be at once burned. As contagions are often stored up and kept over because of imperfect airing and cleansing, safety depends upon what has been done after the cases have ceased.

In these directions it is not claimed that in every case of communicable disease there is to be so much labor and destruction. But the most perfect methods are presented as models, to be varied, if proper, under the advice of the physician, who also thus needs to be reminded of what thorough disinfection means.

SPECIAL DIRECTIONS AS TO VACCINATION FOR THE PREVENTION OF SMALL-POX.

With the present facilities for travel and the thoroughfare character of this State, there is no reasonable expectancy that any person will reach the age of twenty-one without great risk of small-pox, unless the disease is prevented by vaccination. The person who runs the risk not only endangers his own life and comfort, but imperils others to a degree not justifiable.

By the provisions of the Health Law of March 11th, 1880, all school boards are authorized to vaccinate, at public expense, any pupils attending school who are unable to procure vaccination.

All local Health Boards need to see to it that vaccination is recommended, as well as rapid isolation of cases secured, if any occur. The cost of local epidemics of small-pox is very great, besides the peril to life and public health. The prevention of the disease is within the range and duty of your control. All our local Health Boards and School Boards should co-operate in influence and provision for more general vaccination, and for revaccination of persons who have not been vaccinated since full growth. The heads of large manufacturing establishments need to attend to it, both in the interest of capital and labor.

Bear in mind and act upon the following suggestions:

I. Let every parent see to it that each child is vaccinated before one year of age, and sooner, if possible.

II. Let no teacher or child be admitted to a public school without vaccination.

III. Let provision be made by school trustees and Boards of Health for free vaccination to such as need this provision. (See Chapter 153, Section 10, Laws of 1880.)

IV. Would it not be well, just before each April vacation, to have schools close an hour earlier and thus have a vaccination day, on which all scholars could be invited to be vaccinated by their physicians, at home, or, by some public arrangement, at the school building?

V. Do not concern yourself about the kind of vaccine or lymph used any more than you would about the source of medicine you take, but hold the physician responsible therefor. Have the sore examined and take a certificate from the vaccinator that, in his judgment, you are successfully vaccinated.

VI. Have vaccination repeated or retried after the age of sixteen. Most persons, if fully vaccinated the first time, will have but little result from the repetition, but it is advisable to have this additional assurance of safety.

VII. If small-pox or varioloid occurs in your house, do not attempt concealment. At once send for your physician and do as he advises you, or notify the Board of Health. Have every member of the family vaccinated. By some means prevent the possibility of persons coming in unawares. If you know of any person who has been exposed, send him word so that he may be vaccinated.

VIII. Where there are factories, the superintendents should advise or direct all their employes to be vaccinated.

Most of our physicians have full confidence in humanized vaccine lymph, which is easily secured. Vaccine lymph directly from the animal is preferred by those who have any fear of communication of other diseases through humanized lymph-a fear that is greatly magnified in the popular mind. It is, nevertheless, due that all have their preference, and that where vaccination is insisted upon as a condition of school attendance, bovine lymph be used, if desired. Many physicians prefer to use this. The New York City Board of Health, 301 Mott street, New York, furnishes it daily by mail. H. A. Martin & Son send it direct from their herd, Roxbury Station, Boston, Mass. Dr. E. L. Griffin, State street, Chicago, is prompt in remittal. Ready supplies can also be had from Philadelphia and other cities. The price per point is about twenty cents, and less in larger quantities. There is reason to believe that much is sold for bovine lymph which is not such, or that there is a failure in effect because of age and imperfect keeping.

We urge upon all physicians great exactness in selecting lymph, and upon the people protection from the disease. Its outbreak every

few years is not a proof of epidemic tendency. The periodicity rather occurs because that, after an epidemic, as soon as years enough have passed for a younger product of children to be out in public child-life, the susceptible material becomes so abundant as to insure extension if a single case is introduced from another section. Then there is an outbreak of small-pox and of vaccination. Would it not be better if, somehow, the young population could be systematically protected? Let our various communities and the local Boards secure this, not only under present threatenings, but as a wise preventive

measure.

Small-pox is the one contagious disease which ought never to occur, and which could forever cease if the preventive methods now well understood could be enforced. Every case is the result of public or personal imprudence. Where one has been exposed, unless there has been recent vaccination, he or she should be at once vaccinated. If this has been neglected, it should be done even if there has been neglect for several days after exposure. It is not certain but that thorough vaccination, even when too late to prevent an attack, mitigates the severity of the secondary fever.

GENERAL PREVENTIVE MEASURES.

All contagious diseases should be reported to the Board of Health, since public safety requires it, especially in cities, and no public use is made of the fact, save where there is great danger of an epidemic.

Every local Board should have its executive officer, who should know how to stop the spread of the fire before it has attained headway. We urge upon all local boards the prevention of small-pox, scarlet fever, diphtheria and other preventable diseases.

To pursue a disease, in order to stop it, is often a duty; to get ahead of it, both a privilege and a duty, and very often possible. To prevent is to anticipate, to go before; and Health Boards, as well as individuals, may thus be of great service. Afterthought is sometimes good-forethought is better.

When a case of contagious disease occurs in your district, do the right thing promptly, and do not waste the first week in consultations.

While it cannot be claimed that this or that kind of filth can account for the outbreak of every particular or specific disease, we do know that cleanliness of person or of surroundings are great preventives or checks to contagions.

pure

Pure air, pure water, pure homes, pure soils, pure persons and surroundings are the surest safeguards against disease of every kind. Where an epidemic occurs in any locality, it may here and there alight upon those whose homes are in good sanitary condition. But it is wonderful to see how general is the rule that pestilences have their choice of persons and places, and how uniformly those who can furnish the most insanitary conditions are surest to be visited. Malignancy is often in direct proportion to uncleanliness and filth, or to errors in methods for the disposal of decayable material.

Secure dryness for every part of your dwelling, and proper drainage, fresh air and sunlight.

Examine the cellar or basement and see that it is dry and clean, with whitewashed walls, with no concealed wells or cesspools, or decaying vegetables.

See that all house soil-pipes and connections are properly trapped, ventilated and disconnected from the outside cesspool or sewer by a trap, and also an intervening air opening, and that the house system also has a ventilating opening on the roof. Have all garbage frequently removed. Decomposing heaps of animal or vegetable matter near the dwelling are always hazardous.

If wells are used for drinking water, their surroundings should be perfectly clean, no vessels being rinsed by them nor any slop-water thrown on the ground near them; nor should cesspools or privies be located within a hundred feet.

If a cistern is used, it should be cleaned each year or oftener. If at any time the odor of water becomes bad, do not use it without boiling, until you have ascertained the cause.

If only individuals and local Boards recognize the conditions under which communicable diseases occur and spread, and, when they do occur, act promptly and intelligently, it is surprising how life is saved, disease diminished and epidemics prevented.

For copies of all circulars, address E. M. Hunt, M.D., Trenton, N. J. Trenton, April 15th, 1884.

CIRCULAR XLV.

OF THE STATE BOARD OF HEALTH OF NEW JERSEY.

CHOLERA.

TRENTON, N. J., January 1st, 1885.

Whenever the possibility of an outbreak of cholera is threatening, all methods for thorough cleanliness should be applied with renewed vigor. For it is a mistake to suppose that cholera falls like a thunderbolt and accomplishes wide-spread destruction without regard to locality. On this point the Cholera Commission of the German Empire, which convened in 1873, and has met from time to time since and just reported (1882), is full and explicit. "The most important part is played by the locality itself to which the disease germ is brought." It depends in part on "the saturation of the soil with the decomposition of certain substances, and a condition of soil which favors such decomposition." Part VI., pages 314–318, says: "The commission expresses the united opinion of all the most experienced physicians when it says that the strictest attention to all the measures demanded by public general hygiene, offers the best protection against cholera."

Along highways of travel, as wherever else it lights, with occasional apparent exceptions, an analysis of the facts shows the rule to be that its virulence is in proportion to the neglect of sanitary conditions. "It is spread more by infecting localities than by infected persons."

For these reasons city and village officers and all householders should see to it that no form of decomposable matter is kept on or about the premises, that all pipes are thoroughly flushed and ventilated, that there be close inspection of dwellings and surroundings, that pure water and wholesome foods are used, and where soil or cesspools are already filth-sodden and cannot be removed, that the disinfecting solution of copperas and carbolic acid herewith recommended be thoroughly and frequently sprinkled.

But because "all measures for the cleansing of the soil and its better drainage are too often too late when begun, at the time of the outbreak of an epidemic, all places should institute close sanitary