SMALL-POX AND ITS PROPHYLAXIS.

Among the preventable diseases Small-pox, by universal consent, stands pre-eminent, and therefore claims the most careful and patient consideration of every student of sanitary science. It belongs to that class of diseases which are called preventable because we know of means by which we may reasonably expect to prevent it, and in this way diminish the general mortality of the State. Infectious diseases, regarded by sanitarians as preventable, destroy many thousands of persons annually, besides carrying an untold amount of suffering and anxiety into the homes of the community.

It is not within the compass of this report to examine at length all the interesting and important features of this disease, but rather in plain and simple terms group together some facts of great interest which may be calculated to arrest the attention of the citizens of the State, with the hope that they may more fully appreciate and apply the simple preventive measures which are so cheap and so universally available.

We regret that we are not able to give statistics showing the absolute mortality from small-pox in the State for the last decade, or even for the last twelve months, but we are happy to believe that it has been small in comparison with that of many of the other States, nevertheless, during every year, there are more or less deaths from it. In an unexpected day and in a way not anticipated, it enters many homes and in its loathsome manner takes away the dearest treasures of the household, embittering the grief of the sorrowing with the painful consciousness that it might not have been. "Our real happiness," says one, "must ever depend more upon community of health, than on pecuniary or any other circumstances, and it is to little purpose we labor to benefit ourselves, if the fruits of such labors are not shared by those on whom our affections rest. The loss of a child at any period of our lives is a dreadful calamity. Even when it comes upon us without warning under the dispensation of Providence, few can bear it with indifference; but when it is the direct instrumentality of a disease which might have been avoided, and the means of doing so was placed within our easy reach, compunctions and regret of the keenest kind cannot fail to overtake us.'

The very general exemption which the State may have enjoyed during the past few years from the ravages of this disease has served immensely to increase the danger from its approach in the future.

Mankind are so generally indifferent and careless as to any duty or danger which does not immediately confront them, that the means of protection against this disease is most alarmingly neg

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lected, and year by year the State is being filled by an element— unprotected of all ages, which only awaits a tidal wave of smallpox, in which a large number of our citizens cannot fail to be swept away. It is quite likely that, excepting the larger cities lying along the thoroughfares of travel, and which are for this reason peculiarly exposed to an outbreak of small-pox, the inhabitants of a very large proportion of the towns in the State have, to a great extent, neglected the duty of vaccination. Our public schools, with few exceptions, are filled with unprotected children and youth.

In former times the great difficulties and slowness of communication protected mankind in a great degree from the ravages of contagious diseases; but in these later days the facilities for travel have so marvelously increased, as well as the herd of idle tramps that infest the State, that the danger to society, from frequent outbreaks and the spread of contagious diseases, has become very great.

The mortality from contagious and infectious diseases, at the present day, forms an extraordinarily large proportion of the total number of deaths, and this fact shows the great necessity of guarding against the extension of epidemic diseases by availing ourselves of all possible means of protection.

Under the United States registration, by the census of 1870, there were reported 4,507 deaths from small-pox in the United States for the twelve months ending June first, 1870. Of this number 2,012, or 44.64 per cent., were under five years of age. The number of deaths from this disease in Wisconsin during those twelve months were 104, of which number 52, or just 50 per cent., were under five years of age.

In the State of New York there were 582 deaths from this cause, and 318 of this number, or 54.81 per cent., were under five years of age. In Ohio there were 332 deaths, while 216, or 65 per cent., were under five years of age. It is fair to infer that these figures are an approximate index to the annual deaths from small-pox throughout all the States, and that the ratio of mortality of those under five years of age will annually be equal to that of 1870. It is quite likely, also, that with reference to the 2,012 deaths in all the States under five years of age, and of the 52 reported in Wisconsin, that but a small per cent. of them had ever been vaccinated at all, and that, with reference to those upon whom the operation had been performed, it was a total failure, either through an imperfect or unskillful operation, or by the use of inert and worthless

virus.

These facts should direct attention to the statements already made, that there is a wide and general neglect of the duty of vaccination-that all our public schools contain more or less pupils who have not been thoroughly vaccinated, and that the number of unprotected and hence exposed persons in the State, now already fearfully large, is being annually increased.

Accepting the figures of 1870 as the proximate annual deaths from small-pox, and allowing the very liberal ratio of one death to every five cases of the disease, and we have the yearly number of

22,535 cases in the United States, or 520 cases in our own Statean aggregate amount of human suffering, distress and pecuniary loss, at which every thoughtful mind is appalled, when we consider at what a trifling cost of money or time each and every person can be absolutely protected against the approach of this disease.

No fact within the range of human observation is more thoroughly established than that vaccination, thoroughly and properly performed, secures the individual against an attack of small-pox. The exceptions are so few as to render the rule almost absolute. Over against this fact, let there be placed the other one, that there is no disease known in ancient or modern times, more contagious -more loathsome and more to be dreaded-than this, and the thoughtful mind becomes excited with amazement at the prevalent indifference, not to say criminal neglect, everywhere discovered.

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If it be true, as has been said, that man in the exercise of a wise forethought and of his best intelligence can protect his health and control the ravages and mortality from specific and preventable diseases which overtake the ignorant and the careless," it is clearly the duty of the intelligent people of the State and the custodians of public welfare, to see that all available means are used looking to so beneficent an end.

HISTORY.

The history of small-pox is clothed in much obscurity. The question of its origin, antiquity and spread has been a matter of careful and laborious research, but has not elicited an answer definite and satisfactory. Its highly infectious and contagious nature was early recognized, while at the same time it was believed to arise spontaneously under certain circumstances of climate and soil, such as heat, moisture, filth and decaying organic matter. This false theory of its multiple origin has long since been exploded, and the fact established that small-pox spreads exclusively by contagion. It is always disseminated by means of a specific virus which is begotten in the bodies of small-pox patients, which specific virus being applied to a second party through the skin or through the lungs, reproduces itself. It is never spontaneously developed under any circumstances whatever.

This disease does not appear to have been indigenous in Europe, but to have been introduced there at a relatively late period from other lands, "no one of which," says Curschman, "can with certainty be alleged to have been its cradle."

Ambiguous accounts of it have come down to us from China and Hindoostan, where it is thought to have existed long before the Christian era. The first accurate and satisfactory description of it seems to have been given by an Arabian physician, who lived in the early part of the tenth century. It was known throughout England in the latter part of the ninth century, and, after the Crusades, it prevailed in most parts of Europe. dreaded its presence, and there seemed to be no power to stay its ravages. After the discovery of the Western Continent, it passed

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hither with the tide of emigration, and, in 1517, was carried into St. Domingo, and from thence, in 1520, into Mexico, from whence it spread throughout the Western Continent. On its introduction into the city of Mexico, according to Robertson, it destroyed, in a brief space of time three and one half millions of people. Being introduced into Iceland (1707), it swept away one quarter of the entire population. It reached Greenland in 1733, and very nearly depopulated the country. During the eighteenth century, one tenth of the population of the globe died with this disease, while many more were disfigured by it. In Europe, 400,000 persons died annually from this disease alone. From historical accounts the first visits of small-pox into any country or section of the globe, has always been followed by the most fearful devastation. It has very strikingly illustrated the law that seems universally true, that a contagious disease is always most virulent on its first introduction into a new scene of actiou." As far back as we have any knowledge of the disease, it has been the scourge of all countries where it has existed. Up to the commencement of the present century, it was by far the most formidable and fatal disease that afflicted mankind.

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The eloquent English historian Macaulay, in speaking of the ravages of the plague during the seventeenth century, assigned to small-pox the foremost place as "the most terrible of all the ministries of death."

Very few at that time escaped an attack of the disease, and most of those who survived an attack were left with impaired health or serious disfigurement. The average annual deaths in England from this cause were about three thousand to every million of inhabitants, a death rate, says Seaton, which with the present population would give a loss to the kingdom of more than sixty thousand of its citizens. The bills of mortality in London show that during the last half of the eighteenth century, the population was decimated every year by this terrible scourge.

It is well to refresh our minds by these facts in the history of this disease that we may the more fully appreciate the great blessing of vaccination to mankind, for since its discovery, small-pox, in civilized countries, has ceased to be so general or to manifest itself in such wide-spread destruction. And yet, if it were possible at once to remove the protection which mankind now enjoy by this practice, no one can doubt but that the horrors of the last century would return upon us.

It is without doubt true that neither lapse of time nor any improved mode of treatment have served to materially change its malignancy or fatality. Dr. Jurin, as quoted by Seaton, writing early in the last century, laid it down as the result of his investigations, that of persons of all ages taken ill of natural small-pox, there will die one in five or six. Statistics of hospital reports gathered up during the first quarter of the last century show that from twentyfive to thirty-three per cent. of all cases die. We have only to study the disease as it has appeared from time to time in the large cities of our own country in an epidemic form, to be convinced

of the fact that the fatality of the disease has undergone up to the present time little or no essential change.

During the epidemic which prevailed in the city of Mobile in the winter of 1874-75, the percentage of deaths to cases was 26.46, while in 1873, in the same city, when yellow fever was epidemic, the death rate for that disease was only 15 per cent., showing a fatality of the former disease of nearly double that of the latter.

In 1865, during an epidemic of sinall-pox in London, in the small-pox hospital 47 per cent. of the unvaccinated died. In the same year, in Berlin, the percentage of deaths was 42, including hospital and private practice. During the years 1873-74 and 1875, in the city of New Orleans, there were 3,149 cases of small-pox with 1,307 deaths, a per cent. of 41.29. In 1868-9 it was epidemic in San Francisco, Cincinnati, and many other cities, but in these two places especially it claimed a large tribute of human life. At these points its manifestations were as malignant and the mortality among those attacked as great as at any period before the discovery of vaccination. It is reported to have been if possible more severe in private than in hospital practice. Dr. F. W. Hatch, the present secretary of the California State Board of Health, reported, in both private and hospital practice an average death-rate of one in three cases. Dr. Logan, in his report of cases in San Francisco and Sacramento, gives even a larger per cent. of mortality, and he justly remarks, this fatality is almost unprecedented in the annals of this disease."

During this same season many of the Indian tribes were visited by this disease, and the ravages were said to be fearful. Whole encampments were attacked and large numbers swept off. In Cincinnati the deaths were one in every five and a fraction. During the winter of 1876, this same city has been visited with as extensive an epidemic and nearly if not quite as fatal a ratio. At the present writing, August, 1876, San Francisco is again paying the fearful penalty, in human lives, for great neglect of preventable measures, while passing through another epidemic as malignant and fatal as that of 1868-9.

These facts are grouped together to impress the mind with the fact that this loathsome disease has lost nothing of its virulence and fatality, but that, given as favorable soil in which to work, it goes abroad among the cities of the land now, as a century or more ago, "the most terrible of all the ministries of death." They forcibly impress the mind with the criminal neglect of the people, that while it is so preventable a disease, and the means of prevention are so ample and reliable, it is permitted to stalk abroad, destroying one in every three or five it attacks, blasting the beauty of the rest, and bringing distress and desolation into thousands of homes and human hearts.

The mortuary tables of nearly all our large cities duplicate the above facts, showing that everywhere among the unvaccinated and unprotected, this disease is as fearful in its harvest of death as in olden times.

Sre W. B. Davis' report on vaccination.