lation. This has been the result, and at the present day no cases of small-pox occur in that country which are not imported from neighboring lands, outside the limits of Germany. Such might be the case with any State or nation which adopts a similar course; and if all countries were to adopt it, small-pox would become a thing of the past. It is sometimes argued that small-pox is a filth disease, and only prevails among filthy people. But Paris and Vienna are as clean as Berlin, and yet these cities are very often visited by small-pox, while Berlin has none. In one important point, our own laws as well as those of most American States are defective, and that is in the absence of any definite provision requiring a record of vaccination to be made, at least, in the case of all vaccinations. performed under public authority. Boards of health often. make wholesale vaccinations upon the population of large districts, institutions, schools, the employes of corporations, etc., without even a slight record of the names only of those who have been vaccinated. The laws, or at least the regulations of other countries are very explicit in this matter and require not only a record of the date, name, age and sex of each person vaccinated, but also a record of the result of the subsequent inspection, which should always be made at the end of about a week. Such a record is often of very great value in settling disputed cases. To meet this objection, the State Board of Health has furnished to every local board in the State, suitable record-books for this purpose. These books are modelled upon the forms supplied by the Local Government Board of England to the public vaccinators. Herewith is a copy of a single sheet, each of which gives opportunity for recording 10 vaccinations and each. book for 1000 or 2000, according to size of the book. In this paper I have purposely avoided allusion to those vexing questions relating to the economic side of this question which invariably arise in every epidemic of small-pox. I have omitted discussion of this phase of the subject, both for want of time, and because the valuable time of a scientific body can be better employed than by the discussion of financial matters which can quite as well be submitted to the lay members of boards of health. Those health officers, however, who desire to consult the various statutes and decisions relating to the expenses of caring for small-pox patients, the salaries of attending physicians, nurses, attendants, liability for destruction and injury of houses, furniture, bedding, etc., etc., may find abundant reference in the legal works upon the subject. See Parker and Worthington, Law of Public Health and Safety; and the following Supreme Court Decisions : Spring v. Hyde Park, Mass., 137, 554. Brown v. Murdock, 140 Mass., 314. Orono v. Peavey, 66 Me., 60. Hampden v. Newburgh, 67 Me., 370. Farnsworth v. Kalkaska Co., 56 Mich., 640. Rae v. Flint, 51 Mich., 526. Wilkinson v. Long Rapids, 74 Mich., 63. Clinton v. Clinton Co., 61 Iowa, 205. Kellog v. St. George, 28 Me., 255. Kennebunk v. Alfred, 19 Me., 221. One of the unfortunate circumstances connected with sanitary legislation at the present day is the absence of medical men in the Legislature. On this account, Public Health Committees must necessarily be composed either wholly or almost wholly of laymen. Medical questions are constantly arising at every session, and it is important that a committee which is called upon to discuss and present to the Legislature many medical and sanitary questions should have at least one medical member. Laymen do not appreciate the value of legislation intended for the prevention of disease so keenly as men who are trained for this special purpose. Hence it is important that this want should be supplied, in order that the efficiency of sanitary legislation may not be impaired. DISCUSSION. Dr. G. A. MILES, of Somerville: I would like to speak of one thing to which Dr. Abbott refers, and that is with reference to children getting into our schools unvaccinated, not only by certificates given by physicians, certifying that the child is an unfit subject to be vaccinated, but also those children who have been vaccinated, but no inspection of them afterward to see the effect. Since this outbreak in Somerville I have been surprised to find the number of children in school holding certificates of vaccination, although the operation was entirely unsuccessful. This has brought very forcibly to my mind the great importance of examining every case before a certificate is given, not only to see that the patient is protected, but also that it is being properly cared for and doing well. Dr. S. H. DURGIN, of Boston: I think for a physician to give a certificate before he knows that the vaccination has taken is both stupid and illegal, and it should be denounced from one end of the land to the other. ARTICLE X. SMALL-POX: ITS MEDICAL TREAT MENT. BY MICHAEL KELLY, M.D. OF FALL RIVER. SMALL-POX is a disease which affects the entire system. The physician's duties in regard to it are many and varied. Its treatment is necessarily expectant and symptomatic. A self-limited disease, running a definite and regular course, no plan of treatment will abort or modify it when once developed. Perhaps its present extensive spread, giving opportunities for its study by numerous observers using modern scientific methods of research, will soon disclose the nature of the contagium, and thus rob it, in those who through ignorance or misfortune have escaped vaccination, of its loathsomeness and terrors. As soon as the diagnosis is made, if not as soon as a competent observer has a reasonable suspicion that a case is variola, the patient should be isolated. It would be well, of course, to have some suitable place of detention for cases that are only reasonably suspicious. For the treatment of those in whom the disease is diagnosed, an isolation hospital is the proper place, and there they should be sent at once. The isolation hospital, where patients are to be confined from two to three weeks in mild cases, and from four to five weeks or more in severe cases, should be in construction |