in stone. As far as medical legislation is concerned, we are still in the log cabin stage. At the magnificent Board of Health of this state do any of you realize that these people are doing their work on an appropriation of less than $20,000 per year? Do you realize that the State of Georgia appropriates two and a half millions of dollars per year for education; another million for pensions, and expends for the health of its citizens the magnificent sum of $20,000 alone? Is it any wonder that to my mind the average member of the Legislature is a jackass? I wish to state emphatically that this is not my true opinion of the average legislator; my true opinion is not fit to publish, and I fear it would not be accepted in the society columns of any of our great dailies. I have no apology or explanation to make for expressing this opinion. Any so-called legislator that is too ignorant or too careless to the sufferings of humanity not to unlatch the purse-strings of this great State to help the poor indigent sufferer has not my respect. I consider him an ought with the ring rubbed out. Take the National Government. There was expended in the year 1908-9 for past wars, and for preparation for war, four hundred and twenty-three millions of dollars. There was left for other business of the Government one hundred and eighty-one million of dollars, 70% for one and 30% for the other of the income of the United States. The cost of a few battleships wisely spent in the fight against Tuberculosis in a few years would obliterate this disease practically from the masses of the Republic. The secretary of the Peace Society of the State of New York says: "Our defenses, adequate in 1898, are doubly equipped now. Why not let well enough alone, and buy something besides guns? No one can oppose adequate National Defenses. We do oppose actively the following of the prevailing National ambition." Mr. J. A. Tawney, chairman of the committee on appropriations, states that expenditures for this purpose for the coming fiscal year, 1909-10 will be greater than ever for this year. They have been increased rapidly and enormously year

by year, and no one can predict beyond what increase this may not go. The question arises what are we going to do about it? We must awaken the people to the fact that this country is on the verge of delirium concerning expenditures for war alone. To this one fact, every doctor, every humanitarian and every voter should obligate himself to aid in every way movements which tend to reduce this great amount of expense, and in a more sane way. aid in the upbuilding and betterment of mankind.

FURTHER EXPERIENCE WITH VACCINE IN

TUBERCULOSIS

E. C. Thrash, M.D., Atlanta, Ga.

There are a few thoughts I wish to present as a foreword to this essay that have been prompted from my handling tuberculosis in a general way. No disease is attracting so much attention at present from the world as tuberculosis, and justly so, but there are many grave errors being made by well-meaning, but untrained, phthisiphobic people, and it is the duty of the medical profession to attempt to correct them. The warfare against this disease is being fiercely waged, but it is accompanied with too much glamour, sounding of trumpets, ignorant exploitations, and frightening, panic-producing vaporings from those utterly devoid of a proper knowledge of the subject. The medical profession is the proper source from which this work should come, and it should be done quietly, with an eye always avoiding panic-stricken conditions as they now exist. We have reached a point already where we have as difficult a problem on hand in curing the public of phthisiphobia as of ridding it of tuberculosis. What it needs to be taught is truth, and we who are giving our energies, our studies, and even our lives to this work feel keenly our incapacity in properly representing it. This being so, then what should we expect but to produce a 'wild delirium of fright and consternation, putting the people to running to they know not whither and from they know not what, when we are so foolhardy as to call in the clergy, the club woman, teachers, philanthropists, etc., entirely without proper technical and medical train

ing along this line to help to alleviate the world from this scourge.

In my tuberculosis work for the past few years, I have attempted to make painstaking observations as to the value of vaccines, both as diagnostic and therapeutic agents. It shall be the object of this paper, not to enter into the minute details of their administration, but to give the general conclusions I have reached from observation in their use. In summarizing these, I wish to state emphatically that he who depends wholly upon tuberculin either for diagnosis or treatment, will be sorely disappointed, but on the other hand taken with everything else that is available in the proper handling of tuberculosis, I consider no agent so valuable as these, for, frequently after exhausing every other means to make a diagnosis, being still in doubt, tuberculin will often turn the balance and prove an invaluable aid in clearing the doubt. No one who is not a good clinician and diagnostician will get satisfactory results from vaccine. The same good judgment is needed in interpreting the results from the use of these, as is needed in the interpretation of one's clinical findings. Four of these tests are worthy of mentioning, the sub-cuticular, Von Pirquet's cuticular, Moro's ointment, and the Systemic. They are mentioned in the order of their delicacy, but not in that of their administration, as the sub-cuticular will sometimes give a systemic reaction and interfere with the local reaction, should one wish to admisinter the others later. Von Pirquet's and Moro's can be used together, and if these do not clear the doubt the other two may then be used, but separately, using the subcuticular first. Let me say this, any person who is sick enough to go to a physician for an examination thinking there is a possibility of his having tuberculosis, deserves the most painstaking examination and the utilization of every thing one has at hand to enable him to arrive at the truth,-spending not a few minutes, but

hours, days or weeks until he can say yea or nay with some degree of positiveness.

It is superfluous to say that tuberculin is beneficial and curative in the treatment of tuberculosis. This has been and is the decision of practically everyone who has used it extensively, carefully, wisely, and prudently. The longer and the more one uses it, the more profoundly impressed he becomes with its potency for both good and evil, and the more he insists upon its careful administration. But because it must be used properly to get results, and will produce harm used improperly, would no more preclude its use than the same thing would preclude the administration of strychnine or digitalis. There is great need of a more accurate standardization of tuberculin. On account of difference in virulence of different strains of organisms it varies in antigen potency, in proportion as the different strains from which it is made varies. So a mg. of a tuberculin made from one strain of organisms would be practically sure to vary in antigen potency from a mg. of one from another strain. This difficulty with our present knowledge is impossible to overcome, but there is one in reference to a more uniform nomenclature which can be, and that is the variable strength of the solutions made by different manufacturers, and the reference by one to the dilution, and to another to tubercular solids when speaking of doses. To be explicit, T. R. solution carries 10 mg. of solid to the cc., and B. E., put up by some manufacturers, carries 5 mg. to the cc., while others put one mg. of solid to the It makes quite a great difference as to whether one refers to solids or solutions in reference to doses. We should have a universal plan, in my opinion, of referring to solids when we name the dose, and in this way much confusion could be avoided. In the paper read before the Association one year ago, I referred to solutions when doses was mentioned, I have begun since that time to estimate my doses exclusively in solids. This makes a difference of from 200 to 1000 fold less, owing to the

cc.