Rural Hygiene

by Henry N. Ogden

This is the fundamental principle involved in all antitoxin treatment, and the only difference between vaccination and the injection of diphtheria antitoxin is that with vaccination the disease and the consequent protection is developed in the individual during the course of the disease, while with diphtheria the first attack of the disease and the resulting protective agencies are developed first in the horse and then the essential elements of the blood are introduced into the patient, thereby increasing his resistance to the disease. Smallpox, of all diseases, formerly claimed the largest number of deaths. A hundred years ago, persons marked with smallpox were a common sight. Among the Indians, whole tribes were wiped out with it. It is computed that in Europe, during the eighteenth century, 50,000,000 people died of smallpox. In England, the death-rate was 300 per 100,000. As late as 1800, Boston was visited by severe epidemics of smallpox.

Value of vaccination.

Owing to vaccination, the extent and intensity of the disease has continually grown less until to-day attacks of smallpox are not serious and the results are seldom fatal. For this reason and because of the chronic objection of uneducated persons to submit to governmental or outside restrictions, there has been, in recent years, a serious outcry against vaccination, with the result that in New York State, during the year 1908, there were in certain parts of the state epidemics of smallpox with, however, but two deaths. The disease may, however, at any time become serious, and, because of its virulent contagiousness, no objection ought to be made to reasonable requirements in the matter of vaccination.

Vaccination is usually not the cause of any serious inconvenience or illness, and, while some slight swelling of the arm may result, the protection afforded is so great in comparison with the temporary inconvenience that the latter ought not to be even considered. The protection afforded by a successful vaccination lasts usually from two to seven years, and it is understood that after ten years the protection is certainly lost, and in the presence of a smallpox epidemic one ought to be re-vaccinated after the minimum time named. Whether every person always ought to be vaccinated at intervals of five years or so is open to discussion. If one were on a desert island in a large or small community without intercourse with the outside world, vaccination would be of no value since smallpox would be impossible. There are communities where smallpox has been for years unknown, and consequently where the need for vaccination is not apparent. On the other hand, where smallpox is prevalent in the vicinity, and the disease is continually recurring, it is of the greatest importance, in order that it may be promptly suppressed, that every individual lend himself readily to vaccination.

Whatever harmful results formerly came from vaccination were due to a lack of cleanliness on the part of the person vaccinated or in the vaccination material itself. More care is now used in disinfecting the surface of the arm and in protecting the exposed skin after the inoculation. If the vaccination "takes," a certain amount of inflammation follows, the spot on the arm suppurates, the suppuration, however, disappearing at the end of about three weeks. If this does not occur, that is, if the vaccination does not take, it may be either because the vaccine was not good or because of the unsusceptibility of the person. In the largest proportion of cases, however, the difficulty is with the vaccine or with the doctor who does the inoculating, and when smallpox is prevalent in the vicinity a person should be re-vaccinated until the vaccination does take. The disease itself, while disagreeable, is not as hopeless as was formerly thought. There is no particular heroism in being physician or nurse to a smallpox patient now, inasmuch as vaccination absolutely prevents contraction of the disease, and the isolation practiced is the most serious objection from the standpoint of the attendants.

Characteristics of smallpox.

The disease first shows itself as does measles and scarlet fever, with the appearance of a severe cold accompanied with a high fever. On the second day a rash resembling that of measles and scarlet fever breaks out on the body; this preliminary rash almost immediately disappears and is followed by the real characteristic smallpox eruption, usually about the fourth day. This eruption appears first on the forehead or face and then on the other extremities, the hands and feet.

In mild cases, it is very difficult to distinguish between smallpox and chicken pox, and the only safe measure is to consider all cases of chicken pox in adults to be smallpox, as they probably are, since the former disease almost never attacks grown-up people. The pustules which form in smallpox are first hard and red, and then two or three days later they are tipped with little blisters which later fill with pus and appear yellow. About the tenth day of the eruption this yellowish matter exudes, forming the scar or scab which later dries up and falls off. Often this eruption is accompanied by excessive swelling of the face, so that the eyes become closed, it is impossible for the patient to eat, high delirium prevails, and the task of the nurse in such cases is an unenviable one. Although usually the pustules are separate and distinct, sometimes in severe cases they run together, so that the hands and face present one distorted mass of suppuration and crust.

The disease is particularly prevalent among negroes, perhaps because they are seldom vaccinated, and in recent epidemics in New York State it has been chiefly through negroes that the disease has been kept alive. The method of prevention for this disease is almost entirely vaccination. Just how the disease spreads is not clearly understood, although it is supposed that it is transmitted chiefly by clothing, dishes, and other articles in contact with the infection. These should, therefore, be thoroughly disinfected. The hope of eliminating the disease, however, comes rather in the use of vaccination. In New York State, in 1908, only two deaths from smallpox occurred, although twenty years before, with the smaller population, the number of deaths ran up into the hundreds.

Treatment of smallpox.