holder, or family where the disease appears, is required to give notice to the health officer, or if there is no health officer, then to the nearest member of the board of health, stating the name, age and circumstances of the sick person or persons. The medical attendant should at once separate the sick from all others than those who have the care of the cases, and should also carefully instruct the family concerning duties to themselves and to the sick.

Duty of health officer and board of health. Be prepared to give specific directions, both verbally and by the printed card, showing precisely what to do, what to avoid, especially in regard to the apartments and persons where the sick are, the care and disinfection of all things that can communicate the disease, and also in regard to the rules concerning improper intercourse with and movements of the sick and whatever can convey disease; also the sanitary purification required at the termination of the case. The official card for this purpose should be placed in the hands of those in charge. The medical attendant is responsible for the duty of faithfully enforcing such rules and regulations as long as the sick and the family are under his professional care.

The sanitary authorities should direct the methods and extent of disinfection, but it is usually best to do this by the help of medical attendants, in no case, however, permitting these duties to be omitted. The official notice to the households and their medical attendants should state these rules and duties plainly and briefly. The following is a suitable form for such notice to the family or their physician :

A B being sick with [small-pox must be kept entirely separate from all persons except the appointed attendants, and no others can be allowed to remain upon the same floor of the house, unless they have had [small-pox,] or [been successfully vaccinated] within a few years. The directions given in Nos. 15, 16 and 41 of the State Board of Health papers should be faithfully followed.

The attendants, as well as the sick themselves, must be kept entirely away from all persons who are not already protected against the contagion. The attending physician and the undersigned will give any information desired in each case, and the official release from sanitary restrictions will be given in writing as soon as it safely can be. By order of the Board of Health,

(Signed)

Health Officer of·

NOTE. Whenever a transfer to the refuge-hospital is agreed upon, the health officer's or attending physician's orders for the disinfection of premises and materials should be indorsed on this memorandum.

Quarantine and other sanitary orders against contagious disease.— Though it is presumed that the health officer and the board of health will, with rare exceptions, have the confidence and concurrence of the people, so that sanitary orders and instructions will be promptly complied with, the law provides suitable means for enforcing any necessary order of the local board of health.

An order for the isolation or quarantine of any source of dangerous contagion is absolute in its nature, and must be promptly obeyed; and

under sections three and four of the Public Health Act, as amended in 1867, 1881 and 1882, it is provided that "Every person who shall willfully violate or refuse to obey any order or regulation,

* * *

so made and served shall be deemed guilty of a misdemeanor," and by issuing its warrants to the constable, the Board may "apprehend and remove such person as cannot otherwise be subjected to the orders and regulations by them adopted." In the execution of such orders the officers are required "forthwith to execute them, as if the same had been duly issued out of any court of record."

Small-pox, diphtheria, typhus, typhoid and scarlet fevers and cholera may occur under circumstances that require such prompt action. The State Board has issued special sanitary papers, Nos. 13, 14, 15, 16, 38 and 41, to aid health officers and families in their duty concerning these diseases.

Records of deaths and prevalent diseases. The laws require these records to be returned to each local board, as well as the State Board of Health, by the health officer. Card No. 30 has been prepared for this purpose, and is supplied by the State Board. Cards 31 and 32 are for use by the medical attendants upon small-pox and diphtheria, and are supplied by this Board to physicians through the local board.

Temporary quarantine :-Refuge and Hospital. There are four ways of quickly providing a suitable refuge and hospital for contagious disease:

(1) At home, upon the upper floor, or in any completely secluded part of the house,- cleared of all occupants, except the sick and attendants.

(2) A separate little building suitable for a hospital ward ready for use.

(3) A board hut or a pavilion, hastily constructed for the purpose; or

(4) A hospital tent and fly canopy; and these are the safest kind of contagious disease refuges, during the warm season.

The first is the common expedient. It is best that the entire floor, or that a separate quarter or end of the dwelling, be set apart for the domestic quarantine of the sick.

The second is occasionally the most available and suitable method. Such a separate building should be in a healthful spot, and thoroughly ventilated.

The third is frequently the best method of quickly and effectually providing for any increasing number of patients. The preceding plan and specifications for a contagious disease-refuge and hut is designed to show what may be constructed in a single day to meet an emergency, such as frequently occurs in villages, alms-houses and asylums. The hospital tent is the best kind of refuge in the warm season, if the tent-canvas and materials are at hand. The preceding plans and directions for the tent-hospital will be readily understood.*

These methods need no further explanation in this chapter; yet as regards any method of isolation, removal, and the quarantining of contagious diseases, we must be careful to do the sick no harm while the people are being incited to the duty of removing and preventing the causes of disease.

The objects of this chapter will be attained if health officers and boards of health find their duties made clear and their work facilitated by it.

*See pages 268–271 ante; also Sanitary papers 27 and 27 a and b.

[I.]

MEMORANDUM UPON OBLIGATORY VACCINATION AND THE MAINTENANCE OF PERFECT VACCINE VIRUS AND KINE-POCK,

The amazing discovery of the protective property of kine-pock so far preceded any scientific reasons or account that could be given of it, that the civilized world has received this boon as an unaccountable benefit rather than as one of the most recondite evolutions of a truth, the science and application of which necessarily require the most exact observations and proving. Though Dr. JENNER, the discoverer, seems to have comprehended the necessity for the scientific basis of vaccination as it became a branch of medical art which he hoped would redeem mankind from the doom of the horrid and contagious pest which was destroying in a dreadful way nearly a tenth of the race, he lived to witness and protest against the ignorant and reckless abuses of the practice of vaccination, which have, ever since that time, greatly discounted its utility, and invited the harsh criticism of persons who misjudge the charlatanry and stupid malpractice which result in spurious and cruelly deceptive consequences, to be the legitimate outcome of the kine-pock practice.

While JENNER and the chief physicians and statesmen, seventy or eighty years ago, were rejoicing to see numerous governments adopt, provide for, and even enforce the duty of vaccination, they learned, a few years later, how execrably negligent and unworthy were many of the physicians who publicly and privately assisted in this new medical duty. The public as well as private practice of vaccination has ever tended to become a merely formal and empirical matter, because it is so generally viewed as a sort of mysterious incantation, of which the point smeared with lymph-virus, or bearing a particle from the dried sore of a pock, acts as the "charm." Whereas, it is true that instead of mystery and the "charm," the procedure to vaccinate should be treated as the nicest of medical arts and physiological tests, in which a natural susceptibility to the loathsome contagion of small-pox is to be overcome, and in which the perfection of such conquest over the liability to deadly contagion actually depends on the definite qualities of the lymph-virus as respects the precise development or culture and taking of it, and as regards the minutely important conditions of the keeping and using of it.

The facts relating to all these matters were ascertained and very clearly stated by Dr. JENNER, in his day, but for want of a demonstrated and scientific basis of the physiological and etiological knowl edge by which the art and practice of these endless generations of the cow-pock virus would naturally be determined with rigorous precision, the faulty and untrustworthy kinds of vaccination almost equal in amount the correct and completely protective vaccinations.

Experience has long and extensively taught that the average vaccinations in ordinary medical practice will not abide even the old [Assem. Doc. No. 110.]

35

Jennerian tests of worthiness, and that the public or gratuitous vaccinations rarely will rank higher than the vaccinations in private practice. To remove and wholly prevent such perilous faults in the practice of vaccination, there must be timely intervention not only by public health instructions and methods, with some aids and incentives to secure the adoption of correct practice and adequate means, but, also, there must be a minutely careful and physically comprehensive intervention of scientific research to determine the intimate nature of this wonderful inoculation process. The perfect rules and examples of JENNER and other worthy instructors have not been well followed. A rational insight and a comprehensive generalized principle or law seems necessary, to command universal deference to the rules for securing perfect results in vaccination.

Thou

Investigations in progress.-Though the fact seems well established that by incessant watchfulness, skill, and continuous reproduction or generations, it is possible to keep up the perfect protective attributes of the kine-pock in its humanized form, there is no doubt that the tendency to degeneracy, or a decrease of efficiency and energy, is to be confessed. The early vaccinators certainly witnessed wonderful results of tested protection against the contagion of small-pox. sands of vaccinated persons were inoculated with the contagious matter of small-pox, with rare instances of any receptivity of it. During the first thirty years of the present century there were frequent renewals of the kine-pock from the herds. There also followed a great variety of experiments to ascertain the actual origin of the kine-pock and to discover what natural relations exist between that disease, the variolous disease of the horse (variola equina), the variolous malady in sheep (variola ovina,) and the small-pox in man. Each of these discases has been proved to have such alliances with the three others that, so far as human small-pox is concerned, each of the three forms of variola in the domestic animals here mentioned will, when made to operate by inoculation in the human system, protect against smallpox. Further tests go to prove that each of these four kinds of disease-virus confers entire protection against each and all of the other three diseases.

The question of actual identity of these four maladies, as we witness them in four of the families of the mammalia, is of less importance than the fact that whichever is communicated to any individual of these several groups of beings, it tends immediately, by its operation as a morbid infection, to remove the receptivity, before existing, for each one of the other viruses. Though this demonstration is most complete as regards man and the bovine species, and as between the horse and that species, and the horse and man, the entire triple series of interchangeability, or, at least, of communicability and à protective result, may now be regarded as being completely demonstrated.

The pocky maladies in the horse and the bovine species are not all variolous; and it is only in the heifer or bovine animal that the vesicle is found to be identical with that which in turn results from its inoculation in man. While Mr. Ceeley and Mr. Badcock proved that from two to seven per cent. of the heifers they inoculated or attempted to infect with the contagious matter of small-pox, actually took the disease, and that with great care in subsequent culture and humanization of the vesicles, they became apparently identical with vaccine vesi

cles, the fact remains that the natural kine-pock, and the products of its continual artificial inoculations, constitute the defense of mankind against small-pox. Therefore the discovery and utilization of every perfect case of the natural kine-pock have become vital sanitary duties. The local government medical officers in England have for years searched and experimented in vain to secure a valid and efficient new stock of vaccine lymph directly from the cow, and, recently, their inquiries brought the horse, with the "greese" so called, under experimental use for the purpose of developing the true kine-pock in heifers. Failing in this, (from obvious causes,) that government is continuing its search after primary outbreaks in a herd of cows. The English still adhere, by preference, largely to humanized vaccine lymph.

Bovine virus, as cultivated continuously in heifers, for human vaccinations, now so extensively employed in the United States, is depending exclusively upon the line of supply that was started in a dairy herd at Beaugency, in the department of Loiret, France, in the spring and summer of 1866. Designed, at the time, to silence the agitation and fears relating to the alleged contamination of humanized virus, on the one hand, and, on the other, to overcome the objections to further employment of the enfeebled virus produced and cultivated from the degenerative process and practice of retrovaccination, or re-inoculations of humanized virus into the cow, the Beaugency bovine virus is now the chief stock of animal vaccine for the civilized world. It has come gradually into use in the State of New York since the spring of 1870.

To find and utilize an efficient and perfect new stock of kine-pock is so plain a sanitary duty that the State Board of Health has caused extensive inquiries and some investigations and tests to be made. The skillful aid of Prof. James Law, of the Cornell University, has been brought into this important service, and up to the present date three herds, in which the kine-pock has appeared spontaneously (or by some source of contagion yet undiscovered), have been put under observation. The inoculation tests upon heifers have not yet yielded satisfactory results, but the habits and pathological phenomena of the natural cow-pock are successfully studied, and ere long there will be successful inoculations, it is believed, when all the conditions favor.

A memorandum upon the essential rules for perfect vaccination, and concerning the vaccine virus.-Though it may possibly be found at some future time that Pasteur's discovery of a principle and method of reducing a contagious virus to a kind of sterilization that allows its protective operation, without harmful or contagious results, may lead to a benign use of inoculations for other diseases than small-pox, the present interests of mankind are best served by a faithful following of the essential rules for obtaining and applying the kine-pock, and for maintaining the purity and perfectness of this kind of protective virus in continuous generations of it, from child to child, or from heifer to heifer. JENNER and the early vaccinators frequently resorted to the primary source of the pock in dairy herds, yet they did not attempt, by continuous inoculations, to perpetuate a bovine source of such vaccine lymph. In the spring of 1816, when there was just anxiety for the quality and efficency of vaccine virus, and arm-to-arm vaccination was the trusted method, JENNER himself wrote to a friend that the