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Vaccination even by the profession is often carelessly administered, while the laity presume to vaccinate without professional advice, and even give judgment upon the genuineness of the vaccine scar with the confidence of experts.

Vaccination should never be done by inexpert hands. The source of the virus should be unquestionable, and the result should be carefully noted in every case. Nobody but an expert can pronounce upon the genuineness of the vesicle (any kind of sore or inflammatory lesion must not be allowed to pass for a vaccination), and revaccination should be insisted upon in every case after the lapse of five years from the time of the last successful vaccination.

If vaccination and revaccination were made compulsory by legal enactment, and the above rules were carefully followed, smallpox would be stamped off the face of the earth in a decade. As it is, the disease lies in wait till the careless or unsuspecting victims become sufficiently numerous, and then begins the march of death.

Notes and Queries.

WARNING AGAINST SMALLPOX.

OFFICE OF STATE BOARD OF HEALTH,
Bowling Green, Ky., March 25, 1898.

To the Officials, Fhysicians, and People of Kentucky:

This Board again gives warning that our State is seriously threatened with an epidemic of smallpox. Grave conditions already exist in Bell, Whitley, and Madison counties, and cases are reported in Knox and Mason counties. So far the disease has been almost exclusively confined to negroes, but this exemption of the white race can not long be hoped for if it continues to spread.

In spite of repeated and continued warnings from this and county and municipal boards, each community so far attacked was unprepared, a large per cent of the population was unvaccinated, and dangerous and costly delays occurred before the character of the disease was recognized, and hospital and other provisions could be made for the sick and exposed.

Under our laws this expense must be met by the counties and cities affected, and it can only be made small by proper preparation before a case appears. Had Middlesborough and Bell county been thus forehanded and ready to care for the first cases, thousands of dollars would have been saved in actual outlay, very many thousands in loss of business, and the

officials and community the mortification of clamoring for outside aid to do what they were amply able to do for themselves.

In view of these facts, the Board advises that each town and city at once pass and enforce a compulsory vaccination ordinance, beginning with the colored race, but reaching everybody; that isolation hospitals or tents, and suitable ground for their location, be secured; that visiting and strange negroes be hunted out, vaccinated and kept under observation, and especially that physicians practicing among negroes be instructed as to the difficulty of recognizing mild cases of smallpox and varioloid in this race, and of the importance of calling in experienced counsel in every doubtful or suspicious case. Those having this work in hand should deal firmly but kindly with every one, advising that this work is being done for their protection as well as that of the community.

Quarantines against infected places, the first resort of unprepared towns, do much actual harm by giving rise to a false sense of security, thus retarding the work of vaccination and preparation, and, if rigidly enforced, are much more expensive than the precautions herein advised, besides causing much financial loss by interference with travel and commerce. No quarantine can be legally established without the consent of this Board, and this will not be given unless the circumstances are very exceptional. Communities maintaining unauthorized quarantines are liable to persons suffering injuries or damages therefrom.

At this time every person in Kentucky should be vaccinated or revaccinated. If properly protected it will not take, and if it takes there is need of it. The vaccination should always be done in three places about an inch apart, by a competent physician with clean hands and instruments upon a well cleaned arm, by scraping off the scarf skin without drawing blood, and should be allowed to dry thoroughly before the sleeve is put down, and should be protected for a few days with a clean cloth or absorbent cotton. This will give the best chance for a successful result, with much less soreness and suffering.

Fresh, reliable virus may always be had from the National Vaccine Establishment, Washington City, or from its agents, the Henry Drug Company, of Louisville. Vaccination from the arm of a child known to be healthy is equally reliable.

This Board holds itself in readiness to aid local boards to the full extent of its powers, but little aid will be needed from it if each community will intelligently prepare to take care of itself.

By order of the Board.

J. N. MCCORMACK, M. D., Secretary.

J. M. MATHEWS, M. D., President.

PRELIMINARY ANNOUNCEMENT OF THE COMMITTEE OF ARRANGEMENTS, AMERICAN MEDICAL ASSOCIATION, DENVER MEeting, June 7-10, 1898. The Committee of Arrangements announces that preparations for the coming meeting are well advanced. A large number of prominent

men have signified their intention to be present and read papers, and an excellent scientific programme is assured. The indications all point to a large and successful meeting.

Convenient and ample accommodations have been secured for the General Sessions, Section work, Registration, and Exhibits.

The entertainment of members and their families is being planned on an elaborate scale, and the Committee promises all who may come a most enjoyable time.

Denver is an interesting city, and the State offers many and varied attractions to visitors.

Local excursions are being arranged, to take place after the meeting, that all may have ample opportunity of visiting various points of interest in the State and seeing the best scenery of the Rocky Mountains.

The Committee confidently expects to obtain a one-half rate and thirtyday limit for the round trip on roads west of Chicago and St. Louis, and reduced rates on Eastern roads. The rates will be announced in the Journal of the Association as soon as definitely determined.

“Pure” DiphtTHERIA.—At a recent meeting of the Societe Medicale des Hopitaux Dr. Barbier communicated the results of his important and laborious researches on the clinical and bacteriological forms of diphtheria. He showed that cases of pure diphtheria due to infection with the bacillus only were clearly distinguishable from cases of modified diphtheria in which the additional infection of other microbes-streptococci, staphylococci, etc. -played a part. As a result he presented a clinical description of diphtheria much simpler and more definite than the existing one which confounds all forms. This pure diphtheria may be observed experimentally in animals in which the bacillus causes simple vaso-constriction and necrosis but never inflammation. But when diphtheria occurs in man it is usually in the modified form, for being but feebly contagious a pre-existing morbid condition of the affected surfaces is generally necessary to enable the disease to install itself. The diphtherias secondary to scarlet fever and measles are examples of this. In only 54 out of 221 cases examined bacteriologically was the diphtheria pure. Pure diphtheria is to be recognized clinically not by the appearance of the membrane but by the state of the throat especially; the mucous membrane is not inflamed, but, on the contrary, rather pale mucous or purulent secretion is absent, and adenopathy is absent or trifling. The temperature is but little elevated; it is at most a little over 100° or 101° F., and this only temporarily. The pulse is always small and rapid. There is little or no albuminuria. However benign may be the appearance of the throat the patients look ill and have a pale, leaden complexion, because they are under the influence of the diphtheria toxin. No matter what may be the extent of the membranes or the multiplicity of the localities attacked, recovery under the influence of antitoxin manifests itself on the day following injection and is completed in two or three days, rarely later. The prog

nosis is therefore very good. All Dr. Barbier's 54 cases, which included 13 laryngeal cases in which intubation had to be performed, recovered. There is only one danger in this form-extension of the disease to bronchi, which may lead to suffocation. Dr. Barbier never observed paralysis in any of his cases a remarkable fact. In modified diphtheria of the throat the mucous membrane is always red, sometimes it bleeds, and the tonsils are always swollen. The inflammation may be limited to the neighborhood of the false membranes, confined to a part of the mucous membrane-for example, the uvula or generalized. In the pharynx is seen muco-purulent matter, secreted there or coming from the nose or larynx. In almost all cases the lymphatic glands are enlarged. Though the appearance of the membranes is not characteristic, in most cases, and especially when there is staphylococcic infection, they are rather thick and extensive, and often the odor of the breath indicates decomposition which is caused by saprophytes. The nose is almost always attacked, and whether membrane exists or not there is a discharge, serous, purulent, or hemorrhagic, containing numerous septic microbes. The temperature is higher than in the purer form-101.3° to 104°. Complications such as broncho-pneumonia, otitis and impetigo frequently occur, and in the worst cases septicemia.-London Lancet.

GONOCOCCI IN THE BLOOD.-Dr. Ahman has described in the Archiv fur Dermatologie und Syphilis (vol. xxxix, part 3) a case in which gonococci existed in the blood. The patient, who suffered from urethral gonorrhea complicated with multiple arthritis, tenosynovitis, epididymitis, and nephritis, was liable to feverish attacks, during one of which a Pravaz syringeful of blood was taken from a vein in the arm, and this blood when spread over four ascites-fluid agar plates yielded pure cultures of the gonococcus. Dr. Ahman considers that this is the first instance in which general gonorrheal infection of the system (blennorrhoische allgemeininfection) has been directly proved, all previous attempts to cultivate gonococci from blood having failed, perhaps because an insufficient quantity of blood was employed. Ibid.

"OLE DOCTEUR FISET," WHO HAS "GOT NINETY YEARS OR SO."

But Docteur Fiset, not moche fonne he get,
Drivin' all over de whole contree;

If de road she's bad, if de road she's good,
When ev'ryt'ing's drown on de Spring-tam flood,
An' working for not'ing half time mebbe!

Let her rain or snow, all he want to know
Is jus' if anywan's feelin' sick,
For Docteur Fiset 's de ole-fashion kin',
Doin' good was de only t'ing on hees min',
So he got no use for de politique.

-British Medical Journal,

Special Notices.

A NEW METHOD OF LOCAL ANESTHESIA.-Since the discovery of the anesthetic properties of cocaine, its sphere of usefulness has constantly broadened, and it has become one of the most serviceable drugs in the everyday practice of the physician. Recently attention has been directed to a new method of employing cocaine, the aim of which is to facilitate its use and render it more safe and efficient. In devising this method three objects have been kept in view: (1) To secure an absolutely pure grade of cocaine, free from all by-products; (2) To do away with ready-made solutions which are liable to decomposition and then lose their potency and become irritating; (3) To dispense the cocaine in such a form that fresh solutions of any desired strength can be prepared at a moment's notice. To accomplish these objects, it has been found advantageous to employ the cocaine in the form of the discoids, each of which contains a definite quantity of the drug without any excipient whatever. The amount of cocaine hydrochlorate in each discoid is accurately determined by weight, and in consequence of their ready solubility the discoids dissolve in a few drops of water. The physician, therefore, always has at hand the material for preparing fresh cocaine solutions of any percentage strength desired. Thus, for instance, if he wishes to make use of a few drops of a 4-per-cent solution, all that is required is to dissolve a one-fifth-grain discoid in five minims of water, while larger quantities can be prepared in the same way. By proceeding in this manner the physician is always informed as to the amount of the drug he is using in any given case, and unpleasant or serious effects are thus reduced to a minimum. For the induction of local anesthesia in minor surgery, dentistry, diseases of the eye, ear, nose, and throat, in short, wherever there is any indication for the use of cocaine, the cocaine discoids will be found the most eligible method of securing the beneficial effects of this remedy. These discoids are prepared by Schieffelin & Co., who were the first to make cocaine in this country, and, as is well known, their name has long been identified with the manufacture of high-class pharmaceutical products. Every means is taken by them to produce absolutely pure cocaine, and to secure uniformity and accuracy of weight in the preparation of the discoids.

A PRE-ANTITOXIN MORTALITY OF 40 PER CENT REDUCED TO 3.6 PER CENT.-Prior to the introduction of anti-diphtheritic serum, the mortality from diphtheria at the Harper Hospital, Detroit, averaged for a number of years 40 per cent. According to the thirty-fourth annual report of the hospital authorities, as published in the February number of the Harper Hospital Bulletin, page 73, one hundred and forty-one cases were treated at the hospital during 1897, with the following results:

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The antitoxin employed exclusively in Harper Hospital during 1897 was the antidiphtheritic serum of Parke, Davis & Co.'s Biological Department, and the remarkable reduction displayed in the death-rate reflects the highest credit on the efficacy of this matchless product.

CLEANLINESS IN CATARRHAL AFFECTIONS.-One of the fundamental principles in the treatment of catarrhal troubles of the nose and throat may be summed up in a single word, "cleanliness." To permit secretions to remain on the surface of the in

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