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Mr. W. M. Haffkine. 



nations owe the marked improvement in health which has taken place 

 during the present century. 



Only, injustice would be done to the sanitarian by calling him in 

 when a patient lies already on his sick-bed, or when an epidemic 

 actually breaks out in a community, and by asking him to stay the 

 sickness, or the epidemic, to improve the health of the population, so to 

 say, while you wait. 



To be dealt with, epidemics, like individual diseases, require specifics, 

 promptly administrable remedies, and measures of general sanitation 

 can be no more advised for arresting a sharp outbreak of cholera or 

 plague than an individual patient be directed to build for himself a new 

 house, or to dry up the marshy lands or to cut down the jungle round 

 his habitation when he requires a dose of quinine to arrest an attack 

 of ague. 



The part of vaccination and of preventive inoculation in combating 

 epidemics stands in the same relation to general sanitary measures as 

 therapeutics and the art of the healing physician stand to domestic 

 hygiene and sanitation. It is certain that neither of these can ever be 

 substituted for the other. 



Inoculation and the Segregation-Disinfection Method. 



A comparison of another kind now very actively discussed is that 

 between the methods of combating epidemics by separation of sick and 

 healthy, and disinfection, on the one hand, and by preventive inocula- 

 tion of the people, on the other. 



From this point of view the following distinction between infectious 

 diseases is to be made : — 



When we take some affected tissue from a leper, or a pustule from a 

 small-pox patient, or virulent saliva from a rabid animal, or some 

 syphilitic matter, and throw it into milk, broth, or any organic sub- 

 stance such as is to be found in the ordinary surroundings of men, 

 it produces no modification in the medium, and in the course of time 

 loses its infective properties and dies out. When, on the other hand, 

 we repeat the experiment with cholera, or plague, or typhoid products, 

 instead of dying out, the contagion begins to grow and multiply, 

 spreads in the medium and soon transforms the whole of it into one 

 mass of infectious matter. 



It is evident that such a distinction — the strictly parasitic nature 

 of one microbe and the capacity of the other to lead both a parasitic 

 and saprophytic life — must influence most directly the ways in which 

 these diseases spread and assume epidemic forms, and also the measures 

 which are likely to be effective in combating them. 



In the first instance the infection must remain confined entirely, or 

 almost so, to the body of the patient, and the disease can be propagated 



