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disease was known submitted to vaccination. The vaccina-tion was successful, however, only in one of the women.

Thus, of the 12 who had been exposed to the disease

there was but one who had ever been successfullyvaccinated ; that is the woman above referred to. This

woman did not contract the disease, the other 11 did.

The original case and 11 secondary ones made 12 in all, andof these five died. A death-rate of 41-66 per 100 cases."In Marion County, Oregon, 29 cases occurred in a virulentoutbreak. Of these, 17 had been vaccinated at some time oranother,"but they all recovered, while of the 12 who had neverbeen vaccinated 9 died ! I Finally, a farmer and his wife,with an unmarried daughter, went to visit their son. In the

train they sat near a small-pox convalescent (he was detrainedas soon as his condition was discovered). The mother.

who had been vaccinated 55 years before, had a mild attackof small-pox. The farmer, the son who was being visited,the farmer’s daughter, the son’s wife, and his child were

attacked in succession. None of them had ever been vac-

cinated.. All died from virulent small-pox except the child,who ultimately recovered at the cost of great disfigurement.These are all the cases in which vaccination is referred to,yet in the face of such evidence, recounted by himself,Surgeon-General Trask lends the weight of his authority as ahigh official of the United States Public Health and MarineHospital Service, in a periodical which is widely circulatedamong lay as well as medical readers, to the assertion thatit cannot be maintained that the protection afforded by vac-cination is of general application.

SOME VIEWS ON NATIONAL INSURANCE ANDTUBERCULOSIS.

A VERY important part of the National Insurance Bill isthe proposal to devote some of the money to be raised byits operations, if it passes into law, to dealing with the

important problem of the treatment and prevention of

pulmonary tuberculosis among the persons affected by theBill. Such an object must necessarily appeal most stronglyto those interested in the medical and philanthropic aspectsof the tuberculosis problem. We have received a copy of a

collection of the opinions of some representative workers inboth of these fields, which is published in the July numberof the British J016rnal of Tuberculosis. Almost without

exception the opinions expressed in regard to the proposalsof the Chancellor of the Exchequer to set aside a capitalsum of f:l,500,OOO to assist local charity and local autho-rities to build sanatoriums throughout the country and to

provide a fund of £ 1,000,000 a year to maintain these

institutions are commendatory, in some instances enthu-

siastically so. Mr. C. S. Loch, the secretary to the councilof the London Charity Organisation Society, is, how-

ever, of opinion that there is most need for properlocal dispensary and " contact " case work. He thinksthat the Bill as it stands bids fair to kill off

voluntary effort and believes that a much less ambitiousscheme would be much more effective. The necessity of pro-viding homes for advanced cases is strongly urged by Sir

Thomas Oliver, Sir William J. Thompson, and Dr. ArthurLatham. The importance of the housing question in preven-tion is discussed by Sir Thomas Oliver and Dr. DuncanForbes. Dr. G. F. McClearv objects strongly to the proposalto entrust the administration of the sanatorium benefits to theLocal Health Committees rather than to the existing PublicHealth authorities. He suggests that what is required is thedevelopment and coordination of existing agencies and

authorities, not the creation of new official machinery, whichin his opinion is bound to lead to duplication of work, over-lapping, and waste of effort. Sir Thomas Oliver, Mr.

Waldorf Astor, Dr. Latham, and Dr. Duncan Forbes

all emphasise the importance of the detection of earlycases and the diffusion of knowledge in regard to thisdisease with this object in view. Dr. M. S. Paterson

discusses the value of sanatoriums in the treatment of

the disease and the use of specific methods of treatment.He also refers to the importance of preventive measures.Dr. Jane Walker insists that the constitution of the LocalHealth Committees shall be really representative, and thatat least one-third of the members shall be women. Mr.David Davies, M.P., the chairman of the Welsh NationalAssociation for the Prevention and Abolition of Tuberculosis,expresses the opinion that the State grants should be made insome sort of proportion to local effort, and hopes that Walesmay be treated as a unit for the purposes of sanatorium

benefit. Several of the authorities express the hope thatthe tuberculosis dispensaries may share in the proposed bene-fits. While all are obviously convinced of the necessity forthe proposed dealing with the tuberculosis problem, thereis by no means unanimity of opinion as to the best means ofutilising to the best advantage the money which it is pro-posed to raise. We feel strongly that existing institutionsthat are doing good and useful work should be encouragedand helped, and that provision should be made for the

advanced cases, which are the greatest danger to the com-munity at large and for which at present, apart from thePoor-law institutions, little provision exists. We also hopethat if the proposed sums of money are forthcoming stepswill be taken to ensure that the views of those having theclosest and most intimate knowledge of the tuberculosis

problem shall be duly considered, with a view to the mosteffective and economical employment of the money.

THE NASTIN TREATMENT OF LEPROSY.

AN important and highly interesting report, by Dr.K. S. Wise, Government bacteriologist of British Guiana,has recently been issued by the Colonial Office on the treat-ment of leprosy by nastin. The report gives the results ofthe extended trial of this remedy in the Public Leper Asylumat Mahaica during the period from December, 1908, to

September, 1910. What makes the report more interestingis the fact that Professor Deycke, the originator of this treat-ment, visited British Guiana at the end of 1908 at the invita-tion of the Governor, and with the approval of the Secretaryof State for the Colonies, and remained in the colony forabout six months in order that he might personally directthe method in which the treatment should be carried out.When he left his instructions were carefully observedand the treatment was maintained strictly on the lines

he had indicated up to June, 1910, when experiencesuggested some modifications ; among these was increaseof the dose OL nastin hypodermically injected; trial

was also made of intramuscular injections, and singlenodules were injected. In view of the apparent failure

of nastin to cause any change or destruction in

B. lepr2e in the nasal cavities or in the larynx weeklyor bi-weekly sprayings by means of an all-glass nebu-

liser were adopted. Intractable ulcerations were treatedwith ointments containing benzoylchloride in 22 and 5 percent. strengths. Finally, benzoylchloride in olive oil isnow being used in some patients as an injection instead ofnastin itself. These later methods have not been sufficientlylong in use to warrant a report upon them being included inthe present one, but it is hoped to give the results at afuture date. So far as we know, although nastin has been

1 A Report on the Nastin Treatment for Leprosyat the Mahaica LeperAsylum, British Guiana, 1908-10. By Dr. K. S. Wise, GovernmentBacteriologist. Presented to both Houses of Parliament by command ofHis Majesty, May 11th, 1911. Published by H.M. Stationery Office.Price 1s. 2d.