the virus of small-pox or cow-pox, a fatal attack of smallpox might be escaped. While many kindred superstitions in medical practice have been discredited and forgotten, vaccination, because it was endowed by the State, has survived, and has entered into legislation, and is enforced with fines and imprisonment. It is in vain for nonconformists to plead that they do not believe that vaccination has any power to prevent or mitigate | small-pox. They are told they may believe what they like, but that vaccinated they must be, for the benefit of the rite is settled beyond dispute." Now, it is to attack what we believe to be this mischievous superstition (and we may as well say so), that this Association has been formed. To make our attack effective, we invite the fullest possible discussion of the sides of this many-sided question. Thus, at some of our conferences we have had the statistical, at others the political, the historical, the medical, and the social sides of compulsory vaccination taken up. We have invited medical officers of health, eminent physicians, directors of small-pox hospitals, members of Boards of Guardians, magistrates, and all who are concerned in maintaining the practice of vaccination, or in the administration of the law by which it is enforced; and we believe that by this full discussion the end toward which our efforts are directed-the overthrow of compulsory vaccination-will the sooner be obtained. We look upon enforced vaccination as an anomaly in our social condition, altogether unjustified by any circumstances connected with it. Because a certain fraction of the community, say one in 2,500, is liable to the small-pox, we say it is illogical and unreasonable to attack with cow-pox the 2,499 who are not liable. There are numberless ailments to which human flesh is heir; for the mitigation or prevention of these ailments there are many thousands of prescriptions in use among the medical faculty; but there is only one ailment, and that a zymotic of the fifth magnitude, of which the State takes special cognisance, and there is only one prescription (and many of us believe it is worse than the disease which it is designed to prevent) which the State enforces with the strong arm of the law, or shall I say at the point of the bayonet. We maintain that this compulsion is not only unreasonable, but wholly indefensible. I must admit that when vaccination was first introduced, it was received with a considerable amount of favour, and it has been assumed, because of this favour, that Jenner had adduced scientific proof that it was all he represented it to be, namely, a protection against small-pox. The acclamation with which

Jenner's discovery was hailed was not due to its merits. There had been no scientific inquiry by Jenner or his contemporaries. There had been no time for examination. Jenner obtained his reward from Parliament six years after he announced his discovery. Vaccination came into vogue because it was a substitute for the worse Scourge smallpox inoculation. There is abundant testimony that at the end of the last century inoculation was considered a most serious affliction, and relief from it was welcomed with fervour. The speeches in the House of Commons at the time of Jenner's award fully confirm this assertion. I have said that Jenner's prescription was received with favour by the medical profession, and by the public influenced by that profession. In the House of Commons, in 1802, Mr. Addington, the Chancellor of the Exchequer, said: "Vaccination is the greatest discovery ever made by any human being for the benefit of society since the world began;" and other speakers exhausted eulogy in like strains. It is not, therefore, surprising that attempts should have been made to extend vaccination under compulsory legislation; but it is instructive in these days, when compulsory laws are passed with light hearts, to remark what were the opinions of eminent statesmen at a period when our liberties, achieved at a great cost, were not carelessly surrendered. Mr. Canning made this reply in the House of Commons in the year 1808: Although I consider the discovery of vaccination to be of the very greatest importance, yet I cannot imagine any circumstances whatever that would induce me to follow up the most favourable report of its infallibility with any measure for its compulsory infliction." Forty years later, a no less eminent statesman, the late Sir Robert Peel, referring to another attempt made to obtain compulsory legislation, said: "To make vaccination compulsory, as in some despotic countries, would be so opposed to the habits of the British people, and to the freedom of opinion wherein they rightly glory, that I could never be a party to such compulsion." But what these enlightened men refrained from doing, I am sorry to say that men of lesser note have dared to do; and for twenty-nine years this country has been suffering under the infliction of compulsory vaccination. I use the word "infliction" advisedly, because I believe that millions of our countrymen have been coerced into the adoption of this medical prescription, believing it to be wholly injurious, and without any redeeming virtue; and not only so, but thousands of honest, conscientious and upright men have been treated as criminals for no other offence than defending their children from what they believe to be a baneful operation. We affirm this is a state of things which the majority of Englishmen can only look upon with feelings of indignation and shame; and the object of this Society is to wipe this national reproach from our boasted civilisation. This coercion has been justified, as all coercion has been justified from age to age, by the plea that it is for the good of society and the welfare of the State; but we deny that the welfare of the State can be secured by the enforcement of either medical or religious dogmas. Further, we maintain that if even some advantage could be secured by the

our contention

ness."

despotic exercise of power, it would be dearly purchased by rights that are outraged and the liberties that are destroyed-the rights of conscience, and the liberty of the parent to decide what is best for the well-being of his child. Our case has often been thus briefly put, but never answered. If vaccination protects, let the protected rejoice in the immunity which they have secured by the rite, but do not let them force their rite upon those who not only have no faith in it, but who believe it to be most injurious. If vaccination does not protect, then compulsion is wholly unjustifiable. But is maintained upon other grounds, which we affirm are scientific and irrefutable. Mr. Dudgeon, of Quorn, and Dr. Southwood Smith, published facts thirty years ago to show that sanitation was sufficient to abolish all zymotic diseases, and, therefore, vaccination was wholly unnecessary. Dr. Carpenter, I know, by the letter which Dr. Clark has read, maintains an opposite opinion, but this opinion of Mr. Dudgeon's is a reasonable one, and it is supported by nearly all the leading sanitarians of our time, and by many able physicians. Dr. Lyon Playfair, a man of high reputation, says, "No epidemic can withstand thorough cleanliIs it not remarkable that at the recent Health Congress at Brighton not one word was said by any of the speakers in defence of vaccination? and Mr. Edwin Chadwick, one of the oldest sanitarians in the country, after describing the condition under which small-pox and typhus occur, said, "The entire removal of such conditions by complete sanitation and by improved dwellings is the effectual preventive of diseases of those species, and of ordinary, as well as extraordinary, epidemic visitations.' And I think the Local Government Board is almost, if not quite, converted to the same doctrine. The report for the year 1881, published in the Times, on the progress of sanitary work in England, says that the seven zymotic diseases are most influenced by sanitary improvement, and most amenable to control by sanitary authorities; and at the Health Congress before referred to in Brighton, the President, Dr. Richardson, in his admirable inaugural address, published in Fraser, which I would advise you all to read, said, "Pure blood and a healthy life will banish all disease." But under this compulsory vaccination law, pure blood is an impossibility. It is, in fact, a penal offence. Our reasonable demand is, to secure liberty to have pure blood. We maintain that it is indefensible for any Government to insist upon diseasing the blood of the nation; and we have the high authority of Sir James Paget, who says, in his lectures on inflammation, that "vaccine virus produces a permanent morbid condition of the blood." Let it be understood that in this contention we have no war with the medical profession. Some of our ablest allies are professors of hygiene and medicine in the universities of the Continent, of America, and Canada, and they are our most earnest supporters at home. There are medical men on this platform who have been "boycotted" because they have refused to vaccinate; but neither "boycotting," nor loss of prestige, nor of place, nor popularity, nor emoluments, will cause them to swerve one iota from

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the truth they maintain on this matter. while saying this, we also give credit to those gentlemen like Dr. Carpenter for the same honest intentions, and the same desire to serve the public, as we claim for ourselves, but we contend that Dr. Carpenter is labouring under an illusion. I am sure, however, that every member of this Society will give him an attentive, candid, and considerate hearing.

Dr. CARPENTER.-When I received the courteous invitation to come here and give an address, which might enable me to express the convictions to which I was led fifty years ago, and from which I have never seen any occasion to swerve, I thought it better to choose some definite point for discussion. The recent researches of M. Pasteur have shed a great deal of new and interesting light upon the question of vaccination. I have also had the opportunity of perusing what I believe is a unique copy of a pamphlet by Mr. Badcock, who, in 1845, asserted that he had produced the vaccine eruption not only on one cow, but on several cows, by inoculation with small-pox virus. Thus Pasteur and Badcock together confirmed the impression originally suggested by Jenner, that cow-pox is a modified small-pox" modified by cultivation," as M. Pasteur would say, in another animal-and corresponding exactly with the remarkable fact, which M. Pasteur has worked out, that a disease which is just as fatal on the Continent to sheep and cattle as smallpox has been in this country, the charbon or pustule maligne, is preventible by inoculation with a virus modified by 66 cultivation " and certain chemical means in other animals. Now, I do not wish to bring forward this question to-night, nor the question of vaccination from heifers. Upon that question I have expressed a strong opinion, having come to the conclusion that heifer vaccination is a great boon. By heifer-vaccination, I mean vaccination continuously from the original cow-stock, not passing through the human body at all; not what is called retro-vaccination-the inoculating of heifers from the human subject; for that, I believe, is of no good at all. I mean the use of lymph derived by continuous transmission from the cow-stock. I regard that as a great boon, because it would at once sweep away all the objections (the cogency of which I fully admit) to the introduction of human disease into those whom we vaccinate. Leaving these details, which I have discussed in the Nineteenth Century. I take as my text the notice of motion which your president (Mr. P. A. Taylor) has given in Parliament, namely, that the epidemic of small-pox in London, in 1871, 1881, shows the utter incapacity of vaccination to deal with the disease. My object is to give you the reasons for the contrary-for the maintenance of the Compulsory Vaccination Acts, and for bringing them into a more stringent, complete, and thorough operation. With regard to the general question of compulsion, I do not want to discuss it all, further than to make one observation. Latterly, in this country we have gone in for Compulsory Education; and I believe nobody doubts, or scarcely anybody, the desirableness of compulsion in that matter. And why? Because we do not think that a parent should be allowed to choose ignorance for his child. We think that the bringing up a child ignorant, barbarous, brutal,

concerns the public generally, and not merely the child himself. In the same way the State says, "Vaccination is not a question between parent and child, it is a question between the child and the public; because the public is just as much liable to be injured by a child becoming a focus of small-pox, as it is by a child being brutal and ignorant." I could give plenty of instances that have been traced out of small-pox originating and being diffused from the unvaccinated. A wake is held on a dead body at Lambeth, for instance, or Pimlico, and half-a-dozen people are taken with small-pox by attending the wake. It is, therefore, not a question of the welfare of the individual, but a question of the welfare of the public; and I think it is a perfectly arguable proposition that, if vaccination can be proved, I won't say an absolute preventive (nobody that I know says so nowadays), but to have very greatly diminished the risk of small-pox, then I say the public has some interest in the welfare of every child, and has a right to take this matter into its own hands.

Now, sir, I have written a long paper; but I believe it will be better for me to deliver the substance of it extempore. Let us begin with a glance backward at the history of smallpox in relation to vaccination. I think that those who stand up at the present time to say that only a certain small proportion of the population at the present time is liable to small-pox, are bound to acquaint themselves with medical history. No medical writer that I know of in the last two centuries had the smallest doubt whatever, that everybody born into this world had just as much liability to small-pox as to measles, or whooping-cough, or scarlatina. Those diseases were put upon one level; they were grouped by themselves in every medical classification. They belong to the order of Exanthemata, the peculiarity of which is that everybody is liable to have these diseases once in life, and occasionally twice. Now, what are the facts of this case? Why, that there was a constant terror of small-pox in the times to which I go back. There is this peculiarity about London and its records of small-pox. Everybody knows that there were bills of mortality in London, furnished by the parish clerks, collected together, and published weekly. There was a great deal of mistake about the various diseases. If you try to ascertain from the bills of mortality what diseases were prevalent at the middle of last century, for instance, you would have great difficulty, according to the modern conceptions of disease, in ascertaining what those diseases were. Scarlatina is not named; and yet, at the present time, scarlatina is among the most fatal of diseases. Twenty thousand persons not unfrequently die of that disease in a year. Small-pox, however, was universally known and recognised. There was no disease about which there could be such entire absence of any mistake whatever. It is remarkable that even the great Sydenham confounded scarlatina and measles; and I believe the reason may have been that there was in his time a form of those diseases which could be mistaken one for the other; for I remember when there was an epidemic in the East of London which combined these diseases in a most curious way: but about

Now, I have been accused of romancing a little about the former prevalence of small-pox. The first five lines of this table, Sir, are taken from the carefully - prepared statistics of Dr. Farr, who, beyond all question, is the ablest medical statistician of his time, or of any time; and to say that Dr. Farr was influenced by any feeling in this matter, is to accuse one of the truest men I have ever known of deliberate falsification. Now, what were the materials for these statistics? The materials, up to the commencement of the present century, were defective, inasmuch as no one could say precisely what was the population of London. There was no census; but Dr. Farr went on the principle of comparing all the best estimates he could obtain; and the entries in that table, down to 1831-1835, are made up from the best data that Dr. Farr could find. The first regular census was taken in 1801, and from that time we know accurately the population, and the deaths from smallpox within the limits of the Bills of Mortality. You must remember that the Bills of Mortality only refer to a portion of London; and at the beginning of the present century London had far outgrown the limits covered by the Bills; and, therefore, the best way to compare the small-pox deathrates is to reduce them all to one standard, as I have done. We begin with the period, 1660 and 1679. The general death-rate of London was, at that time, 8 per cent.-80 in a thousand-a most fearful death-rate; but, then, remember that that included the year of the Great Plague; yet, notwithstanding the Plague, the average small-pox death-rate for those twenty years was 4,170. Small-pox then pervaded all classes of society. The Duke of Gloucester died while the rejoicings for the Restoration of 1660 were going on. Anybody who reads "Pepys' Diary "will find frequent references to the prevalence of small-pox in the highest places of the land. Every one who knows who Evelyn was, knows that he was not a man to be

common

* I have been accused by Dr. Pearce of having selected these periods with a purpose, and of passing over intermediate periods of smaller mortality. I give the table exactly as I found it on p. lv. of Mr. Simon's well-known Blue-book (1857), omitting only the first period 1629-35, as short and obviously exceptional, the long periods which succeed it giving a death. rate which accords closely with the estimates formed by the medical historians of the time. It has been asserted that these statistics must be wrong, because the general death-rate given in them far exceeds any possible birth-rate, and that thus London would have been depopulated. But it is perfectly well known to statisticians, that the maintenance of the population of the Metropolis during a large part of the last century, depended upon immigration from the country; its own deathrate exceeding its birth-rate.

*

living under bad sanitary conditions; but in his diary he wrote, "in bitterness of sorrow and reluctancy of a tender parent," of the death of his daughter by small- pox. There was the case of Queen Mary, the wife of William III. Burnet, the historian, says, "The small-pox has broken out afresh in London; we had the greatest apprehension for the Queen, because she never had it." The Queen died of it. Does anybody now entertain any apprehension for the Queen or any of the Royal Family? They never had the small-pox, not one of them. I happen to know they were all re-vaccinated some years ago; I remember hearing of it from my friend Sir James Clark, who caused them all to be revaccinated. Now, does anybody suppose that if small-pox were prevalent at Pimlico, near the Palace, the Queen would hesitate to go to the Palace for fear of catching it? I am perfectly certain it would not prevent her, if she felt called upon. I turned up a passage in Pepys that I shall read in his own words, because I have been accused of romancing. He says, "And among other things, it hardly ever was remembered such a season for the small-pox as these last two months have been. People have been seen all up and down the streets newly come out after the small-pox." And again, in the winter of 1694-5, we read in "Burnet's History" that the smallpox was raging about London. Some thousands died of it. Now, remembering what London was at that time-about one-tenth of what it is now-think of some thousands dying of it, and giving great apprehension with regard to the Queen, "for she never had it." And then, in January, 1695, after the Queen had died of it, Pepys reports 500 deaths from small-pox more than in the preceding week. These were not vague stories; these were reports from the Bills of Mortality-500 more in one week than in the preceding week! Think what that must have been; and here we were, all last year, reckoning the deaths in this population of nearly four millions by tens-not by hundreds, but by tens. To the best of my recollection, there was no one week in which 100 deaths occurred. Now, the next period taken by Dr. Farr is from 1728 to 1757. There you see the general death-rate had come down to 52,000 per million, but the smallpox death-rate had increased. I think it very likely that the increase was due to what shows itself much more in the next period, in which you see it rose to 5,020. I believe that that was the result of inoculation; and I say 80 upon the authority of some of the best medical writers of that period. At the end of the century, Dr. Heberden, looking back over the century, says, "I think from the best evidence we can collect that inoculation increased the mortality of London by about one-fourth." Now that exactly corresponds with Dr. Farr's table. Adding a quarter to 4,000 (in round numbers) gives 5,000. It is curious, however, that, notwithstanding inoculation increased the general mortality, it diminished very much indeed the individual liability. The two things are not in the least degree incompatible. In the country, smallpox was introduced into localities where it had never been before, and where it never would have been. There can be no doubt at all that inocula

tion did great mischief in that way. Small-pox being always prevalent in London, and London then being not anything like as large as it is now, people would always be in the way of catching it; and therefore the mischief it did by inflicting small-pox upon people who otherwise would have escaped it was comparatively small. But in the country, I believe, there was no doubt that inoculation increased considerably the general mortality. We have not, however, the same information with regard to the mortality of England that we have of London. I therefore limit myself to London; and it is pretty clear that inoculation was answerable for about one-fourth of the average of 5,000 deaths. Therefore I propose to knock off that one-fourth altogether-to put it out of the question, as it were; and say that during the 140 years, from 1660 to 1800, we may take what we may call the natural rate of small-pox as about 4,000 per million-that is, out of one million persons, 4,000 died annually, taking the average of long periods. And we have just the same evidence in the eighteenth century of persons of all ranks being attacked, as in the seventeenth. There has been published a catalogue of noble and royal personages who died of smallрох in the eighteenth century. Take Louis XV. in 1774; take the Dauphin of France in the early part of the century. And it is not only their deaths, but the apprehension that was shown of the smallpox by the people about them, that marks what small-pox was in those days. Everybody dreaded catching small-pox. When the Dauphin was dying, there was not a single person who would sit near him in his last moments, or near his body after he died, but one of his mistresses, La Vallière; and when Louis XV. died there was just the same terror, Madame Du Barry alone (if I remember right) staying with him. His body was hurried, huddled into a coffin; and the priests who were sent to pray by the side of his coffin in the chapel, were said to be "condemned" to perform this last office for him, on account of the apprehension of their taking small-pox. He died of a particularly malignant type of smallpox; and I want to impress this fact upon you, that in the last century there was, every now and then, a form of small-pox which was terrible -as bad as the worst forms of what we used to call putrid fever. I will give you an illustration of it from Horace Walpole (and this, again, will show you that small-pox attacked people of all ranks), written in 1750. Walpole says: "Lord Dalkeith is dead of small-pox in three days,"-now, that at once marks the severity of the type;-"it is so dreadfully fatal in his family, that, besides several uncles and aunts, his eldest boy died of it last year; and his only brother, who was ill but two days, putrefied so fast that his limbs fell off as they lifted his body into the coffin." I bring this forward to show you what different degrees there are in small-pox; a fact which I shall again bring before you prominently with regard to the recent epidemic.

I now come to the present century, in the beginning of which Jenner's discovery was announced, and in the course of a few years took strong hold on the public, in spite of very great opposition. Any one conversant with the history