requirements. There is general complaint that much of the best quality of vaccine on the market is not effective. It is no unusual experience to vaccinate and revaccinate unprotected children, using all the necessary precautions, without producing vaccinia. On the other hand, the conclusion is forced on physicians that some vaccine conveys only pyogenic infection. The inoculation of such vaccine is followed by severe reaction, including fever, erysipelatous dermatitis, a deep, sloughing sore, and great swelling of the arm. Such a vaccination, in spite of its apparent thorough reaction, produces no immunity to subsequent smallpox."

We laics have been taught, a newspaper remarks, to believe that the sorer and the more swelled the arm became after vaccination, the better had the vaccine taken, and the more securely immune should we be against smallpox. But now the physicians let the cat out of the bag, and we find that we were grievously mistaken. It is not the successful inoculation of the vaccine matter in the wound that produces the "fever, the erysipelatous dermatitis, the deep, sloughing sore, and the great swelling of the arm," but quite the reverse. When these ugly results are the sequel of vaccination, it implies that the vaccine matter injected into the arm was not pure; that the "fever," "the great swelling of the arm," etc., were caused by "pyogenic infection," that they were produced by poisonous stuff mixed with the vaccine.

These admissions, with regard not only to the impure but also to the ineffective and the poisonous character of much of the vaccine matter that is put upon the market at the present day, being thus made publicly by physicians of high standing, it is certain that something will have to be done "to insure that all vaccine placed on the market shall be pure and effective." We have not the least doubt but that nine-tenths or perhaps ninety-one onehundredths of the vaccine virus now used is both pure and effective. But there is no telling how much harm may be done by the remaining one-tenth or one-hundredth which is not pure or not effective; or how many anti-vaccinationists it may produce.

Unless the American Medical Association, or State Medical Associations, intervene and take such action as will hold the manufacturers of serums up to a proper standard of purity and strength in the commodities they manufacture, the Government will have to be invoked to create a national commission to perform this necessary work which the medical profession itself is not apparently disposed to undertake.

At the January meeting of the New York County Medical Association the Committee on Public Health, of which Dr. N. E. Brill is chairman, made an elaborate report of its investigation into the anti-toxin and vaccine virus products of the laboratories of the Health Department. The conclusion reached was that it was unanimously agreed that the character, professional qualifi cations and standing of the men engaged in the supervision and control of the manufacture of these products, none other than skilled help carrying out the details, are more than sufficient guarantee as to the quality of the curative sera and vaccine virus. These men represent the highest professional and scientific skill in these departments to be found in the city, and the methods. which are used are beyond criticism. The committee stated that they had been unable to find any recorded cases of tetanus in New York following the use of anti-toxin or vaccine virus, and it was their opinion that these products of the laboratories of the Department of Health are absolutely safe. They found that the horses selected for anti-toxin production were under nine years of age. and perfectly healthy, and were stabled in a special building on East Fifty-seventh street. Until recently about two-thirds of them have been kept in the basement, and the remainder on the first floor, but at the present time all the horses are kept upstairs. All are exercised one hour daily, except in very stormy weather. Before treatment the horses are systematically injected with tetanus anti-toxin, in order to prevent the possibility of their contracting tetanus, and since this plan was adopted, five years ago, no horse has contracted the disease. As to vaccine virus, the committee's investigations showed that the calves selected, the precautions for cleanliness employed, the care given to the stable, and the handling of the virus left nothing to be desired.

Dr. S. H. Durgin, Chairman of the Boston Board of Health, recently said at a meeting of the Society for Medical Improvement ("Boston Medical and Surgical Journal," January 30): "We shall ask the Legislature at its next session to authorize the State Board of Health to produce and furnish our vaccine lymph. The State Board of Health is competent, has the confidence of the people of the State, and can give its guarantee of pure and active vaccine lymph, free of charge, to every person in Massachusetts, just as is being done with diphtheria anti-toxin. We shall hope for the backing of every physician in Boston. As to the percentage of vaccinated people in London, some of the figures

quoted are a little old at the present time. They are beginning to suffer from the neglect of vaccination. The people of London are to-day suffering from smallpox more than any city in this country. England, in consequence of its neglect of vaccination, is in serious contrast with Germany, which enforces vaccination and has no smallpox.

"With regard to Boston, I am sorry to say that she has been caught in a poorly vaccinated condition. We went through the city in the winter of 1872 and 1873 and gave thorough vaccination. Since that time we have experienced an unusual freedom of smallpox, much indifference and some misguided objection to vaccination, and are in consequence easy victims to smallpox. Under the statute law, every child in Massachusetts must be vaccinated before it attains the age of two years, and for neglect of this duty the parent or guardian may be prosecuted and fined. An amendment to this law took place a few years ago, so far as school children are concerned, which allows any child to attend school who can bring a certificate from a physician stating that it is an unfit subject for vaccination. The anti-vaccinationists are apparently utilizing this law as a convenience to their belief, which is that nobody, however healthy, is a fit subject for vaccination, and they are certifying the most healthy children as unfit subjects for vaccination.

"In regard to the difference between humanized and bovine lymph, I would like to say, as a matter of interest, that in the Republic of Mexico for ninety-seven years they have used almost nothing but humanized lymph. This lymph was brought from Europe in 1800, and since that time it has been produced and handled by only four persons selected by the Government. The children from whom the lymph is taken are well selected, the lymph is well cared for, and furnished free of expense, as it should le here. They never revaccinate, neither do they have smallpox among the vaccinated. My authority for this statement is Dr. Eduardo Licéaga, the president of the Supreme Board of Health of the Republic, a man of long public experience and unimpeachable character. This experience in Mexico has impressed me so strongly that I have asked that there be a committee appointed, and it was appointed in September, at the last meeting of the American Public Health Association in Buffalo, to investigate and report upon the respective immunizing powers of human and bovine lymph.'

DO PHYSICIANS ALWAYS PROTECT THE RIGHTS OF OTHERS?

It is an established fact that when a physician has visited a patient afflicted with an infectious disease no other patient should be seen by him until his person is entirely free from contagion. No one will controvert this statement. All agree. Then we know the right course to pursue-but do ali physicians use these precautions? Let the reader hold a self-examination. Will the verdict be guilty or not guilty?

Are there not some physicians whose precautionary measures are superficial-merely an excuse to satisfy their consciences? Sometimes, when the question is propounded to an individual, the answer is a sickly smile, evidence of guilt due to ignorance or gross carelessness.

Preventive medicine is given recognition by the more learned men in medical science, and the enemies of anti-toxin, vaccination and sanitary science are, if nothing worse, tainted with the ideas of "ye olden time."

The three classes-careless, pseudo believers, and "antis"become dangerous persons in a community when they are opponents to measures that modern sanitation has established as facts bevond a doubt.

HOUSE DISINFECTION AND ITS TECHNIQUE.

The principle upon which house disinfection depends is probably well understood, but it is necessary to be familiar with the technique in order to give intelligent instructions when interrogatories come from the family of a patient suffering from an infectious disease. The rules promulgated by Dr. J. N. Hurty, of the Indiana State Board, are among the best; any physician can obtain them by solicitation. The rules of the State and local boards are necessarily up to date, and are a safe guide and should be followed. If these facts had been given consideration by residents of Illinois it would have been unnecessary for Dr. J. Y. Shamel to card the "Philadelphia Medical Journal" asking that the best method calculated to disinfect rooms after occupancy by a smallpox patient be published, stating that it would be of great interest to the Illinois readers of the "Journal." The writer suggested the name of Dr. Abbott or Dr. Welch as the author of the statement.

The secretary of the Illinois board has undoubtedly published instructions quite frequently, and no one is more competent than Dr. J. A. Egan, the secretary.

However, the reply by Dr. Welch is brief and complete in its details. It is as follows ("Philadelphia Medical Journal," January 25, 1902):

"Replying to the question of Dr. Shamel, I would say that after the sick chamber has been vacated, either by recovery or death of the patient, every article in it of no great value should be immediately burned. Articles which it may be desirable to preserve, and which will not be injured by water, can be disinfected safely and cheaply by immersing them in boiling water for thirty minutes and then subjecting them to the ordinary process of the laundry. But if this cannot be done at once, such articles should be immersed for four hours in some reliable disinfectant, such as mercuric chloride, in the proportion of 1 to 2,000, or carbolic acid, I to 50, and subsequently boiled. For the disinfection of woolen clothing, carpets, bedding and the like, there is nothing equal to steam under pressure. All pathogenic germs will certainly perish if exposed for thirty minutes to this agent at a temperature of 230° to 250° F. When, however, this process cannot be carried out for the want of proper facilities, the articles named, with the exception of the carpet, which may remain on the floor, should be hung up in the room and subjected to the influence of formaldehyde. This may be very conveniently and effectively used in the form of formalin. The formalin may be diluted with two parts of water and used in a large atomizer, such as is commonly employed in the spraying of garden plants. In determining the amount required to disinfect a room, the estimate should be on the basis of one pint of formalin to every one thousand cubic feet of air space. Of course, the room should be as tightly sealed as possible, and left closed for eight to twelve hours. This method of disinfecting rooms was adopted by the Philadelphia Board of Health after having proved its efficacy by culture tests.

"When this process is finished and the room opened and ventilated, all surfaces, including the furniture, should be washed with a disinfecting solution (carbolic acid, 1 to 50, or mercuric chloride, I to 1.000), and afterward the floor and woodwork thoroughly scrubbed with soap and water. The wall paper, if there be any, should be well moistened with the carbolic acid solution and scraped off and burned. Paper may be reapplied or the walls whitewashed, according to fancy. I believe that any infected room could be considered safe for occupancy after having been faithfully subjected to the treatment herein outlined."-Medical and Surgical Monitor.