year, Dr. Carpenter asked him as to the relationship of vaccine lymph to human smallpox; but Pasteur was too wide-awake to commit himself. He preferred to leave it an open question. Am I, therefore, not justified in saying that, as to its nature, vaccine lymph has not a scientific basis of positive knowledge upon which to rest its claim to the confidence of scientific men? I now come to the mode in which it acts upon the human body. As a general practitioner I have a right to demand from an eminent physiologist like Dr. Carpenter the minutest information upon this subject. There never was a time when physiological knowledge was advancing with such decisive steps as now. The great school of physiology which Professor Michael Foster has created at Cambridge, and the valuable works emanating therefrom, have brought us face to face with minuter conditions of animal life than have ever been made known to us before. Has this increased knowledge elucidated in the slightest degree the mode in which vaccine lymph works a protective change in the tissues of the human body? Sir Erasmus Wilson, in his great work on Skin Diseases, says, in 1863:-" For what length of time is the susceptibility destroyed?"-and"At what period after contagion is the restoration of the organism so far effected that a second attack of contagious disease may take place? "To both these questions the answer is, we know not," and he emphasises these words in italics. And if I turn to the British Medical Journal of Nov. 12, 1881, I find in an editorial article the following:-"At the same time, the labours of M. Pasteur and others do not appear to have brought us any nearer to an intelligible explanation of the prophylactic virtues of inoculation. The pathological theory, in the hands of M. Pasteur, lags almost as far behind the practice as it originally did in the hands of Jenner." Now, I am not acquainted with any later opinion as to the scientific position of vaccine lymph as a remedial agent, but I think I am justified in saying that it lacks absolutely a scientific basis of positive knowledge upon which to rest its claim to the confidence of scientific men. But, although there may be no positive knowledge, there have been several theories put forth by ardent believers in vaccination. Mr. Simon is an eminent man, and in 1857 published an elaborate history of smallpox and vaccination. One of his theories as to the action of the vaccine lymph is thus stated :-"Lymph of shorter descent has been more successful in disinfecting the body of that ingredient which constitutes its susceptibility to small-pox." To speak of vaccine lymph "disinfecting" the animal body of an ingredient, is so glaringly inconsistent with the ideas now prevalent in these days of antiseptic surgery, that I venture to say Mr. Simon would modify this opinion, as he has modified other opinions contained in his papers of 1857, if he had to revise them. Vaccine lymph is a phase in the life of one of the many forms of purulent matter. The areola said to be necessary to every "protective" vesicle is the beginning of common septic inflammation. So near is it to the stage of a rapid blood poison, that Mr. Simon thus writes of its nature:-"Especially as regards the quality of vaccine lymph, the careless or uneducated vaccinator is using a dan

gerous weapon. It is only during part of the course of a vaccine vesicle that its lymph is suitable for further vaccinations; for after a given moment, at which the contents of the vesicle possess their maximum of simple contagiousness, they tend more and more towards the quality of common inflammatory products, and matter now taken from the vesicle is no longer the simple agent of a specific infection, but both has less efficiency for its real purpose, and is specially able to produce other undesired results. A danger of a somewhat similar kind is that of taking lymph from vesicles which already have been accidentally ruptured, or where, from any other cause, local or constitutional, their specific fluid is likely to have been modified by common irritative processes. Still more critical changes occur in lymph when removed from the body, unless appropriate means be taken to preserve it, for, under the influence of air and moisture, it tends, like other dead organic matter, to putrid decomposition; and inoculation with it, when thus changing, can hardly be more useful, or less dangerous, than a casual scratch inflicted in the dissecting room."

These opinions, if my own observation did not help me, justify me in saying that vaccine lymph is a phase in the life of one of the many forms of purulent matter; and to speak of it as Mr. Simon does, as a disinfectant of an ingredient in the living animal body, is, in these days of antiseptic treatment, to oppose the most certain principles of scientific surgery. That the expectations and ideas of the first promoters of vaccination have not been fulfilled by the experience of eighty years is shown in the two following opinions with which I conclude this argument. In combating Jenner's idea of the protective quality of a primary vaccination, Dr. Warlomont thus writes (Nov. 12, 1881, British Medical Journal): "It has been objected that Jenner's opinion was against it (repeated vaccination). This argument has no weight with me. In matters of experimental science, the predictions of the greatest geniuses only show the imprudence of those who express them. Facts have decided against the predictions expressed on this subject by the immortal discoverer of vaccination." And the Times of December, 1880, writes thus:"It would appear, therefore, as if the advocacy of vaccination might with advantage be placed on a different ground from that which has recently been urged by its supporters, and as if the operation might be recommended or enforced, not as a means of preventing small-pox, but as a means of preventing mortality from it when it occurs." Dr. Carpenter has not given us any clue as to the direction this method of increased efficiency is to take: whether the lymph is to be from a new source, or to be subjected to more careful microscopic examination, or to be taken from the vesicle at a different period, or whether more marks, or more frequent re-vaccinations, or vaccinisation is to characterise the practice. The agent in whose protective virtues we have faith is not enveloped in mystery. Its name, qualities, and permanent influence are amongst the positive facts of science. It is every Englishman's birthright. It has not to be fetched

# Report 1871, page 381.

from a foreign country. It does not need to be cultivated or manufactured. It is the free oxygen in the atmosphere outside the body, and the free oxygen in the red discs of the blood within. Pasteur's experiments demonstrate its power to destroy the most virulent qualities of disease germs, inasmuch as he trusts to its influence to produce his attenuated diseases. His broad generalisation attributes the cessation of all epidemics to its purifying influence. The conditions which are inseparable from a crowded population will account for the prevalence of these contagious diseases. If the carbonic acid is not readily carried away from the lungs, but is allowed to accumulate with the animal matters dissolved in the expired air, the carbonic acid in the blood cannot get out, and fresh oxygen cannot pass in. Hence an absence of that free oxygen in the red discs of the blood which is the true stimulant to healthy action. The degraded condition of the blood, described by Dr. Carpenter as characterising the worst forms of small-pox, is rationally explained by the absence of the due amount of free oxygen. I should be unfaithful to the teachings of physiology, and to the experience of every-day life, if I were to ignore the permanent necessity of this grand agent in nature, and I should be false to the cause of truth if I were to lead the people amongst whom I practise-if I were to teach them to trust, first to the protective virtues of an animal disease, and only, in the second place, to the oxygen of the air. The agent in which we believe is oxygen, and its virtues will stand when all the systems of animal disease inoculations have passed away.

Dr. C. R. DRYSDALF.-I presume I have been asked to speak out of fairness, because it has been thought that speakers should be heard who take opposite sides. Allow me to say that I entirely agree with everything that fell from our beloved and venerable friend, Dr. Carpenter. I have read many things that he has written upon this question, but I may say that nothing I have ever read is equal in its convincing effect to what he has said this evening. I cannot quite understand how my able friends, especially Dr. Collins, can stand against such arguments. I venture to prophesy that they will not be able to stand any length of time. I sincerely thank your Society for giving us the opportunity of proving again the value of vaccination. I have no hesitation in saying that it was the greatest discovery of its kind ever made. There are one or two points upon which I should like to lay some emphasis. Is it not perfectly clear, looking at these statistics of Dr. Carpenter's, that whereas the small-pox deathrate used to be, during last century, about 1 in 10 of all deaths in London, at the present moment it is about 1 in 62 or 63? I have had the honour of carrying on a paper war with the esteemed member for Leicester, Mr. Taylor, and I think I am not betraying confidence when I say that having the pleasure of meeting him in his own house at Brighton, I mentioned that fact, and he said that the great difference was, that we were in a better sanitary condition than formerly. Now there are many things in which the law is very unequal toward the citizens, but small-pox in former times was no respecter of persons. Every person was amenable to small-pox, whatever else

he might be exempt from. In last century, the population of London must have been exceedingly uncomely; but when I look around this audience, I see a number of smooth faces, very different, Í think, from what their appearance must have been in London, judging from the old caricatures. I think, therefore, that the ladies especially might say something in favour of vaccination. I wish to take some exception to what Dr. Carpenter says upon a point of theory. He states that during the last ten years the increased mortality has been almost entirely due to the malignancy of the epidemic of 1871. It may be so; but I am inclined to put a little of that severity to the deterioration of the lymph of the present day. Allow me to tell you what lymph was in the days of Jenner. In the Paris Pitié Hospital, in 1802, there were 102 children taken who had been vaccinated a year before, or nine months before, and were inoculated with small-pox all round, but not one of those children took the small-pox; and, as if to make assurance doubly sure, a number of those children were put into the small-pox ward of the hospital in order to try if they would take it naturally, but that also failed. Not one of the children took the disease. It appears to me that the preventive power of vaccination was greater at the beginning of the century than it is now. Last year, in the Small-pox Hospital, there were 491 cases, and of these only 21 were not vaccinated. Only 21 were unvaccinated! Very few of these were children, for the vaccination of the present day preserves us, at least when we are young, for ten years or so. But the vaccine of the earlier part of the century would have preserved us for the whole of our lives. I believe that vaccination from the calf-a practice which is universal in Holland, Belgium, and Americawould preserve us, if we were vaccinated in infancy, the whole of our lives. If you are vaccinated on two arms, one with calf lymph and the other with ordinary lymph, you will find that with the calf lymph the scab will remain thirty days, whereas with the ordinary lymph it will remain only fifteen days. Hence, I do not agree, if I may dare to say so, with Dr. Carpenter in putting down the whole of the virulence of the last epidemic to the wickedness of a particular epidemic. I think it partly due to the fact that we have not such a strong prophylactic. And now, as a clincher to my argument, I would say that we should abandon human vaccination altogether, and vaccinate ourselves entirely from the calf. The expense is a mere nothing. It can be easily done, and I am certain will be done.

Dr. C. T. PEARCE.-I expected to have heard to-night a lecture on the recent epidemic of smallpox in London, but as the lecturer has taken us to Scotland, to San Francisco, to New England, and other places, perhaps, I shall not be considered out of order if I do not follow him with great consecutiveness, but take here and there some points to which I wish to direct special attention. Stress has been laid on the immunity enjoyed by provincial towns for several years from small-pox, particularly in the year 1880, while London was visited by an epidemic. Credit has been given to vaccination for the immunity of the provinces, and the attack in London has been attributed to the want of efficient vaccination.

That, I say, speaks very unfavourably for the vaccinators. We have been assured by Mr. Simon, in his evidence before the Committee of the House of Commons, in 1871, that the whole of this country was well vaccinated even in 1863; and in 1871 London contained a population which was vaccinated to the extent of 97 per cent. of the population. If that be the case, the results of the vaccination practice for which this overtaxed country has paid so dearly are sadly disappointing; for we are told that, notwithstanding the great expenditure for vaccination, a very small percentage of those who died of small-pox are found to be properly vaccinated-that is, successfully, or well vaccinated. Dr. Carpenter observed that as the Royal Family had been vaccinated and re-vaccinated, they had not been visited by small-pox. Perhaps Dr. Carpenter has forgotten that his Royal Highness Prince Arthur had an attack of small-pox at Blackheath, where three physicians attended him, and it was said that the vaccination could not have been properly performed. Now, if a Royal vaccinator cannot properly perform the operation, how shall a general practitioner succeed? Let me now make a comment or two on Scotland. Dr. Carpenter has taken the same ground that Dr. Wood took when he gave his evidence before the Committee of the House of Commons in 1871. I have here a little work, now going through the press, which, I trust, will be in your hands in a few days, containing an account of Dr. Wood's evidence. He stated that since vaccination had been so thoroughly and efficiently performed in Scotland, small-pox mortality had diminished to such an extent that it had become quite insignificant, in fact, to all appearance the disease was stamped out. Dr. Wood is a Fellow of the Royal College of Physicians of Edinburgh, and has been its President, and is also a member of the General Council for Medical Education, under the Medical Act of 1858. In 1863, the Scottish Compulsory Vaccination Act was passed. It came into operation on the 1st of January, 1864. In 1871, to question No. 4,366, Dr. Wood replied, "Since the Compulsory Vaccination Act, there is a decided diminution of small-pox; in fact, we have had no epidemic of small-pox in Scotland since the passing of the Vaccination Act eight years ago." In reply to question 4,389, he said: "The operation of the Act of 1863 has very largely diminished the amount of epidemic small-pox. Both the Registrar-General in his reports and the Board of Supervision have testified to the extreme value of the Scottish Act." To question 4,390, he replied: "There is no reason to believe that the protection afforded by vaccination has diminished, or that there is the least occasion for any fear that it will ever regain its former power." To question 4,471, he replied:-"The amount of small-pox mortality in Scotland in the last few years has very markedly diminished, as the result, I believe, of a more perfect system of vaccination resulting from putting into operation the Act of 1863." The Third Annual Report on Vaccination of the Scottish Registrar-General states: "Never since the civil registers began in Scotland has smallpox been so rare as during the past three years when the Vaccination Act was in full operation." The Registrar-General's Eighteenth Annual Re

port for Scotland gives the small-pox deaths in each year from 1855 to 1872. In 1855 the deaths were 1,309; in 1863 they were 1,648; in 1864, they were 1,741. That epidemic, as usual, lasted two years. In 1865 the small-pox mortality fell to 383, in 1866 to 200, in 1867 to 100, in 1868 to 15, in 1869 the number was 64, and in 1870 it was 114. "See what vaccination has done !" exclaimed Dr. Wood; and he showed how superior was an apparatus which was used in Scotland-not a mere lancet, but a machine which effectually vaccinated the patient, and rendered him perfectly safe. It was exhibited before the committee when I was present in 1871, while Dr. Wood was giving his evidence. As I had foretold, the epidemic which had begun in London and Liverpool went to Scotland, and thence to Ireland. In 1871 the deaths from small-pox rose to 1,442, and in 1872 the number was no less than 2,488. Small-pox was "stamped out," they said; but was it? It has been "stamped out" in London I know not how many times. It has been "stamped out" in England, but only to return. So much for Scotland. I could tell you the same tale about Ireland, but let us come back to London. I admit that the London mortality of the last two centuries was heavy. It should be borne in mind that all fevers in those centuries were of a malignant type; and all our medical historians (Dr. Carpenter is not ignorant of the fact) tell us that the subsidence of serious fevers took place toward the middle of the eighteenth century, small-pox following the same course; indeed, small-pox was dying out last century, as statistics show, but it was revived by inoculation. Apart from the period 1650 to 1700, the average mortality when there was no artificial inoculation was 56 per 1,000 deaths, and in the next period, from 1750 to 1800, it was 96, the increase being caused by inoculation. Then from 1800 to 1810 it was 64, and from 1810 to 1850 the figure was 36. That was a great diminution, but was it attributable to vaccination? We say it was not. Credit is taken for vaccination from 1801 to 1810. Mr. Simon ascribes the reduction to vaccination, but as only some 30,000 persons had then been vaccinated in London up to 1810, how could their vaccination protect the remaining million of inhabitants? Dr. Carpenter has stated that in the epidemic of 1880 there were 475 deaths in London, and only ten in nineteen large towns having together a population equal to that of London. The real condition of London is given by the Registrar-General in his Annual Summary for 1880. London is divided into five districts,-the West, the North, the Central, the East, and the South. The west district contains a population of 561,000, and there died of smallpox in 1880, fifty-three. The northern district contains a population of 750,000, and the number of deaths was 185. In the central district, comprising the City and the northern parts of London, including Clerkenwell and Islington, and containing a population of 334,000, there were only 4 deaths. In the east district, containing a population of 640,000, there were 67 deaths. In the south district, containing a population of nearly one million, there were 166 deaths. In the outer ring, outside of the twelve-mile circuit, in a population of 631,000,

there were 16 deaths. Such is the contrast of London at this day with London when smallpox was a pestilential fever, owing to the filthy condition of its inhabitants. Much has been said about the seriousness of small-pox mortality, but it bears a very small proportion indeed to the general mortality. From the diseases, smallpox, measles, whooping - cough, scarlet fever, diarrhoea, and fever, there occurred 13,340 deaths in 1880, and of all this mortality only 475 were due to small-pox! In the nineteen principal towns, with a similar population, there died only ten. Will it be said that the vaccination in the provinces was so superior to that of London that small-pox was stamped out? If so, what is to be said of the year 1874, when only 56 died in London, whilst in Birmingham alone 639 died? It is absurd to suppose that vaccination protected London in 1874 and failed to protect Birmingham, which had a small-pox mortality in the four years, 1872-5, of 1,234. Again, in 1877, 2,544 persons died in London, whilst only 497 died in the nineteen cities having a similar population. The migration of small-pox from place to place has been overlooked, and it is assumed that all parts of England must be simultaneously affected by small-pox; but every one who has given is attention to epidemics knows that cholera may be raging in one part of England and wholly absent in others. In 1854 and 1866 that was the case. Indeed, observers of epidemics centuries ago recognised that the plague and similar diseases travelled from place to place. In India, Colonel Bedford tells me that he has stood on the Nilgherry hills and seen the cholera cloud pass over, and predicted, when it has settled over a village, that the village would be attacked with cholera, while other villages have been exempt. So I apprehend that these epidemic diseases are beyond control. There is a law which governs the recurrence of small-pox over which vaccination has no influence, or anything, save the observance of sanitary precautions. Epidemics occur at intervals of about six years in the provinces and three years in London. Following the law that I have worked out, by a study of statistics for the last twenty-five years, you may expect a severe epidemic, perhaps of cholera or small-pox, in 1883-4.

Dr. W. J. COLLINS, B.S., B.Sc.-As I have the honour to be connected with that University over which Dr. Carpenter has so long and so ably presided, I have naturally very much respect for any. thing which he has to say; and hence my regret on this occasion is greater that I feel compelled to differ from him in almost everything he has said. I shall be as brief as possible, and confine myself as strictly as I can to the words laid down in Dr. Carpenter's proposition. First, I must refer to the table before you. That table exhibits a selection of years; the dates certainly do not run continuously, and the periods are very unequal in duration.

Dr. CARPENTER.-They are Dr. Farr's.

Dr. COLLINS.-Dr. Farr, I admit, is the greatest authority in this matter, but I have his own words, which I will read. He says, "Small-pox attained its maximum after inoculation was introduced. The annual deaths from small-pox were 2,323 in 1760-79; in the next twenty years [not

figured on the table] they declined to 1,740. This disease, therefore, began to grow less fatal before vaccination was discovered, indicating, together with the diminution in fever, the general improvement in health then taking place." Those are Dr. Farr's own words. I agree with Dr. Farr's opinion. If Dr. Carpenter had placed beside those of small-pox the figures relating to fever, he would have found that fever was declining in the same degree. I ask, what has made fever decline? Certainly not cow-pox; perhaps sanitary improvements. With regard to the proposition of Dr. Carpenter, it consists of three minor propositions. The first is, that there is an increase of small-pox in London. That is an admission on Dr. Carpenter's part, and the only question is, why has it increased in London? In one of his letters to the Times, Dr. Carpenter speaks of "the lingering of small-pox in London amongst the unvaccinated residuum." "Lingering" is different from "an increase;" and while lingering might be compatible with the theory of an unvaccinated residuum, increase could not possibly be so, for while the unvaccinated residuum was becoming smaller and smaller year by year, the small-pox mortality had become greater and greater; therefore, tested by the principle of concomitant variation, increased vaccination and diminished small-pox do not stand to one another in the relation of cause and effect. Dr. CARPENTER.-There is a constant fresh residuum.

Dr. COLLINS.-But the percentage of vaccinations to births is constantly increasing. The second proposition of Dr. Carpenter is that there is no corresponding increase in other parts of the Kingdom. Well, sir, in to-day's Times I read :"Small-pox, which has been more or less prevalent in the Metropolis so long, seems to indicate a tendency to spread into the Midland counties. There have been cases at Bedford, Northampton, Irchester, and Huntingdon, and within the last few days a serious outbreak has occurred at Ampthill." So that Dr. Carpenter is holloaing before he is out of the wood. Thirdly, as to efficiency. No one can speak with greater authority as to the efficiency of the Compulsory Vaccination Act than the inspectors of the Local Government Board. What do they say? Dr. Stevens, who says he has seen more vaccination than any man living or who has ever lived,

says:

:-"The present system is as perfect as a system could be made, and as efficacious as could be desired." Then Dr. Ballard says that in 1871 the Compulsory Vaccination Act was perfected. Now, in 1871, according to Dr. Seaton, we had the worst epidemic of small-pox within living memory. Then, again, so efficient is this system of compulsory vaccination, that the public vaccinators in London alone in one year, 1879, received £2,482. 178. as awards over and above their ordinary fees for the excellence of the work done. Dr. Carpenter has referred to places less well vaccinated than London, such as Leicester and Keighley, which exhibit little or no smallpox, and he explains that by saying that their susceptibilities-congenital susceptibilities of which we have heard so much-have not been tested. Now, we could not appeal to a greater authority than Mr. Ernest Hart, who, everybody knows, has a monopoly of truth upon all subjects con

nected with vaccination. In reading Mr. Ernest Hart's journal (the British Medical Journal) of March 13, 1881, we find this statement:-"Smallpox has, it is stated, broken out in Leicester. Mr. P. A. Taylor's constituents may possibly have an opportunity of estimating the worth of the antivaccination movement with which their representative has identified himself." So that their susceptibilities were tested in Leicester in 1881.

Dr. CARPENTER-I think there is no case in 1881 in the Registrar-General's report.

Dr. COLLINS-You must square that with Mr. Ernest Hart, sir.

This was small

Dr. COLLINS-I cannot guarantee that I am a faithful believer in Mr. Ernest Hart's statements. The constituents of Mr. Peter Taylor, then, according to Mr. Ernest Hart, have had an opportunity of testing the worth of the anti-vaccination movement, and they find that while in badly-vaccinated Leicester there has been only one death from small-pox since 1874, in London, small-pox is a perennial visitant, and the people have been dying by the thousand. I submit that if smallpox in London is so prevalent, because it is so badly vaccinated, compared with the rest of the country, we ought to find that in those parishes in London in which the vaccination is best, there is the least small-pox, but this does not hold. Poplar, for instance, the second-best vaccinated parish in 1877, was the second worst in the smallpox list. Then Hackney, to which Dr. Carpenter referred was fifth best on the vaccinated list, and yet was the fourth worst on the small-pox list.

Dr. CARPENTER-There is not so much difference.

Dr. COLLINS-You do not understand me. It was the fifth best vaccinated parish and the fourth worst as regards small-pox mortality. It is hardly fair of Dr. Carpenter to look to the increased efficiency of the Act in future as the means of exterminating small-pox, when increased efficiency in the past has not been accompanied by any diminution. The table that has been brought before us does not give the last decade. I have the figures of the last decade here, and if they were added, the facts would be as follows:population, 3,466,486; deaths from small-pox, 15,551; or about 500 per million, showing, after nearly thirty years' compulsory vaccination, a mortality twice as great as in the preceding decade. What, then, is the real cause of the continuance and increase of small-pox in London? I think we find an answer in the last annual summary of the Registrar-General's return. I will read five small paragraphs. "The decennium which closed with 1880 was one of lower mortality in London than any of the preceding decennial periods.'

"These facts are strong evidence that the sanitary efforts of recent years have not been unfruitful." . . . . "It will be found that the saving of life was almost entirely due to diminished mortality from those causes whose destructive activity is especially amenable to sanitary interference-namely, the so-called zymotic dis"The death-rate ascribed to fever that from scarla

eases."

....

fell nearly 60 per cent., tina and diphtheria fell 33 per cent." "One disease alone in this class showed exceptionally a

rise, and no inconsiderable one. pox, which, owing to the two great outbreaks of 1871-72 and 1877-78, gave a death-rate nearly 50 per cent. above the previous average." Thus, that zymotic disease alone against which we invoke a special prophylactic, is the only one which has increased, while all those which we fight on broad sanitary principles, have one and all declined. Vaccination, sir, has blinded us to the real cause of small-pox. It has made us look more to the scars upon the arm than to the health of the individual and his sanitary surroundings. If we fortify the body and purify the surease will vanish away. I know Dr. Carpenter does not agree with that. In one of his letters he has told us that "small-pox is a disease over which general sanitary measures have little or no control." I am happy to find Dr. Carpenter contradicted by leading sanitarians on the subject, Dr. Richardson, Mr. Edwin Chadwick, and Dr. Carpenter's namesake at Croydon. I also venture to think, with the greatest deference, that Dr. Carpenter is contradicted by himself. In a most instructive and interesting article by him in the "British and Foreign Medico-Chirurgical Review," 1853, there is this paragraph, in which he has been stating that normal healthy blood has a resistant power towards disease germs, and he goes on:-"If it be inquired, what is the practical bearing of this discussion we at once reply that, if our view be correct, it would be possible to extinguish the greater number of epidemic diseases, however intense or abundant may be the atmospheric or other agencies which constitute their potential causes, by preserving the blood of every individual in a state of unfermentibility, which shail effectually prevent these persons from finding the conditions of their development within the body." If I might venture to reconstruct the proposition which has been put forward by Dr. Carpenter, I would do so as follows:-The increase of small-pox mortality in London under a vaccination system as perfect as it can be made, accompanied by a decline of all other zymotics, a reason not for more vaccination or more compulsion, but for seeking out, ascertaining, and removing the causes under which small-pox, like all other zymotic diseases, arises and prevails, and diminishing the predisposition thereto by improved sanitation. In conclusion, I venture to think, with the greatest respect and deference to those gentlemen who, like Dr. Carpenter, are strongly in favour of vaccination, when the facts are so strongly against them, that they are labouring under what has been termed

a fixed idea." No one has written with greater force upon that subject than Dr. Carpenter himself. It simply amounts to this: the mind is so filled and possessed with one predominant principle, that however much the evidence may be against them, they are unable to change their minds. This is what Dr. Carpenter says himself in his "Mental Physiology "- -an excellent work: "There is no end to the strange performances which may be thus called forth; but they are all referable to one simple principle-the possession of the mind by a predominant idea which the individual himself has lost all power of testing by his present or past experience, simply because he