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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
time of inspection on the day week after vaccination, have not, as a rule, their vesicles entirely free from areola.
"(9.) Keep in good condition the lancets or other instruments which you use for vaccinating, and do not use them for other surgical operations. When you vaccinate, have water and a napkin at your side, with which invariably to cleanse your instrument after one operation before proceeding to another.
"N.B.-Supplies of lymph are furnished to medical practitioners, on personal application, at 3 Parliament Street, London, S.W., between the hours of 12 and 2; or by letter (unstamped) addressed as follows:
To the Medical Officer of the Privy Council,
3 Parliament Street,
10. With respect to Quarantine, it is enacted by the Sanitary Act 1866, sect. 52, as follows:
Every vessel having on board any person affected with a dangerous or infectious disorder shall be deemed to be within the provisions of the Act of the sixth year of King George the Fourth, chapter seventy-eight, although such vessel has not commenced her voyage, or has come from or is bound for some place in the United Kingdom; and the Lords and others of Her Majesty's Most Honourable Privy Council, or any three or more of them (the Lord President of the Council, or one of Her Majesty's Principal Secretaries of State, being one), may by Order or Orders to be by them from time to time made, make such rules, orders, and regulations as to them shall seem fit, and every such Order shall be certified under the hand of the Clerk in Ordinary in Her Majesty's Privy Council, and shall be published in the London Gazette, and such publication shall be conclusive evidence of such Order to all intents and purposes; and such
Orders shall be binding and be carried into effect as soon as the same shall have been so published, or at such other time as shall be fixed by such Orders, with a view to the treatment of persons affected with cholera, and epidemic, endemic, and contagious disease, and preventing the spread of cholera and such other diseases, as well on the seas, rivers, and waters of the United Kingdom, and on the high seas within three miles of the coasts thereof, as on land; and to declare and determine by what nuisance authority or authorities such orders, rules, and regulations, shall be enforced and executed; and any expenses incurred by such nuisance authority or authorities shall be deemed to be expenses incurred by it or them in carrying into effect the Nuisances Removal Acts. Under the provisions of the above section the following Order in Council was issued July 29th, 1871 :
Art. (1.) In this Order
The term "ship" includes vessel or boat.
The term "master" includes the officer or person for the time being in charge or command of a ship.
The term "cholera " includes choleraic diarrhoea.
The term "nuisance authority" has the same meaning as in "The Sanitary Act 1866."
Art. (2.) It shall be lawful for any nuisance (sanitary) authority having reason to believe that any ship arriving in its district comes from a place infected with cholera, to visit and examine such ship before it enters any port, or lands any person or thing in the district, for the purpose of ascertaining whether such ship comes within the operation of this Order.
Art. (3.) The master of every ship within the district of a nuisance (sanitary) authority, having on board any person affected with cholera, or the body of any person dead of cholera, or anything infected with, or that has been exposed to the infection of cholera, shall, as long as the ship is within such district, moor, anchor, or place her in such position as from time to time the nuisance authority directs.
Art. (4.) No person shall land from any such ship until the examination hereinafter mentioned has been made.
Art. (5.) The nuisance authority shall, immediately on the arrival of such a ship, cause all persons on board of the same to be examined by a legally-qualified medical practitioner (health officer), and shall permit all persons who shall not be certified by him to be suffering from cholera to land immediately.
Art. (6.) All persons certified by the examiner to be suffering from cholera shall be dealt with under any rules that may have been made by the nuisance authority under the 29th section of the Sanitary Act 1866 (see ante, page 359); or, where no such rules have been made, shall be removed, if their condition admits of it, to some hospital or place to be designated for such purpose by the nuisance authority, and no person so removed shall quit such hospital or place, until some physician or surgeon shall have certified that such person is free from the said disease.
Art. (7.) In the event of any death from cholera taking place on board of such vessel, the body shall be taken out to sea and committed to the deep, properly loaded to prevent its rising.
Art. (8.) The clothing and bedding of all persons who shall have died, or had an attack of cholera on board such vessel, shall be disinfected, or (if necessary) destroyed, under the direction of the nuisance authority.
Art. (9.) The ship, and any articles therein, which may be infected with cholera, shall be disinfected by the nuisance authority.
Art. (10.) Every person obstructing the nuisance authority in carrying this order into effect, or otherwise offending against this order, shall be liable, on summary conviction, to a penalty not exceeding twenty pounds.
1. Comparison of the metrical with the common English measures, as regards capacity and weight, from tables arranged by Mr. Warren de la Rue, F.R.S.
2. For the convenience of medical officers of health, the following price-list of apparatus and reagents, mentioned in various parts of the work, has been supplied by Messrs. Griffin and Sons, manufacturers of chemical and philosophical apparatus,