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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 areolae.

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.

JOHN SIMON.

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,
Local Government Board,
3, Parliament Street,
London, S.W.

National Vaccine
Establishment.

MEDICAL DEPARTMENT OF THE PRIVY
COUNCIL OFFICE.

I.—Re-Vaccination.

By vaccination in infancy, if thoroughly
well-performed and successful, most people
are completely insured, for their whole life-
time, against an attack of small-pox; and in
the proportionately few cases where the
protection is less complete, small-pox, if it be
caught, will, in consequence of the vaccination,
generally be so mild a disease as not to
threaten death or disfigurement. If, however,
the vaccination in early life have been but
imperfectly performed, or have from
any other cause been but imperfectly
successful, the protection against small-pox
is much less satisfactory; neither lasting
so long, nor while it lasts being nearly
so complete, as the protection which first-rate
vaccination gives. Hitherto, unfortunately,
there has always been a very large quantity of
imperfect vaccination; and in consequence
the population always contains very many
persons who, though nominally vaccinated
and believing themselves to be protected
against small-pox, are really liable to infection,
and may in some cases contract as severe
forms of small-pox as if they had never been

vaccinated. Partly because of the existence
of this large number of imperfectly vaccinated
persons, and partly because also even the
best infantine vaccination sometimes in process
of time loses more or less of its effect, it
is advisable that all persons who have been
vaccinated in infancy should, as they
approach adult life, undergo Re-Vaccination.
Generally speaking, the best time of
life for re-vaccination is about the time when
growth is completing itself, say from 15 to
18 years of age, and persons in that period of
life ought not to delay their re-vaccination
till times when there shall be special alarm of
small-pox. In proportion, however, as there
is prevalence of small-pox in any neighbourhood,
or as individuals are from personal
circumstances likely to meet chances of
infection, the age of 15 needs not to be waited
for; especially not by young persons whose
marks of previous vaccination are unsatisfactory. In circumstances of special danger,
every one past childhood, on whom re-vaccination
has not before been successfully performed,
ought without delay to be re-vaccinated.

Re-vaccination, once properly and successfully
performed, does not appear ever to require
repetition. The nurses and other servants
of the Small-Pox Hospital when they enter
the service (unless it be certain that they
have already had small-pox) are invariably
submitted to vaccination, which in their case
generally is re-vaccination, and is never
afterwards repeated; and so perfect is the
protection, that though the nurses live in the
closest and most constant attendance on small-
pox patients, and though also the other
servants are in various ways exposed to
special chances of infection, the Resident
Surgeon of the Hospital, during his thirty-
four years of office there, has never known
small-pox affect any one of these nurses or
servants.

Legal provisions for re-vaccination are
made in the 8th section of “The Vaccination
Act, 1867,” and in section IV. of the
Regulations which the Lords of the Council, under
authority of the Act, issued in their Order of
February 18th, 1868. Under these provisions,
re-vaccination is now performed by
all Public Vaccinators at their respective
Vaccinating Stations; and, so far as is not
inconsistent with the more imperative claims
for primary vaccination, any person who
ought to be re-vaccinated may, on applying
to the Public Station of the District in