dangerous and infectious disorder; and they may, by such rules impose any penalty not exceeding five pounds on any person committing any offence against the same. (Sanitary Act 1866, sect. 29.)

8. Diseases Prevention Act 1855.-Whenever any part of England appears to be threatened with, or is affected by, any formidable epidemic, endemic, or contagious disease, the Local Government Board may, by order or orders to be by them from time to time made, direct that the provisions of this Act for the prevention of diseases be put in force in England, or in such parts thereof as in the order or orders respectively may be expressed. The order so made is to be in force for six calendar months, or for such shorter period as shall be expressed in it, and the order may at any time be revoked or renewed in like manner. (Sect. 5.)

From time to time after the issuing of any such order as aforesaid, and whilst the same continues in force, the Local Government Board may issue directions and regulations as the said Board may think fit—

For the speedy interment of the dead;

For house to house visitation;

For the dispensing of medicines, guarding against the spread of disease, and affording to persons afflicted by or threatened with such epidemic, endemic, or contagious diseases, such medical aid and accommodation as may be required.

And from time to time, in like manner, may revoke, renew, and alter any such regulations as to the said board appears expedient. (Sect. 6.)

The sanitary authority shall superintend and see to the execution of such directions (sect. 8), and they or their officers shall have full power of entry for the purposes of the Act. (Sect. 4.)

9. With respect to Epidemics of Smallpox, the following Memoranda issued by the Privy Council may be quoted. (See First Report of Local Government Board, 1871-72.)

"By vaccination in infancy, if thoroughly well performed and successful, most people are completely insured, for their whole lifetime, against an attack of smallpox; and in the proportionately few cases where the protection is less complete, smallpox, if it be caught, will, in consequence of the vaccination, generally be so mild a disease as not to threaten death or disfigurement. If, however, the vaccination in early life have been but imperfectly performed, or have from any other cause been but

imperfectly successful, the protection against smallpox is much less satisfactory; neither lasting so long, nor while it lasts being nearly so complete, as the protection which first-rate vaccination gives. Hitherto, unfortunately, there has always been a very large quantity of imperfect vaccination; and in consequence the population always contains very many persons who, though nominally vaccinated and believing themselves to be protected against smallpox, are really liable to infection, and may in some cases contract as severe forms of smallpox as if they had never been vaccinated. Partly because of the existence of this large number of imperfectly vaccinated persons, and partly because also even the best infantine vaccination sometimes, in process of time, loses more or less of its effect, it is advisable that all persons who have been vaccinated in infancy should, as they approach adult life, undergo RE-VACCINATION. Generally speaking, the best time of life for re-vaccination is about the time when growth is completing itself, say from 15 to 18 years of age; and persons in that period of life ought not to delay their re-vaccination till times when there shall be special alarm of smallpox. In proportion, however, as there is prevalence of smallpox in any neighbourhood, or as individuals are from personal circumstances likely to meet chances of infection, the age of 15 need not be waited for ; especially not by young persons whose marks of previous vaccination are unsatisfactory. In circumstances of special danger, every one past childhood, on whom re-vaccination has not before been successfully performed, ought without delay to be re-vaccinated.

"Re-vaccination, once properly and successfully performed, does not appear ever to require repetition. The nurses and other servants of the Smallpox Hospital, when they enter the service, are invariably submitted to vaccination, which in their case generally is re-vaccination, and is never afterwards repeated; and so perfect is the protection, that though the nurses live in the closest and most constant attendance on smallpox patients, and though also the other servants are in various ways exposed to special chances of infection, the resident surgeon of the hospital, during his thirty-four years of office there, has never known smallpox affect any one of these nurses or servants.

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Legal provisions for re-vaccination are made in the 8th Section of the Vaccination Act 1867, and in Section IV. of the Regulations which the Lords of the Council, under authority of the Act, issued in their Order of February 18th, 1868. Under

these provisions, Re-vaccination is now performed by all public vaccinators at their respective vaccinating stations; and, so far as is not inconsistent with the more imperative claims for primary vaccination, any person who ought to be re-vaccinated may, on applying to the public station of the district in which he resides, obtain re-vaccination at the public expense.

"Where medical practitioners, not being public vaccinators, and not having otherwise in their practice cases for primary vaccination, are called upon to re-vaccinate on a considerable scale (as in hospitals, commercial establishments, schools, and even large households), they would generally find it best to make direct application for assistance to the public vaccinator of the district in which they have to act; with whose assistance they may commonly find it in their power to arrange with the parents of children recently vaccinated at the public station, that some of such children shall at the proper time be taken to places where private re-vaccinations have to be performed, so as to furnish from arm to arm any required quantity of lymph. Generally, too, any private medical practitioner who, from any cause, desires to obtain extraordinary supplies of lymph, will most easily attain his object by applying to the public vaccinator of the district in which he resides. And as public vaccinators, appointed under the Vaccination Act 1867 are of course free to accept payment for any extra-official work which they may be willing to undertake, private practitioners would probably have no difficulty in obtaining, by voluntary agreement, the assistance of some of these officers as collectors of lymph for private re-vaccination.

"It is important for the public to observe that re-vaccination on a large scale is not easily conducted unless in a thoroughly systematic manner, and that individual difficulties in finding lymph for re-vaccination are inseparable from the too general practice of deferring re-vaccination to periods of panic, instead of having it proceed, as it should, regularly and uniformly, in proportion as successive numbers of population reach the proper age for its performance."

By an Order dated July 29th, 1871, all vaccinations and inspections under contract shall be performed in accordance with the "Instructions for Vaccinators under Contract " hereto annexed :

"(1.) Except so far as immediate danger of smallpox may require, vaccinate only subjects who are in good health. As

regards infants, ascertain that there is not any febrile state, nor any irritation of the bowels, nor any unhealthy state of skin; especially no chafing or eczema behind the ears, or in the groin, or elsewhere in folds of skin. Do not, except of necessity, vaccinate in cases where there has been recent exposure to the infection of measles or scarlatina, nor where erysipelas is prevailing in or about the place of residence.

"(2.) In all ordinary cases of primary vaccination, if you vaccinate by separate punctures, make such punctures as will produce at least four separate good-sized vesicles, not less than half an inch from one another; or, if you vaccinate otherwise than by separate punctures, take care to produce local effects equal to those just mentioned.

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(3.) Direct care to be taken for keeping the vesicles uninjured during their progress, and for avoiding afterwards the premature removal of the crusts.

"(4.) Enter all cases in your register on the day when you vaccinate them, and with all particulars required in the register up to column 9 inclusive. Enter the results on the day of inspection. Never enter any results which have not been inspected by yourself or your legally-qualified deputy. In cases of primary vaccination, register as "successful" only those cases in which the normal vaccine vesicle has been produced; in cases of revaccination, register as "successful" only those cases in which either vesicles, normal or modified, or papules surrounded by areolæ, have resulted. When the vaccination of an unsuccessful case is repeated, it should be entered as a fresh case in the register.

"(5.) Endeavour to maintain in your district such a succession of cases as will enable you uniformly to vaccinate with liquid lymph directly from arm to arm; and do not, under ordinary circumstances, adopt any other method of vaccinating. To provide against emergencies, always have in reserve some stored lymph; -either dry, as on thickly-charged ivory points, constantly well protected from damp; or liquid, according to the method of Dr. Husband of Edinburgh, in fine, short, uniformly capillary (not bulbed) tubes, hermetically sealed at both extremities. Lymph, successfully preserved by either of these methods, may be used without definite restriction as to time; but with all stored lymph caution is necessary, lest in time it have become inert, or otherwise unfit for use. If, in order to vaccinate with recent liquid

lymph, you convey it from case to case otherwise than in hermetically-sealed capillary tubes, do not ever let more than eight hours intervene before it is used.

"(6.) Consider yourself strictly responsible for the quality of whatever lymph you use or furnish for vaccination.. Never either use or furnish lymph which has in it any, even the slightest, admixture of blood. In storing lymph, be careful to keep separate the charges obtained from different subjects, and to affix to each set of charges the name, or the number in your register, of the subject from whom the lymph was derived. Keep such note of all supplies of lymph which you use or furnish, as will always enable you, in any case of complaint, to identify the origin of the lymph. (7.) Never take lymph from cases of re-vaccination. Take lymph only from subjects who are in good health, and, as far as you can ascertain, of healthy parentage; preferring children whose families are known to you, and who have elder brothers or sisters of undoubtful healthiness. Always carefully examine the subject as to any existing skin-disease, and especially as to any signs of hereditary syphilis. Take lymph only from wellcharacterised, uninjured vesicles. Take it (as may be done in all regular cases on the day week after vaccination) at the stage when the vesicles are fully formed and plump, but when there is no perceptible commencement of areola. Open the vesicles with scrupulous care to avoid drawing blood. Take no lymph which, as it issues from the vesicle, is not perfectly clear and transparent, or is at all thin and watery. From such a vesicle as vaccination by puncture commonly produces, do not, under ordinary circumstances, take more lymph than will suffice for the immediate vaccination of five subjects, or for the charging of seven ivory points, or for the filling of three capillary tubes; and from larger or smaller vesicles take only in like proportion to their size. Never squeeze or drain any vesicle. Be careful never to transfer blood from the subject you vaccinate to the subject from whom you take lymph.

"(8.) Scrupulously observe in your inspections every sign which tests the efficiency and purity of your lymph. Note any case wherein the vaccine vesicle is unduly hastened or otherwise irregular in its development, or wherein any undue local irritation arises; and if similar results ensue in other cases vaccinated with the same lymph, desist at once from employing it. Consider that your lymph ought to be changed, if your cases, at the usual