cases had occurred before the vaccinations were completed. Omitting these, there remained so few cases in the large unvaccinated group as compared with those that had occurred among the vaccinated, that the difference was not striking enough to be regarded as satisfactory evidence.

A second source of error occurs in vaccinating all persons in a group, large or small, and interpreting failure of the disease to appear or to spread as evidence of protection. One has but to study the dati with regard to certain institutions, where, without vaccinations, the disease has been excluded or has spread but slightly, to realize hun fallacious are such arguments. Thus, the writer is acquainted with a large group, where vaccinations have been done and where a rigid quarantine has been in force, which has remained free from the disease; and he is acquainted with a number of institutions where the samo result has been obtained by quarantine alone.

The third, and perhaps commonest, pitfall is the drawing of conclusions from too meager data. Thus, one observer assured me tha: he had been exposed to influenza patients many times and had taken no precautions beyond being vaccinated and he had not developed the disease. Evidence of this sort should be given no consideration, as many of us, the majority, indeed, have escaped the disease without having taken any particular means to prevent it.

We hear of numerous examples of the cure of cases by means of vaccine. I have heard related the most astonishing examples of apparent great benefit from vaccines in the pneumonia that follows influenza. When the records were scrutinized, however, it was found that these remarkable cases could be duplicated by others that had done equally well without vaccine. In the only examples with which I am familiar in which a racrine

a was used on alternate cases, no better results were secured in the vaccinated than in the control group.

The writer suspects that those who have used vaccines must commonly have been more facile in making the diagnosis of a complicating pneumonia than have others. The author has examined numerous clinical records submitted to support the value of vaccines in pneumonia, and many of the cases, judged by the evidence presented, most certainly would not ordinarily have been regarded as pneumonia. Physical signs were equivocal or could probably be attributed to bronchial involvement when there was no definite acceleration of respiration, and the general trend of the record did not support the view that the patient had pneumonia. In a certain large hospital, on one service, about 60 per cent of the cases admitted were diagnosed pneumonia and all were treated with vaccine, with a mortality of about 10 per cent, while in the same institution, on

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another service, about 15 per cent of cases were diagnosed pneumonia and the mortality was 40 per cent. In this instance, the actual number of deaths was approximately the same, but vaccine-treated cases showed a much lower case-mortality in the pneumonias. I am by no means sure that the higher percentage of pneumonias diagnosed may not have been more nearly accurate than the lower, but it should not be made the basis of misleading deductions.

The only way in which we are to secure promptly acceptable evidence of the value of a bacterial vaccine is by the vaccination of only a portion of the individuals in a large group, holding the remainder as controls; age, sex, and conditions of exposure being the same in the two groups.

On the other hand, a vaccine should not be condemned unless controlled as just indicated, and unless it has failed to show protective value when sufficient time has elapsed after the inoculation to make it reasonably likely that any immunity which may develop will have had an opportunity to do so.

A large number of vaccines have been used, some made from the influenza bacillus alone, others from this in conjunction with pneumococci, staphylococci, and streptococci, and in various combinations; the failure of one does not necessarily mean the uselessness of others.



Two opinions relative to the so-called Harrison Narcotic Drug Act have recently been rendered by the United States Supreme Court. Both cases arose under section 2 of the act, the constitutionality of this section being brought into question.

In the first case the defendant, a physician, was indicted for selling and distributing narcotic drugs unlawfully because not in pursuance of a written order on a form furnished for the purpose, and for selling and distributing narcotic drugs not in the course of professional practice. The United States District Court for the western district of Texas held that section 2 was unconstitutional because it was not a revenue measure but an invasion of the police power reserved to the States. This decision the Supreme Court reversed, holding the act to be within the taxing authority of Congress.

In the second case ? the defendants were convicted and sentenced in the United States District Court for the western district of Tennessee on a charge of conspiracy to violate the Harrison Act. The facts were that one of the defendants, a physician, prescribed morphine for habitual users without intent to effect a cure but to keep

United States o. Doremus, 39 Sup. Ct., 214.

: Webb et al. v. United States, 39 Sur

the users of the drug supplied; and that the other defendant, a druggist, filled these prescriptions with full knowledge of the circumstances. In answer to certain questions certified to the Supreme Court by the Circuit Court of Appeals for the Sixth Circuit, tho Supreme Court held as follows: That retail sales of narcotic drugs by druggists to persons without a physician's prescription or without an order on the prescribed form are prohibited; that the prohibition of such sales is constitutional; and that an order for the drugs given by a physician to an habitual user, not in the course of professional treatment to cure the disease but to keep the user supplied with the drugs, is not a "prescription" under exception (b) of section 2 of the act.

This decision means that it is unlawful for a druggist to fill a prescription for narcotic drugs when he has knowledge that the prescription was given for the purpose of supplying the drugs to an addict, and not for treatment. It does not prevent a physician from prescribing narcotic drugs in good faith or a druggist from filling such a prescription. Portions of the opinion in the first case follow:

This statute [the Harrison Act] purports to be passed under the authority of the Constitution (Art. I, sec. 8), which gives the Congress power to lay and collect taxes, duties, imposts, and excises to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts, and excises shall be uniform throughout the United States."

The only limitation upon the power of Congress to levy excise taxes oi the character now under consideration is geographical uniformity throughout the United States. This court has oiten declared it can not add others. Subject to such limeitation, Congres3 may select the subjects of taxation and may exercise the power coníerred at its discretion. (License Tax Cases, 5 Wall., 462, 471.) Of course Congress may not in the exercise of Federal power exert authority wholly reserved to the States. Many decisions of this court have so declared. And from an early day the court has held that the fact that other motives may in pel the exercise of Federal taxing power dose not authorize the courts to inquire into that subject. If the legislation enacted has some reasonable relation to the exercise of the taxing authority conferred by the Constitution, it can not be invalidated because of the supposed motives which induced




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Nor is it suficient to invalidate the taxing authority given to the Congress by the Constitution that the same business may be regulated by the police power of the State. (License Tax Cases, 5 Wall., supra).

The act may not be declared unconstitutional because its effect may be to accomplish another purpose as well as the raising of revenue. Ii the legislation is within the taxing authority of Congress, that is suflicient to su:tain it. (In re Kollock, 165 U.S., 526, 536).

Considering the full power of Congress over excise taxation, the decisive question here is, Have the provisions in question any relation to the raising of revenue? That Congress might levy an excise tax upon such dealers, and others who are named in section 1 of the act, can not be successfully disputed. The provisions of section 2, to which we have referred, aim to confine sales to registered dealers and to those dispensing the drugs as physicians, and to those who come to dealers with legitimate prescriptions of physicians. Congress, with full power over the subject, ahort oi arbitrary and unreasonable action, which is not to be assumed, inserted these provisions

in an act specifically providing for the raising of revenue. Considered of themselves, we think they tend to keep the traffic aboveboard and subject to inspection by those authorized to collect the revenue. They tend to diminish the opportunity of unauthorized persons to obtain the drugs and sell them clandeztinely without paying the tax imposed by the Federal law. * * *

We can not agree with the contention that the provisions of section 2, controlling the disposition of these drugs in the ways described, can have nothing to do with facilitating the collection of the revenue, as we should be obliged to do is we were to declare this act beyond the power of Congress acting under its constitutional authority to impose excise taxes. * *



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A striking illustration of the modern educational methods employed in the campaign now being conducted under the auspices of the Commission Américaine de Préservation Contre la Tuberculose en France is shown in a poster which has just

L'AUTRE reached this country. (The original is printed

PERIL in four colors and measures 32 by 48 inches.) The legend on this poster is one which we should all take to heart, for, despite the nation-wide campaign of educational publicity, there still appears to be far too little realization of the great preva


SUR NOUS LAURIERS, lence of tuberculosis



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The purpose of the educational campaign for furthering venereal disease control is to bring to the people of America a knowledge of the effects of gonorrhea and syphilis on the health and efficiency of the Nation. By presenting this information to the public it is expected to secure the cooperation of the people in assisting their State boards of health in carrying on the work.

This information is given by (1) the distribution of pamphlets; (2) lectures, addresses, and conferences; (3) the showing of card exhibits, lantern slides, and motion-picture films.

The material used in the campaign has been carefully prepared and initial publicity has been given by the Division of Venereal Diseases of the United States Public Health Service. The details and follow-up work are being carried out by the various State boards of health cooperating with the Service. The Bureau caused to be distributed a very large number of pamphlets on the subject of venereal diseases, using in this circularization 35 different publications.

Reports of 400 lectures and 18 conferences have been received, but these reports are incomplete in that they do not cover all of the work done by the State boards of health. A total of more than 200.000 registrants in the last draft received instruction in regard to the venereal-disease-control campaign. Card exhibits have been prepared for both adults and boys of high-school age, and sets of these exhibits have been lent to the various State boards of health. Wherever they have been shown unanimous approval and comment thereon have been received. The lantern slides referred to are slides made of the exhibit cards of the "Keeping Fit" exhibit for bors. Motion pictures referring to venereal diseases have been shown to 333 audiences. This includes only the free showings for which invitations

. are issued.

Special features of the educational campaign are the work being carried on with the cooperation of the Rotary Clubs; the development of programs to be carried out by large employers of labor; the campaign through ministers of the country, 15,000 of whom have pledged their cooperation; the campaign for elimination of advertisement of venercal nostrums and quack doctors from newspapers and magazines; the appeal to druggists for their cooperation and obtaining the absolutely necessary support of the medical profession in securing proper treatment of venereally infected persons.

Ono phase of the work now being developed, which will be of farreaching importance, is the organization in each of the 710 cities in the United States having a population of 10,000 and over, of a local committee for stimulating venereal disease control work. This committee is selected upon the recommendations of representative citizens and officials and must be approved by the State board of health. Each city will lator be graded on the basis of possibly 1,000 points, according to the medical, educational and law-enforcement measures adopted and carried out by its municipal authorities.

The results of this educational campaign can be measured in some degree by the number of letters received by the Bureau requesting

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