6. The Age of the Small-pox Patients. The Connexion between the Epidemic and the War. The German Imperial Vaccination Law

Thus far very little attention has been called to the fact that the age of the persons who succumbed to small-pox varied greatly in the different countries. This depends upon how well vaccinated the population of the country or countries was. Formerly, when nobody was ever vaccinated, the first year of life and the following years were by far the most seriously threatened; after the first few years the mortality of small-pox gradually decreased as the age of the patients increased. This also applies to-day to those countries in which vaccination is neglected. On the other hand, in those countries in which children are vaccinated in the first year of their lives, the infant mortality is low, although the same children lose their immunity to the disease when they grow older. To illuminate these facts let us adduce a few figures. In estimating the number of deaths, however, we cannot use the number of the living as a relative basis to work on, since the prevalence of small-pox varied greatly in the different countries; consequently we must take the total number of deaths and estimate the mortality on the basis of age from that alone. But in doing this we can compare with one another only entire countries in which the various ages are all about equally represented; if we were to take smaller units, for example, city and country, or agrarian and industrial districts, and use them for a basis of comparison, more detailed computations would be necessary. Of the four states included in the table below, Bavaria and Hesse introduced compulsory vaccination (the law required everybody to be vaccinated at least once) in the year 1807; Saxony and the Netherlands, on the other hand, did not have compulsory vaccination. Of every 100 persons who died of small-pox the following table indicates the relative proportion on the basis of age:

Vaccination compulsory.Vaccination not compulsory.
Bavaria.
(1870–5).		Hesse.
(1870–2).		Saxony.
(1872).		Netherlands.
(1870–3).
0–20 years old22·421·876·368·3
20–60 years old59·065·421·929·6
Over 60 years old18·612·81·82·1

This table clearly shows that vaccination protects a person against contracting small-pox for a number of years, or at least against succumbing to it, but that this immunity lasts only for a certain length of time and should be prolonged by revaccination—a fact which the Prussian military authorities recognized and took into practical consideration for many decades prior to the year 1870.

Many have contended that the epidemic of small-pox which ravaged a large part of Europe, from the year 1870 on, was not a consequence of the Franco-German War, but an independent outcome of unknown conditions that were particularly favourable to the dissemination of the disease. The main argument used to uphold this contention is that epidemics of small-pox had occurred in all the states in the years before the war, without having gained such irresistible headway, and that the disease had broken out in the form of epidemics in many parts of Germany and the neighbouring countries even in the first half of the year 1870. But to refute this argument it can be clearly shown through Guttstadt’s instructive compilation of data that the German epidemic was in countless instances, in the case of Prussia as well as in that of other states in the German Confederation, brought about by the transplantation of the disease from France. Whenever small-pox broke out anywhere in times of peace, it was possible to keep the disease localized, through isolation of patients and the vaccination of the inhabitants of all regions in which fugitives from pestilence took refuge. In the year 1870, on the other hand, the contagion of small-pox was spread throughout all Germany in a few months; the increased intercourse caused by the war, together with the habit the Germans had of visiting the prisons where the French soldiers were confined, also helped to spread the disease in all directions.

For Germany this disastrous epidemic, which throughout the German Empire, including the Imperial Provinces, carried away upwards of 170,000 persons, had just one good result—it led to the passing of a law in the year 1874 which rendered vaccination compulsory. ‘Besides taking thousands of human lives the epidemic also caused considerable economic loss; the care of the sick and the measures adopted to prevent the disease from spreading necessitated large expenditures of money, while large numbers of working-men contracted the disease and were thus incapacitated for a long time; furthermore, the disease left unnumerable sickly people, who had to be further supported, and at the same time the fear of infection interfered with commercial intercourse. Those who managed to escape infection, or to recover from an attack of the disease, naturally wished to run no more risks in the future, or to expose the welfare of their families to danger or destruction.’[[303]]

In consequence of all this grave suffering, the representatives of the people petitioned the Imperial Government to provide as soon as possible for a uniform legislative regulation, making universal vaccination compulsory. The desire expressed in this petition was soon fulfilled by the submission of a bill on February 5, 1874; the bill was passed by the Reichstag on March 14, and received the signature of the Kaiser on April 8, 1874. This law required all persons to be vaccinated in the first year of their lives, and to be revaccinated in their twelfth year; it applied generally to all Germany.

The beneficial result of the passing of this law was clearly demonstrated in the course of the following decades. Notwithstanding the fact that Germany is almost entirely surrounded by states in which epidemics of small-pox, in consequence of insufficient vaccination, are of frequent occurrence, since the passing of the Imperial Vaccination Law the disease has not once made its appearance on German soil in the form of a widespread epidemic. Despite the fact that small-pox is frequently conveyed into the country, especially by foreign working-men, the efforts to keep it confined within narrow limits have always been successful. The measures which are so effective in the case of other diseases—isolation of the patients and of suspected persons living in the vicinity, disinfection of the room and effects which have been used by patients—in an insufficiently vaccinated community do not have the desired rapid success, since the contagion of small-pox clings with extraordinary tenacity to clothes and articles of general use. This fact has been abundantly proved in the epidemics of small-pox that have occurred in Europe in the course of the last few decades.

CHAPTER IX
FROM THE FRANCO-GERMAN WAR TO THE PRESENT TIME

Among the great advances made in the last few decades of the nineteenth century must be included the successful battle of modern hygiene against infectious diseases. This struggle was introduced by the development of practical hygiene in England and by the perfection of scientific hygiene through the work of Pettenkofer. But a firm basis on which to combat pestilence was not secured until the brilliant discoveries of Koch and his successors pointed out to us the cause of these pestilences, and methods were found to demonstrate in a short time the presence of disease-germs, even among persons who become ill but slightly, or not at all, and who for that reason are very dangerous to those about them.