h histories of recurrent
tonsilitis, and where the size of the tonsils causes
difficulty of swallowing or thick speech. Do not report
moderately enlarged tonsils with no history of tonsilitis
nor evidence of mechanical obstruction.

_Adenoids_--Report mouth breathers with characteristic
adenoid faces, convincing yourself as to diagnosis by having
the pupil say "l, m, n, o, p." Do not try to confirm the
diagnosis of adenoids by a digital examination of the
nasopharynx.

_Glands_--Report general glandular enlargement and cervical
enlargement of the lymphatic glands accompanied by
malnutrition and anemia. Do not report submaxillary
enlargement in recurrent tonsilitis or carious teeth or
post-cervical enlargement in pediculosis capitis, or in
impetigo or eczema of the scalp.

As a result of rules such as these, a given report means the same
thing to every member of the staff; only important defects are
stressed; and the effort to remedy them is concentrated where it will
be most effective. Statistics based on records such as these will be
reliable and may be used for scientific study.

VACCINATION

Thirteen years ago smallpox visited Cleveland. Twelve hundred and
forty-eight cases were reported. There were 30 cases of black
smallpox. Many of the patients were blinded or disfigured for life;
224 died. We find in the annual report of the Board of Health for that
year: "It was the smallpox we read about, that terrible scourge which
struck terror into the former generations. Its contagious nature
showed itself everywhere. One case, if not promptly reported to the
health office and removed to the hospital, would invariably infect the
whole neighborhood. Its severity manifested itself even in the milder
cases, while confluent cases, almost without exception, developed
hemorrhages during the pustular state.... At the Mayor's request, a
meeting of physicians was held ... to consider the smallpox
situation.... Vaccination was recommended on all sides, but the
people were not prone to get vaccinated.... Wholesale vaccination was
finally effected by the action of the School Council and the help of
the Chamber of Commerce. The School Council amended the vaccination
clause, making vaccination a conditio sine qua non for attending
school and giving the health officer the whole control of the matter.
Without this amendment the schools could not have