A full course of college instruction was gradually organised, with the important improvement of establishing the subject of hygiene as one of the principal professorial chairs, thus making it an equal as well as obligatory study. Another important improvement adopted was the establishment of an Examination Board, independent of the teaching staff, a plan not then customary in the United States. This Board was composed of some of the best known members of the profession, and at the same time we changed the ordinary term of medical study from three years to four. During the early years of the college I occupied the Chair of Hygiene, and had the pleasure of welcoming Miss Jex Blake, then visiting America, as a member of the first class. The Professor of Hygiene also superintended the important work of the sanitary visitor at the homes of the poor. It has always seemed to me, during many years of active private practice, that the first and constant aim of the family physician should be to diffuse the sanitary knowledge which would enable parents to bring up healthy children. The most painful experience which I met with in practice was the death of one of my little patients from the effects of vaccination. This baby, though carefully tended and the lymph used guaranteed pure, died from the phagedenic ulceration set up by vaccination in a rather scrofulous constitution. To a hygienic physician thoroughly believing in the beneficence of Nature’s laws, to have caused the death of a child by such means was a tremendous blow! This serious experience awakened a growing distrust as to the wisdom of all medical methods which introduce any degree of morbid matter into the blood of the human system; a distrust which no amount of temporary professional opinion or doubtful statistics has been able to remove. Although I have always continued to vaccinate when desired, I am strongly opposed to every form of inoculation of attenuated virus, as an unfortunate though well-meaning fallacy of medical prejudice. CHAPTER VII RETURN TO ENGLAND 1869 In 1869 the early pioneer work in America was ended. During the twenty years which followed the graduation of the first woman physician, the public recognition of the justice and advantage of such a measure had steadily grown. Throughout the Northern States the free and equal entrance of women into the profession of medicine was secured. In Boston, New York, and Philadelphia special medical schools for women were sanctioned by the Legislatures, and in some long-established colleges women were received as students in the ordinary classes. Our New York centre was well organised under able guidance, and I determined to return to England for a temporary though prolonged residence, both to renew physical strength, which had been severely tried, and to enlarge my experience of life, as well as to assist in the pioneer work so bravely commencing in London, and which extended later to Edinburgh.