quently is, entirely protective; but sometimes it protects only in part, and when a person who has been successfully vaccinated contracts the disease, as is sometimes, but very rarely, the case, he has a modified smallpox,-varioloid. I mean by that: The experience of the world is that to insure the fullest measure of protection one should be vaccinated in infancy, and again in from seven to nine years. If repeatedly exposed to the infection of smallpox, it is best to still again be vaccinated. The above method is, I think, the rule in Germany and France. Still, persons who have two, three, even four scars (not always indicative of successful vaccination), occasionally, very rarely indeed, have varioloid, but it is seldom fatal.

The lymph used in the present day is taken from healthy young heifers, under the strictest sanitary and antiseptic precautions, under the supervision of capable and conscientious physicians. There is an establishment where it is done under government supervision; and from all the great vaccine establishments the lymph is sent out under guarantee of purity, with date of the extraction stamped on the package, so that one may know the age; and with strict injunctions to return it (if the "dry" kind, on "points") if not used, and exchange it for a fresher package. It is put up in sterilized packages, or "glycerinated"; in fact, every precaution is taken to insure its purity and to preserve it from contamination.

The operation of vaccination should be performed by a physician, and if he be a capable man, he will take the same precautions that he would do in any other surgical operation, to insure asepsis. That is, his hands will be cleansed; his lancet, if not a new one, should be held in the flame of an alcohol lamp or dipped in boiling water. The spot selected for the operation should be thoroughly cleansed, preferably with ether, after washing and drying, or with ether-soap. No blood should be drawn, but the arm should be scratched until there is a slight oozing of lymph, and the vaccine should be spread on and rubbed in. A protective shield, made for the purpose, and to be had from all depots of vaccine lymph, should be worn until the pustule "matures," and the "scal" dries up and falls off. It should never be forcibly removed or rubbed off. When the operation is done as described, and with fresh and pure lymph, it is almost sure to "take," and will cause no inflammation or other distressing symptoms. In a few days a small vesicle filled with a clear fluid (lymph) will appear, surrounded by a small area of infiltrated skin-an areola-which should not be larger than a ten cent piece. At the end of eight or ten days the vesicle has "matured," its contents having become first milky, then purulent, a

pustule is formed, and then begins the decline, which results in the formation of a dried, indented ("umbillicated"), scab, which will fall off later, and will leave a scar, "pitted" with what is known as "strawberry" pits or indentations.

Were the people enlightened upon the subject, and assured of the fact, for it is a fact, well established and demonstrated, that vaccination, when properly done, not only occasions no suffering or inconvenience and involves no danger whatever, but will afford almost absolute safety in the midst of this dreadful disease, all rational people would hail it as a boon and blessing. Amongst the unenlightened, the people should be persuaded, for their own safety and the safety of the community, to submit to vaccination, and the densely ignorant who cannot be convinced should be subjected to the process as a means of public safety. The State should pass a law which shall be practically compulsory. Rational people will need no compulsion. In some such measure lies the only hope of exterminating the pest. In this question is involved a problem upon the solution of which depend thousands of lives and millions of money. Vaccination, as has been demonstrated in England and in Germany and in France, offers the only solution. Quarantining against it, and quarantining those down with the disease, and those who have been exposed to it, is a failure, as has been clearly shown, not only in Texas, but in other American States. Where will it end? It will not end until thousands of lives and untold sums of money have been wasted; until the entire unvaccinated population have had the disease, and pock-marks will have become a distinguishing feature of every other individual one meets, as it is among the masses in Mexico. Texas should profit by the lesson learned in other countries and States, and follow the examples set by them in resorting to the only effectual means of arresting the disease. As before said, the intelligent class will need no compulsion; they will not need the services of any health officer, but will have their physician to perform the operation. I will give presently an illustration of what I mean by the "lessons learned" and the "example set" by more enlightened people. Before doing so, I wish to call attention here to a danger which, if not guarded against by timely measures, will touch not only the public health, but the pocket-book of State and people in a quarter very dear to their hearts.

Cotton is the greatest source of wealth to Texas. Cotton is a dangerous carrier of the infection, and as negroes and Mexicans with smallpox were engaged in cotton picking the past fall, and others just recovered, and before the scabs of the loathsome disease had been shed, there is no knowing where or how far the infection has

been disseminated. Texas need not be surprised some morning to wake up and find Texas cotton quarantined in all parts of the civilized world; and cotton raising countries would want no better pretext, and could have none, than the danger of introducing the disease into that territory.

In 1870-1, during the Franco-Prussian war, 43,000 German soldiers died of smallpox, and 23,000 French. In 1874, Germany enforced vaccination throughout the empire, and the annual death rate from smallpox amongst 70,000,000 people was reduced to 116. (See Reports United States Marine Hospital Service, January 6, 1899.) England exterminated the disease during the time the compulsory vaccination act was in force, and I have the authority of Andrew Dickson White, United States Embassador to Russia, and long time president (and joint founder) of Cornell University, for the statement that in 1890 only one death from smallpox occurred in London. (See President White's great book: "Warfare of Science and Theology.") To come nearer home: I have the authority of our own State Health Officer, Dr. Blunt (and it is a matter of record as well), for saying that, at Laredo, two years ago, 1200 cases of smallpox occurred amongst the unvaccinated Mexicans, of whom over twenty-six per cent. died (some 320); while in the 2200 white population, all of whom but one were vaccinated (an old lady who begged to be not vaccinated), there occurred twelve cases (varioloid) and one death-the old lady referred to.

If stronger evidence of the protective value of good vaccine were needed, it is to be found in the fact that it will protect a baby born. of a mother suffering with smallpox at the time of its birth; and will protect those who have been in direct contact with the disease at its height, if done within three, four or five days after the exposure.

In "A Statistical Record of 5000 Cases of Smallpor" observed by him. Professor W. M. Welch, of the University of Pennsylvania, and Surgeon of the Hospitals for Infectious Diseases in Philadelphia, the highest authority in America on smallpox and vaccination, referring to a statistical table (which I regret I cannot introduce here) says:

"It is impossible to illustrate in this table the very striking and conclusive evidence of the protective power of vaccination that frequently came under my notice while observing these five thousand cases of smallpox-such, for instance, as witnessing, on the one hand, an unvaccinated person suffering from the confluent form of the disease, loathsome and offensive, with the final issue for several days uncertain, and on the other hand a vaccinated person undergo

ing a modified form of the disease, so mild and innocent in its character as not to excite any apprehension for the safety of the patient. In the former case, if recovery took place, the individual was left disfigured for life, while in the latter, after a few months had passed, there was but little, if anything, in the appearance of the individual to indicate that he had ever suffered from the disease at all.

"Also, I have seen over and over again entire families brought into the hospital when all the unvaccinated children have been suffering from smallpox and the vaccinated children unaffected; have seen the former perish and the latter remain exempt from the disease, although living, eating, and sleeping in the infected atmosphere for several weeks. But I have yet to see a single unvaccinated child escape the disease under similar circumstances. Furthermore, I have more than once seen a vaccinated infant draw its daily supply of nourishment from a mother suffering from varioloid, and the infant remain as free from any symptom of the disease as if the infection were a thousand miles away and the food were received from a most wholesome source. All this is evidence of the prophylactic power of vaccination that cannot be shown in mortality tables."

The history of vaccination, in all countries, is an unbroken record of success in arresting the spread of and exterminating smallpox. Hundreds of instances could be given similar to the above, did space permit. Especial reference is made to Loomis' System of Medicine, to Osler's Practice of Medicine, and to Buck's Reference Handbook of the Medical Sciences, Vol 7, for statistics of vaccination in America. Several of the States in America have compulsory vaccination laws. In many States there are laws that are practically compulsory, if not literally so. For instance, in many States no child is permitted to enter any school without a certificate of successful vaccination. In some the prohibition extends to all industries where operatives are employed; mills, factories, etc. I am under the impression that the United States immigration laws. prohibit the landing of any foreigner without evidences of successful vaccination. Were such evidences made the sine qua non to getting employment (especially cotton picking), or of sending a child to school, in a very short time the good effect of the reform would be felt, and we would have, practically, "compulsory vaccination."

THE

TEXAS MEDICAL JOURNAL.

AUSTIN, TEXAS.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY.

EDITED AND PUBLISHED BY

F. E. DANIEL, M. D.

ASSOCIATE EDITOR:

WITTEN BOOTH RUSS, M. D.,

San Antonio, Texas.

Published Monthly at Austin, Texas. Subscription price $1.00 a year in advance.

Eastern Representative: John Guy Monihan, St. Paul Building, 220 Broadway, New York City.

Official organ of the State Association of Health Officers, the West Texas Med:cal Association, the Houston District Medical Association, the Austin District Me dical Society, the Brazos Valley Medical Association, the Galveston Courty Medical Society, and several others.

A SCHOOL FOR HEALTH OFFICERS.

Under the above caption our friend Atkinson, long time secretary American Medical Association, now editor of Public Health,, Philadelphia, has an excellent article from which we extract a few sentences below. We take the subject for our text in connection with the approaching meeting (January 15, 1902, at Austin) of the Texas State Association of Health Officers. The State Association of Health Officers has a great work before it, the nature and extent of which, I feel assured, is not sufficiently known and appreciated even by its members. The situation in Texas is peculiar. Our quarantine laws take cognizance of nothing except imported. diseases. There is no provision whatever for the institution of sanitary reforms throughout the State looking to the prevention of those diseases of local origin, and due to filth, seepage water, defective plumbing, want of drainage, etc., and which carry off annually more people than all the epidemics of yellow fever and smallpox combined. True, the law does provide for the appointment by the county judge in each county of a county health officer, and the health officer of each county is supposed to be a part of the