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of this injustice to his medical brethren who are not for-tunate enough to be reaping the plums from this enormous"charity," which is so well supported by handsome sub-scriptions from firms in the neighbourhood and the King’sHospital Fund. If so, I shall, for one, consider him any-thing but a fit representative on the General Medical Council.Trusting you will find space for this, ,

I remain. Sirs. yours faithfully.H. NUNAN COLLIER.

Lavender-gardenF, Clapham Common, S.W.,Oct. 23rd, 1906.

To the Editors (If THE LANCET.SIRS,—I do not quite follow Mr. Harford’s letter. The

Battersea Provident Dispensary is one of the oldest in

England, is conducted on absolutely correct lines, and hasbefore now been commended in your journal. There is astrict wage limit. The medical staff form a majority of thecommittee and all money received, after paying expenses, isdivided among them. The patients are at liberty to selecttheir own medical man and, if popular, he naturally wouldhave the largest number. I admit freely that all medicalmen of repute who have been practising in the neighbour-hood for at least a year ought to be eligible for appointment,the time limit being intended to keep off medical practicejobbers who might try to make it an asset when selling,but my conscience is perfectly clear, for some time ago, whenDr. J. M. Dunbar was president of the South-West LondonMedical Society, I caused a meeting to be summoned at whichI strongly advocated its being thrown open on the above linesand I have consistently followed that course ever since.

v......., faithfully

LEONARD STRONG MACMANUS.Spencer-park, Wandsworth Common, S.W., Oct. 23rd, 1906.

VACCINATION AND ANTIVACCINA-TIONISTS.

WE have received the following letter with a request forpublication :-

To the Editors of THE LANCET.

SIRS,-The communications of your Manchester corre-

spondent are always interesting reading, but at times, as inyour issue of Sept. 29th, I think it is marred by referring tothose who differ from him in opinion as fools, even thoughhe adopts a circumlocutory method of saying so. Much canbe said in defence of the anti-compulsory vaccinator. The

history of vaccination records a considerable change of

opinion from the time of Edward Jenner’s statement that

thereby absolute immunity from small-pox was securedto to-day, when members of the profession would hesitate,if not decline, to give a financial indemnity in case ofan attack of small-pox within three or six months after" successful vaccination: there is also the fact that the

majority of cases of small-pox are vaccinated and re-

vaccinated persons ; this makes a dogmatic statement onthis subject suggestive that the assertor has but a slightknowledge of the historical and statistical aspects of thisquestion. Therefore I think that on this subject an

opponent can reasonably expect a more courteous referencethan that used by your Manchester correspondent, and

especially so from a member of a profession that is creditedwith possessing self-control and courtesy in more thanordinary degree.- I am, Sirs, yours faithfully,Whalley Range, Manchester, Oct. lst, 1906. J. E. STOREY.

We submitted Mr. Storey’s letter to our Manchestercorrespondent who replies as follows :-

To the Editors of THE LANCET.SIRS,-I regret that the susceptibilities of Mr. Storey, and

perhaps those of others sharing his views, were wounded bysome remarks of mine in your issue of Sept. 29th, andhasten to acknowledge the courteous tone of his letter.Pethaps the language habitually used by many of the anti-vaccinationists had obscured the fact that in addition to

being antivaccinationists they might also suffer from thedelicacy of the hyper-sensitive. " Absolute immunity" wasnot claimed by me as the result of vaccination, which maybe efficient or non-efficient according to conditions. Itsapparent failures are far too numerous, but experience leads

me to the belief that in most cases they are due to the dis-regard of the conditions necessary to success-as a matter offact, to vaccination having been scamped. Mothers haveobjected to their babies being "punished and medical menhave naturally been reluctant to offend or to distress theirpatients. Moreover, the long immunity from serious generaloutbreaks of small-pox-so long that many of the present-day practitioners have never, or hardly ever, seen a case-hasrendered some of them almost sceptical as to the need forsuch strong measures against a foe so long invisible. It

might be worth while for Mr. Storey to examine the factsbearing on this matter provided by the German Army. Asto compulsion, it is late in the day to object; notwith-standing what we consider our liberty we are surrounded byit, it is the air we breathe from the cradle to the grave, andthere is no getting away from it. The anti vaccination cultis one of sentiment, not of science, and its devotees appearto be forgetful or selfishly regardless of the danger to othersinvolved in its pursuit.

I am, Sirs, yours faithfully,Oct. 4th, 1906. YOUR MANCHESTER CORRESPONDENT.

We, too, are sorry that Mr. Storey feels that the commentsof our Manchester correspondent were, in effect, a

reflection upon himself. But we think that even Mr. Storeywould agree, were he often present when certificates ofconscientious exemption are being applied for, that "theignorance and in many cases the sheer and absolutefanaticism displayed are somewhat depressing " to those whohad hoped that the education of the poorer classes would bythis time have led them to appreciate the teachings ofscience and the advances of protective inoculation generally.We do not think that our correspondent can be reasonablyaccused of having uttered any "dogmatic statement" inhis observations of Sept. 29th and we are quite satisfiedthat he would agree with Mr. Storey that the position asregards the duration of protection has been very materiallymodified since Jenner’s day. Indeed, we expect that oneof the signs of the ignorance which our correspondentdeplores is the inability of the least educated classes toaccept the position and to get themselves revaccinated.

Looking Back.FROM

THE LANCET, SATURDAY, Oct. 25th, 1828.

BIRMINGHAM SCHOOL OF SURGERY ANDMEDICINE.1

DR. PEARSON’S INTRODUCTORY ADDRESS.

To the Editor of THE LANCET.

SIR,-I beg leave to hand to you (with the consent of thelecturer) the preliminary address delivered at the openingof the School of Medicine and Surgery in Birmingham thisday, by Dr. R. Pearson. I am, Sir,

Your obedient Servant,W. S. Cox, Honorary Secretary.

24, Temple Row, Oct. 20, 1828.Gentlemen,-Before I proceed to deliver the discourse

which I have prepared for the present occasion, it will beexpected that I should offer a few remarks relative to theorigin and formation of this Institution. The most super-ficial observer must have perceived how much superior, inevery respect, the present state of society is, to the state in

1 A letter from Mr. William Sands Cox, F.R.S.L., senior surgeon ofthe Queen’s Hospital, dean of the faculty, appeared in THE LANCET ofJuly 29th, 1843, stating that " Her Majesty has been graciously pleasedto grant a royal charter of incorporation to the School of Medicine andSurgery at Birmingham, with the privileges, immunities, rank, andtitle of the ’Queen’s College, Birmingham."’ In THE LANCET ofOct. 8th, 1892, it was stated " October 1st was a memorable dayin the history of Queen’s College. The old associations of the past,the relations of the former buildings and the traditions of the medicalschool flourishing therein for many years have been uprooted andconveyed to ’fresh scenes and pastures new’ at Mason College." Inthe same number of THE LANCET is published the inaugural addressby Sir George Murray Humphry, M.D., F.R.C.S., F.R.S., celebratingthe union of the two institutions. The Mason College (opened in 1880),it will be remembered was incorporated in the University of Birming-ham early in 1900.

1166

which it was twenty or thirty years ago. In what does this Wsuperiority consist ? Is it not in the higher dfgree of mental h(improvement throughout every walk of life ? But how has se

this pleasing change been effected? How have the various J(ranks in society emerged from comparative ignorance and ac

uncivilization, into the present degree of culture and refine- thment? I answer, by the increased attention given to educa-tion, and by the establishment of various institutions b<calculated to diffuse knowledge and science, and to pro- or

mote a taste for the arts. Look at what has been hidone in the metropolis in this way. What a numberof literary and scientific institutions have sprung upthere within a very few years, to which may now beadded the two universities. From the metropolis let usturn our eyes to our large provincial towns-to Liverpool,Manchester, and Bristol, and we shall see that this spirit ofthe times, this ardour for mental improvement, has spreaditself there also. We shall see that there also education, inall its branches, has been promoted-that there also the finearts and the useful arts have been encouraged, and that in dthose towns, as well as in the capital of the empire, temples Tdedicated to science have been erected, and their portals dthrown open to all who desire to enter. It would indeedhave been a reproach if Birmingham had viewed with in- .

difference all that has been going on in this way in rival atowns ; but Birmingham has, all along, been actuated by thevery same spirit, omitting its excellent charitable institu- ations relating to education, I will instance, as suitedto the present purpose, and as forming an era in the 7history of this town, its public libraries, its PhilosophicalInstitution, its Mechanics’ Institution, and its two institu-tions for the encouragement of the fine arts, in the supportof which the liberality of many of the neighbouring noble- j.men and gentlemen has been so conspicuously displayed.

f

But amidst all these improvements, there was yet wanting a r

school of medicine and surgery. This has, at length, been pestablished after the example of those at Manchester,

f

Liverpool, and Bristol, where the utility of such schools to s

young men brought up to the profession, has been amplyproved during the space of several years. But it may be

"

satisfactory to state the information on this subject, com-municated by Mr. Watson, secretary of the Apothecaries’Company to the Committee on Anatomy, appointed bythe House of Commons during the last session of Parlia-ment. "On an average," (says Mr. Watson,) "during

a

the last seven years, about 400 students have been exa-mined annually by the Court of Examiners at Apothecaries’Hall; these have not all been educated in London, many chave been in attendance at Edinburgh, some have been

,wholly educated at Manchester-and, of late, several

tEnglish students have received their instructions from

iteachers in Dublin. No young men come before the Courtbetter qualified, in every respect, than those who have been :entirely educated at ltlcrnchester, where excellent lectures inevery branch of medicine are given by competent teachers,and the Manchester infirmary affords, under the physiciansbelonging to it, most ample opportunities for the acquire-ment of practical knowledge." A stronger proof than this,of the utility of provincial medical schools, there cannot be.Now Birmingham being little, if at all inferior to the above- jmentioned towns in wealth and population, it is obviousthat the aggregate amount of young men brought up to themedical profession in this place and neighbourhood, mustbe nearly as great as in those places. The demand,therefore, for a school of medicine and surgery must be thesame. Under this conviction, and in accordance with thespirit of the times, has been formed the present Institution,which has been honoured with the patronage of the followingnoblemen and gentlemen :-Marquis of Lansdowne, Earl ofPlymouth, Earl Fitzwilliam, Earl Spencer, Earl of Bradford,Earl Howe, Earl of Mountnorris, Lord Viscount Hood, TheLord Bishop of the diocese, The Hon. Mr. Lyttleton, Sir G.Shepwith, Bart., Sir Robert Peel, Bart., Sir Eardley Wilmot,Bart., D. Stratford Dugdale, Esq., M.P., Frances Lawley,Esq., M.P.We are proud, as indeed we ought to be, of the names of

these distinguished characters ; men not more respected fortheir rank and titles, than for their highly-cultivated minds,their benevolent principles, and their uniform attention topublic good. By their courtesy in the present instance, theyhave evinced the estimation in which they hold the medicalprofession, and their desire to promote its interests ; and thesanction which they have been pleased to confer on thisschool, cannot but give additional stimulus to our exertions.

s Whilst speaking of our patrons, I must not omit to mention1 how much our institution has been befriended by the threes senior physicians of this town, I mean Dr. Edwards Johnstone, Dr. John Johnstone, and Dr. Male. With theiri accustomed liberality, these gentlemen have thrown open- their libraries to us, and hhve allowed us the use of many

valuable plates relative to the departments of anatomy ands botany ; and Dr. John Johnstone has permitted the lecturer

on the practice of physic, in addition to his own, to availn himEelf of his privileges with respect to the admission ofr pupils at the General Hospital, an arrangement whichp cannot but be advantageous to the school.2e

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8444 births and 4419deaths were registered during the week ending Oct. 20th.The annual rate of mortality in these towns, which haddeclined in the six preceding weeks from 22’ 3 to 15’ 5 per1000, further fell last week to 14’ 6 and was lower than inany week since the middle of August. During the first threeweeks of the current quarter the death-rate in these townsaveraged 15 - 7 per 1000 ; the rate during the same period inLondon did not exceed 14’ 5. The lowest death-rates in the76 towns during the week under notice were 6’5 in King’sNorton, 6 6 in Hornsey, 7’ 1 in Leyton, and 7 ’ 3 in Wallasey;the rates in the other towns ranged upwards to 21’ 7 in St.Helens, 21.8 in Stockton, 24 ’ 0 in Middlesbrough, and 24’ 8in Warrington. The 4419 deaths in the 76 towns showed afurther decline of 276 from the decreasing numbers inrecent weeks, and included 591 which were referred to theprincipal epidemic diseases, against numbers decliningfrom 2570 to 807 in the six preceding weeks; of these,so many as 349 resulted from diarrhoea, while 60 werereferred to measles, 58 to diphtheria, 45 to "fever"(principally enteric), 42 to scarlet fever, 37 to whooping-cough, and not one to small-pox. The deaths from theseepidemic diseases were equal to a mean annual rate of 1’9per 1000 in the 76 towns, and to 1-4 in London. Theannual death-rate from these diseases was 0-0 in South-ampton and 0 ’ 4 in Derby and in Willesden, while it rangedupwards in the other towns to 4’ 7 in Middlesbrough andin Bootle, 5’1 in Burnley, and 7’0 in Blackburn. Thedeaths referred to diarrhoea (mainly of infants underone year of age), which had declined in the six precedingweeks from 2342 to 550, further fell last week to 349;the annual death-rate from this disease during the weekunder notice was still so high as 2’ 8 in Merthyr Tydfil,3 - 1 in Middlesbrough, 4’ 1 in Burnley, and 5’ 8 in Blackburn.The fatal cases of measles showed an increase upon recentweekly numbers, and caused the highest death-rates in

Stcckport, Oldham, Norwich, and Warrington. The deathsreferred to "fever" were fewer by 20 than in the previousweek, but showed a marked excess in Bolton. The highestdeath-rates from diphtheria occurred in Wallsall and WestHartlepool ; from scarlet fever in Walthamstow; andfrom whooping-cough in Birkenhead. No case of small-pox was under treatment in the Metropolitan Asylumshospitals during the week, no case of this disease havingbeen admitted thereto since the end of June. The numberof scarlet fever cases under treatment in the MetropolitanAsylums hospitals and in the London Fever Hospital, whichhad increased in the seven preceding weeks from 3042 to3803, further rose to 3923 during the week under notice;548 new cases were admitted to these hospitals duringthe week, against 621 and 566 in the two previousweeks. The deaths in London referred to pneumonia andother diseases of the respiratory organs, which hadbeen 188 and 187 in the two previous weeks, declinedlast week to 146, and were so many as 95 below thecorrected average in the corresponding week of the four

preceding years, 1902-05. The causes of 47, or 1.1 per. cent., of the deaths registered in the 76 towns during the.

week were not certified either by a registered medical’ practitioner or by a coroner. All the causes of death were)

duly certified in Leeds, Bradford, Newcastle-on-Tyne, Hull,and in 50 other smaller towns ; the proportion of uncertifieddeaths showed, however, a considerable excess in Liverpool,

2 The succeeding paragraphs relating to the resources and apparatusof the institution have not been transcribed.