A Handbook of Health

by Woods Hutchinson

DEATH-RATE FROM DIPHTHERIA AND CROUP

Statistics from the City of New York. Antitoxin was used largely from 1893-95, during which time there was a steady decrease (from 60% to 30%) in the death-rate. After the Board of Health took up the matter, furnishing antitoxin without cost, the death-rate continued to decrease to less than 10% of the total number of cases, in 1909.

With this remedy, our entire feeling toward diphtheria is changed. Instead of dreading it above all things, we know now, from hundreds of thousands of cures, that, if a case is seen on the first day of the disease, and this antitoxin injected with a hypodermic needle, it is almost certain that the patient will recover; not more than two or three cases out of a hundred will fail. If the case is seen and treated on the second day, all but four or five out of a hundred will recover; and if on the third day, all but ten. In fact, the average death rate of diphtheria has been cut down now from forty-five per cent to about six per cent.

We now have antitoxins, or vaccines, for blood-poisoning; for typhoid fever; for one of the forms of rheumatism; for boils; for the terrible cerebro-spinal meningitis, or "spotted fever"; and for tetanus, or lock-jaw. And every year there are one or two other diseases added to the list of those that have been conquered in this way.

None of these vaccines is so powerful, or so certain in its effects, as the diphtheria antitoxin. But they are very helpful already; and some of them, particularly the typhoid vaccine, are of great value in preventing the attack of the disease, as small doses of it given to persons who have been exposed to the infection, or are obliged to drink infected water, as in traveling or in war, very greatly lessen their chances of catching the disease.

Vaccination, the Great Cure for Smallpox. Another valuable means of preventing disease by means of its germs is by putting very small doses of the germs into a patient's body, so that they will give him a very mild attack of the disease, and cause the production in his blood of such large amounts of antitoxin that he will no longer be liable to an attack of the violent, or dangerous, form of the disease. Vaccines, for this purpose, usually consist either of a very small number of the disease germs, or of a group of them, which have been made to grow upon a very poor soil or have been chilled or heated so as to destroy their vitality or kill them outright. When these dead, or half-dead, bacilli are injected into the system, they stir up the body to produce promptly large amounts of its antitoxin. In some cases the reaction is so prompt and so vigorous that the antitoxin is produced almost without any discomfort, or disturbance, and the patient scarcely knows anything about it. In others there will be a slight degree of feverishness, with perhaps a little headache, and a few days, or hours, of discomfort. When this has passed, then the individual is protected against that disease for a period varying from a few months to as long as seven or eight years, or even for life.

The best-known and oldest illustration of the use of these vaccines is that of smallpox. A little more than a hundred years ago, an English country doctor by the name of Jenner discovered that the cows in his district suffered from a disease accompanied by irritation upon their skins and udders, which was known as "cowpox." The dairymaids who milked these cows caught this disease, which was exceedingly mild and was all over within four or five days; but after that the maids would not take smallpox, or, as we say, were immune against it. Smallpox at that time was as common as measles is now. Nearly one-fourth of the whole population of Europe was pock-marked, and over half the inmates in the blind asylums had been made blind by smallpox. So common was it that it was quite customary to take the infectious matter from the pocks upon the skin of a mild case and inoculate children with it, so as to give them the disease in mild form and thus protect them against a severe, or fatal, attack; just as in country districts, a few years ago, some parents would expose their children to measles when it happened to be a mild form, so as to "have it over with."

It occurred to Dr. Jenner that if this inoculation with cowpox would protect these milkmaids, it would be an infinitely safer thing to use to protect children than even the mildest known form of inoculation. So he tried it upon two or three of his child patients, after explaining the situation to their parents, and was perfectly delighted when, a few months afterward, these children happened to be exposed to a severe case of smallpox and entirely escaped catching the disease. This was the beginning of what we now call vaccination.

The germ of cowpox, which is believed to be either the cow or horse variety of human smallpox, is cultivated upon healthy calves. The matter formed upon their skin is collected with the greatest care; and this is rubbed, or scraped, into the arm of the child. It is a perfectly safe and harmless cure; and although it has been done millions of times, never has there been more than one death from it in 10,000 cases. In a little over a hundred years it has reduced smallpox from the commonest and most fatal of all diseases to one of the rarest. But in every country in the world into which vaccination has not been introduced, smallpox rages as commonly and as fatally as ever. For instance, between 1893 and 1898 in Russia, where a large share of the people are unvaccinated, 275,000 deaths occurred from smallpox; in Spain, where the same condition exists, 24,000. In Germany, on the other hand, where vaccination is practically universal, there were in the same period only 287 deaths—1/1000 as many as in Russia; and in England, only a slightly greater number.

Another illustration, which comes closer home, is that of the Philippine Islands. Before they were annexed by the United States, vaccination was rare, and thousands of deaths from smallpox occurred every year. In 1897, after the people had been thoroughly vaccinated, there was not a single death from this cause in the whole of the Islands.