Throughout the progress of the disease, except in the period of incubation, the patient is able to communicate his disease to persons about him who have not been rendered safe by a previous attack. The way in which he thus communicates his disease varies in different cases. In scarlet fever, the throat and skin are the chief sources of contagion; in influenza, whooping-cough, and measles, the secretions from the respiratory passages; in hydrophobia, the saliva; in enteric fever and cholera, the vomit and stools.
Prevention of the Spread of the Chief Acute Infectious Diseases.—We may divide these into three classes. (1) Those which are infectious by contact with the patient or by the atmosphere around him. (2) Those in which the intestinal and renal evacuations are almost alone infectious; as enteric fever and cholera. (3) Those in which inoculation through an abraded surface is generally if not always necessary to produce infection.
SMALL-POX OR VARIOLA.
The contagium of small-pox is very tenacious of life. All parts of the body, and all secretions and excretions contain it. As in typhus it adheres to every article in the room, but unlike typhus is possessed of great vitality, and if not exposed to the air may be active after many years. There is considerable evidence indicating that the contagion of small-pox may occasionally be conveyed aerially for a considerable distance, for even a quarter or half a mile from hospitals in which small-pox patients are isolated. Whether this is the aerial convection of infection, or in part at least due to carelessness of persons connected with the hospital in their movements to and fro, may remain an open question; but such hospitals in the midst of towns are in practice a mistake; and in London small-pox has been found to be more manageable since its small-pox patients were all conveyed to extra-urban hospitals. The means for the prevention of small-pox are (1) Isolation of infectious patients. (2) Disinfection of all infected articles. For particulars under these two heads, see pages 319 and 324. They must be carried out most rigidly in this disease. (3) Vaccination and re-vaccination.
Inoculation of small-pox virus was largely practised as a means of ensuring a comparatively mild attack, until it was made illegal in 1840. Sometimes, however, the attack thus produced was fatal, and every case of inoculated small-pox became a new focus of infection, and a source of high mortality, especially among young children.
Vaccination. About the year 1795 Dr. Edward Jenner was informed by a milk-maid that she could not take small-pox, as she had already contracted the natural cow-pox during milking. Many had previously heard this same statement made; but Jenner was the first to put the matter to the test. He took the lymph or virus from a woman who had accidentally acquired cow-pox (vaccinia) from a cow, and inoculated a boy with it. Some months later he inoculated the same boy with small-pox, and a second time five years afterwards, without producing small-pox on either occasion. Many other experiments were made, all confirming these results; and in 1798 Jenner published his results.
The practice of vaccination gradually became more general, and was followed by a progressive decrease in the mortality from small-pox.
Cow-pox or vaccinia is small-pox modified and mitigated by its passage through the system of the cow, and not a spontaneous disease of the cow. By its passage through the cow it has become attenuated and altered. Instead of a general eruption all over the body, there are vesicles only at the point of inoculation; and vaccinia, unlike small-pox, is not communicable from person to person except by inoculation. Furthermore it is in the vast majority of instances an extremely mild ailment, not involving more than a few days discomfort.
Objection is taken to vaccination for small-pox on the ground that serious diseases such as syphilis, erysipelas, and tuberculosis may be inoculated at the same time. With lymph obtained from healthy children this is impossible. Most of the cases of infection described have been in reality hereditary disease, the local irritation of vaccination serving to call into activity the morbid tendencies of the child. The risk of such infection is infinitesimal; it may be reduced to zero by moderate care and attention to detail. With modern antiseptic methods, it is very rare for a vaccination sore to “go wrong.” Erysipelas may be inoculated from dirt getting into a vaccination sore, as it may be into any other sore; but with cleanliness this need not occur; and in fact very seldom does occur. The risks are so small as to be negligible; and if the protection afforded is one tithe of what is claimed for it, no parent is justified in withholding this protection from his infant. The law as to vaccination requires that every infant shall be vaccinated within six months of its birth, domiciliary visits for this purpose being made by the public vaccinator. The obligation can only be avoided by a statement on oath before a magistrate by the parent of conscientious objection to vaccination.
Does Vaccination protect against Small-Pox? The registration of deaths for the whole country only began in 1837, and before this period death-rates from small-pox in terms of the population cannot be accurately stated. Since that time there has been less or more vaccination, so that it is difficult to obtain a true comparison between periods with and without vaccination. Some indication of the facts in London prior to 1801, when the first English census was taken, may be obtained from the fact that in 1796 (two years before the date of Jenner’s “Inquiry,”) small-pox reached its highest point, causing 18½ deaths out of every 100 total deaths from all causes. In the præ-vaccination period small-pox was 9 times as fatal as measles, and 7½ times as fatal as whooping-cough (McVail), while since vaccination has been practised it has sunk to an insignificant position, when compared with these diseases. Dr. Guy found that in London there were in 48 years of the seventeenth century ten epidemics, in the whole of the eighteenth century 19 epidemics, and in the nineteenth century no epidemic during which the deaths from small-pox caused one-tenth or more than one-tenth of the total deaths from all causes in any year. The worst year under obligatory vaccination in London was 1871, in which barely 4½ per cent. of the total deaths was due to small-pox, a proportion which was exceeded in the eighteenth century ninety-three times.