PRESENT PROBLEMS 77 



toxin to healthy members of a family having a case of diphtheria, 

 and in the last eight years upwards of 13,000 persons have been so 

 immunized by department inspectors and family physicians. Of 

 the persons so immunized, .3 of one per cent contracted the 

 disease, and one case terminated fatally. Could any stronger testi- 

 mony than these figures be offered as to the efficiency of diph- 

 theria antitoxin in the cure and prevention of the disease? 



Naturally enough, such results have led to the establishment 

 of other laboratories for the preparation of this serum. Some are 

 maintained by state authorities, notably in Massachusetts, but 

 the larger ones are now under private auspices. 



High prices are charged for serums by manufacturing chemists, 

 and there is no means of testing their efficiency comparable to the 

 records of public laboratories. It therefore would seem to be a 

 reasonable precaution, in the interest of the public health, that 

 these private laboratories should be placed under strict govern- 

 mental supervision and control, if, indeed, the manufacture of 

 serums should not be one of the functions of a national board of 

 health, organized according to plans which I have mentioned, and 

 which are by no means novel. Products of public laboratories might 

 be distributed free or at small cost, and thus be made far more 

 effective in the prevention of disease, while control of the labora- 

 tories by recognized sanitary authorities would be a more satis- 

 factory guarantee of the potency and uniformity of their serum 

 products. A highly organized governmental laboratory service 

 would also offer splendid opportunities for research work in a field 

 the enormous importance of which few people are yet in a position 

 to realize. 



One of the most hopeful signs of progress in popular apprecia- 

 tion of sanitary endeavor is the general interest now awakening 

 in methods for the prevention of tuberculosis. Medical men are 

 everywhere agitating for better facilities to fight this disease, the 

 worst enemy of the human race, and lay associations are taking 

 steps to establish sanitariums for the reception of patients. This 

 work is a stupendous one, and we have thus far only touched its 

 edge. Efforts to. discover a serum for the cure of the disease, though 

 thus far disappointing, have already much increased medical 

 knowledge of the subject. 



It is not enough that the world should wait on the researches 

 of the bacteriologist. Our cities are full of consumptives, spread- 

 ing infection among their fellows in spite of all efforts of the sani- 

 tary authorities to instruct them in personal precautions. We must 

 have sanitariums and hospitals of large capacity for the reception 

 of cases in all stages of the disease. The cost will be great; but 

 tuberculosis claims most of its victims at a time when their use- 



