Part 27

No matter what medical science may say to the contrary, many priests hold that they have often left smallpox cases, for example, without disinfecting themselves, and that they have not spread the disease. This is a very rash assertion. It is absolutely certain that smallpox has been communicated to susceptible persons by those coming from patients ill with that disease merely passing the susceptible man on the street. The number of persons that will not take smallpox when exposed to it is very large. In Washington in 1895, during an epidemic of smallpox, 187 persons, to my personal knowledge, were exposed to one group of 39 smallpox patients without taking the disease. The unharmed had been present in sick-rooms or had even nursed the patients, not knowing that the disease was smallpox. In this epidemic eight persons lived in the same rooms with, or visited frequently, two patients that afterward died of virulent smallpox, and none of the eight took the disease. One of these eight, however, went into a dramshop, had one glass of beer and left immediately, and in fourteen days afterward (the average time of incubation) we took the barkeeper to the smallpox hospital. This barkeeper had not been exposed to smallpox except by contact with the man mentioned here. There were about 60 cases of smallpox in that epidemic, and we traced every one to direct or indirect contact with one initial case.

If we were infected by every exposure to contagious disease the world would be depopulated. It is true that you cannot give some persons diphtheria if you actually put the Klebs-Loeffler bacillus into their mouths, and nurses and physicians in consumptive wards have the tubercle bacillus in their nostrils without ill effect. So for many diseases; but it unfortunately remains true that there are susceptible persons everywhere who will at once take a disease when they are exposed to it.

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Immunity changes in the same person. Starvation, fatigue, loss of blood, unsuitable diet, exposure to heat, cold, and moisture, and other influences lessen the power of resistance to infection. Men vary almost as do the lower animals as regards infection. The quantity of tetanus toxin that will kill 400 horses will not bother a hen; Algerian sheep and the white rat are not affected by anthrax, but other sheep and the brown rat are very susceptible; a hog will not take glanders, man and a horse will; men, cattle, and monkeys have tuberculosis, dogs and goats do not; white men with few exceptions are susceptible to yellow fever and malaria, negroes are practically immune; negroes readily succumb to the fatal sleeping sickness, white men are almost immune; and similar differences are observable in the same race or family.

The question of immunity to infectious disease is very difficult to make clear because it is so technical, and it is only a theory at best. The poison of an infectious disease kills by splitting and destroying the nuclei of the body's cells. The toxic products of the micro-organisms seem to become chemically united with certain molecules of the body cells and to inhibit the normal function of these molecules. According to Erlich's theory there are other molecules in cells which neutralise toxic molecules, and when the neutralising molecules appear in excess the patient recovers. These neutralising bodies are called antitoxins.

Some antitoxins are always present in cells, and where the normal quantity of these is used up in neutralising toxins, other antitoxic bodies are formed, until finally the excess of these is thrown off into the blood serum. After they are called into being by the excitation of some toxic products, like those of the typhoid bacillus for example, the antitoxins remain in the blood for years, ready to neutralise at once any influx of fresh infection. In other diseases, like diphtheria and pneumonia, they are soon lost,--hence the recurrence of such diseases. The acquired antitoxin lasts after smallpox, vaccinia, yellow fever, scarlet fever, measles, typhoid, mumps, and whooping-cough; it is very transient after pneumonia, influenza, diphtheria, erysipelas, and cholera.

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In serum therapy antitoxins are artificially excited into being in the blood of beasts. This artificially prepared antitoxin is injected into the blood of, say, a diphtheria patient, and the poison is at once neutralised, instead of leaving the patient to make his own antitoxin and letting him perhaps fail in the effort.

The antitoxin produced in the contest of the body cells against some diseases will not only neutralise the toxin of a particular disease, but it will also neutralise the toxin of a second disease. By vaccinating a person we inoculate him with vaccinia or cowpox. His body cells make an antitoxin which neutralises the toxin or virus of cowpox, he recovers from this light disease, and the antitoxin now remaining in his body prevents for years another successful inoculation with cowpox. It does more: in 90 per centum of cases it will prevent successful infection with smallpox.

Smallpox (the pocks, pokes or pockets of matter,--opposed to the great pox or syphilis) has been known from very early times--probably even from 1200 B.C. The name "small pokkes" was first used in England in 1518. The disease was brought to America in 1507.

It may be communicated from the sick to the healthy (1) by persons suffering with the disease; (2) by bodies of persons that have died of smallpox; (3) by infected articles; (4) by healthy third persons; (5) by the air, to persons living even at some distance; (6) by inoculation. The poison enters the body by the mucous membrane of the nose, mouth, or respiratory tract, and probably through the mucous membrane of the stomach and through the broken skin.

Patients can communicate the disease probably during the period of incubation (from 5 to 20 days after exposure to the disease--commonly about 14 days); and certainly from the initial stage until no trace is left of the final skin-desquamation. The infection is most active during the formation and duration of the pocks. The mildest smallpox in one person can cause malignant smallpox in another, and vice versa. The mortality in the unvaccinated is between 40 and 50 per centum.

A typical case of confluent smallpox at its height is the {173} ugliest disease in appearance and stench and almost in substance, known to medicine. Anyone liable to infection by it, or likely to carry it to others, who says he is "not afraid of it," has either never seen it and he is talking childish nonsense, or he has seen it and he is a fool.

The face is a bloated mass of corruption; the eyes are swollen shut; the nose, cheeks, lips, and neck are puffed out enormously; the mouth is a large sore, ulcerous, and spittle trickles from it ceaselessly. The fever is up to 103 or 105 degrees; there is an unquenchable thirst, a vile stench, sleeplessness; often delirium is the only relief, and there is one chance in two of a disfigured recovery. Tobacco, alcoholic liquor and a walk in the fresh air will not disinfect the visitor to such a disease. Years ago I investigated in the laboratory the popular notion that tobacco is a disinfectant. I found that bacteria, the diphtheria bacillus and swarms of others more delicate, will grow as well in the presence of a large piece of "Navy Plug," as when tobacco is absent. Chewing tobacco, whiskey, a walk in the fresh air as disinfectants, the Sioux medicine-man's powwow, the hind leg of a rabbit as a charm, are all in the same category.

The first and chief protection against smallpox is vaccination. Vaccination does not always prevent infection by smallpox, but it does prevent it in more than 90 per centum of exposures to the disease. Welch reported in 1894 that the death-rate in one series of 5,000 cases of smallpox was 58 per centum in the unvaccinated, and 16 per centum in the vaccinated, but the vaccinated took the disease in less than 10 per centum of the exposures. During the Franco-German War in 1870-1871, the Germans who had a million vaccinated men lost 458 soldiers from smallpox while a great epidemic of smallpox was existing in Germany; the French, who were indifferent to vaccination, during the same time lost 23,400 men from this disease alone. In the United States, where there is no compulsory vaccination except such attempts as school boards make, there were between July and December, 1903, 13,739 cases of smallpox; in Germany, where there is a compulsory {174} vaccination law, there was no smallpox at all, during the same time, except 14 cases in two seaports, Bremen and Kiel, whither the infection had been brought from without.

Before 1874 there had been no compulsory vaccination law in Germany except for the army. In 1871, 143,000 Germans died of smallpox. Since the law went into effect in 1874 the disease has been stamped out, until there was between July and December, 1903, only one death from smallpox in Germany.

The chart on page 175 will show very graphically the effect of vaccination upon smallpox.

In October, 1898, smallpox was endemic in Puerto Rico; in December, 1898, it was epidemic; in January, 1899, it was all over the island and spreading rapidly. In February, 1899, compulsory vaccination was begun and carried out for only four months, when 860,000 vaccinations had been made in a population of about 960,000 people. The death-rate from smallpox dropped from 621 a year to 2.

During the century preceding Jenner's discovery of vaccination, according to Neimeyer's calculation 400,000 people died of smallpox each year in Europe. Bernouilli, a trustworthy statistician, says that during that same century, "Fully two-thirds of all children born in Europe were, sooner or later, attacked by smallpox, and on an average one-twelfth of all children born succumbed to the disease."

Early in the sixteenth century 3,500,000 people in Mexico had smallpox (Prescott's Conquest of Mexico). In 1707, in Iceland, 18,000 of the population of 50,000 died of smallpox; and in 1891, 25,000 persons in Guatemala died of this disease. In 1875 there were anti-vaccination riots in Montreal, and as a consequence most of the younger inhabitants of that city were not vaccinated. In 1885, smallpox was brought in from Chicago; 3,164 persons died of the disease; of these 2,717 were children under ten years of age, and thousands had the disease.

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PRUSSIA.--With compulsory vaccination and compulsory revaccination at the age of 12.

HOLLAND--With compulsory vaccination of children before entering a school.

AUSTRIA.--Without compulsory vaccination.

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Vaccination may render one immune to smallpox for many years, but if the disease is epidemic it is well to renew the vaccination after about eight years. In normal vaccination, where the lymph has been derived from a reliable source, on the third or fourth day pale red papules develop at the point of inoculation, and about the tenth day these have become pustules. The vesicles dry gradually, and between the fourteenth and twentieth days the scab falls off, leaving a pitted scar. About the fifth day an aureola of inflammation forms around the pocks, from a quarter of an inch to two inches in extent, and the inflamed area may be somewhat sore. A shield should be kept over the vaccination spot for two days, and this is then to be replaced by a piece of sterile gauze held in place by narrow strips of sticking-plaster above and below the inflamed area. Sometimes hives and other rashes occur in vaccination, but they are unimportant.

Where there is a very sore arm or other trouble, the cause may be a pre-existing unhealthy condition, like scrofula for example, or the patient has scratched the pocks, or infected them from his clothing, or the vaccine lymph was unsterile. A careless and dirty vaccinator might infect an arm with pus organisms. If good glycerinated lymph, not too fresh or too old, is used, there is seldom any trouble; but in any case all the annoyance that may come from vaccination is infinitesimal when compared with the smallpox it averts.

We may take a smallpox case as a typical contagious disease in which the priest is to give the last Sacraments; and the disinfection and other precautions observed in such a visit will serve for any other very contagious disease. For only typhus and one or two other maladies are the precautions so elaborate as those needed in smallpox.