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Chemist C. P. O'Conner made an analysis of a sample powder, and reported it to be "made up of acetanilid."
The analysis of this nostrum, made under the direction of the Council. on Pharmacy and Chemistry, was published in "The Journal," June 3, 1905, p. 1791. According to this analysis, Koehler's headache powders contain, approximately: acetanilid, 76 per cent.; and caffein, 22 per cent. (“Journal of the American Medical Association," 1907, No. 9, p. 813.)
PHENACETIN (ACETPHENETIDIN) V. ACETANILID.
It is interesting to trace the influence of medical fashion and similar factors on the estimation in which the various synthetic analgesics are held by the medical profession. Acetanilid, the most widely known of these agents, has met condemnation chiefly because it has been most indiscriminately employed, not only by the medical profession, but also by the lay public. It was one of the first to be freed from the restrictions of the patent laws, and, on account of its cheapness, rapidly rose in professional and public esteem. In consequence, however, of some fatalities and of the evil done by its indiscriminate and habitual use, it passed under the ban, and phenacetin took its place to a large extent in the armamentarium of the careful physician. The extensive use of acetanilid in proprietary mixtures and popular headache powders, and the fatalities following such use, tended to increase its ill repute among physicians. How far the fact that phenacetin was still a patented and proprietary article has shielded it from condemnation as a toxic agent cannot be stated, but undoubtedly less has been heard of its dangers than would have been the case had it stood alone, without the protection which goes with proprietary articles. Phenacetin is reputed to be much safer than acetanilid, but how well-founded this opinion is cannot be determined until it shall have been used as extensively and as recklessly as the cheaper and better-known drug. It is the opinion of pharmacologists that, except for the difference in dose needed to produce the effect, the actions of the two drugs are identical. While the toxic dose is much larger for phenacetin than for acetanilid, the amount necessary to produce the desired therapeutic effect is also proportionately larger. This being the case, caution regarding the use of phenacetin is as appropriate as in the case of acetanilid. There is reason for the legal regulation of the sale of phenacetin, as well as of acetanilid. The ill repute of acetanilid has secured its mention by name in the pure food and drugs law, while
phenacetin can be included only by implication as one of the derivatives of acetanilid. There has been some question whether phenacetin can be so classed. The commission appointed to draft rules and regulations governing the administration of the law decided that phenacetin belongs among the derivatives of acetanilid, and that its name must appear on the labels of medicines or foods which contain it. The decision of the commission appears not to be final, and the question is still undecided. It has been surmised that the manufacturers of analgesic proprietaries were about to seek to escape the odium which now attaches to acetanilid, and the necessity of publishing the fact of its presence in their remedies, by substituting phenacetin for it. Whether this will be extensively done remains to be seen. It is stated on good authority that the proprietors of some nostrums heretofore containing acetanilid, and advertised to the medical profession, have already made this change. Thus, they think, they may be saved the disgrace of having to confess openly the real character of their mixtures. In view of the possibility of such a movement, it would be much to be regretted if phenacetin should escape the operation of the law. It is to be hoped that the decision of the commission will be sustained, and that the proper labelling of mixtures containing this drug will prevent its becoming as great a menace to the public as acetanilid has been. We have used the word "phenacetin" because it is best known under this title; this name, however, is controlled; the official title given it is acetphenetidin. ("Journal of the American Medical Association," Dec. 8, 1906, p. 1924.)
NOTE ON VACCINATION.
The cruiser" Chattanooga" arrived in Manila from Shanghai, January 9, with a case of smallpox on board, in the person of the paymaster's clerk. It is of medical interest to state that the entire personnel, including officers, were vaccinated several months ago, with the exception of the paymaster's clerk, who evaded the operation, and is now apparently suffering the penalty. None of the balance of the personnel showed any evidence of having contracted the disease, although many of them must no doubt have been exposed to the same infection. The vessel was remanded to the Mariveles quarantine station for treatment. ("Medical Record," March 2, 1907, p. 363.)
THE SUPREME COURT OF MASSACHUSETTS ON THE POWER TO EXCLUDE UNVACCINATED CHILDREN FROM SCHOOLS WHEN SMALLPOX IS PREVALENT.
HAMMOND, p. p. a., v. TOWN OF HYDE PARK.
MARCH 1, 1907.
Exclusion of Pupils from School, -Compulsory Vaccination. Two actions of tort, brought to recover damages on account of the exclusion of Mary D. and J. Forest Hammond from the public schools of Hyde Park. In the Superior Court, Hitchcock, J., directed verdicts for the plaintiffs, and reported the case to the Supreme Judicial Court. Thomas E. Grover and Joseph P. Fagan for plaintiffs.
James E. Cotter and J. W. Pickering for defendant.
KNOWLTON, C.J. — Each of the plaintiffs was suspended from one of the public schools of the defendant town because of a refusal to be vaccinated at a time when smallpox was prevalent in the town. A short time before the suspension the school committee made a regulation, as follows: "Voted, to exclude from attendance all unvaccinated children, and also all children who do not present a certificate of revaccination as required by the board of health, until such time as this committee may become satisfied that the imminent danger from smallpox in our town has ceased."
Our statutes give the school committee of a town "general charge and superintendence of all public schools," etc. (R. L., c. 42, § 27.) This power is broad and ample. For the promotion of the best interests of pupils and of all the people, it necessarily has been construed broadly by the court. (Roberts v. Boston, 5. Cush. 198; Sherman v. Charlestown, 8 Cush. 160; Spiller v. Woburn, 12 Allen, 127; Morse v. Ashley, 192 Mass. [79 N. E. Rep. 481.])
By R. L., c. 44, § 3, children are given the right to attend the public schools, "subject to such reasonable regulations as to the numbers and qualifications of pupils to be admitted to the respective schools, and as to other school matters, as the school committee shall from time to time prescribe." We have no doubt that the condition of pupils, in reference to the risk of exposing other pupils in the school to a contagious disease, is to be considered in making regulations as to their qualifications for admission to the school. In Sherman v. Charlestown, 8 Cush. 160, it was held that the school committee may exclude from the public schools a child whom they deem to be of a licentious and immoral character,
although such character is not manifested by any acts of licentiousness or immorality within the school. In giving the opinion Chief Justice Shaw used these words: "Take the case of a contagious disease. Can it be doubted that the presence of a pupil infected could be lawfully prohibited, not for any fault, or crime, or wrong conduct, but simply because his attempt to insist on his right to attend under such circumstances would be dangerous and noxious, and was an interruption of the equal common right? So, if one who never had been vaccinated should refuse to be vaccinated in accordance with a lawful order of the board of health, when an epidemic of that disease was prevalent in the neighborhood, the same reasoning would apply. (See Com. v. Jacobson, 183 Mass. 242; S. C. 197 U. S. 11.)
In R. L., c. 44, § 6, we find this language: "A child who has not been vaccinated shall not be admitted to a public school, except upon presentation of a certificate signed by a regular practicing physician that he is not a fit subject for vaccination." Each of these plaintiffs presented such a certificate. It appeared that it was given without an examination of either of them; and the daughter of the physician testified, he having deceased, that her father was a member of what is called the AntiVaccination Society, and it was his opinion that nobody was a fit subject for vaccination, and he would give a certificate to anybody who applied for it that that person was not a fit subject for vaccination.
The judge instructed the jury as follows: "The statutes seem to provide that the school committee may exclude from the public schools children who have not been vaccinated, except such as present certificates from a practicing physician that they are unfit subjects for vaccination. The plaintiffs in these cases have presented certificates, which the court rules were sufficient in point of form, that they are or were unfit subjects for vaccination. That having been done, the school committee have no authority under the laws of this Commonwealth to exclude such children from the public schools." He then ordered verdicts for the plaintiffs, and reported the cases for the determination of this court.
The question on this instruction is, whether the statute which absolutely forbids the admission of an unvaccinated child to a public school at any time, without a certificate from a physician, is an implied enactment that, with a certificate, such a child shall be permitted to attend at all times, even when smallpox is raging in the neighborhood. We see nothing to indicate such an intention on the part of the Legislature. This is a prohibition of attendance at any time except upon a condition. There is an implication that, with the certificate, such a child properly may be permitted to attend when there is no particular reason to apprehend danger; but it was not intended to take away from the school com
mittee the power to make proper regulations for the protection of all the pupils, if the prevalence of smallpox seems to require special precautions. The ruling of the court was wrong.
By the terms of the report made at the request of the parties, such entry is “to be made in each case as law and justice may require." It is expressly admitted that the school committee acted in good faith. The uncontradicted evidence shows that smallpox had been prevailing in the neighborhood for several weeks, that a temporary hospital had been established in the town, that the people of the town generally were being vaccinated, that the board of health had given notice that free vaccination would be given, and two thousand or three thousand vaccinations had been performed under the direction of the board.
It has been held repeatedly that the "decision of a school committee of a city or town, acting in good faith in the management of the schools upon matters of fact directly affecting the good order and discipline of the schools, is final, so far as it relates to the rights of pupils to enjoy the privileges of the school." (Watson v. Cambridge, 157 Mass. 561; Hodgkins v. Rockport, 105 Mass. 127; Spiller v. Woburn, 12 Allen, 127; Alvord v. Chester, 180 Mass. 20.) Whether this rule should be applied to such a regulation as appears in the present case, it is not necessary to decide, for, upon the undisputed facts, the regulation was reasonable.
As soon as the crisis had passed the committee relieved the plaintiffs from suspension and allowed them to return to the schools. There is no evidence that there was anything objectionable in the manner of enforcement of the regulation. There is no contention that the plaintiffs were not given a proper hearing as to their claim of right to attend the schools. (See Bishop v. Rowley, 165 Mass. 460; Morrison v. Lawrence, 186 Mass. 456.)
We see no ground on which a verdict properly could be found against the defendant. Law and justice require, under the terms of the report, that there should be an entry in each case of
Judgment for the defendant.