During the past year I have investigated the reasons for the preference in Europe for tubes rather than for points. From conversations with the authorities there and a careful observation of their methods, I am convinced that the modern tube, prepared as I have described above, is much more reliable than the old-fashioned tube of clear virus taken directly from the vesicle.

Our method, however, of charging the ivory points is much more simple, economical and reliable, and we certainly obtain a far purer virus at the start. The vesicle which they grind up and use is not the old-fashioned vaccine crust, with which many of you are familiar. That was the dried covering of the vesicle, which was allowed to remain undisturbed until it dropped off naturally at about the twentieth day. It was then cleaned thoroughly and scraped, and was perfectly dry and almost odorless. The European crust is taken at the height of the disease, when its reticulations and under surface abound with pus cells, and these are all included in the mass that is combined with the glycerin. I am not prepared to deny that this combination renders all the germs present, except the vaccine germ, inert and innocuous. I only say that, if true, it is an extraordinary fact. and that certainly the pure, clear virus that is collected on the points, after all the pus is removed, is a very much purer lymph, as it is taken from the animal.

The real reason, as it seems to me, for the adoption of these tubes in Europe lies in the difficulty of preserving the points in a moist climate and of obtaining ice with which to keep them. We have no such difficulties here, and with us the ivory point will long keep its supremacy as the best form of preserving and using vaccine.

Every one of you has his favorite way of vaccinating. My way is to make two sets of scarificatious about two inches apart. I cut with a dull bleedinglancet about half a dozen short lines close together, just deeply enough through the skin to draw a tinge of serum and blood. These I cross with a similar set of cuts at right angles. I thoroughly dissolve the virus on the point with a little water, then wipe the cuts thoroughly, and immediately rub the virus into the cuts for about ten seconds with the flat side of the point. Then I expose the arm for one minute to the air. No plaster or subsequent dressing is necessary. The arm should be washed at bedtime. In three or four days the vesicle will begin to appear and will be at its height in about eight or nine days, after which it will decline. Unless the crust is broken there will be no severe symptoms with good virus, and indeed there should never be bad and sloughing arms if the patient is in any reasonably healthy condition at the time.

DIPHTHERIA.

It is pleasing to announce that the presence of diphtheria during the biennial period was less frequent than during the preceding period, demonstrating very conclusively that local

boards were more faithful in their duties; for, being a preventable disease, it cannot prevail to any extent, or become epidemic in any community, except by assent of local boards. And herein lies a responsibility which local boards very generally fail to recognize. The record of diphtheria in any community is the record of official faithfulness or unfaithfulness; and every spreading of the disease beyond the original source, and every death therefrom, is a charge, socially and legally, against them. Having the authority and means to prevent it, they are both civilly and criminally liable for their negligence.

The imperfect, unreliable, and unsatisfactory returns made of vital statistics render it impossible to give any comparative mortuary report worthy of credence.

During the period there has been very general complaint against the arbitrariness of the rule respecting heads of families placed under quarantine. As complete isolation of the sick from the well is the essence of quarantine, the Board has modified the rule relating to diphtheria and measles as follows:

When a family is quarantined for diphtheria or measles, the head of the family, or bread-winner, shall have the privilege of attending to his regular business, and of going to and from his house only when complying with the following conditions:

First. He shall change his clothing before going to and leaving his home to go to his place of business.

Second. He shall wash his hands, face, head and beard with a 2 per cent solution of carbolic acid, each time after leaving his home to go to his place of business.

Third.—While in the house he shall not act as nurse or live in the same room with the sick person.

Fourth. He shall not attend any public meeting, or attend any place where persons are congregated

Fifth --This privilege shall not be granted to school teachers, or to any person whose business brings him in intimate contact with children.

There is prevalent throughout the State a feeling of hostility to quarantine, engendered largely by injudicious action of local boards. It is regarded as an arbitrary intervention of human rights, whereas it is simply a misfortune liable to fall upon a family any moment. This antagonism seeks the release of quarantine in the shortest time possible, if indeed it does not evade it altogether.

The State Board has very wisely provided that quarantine shall be maintained not less than seventeen days after the recovery of the last case in a family, and after there has been proper disinfection of the premises and person. The purpose

of this is to cover the incubation period, in case there has been unknown exposure of other persons. It is a provision for safety. And even this is not sufficient. Experience and observation have demonstrated that after the membrane has disappeared the germs persist for many days-even months-and the patient, though to all outward appearance has recovered, can transmit diphtheria to others. An instance in point occurred recently in one of the southern counties of the State, where several members of a family had diphtheria. There were two deaths. On the eighteenth day after the convalescence of the last case, the premises having been previously disinfected, the quarantine was released. The next day a boy of the family was attacked by the disease, followed by the hired girl a week after, and from these two several other persons became infected.

Whether or not the germ of diphtheria has entirely disappeared from the throat of a patient can only be determined to a certainty by bacteriological examination. The safety of the public therefore would be best secured if local boards, especially in cities and towns, and massed communities, would establish a rule that quarantine in cases of diphtheria shall not be released until a bacteriological examination has demonstrated the absence of the infecting germs from the throat of convalescent patients. In many large cities this precaution is now taken with highly beneficial results. The same method may be used in a suspected case of the disease, and the result obtained within twenty-four hours, thus quickly settling a vexing question of diagnosis.

DIPHTHERIA ANTI-TOXIN.

Ever since anti-toxin was announced as a curative agent in diphtheria, there has been increasing interest to know what the outcome would be - not so much from a therapeutic as a sanitary standpoint - or more strictly stated from a restrictive standpoint. If it possesses the curative value claimed-destroying the toxic, and therefore the infectious character of the disease, in two or three days—it is valuable, not for the number of lives saved; but by shortening the duration of the disease the period of communicability from exposure would be correspondingly shortened. It would be interesting to present the results of extended and painstaking experiments and observations as to the reliability and great value of anti-toxin as a curative agent in the treatment of this dreaded disease.

While a great deal has been written against its use it must be conceded that the consensus of opinion, even after eliminating much that smacks of too hasty and superficial experimentation, is that the death-ratio has been lowered by its use and that the duration of the disease has been greatly shortened. Perhaps the most valuable testimony in favor of its use comes from the celebrated pathologist Virchow who as is well known has been hostile to the germ theory of disease.

At a meeting of the Berlin Medical Society, in December, 1894, Virchow stated that during the months of June and July at the Kaiser and Kaiserin Frederick Hospital five hundred and thirty-three cases were treated — three hundred and three with serum (anti-toxin) and two hundred and thirty without. former had 13 deaths and the latter 47% deaths!

The

The Iowa State Board of Health has given no official expression as to the value of this agent, either as a curative or preventive agent.

DIPHTHERIA - QUESTIONS ANSWERED.

During the month of June, 1895, diphtheria, mild in type, and with no fatalities, was prevalent in a town in one of the eastern counties of the State. Some of the physicians regarded it as diphtheria, and others as follicular tonsilitis. Some sputum or portion of membrane was sent to the bacteriologist of the State Board for examination. He reported "true diphtheria based upon the presence of the Loeffler bacillus, whereupon the child was promptly quarantined, though it was alleged the child had been entirely well for four days prior to the establishment of the quarantine. The establishment of the quarantine, under the circumstances, led to an animated telegraphic and postal correspondence between the Secretary of the State Board and the residents of the town.

Dr. declared he was skeptical in regard to the germ theory of disease, and submitted the following interrogatories: (1) "Does the State Board accept the theory that the presence of the Klebs-Loeffler bacillus necessarily proves that this bacillus is the cause of genuine diphtheria in man?"

(2) "Does the State Board accept the theory that there are two varieties of the diphtheria bacillus-one pathogenic, the other non-pathogenic; the first found in genuine diphtheria, the latter in various benign throat affections, and in the throats of healthy individuals? Or

(3) Does the State Board accept the fact of true scientific pathology, which is applicable in actual practice and has stood the test of years, and has been sustained by such authorities as Professor Virchow, Lawson Tait, Professor Park, of New York, Professor Chappel, and Professor Houseman?"

The Secretary has no authority, nor is he disposed, to express the individual opinion of members of the State Board. The following, therefore reflects his own views, which in a measure are in accord with the practical belief of the Board, as expressed in its rules and regulations for the prevention and restriction of diphtheria:

(1) He believes that the presence of the Klebs-Loeffler bacillus necessarily proves that this bacillus is the cause of genuine diphtheria in man. He recognizes the fact that this bacillus has been and may be found in the mouth of healthy persons-persons who fortunately have vigor of constitution and general health sufficient to prevent toxic conditions. He believes that no case of genuine diphtheria can be found in which this bacillus is not present, although it may not be found in all cases.

(2) Yes.

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(3) He accepts the facts of true scientific pathology" so far as they are demonstrated to be facts. He believes they are facts applicable in actual practice." As to their having "stood the test for years," he admits that most of the demonstrated facts of pathology as recognized to-day are modern and that the laboratory is playing havoc with many of the cherished theories of yesterday. As to the names paraded by Dr.

and their theories, the parties are human and their theories are not Gibraltars. There are others equally eminent and vastly superior in numbers, whose opinions based upon careful observation and impartial investigation, are widely at variance with the views expressed by the parties quoted by Dr. The State Board of Health is laboring for the protection of the public against communicable diseases, and they cannot afford to wait until all these questions are incontestably settled.

The Board has taken the only sensible position it can, and that is to formulate and promulgate rules and regulations respecting small-pox, diphtheria, etc., that express the consensus of opinion of nearly all eminent pathologists and bacteriologists of the world as to the cause, prevention and restriction of the spread of these diseases. Those who are interested in the details of the discussions relative to the germ theory of disease are respectfully referred to the medical press of the country and to standard works upon bacteriology and upon the causes of infectious diseases.

It is not wise for local boards of health t› stand around with