Abstract
In a recent report on smallpox, emphasizing the possibilities of exposure and the importance of preventive measures, Leiter<sup>1</sup>states that "... it is possible to have the<i>procedure</i>of vaccination accomplished, even repeatedly, without<i>effective</i>vaccination." This is indeed true and may represent a more common cause of failure in the prevention of this dread disease than is generally recognized. In matters that are considered routine, one may unwittingly become lax. Very often people are satisfied to know that a medical procedure has been performed and that there is definite proof, written or other, of its completion. If one is accustomed to good work, the question of how well it was done may not enter his mind. When a physician performs a primary vaccination, he personally checks the type of reaction and, before signing the certificate, makes sure that there was primary immune reaction, not some other form of reaction
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