PRESENT PROBLEMS 75 



cities. In that year, by vigorous effort, free public vaccination was 

 performed upon nearly 25 per cent of our population of 3,500,000 

 persons, and there is reason to believe that private vaccinations 

 reached an unusually large total, due to the alarm of the inhabit- 

 ants over their danger, which was purposely not allayed by the 

 sanitary authorities. In fact there was a genuine public awaken- 

 ing to the need of vaccination. 



Cases of small-pox that year in New York numbered some 1900; 

 the next year they fell to less than 100, although the disease con- 

 tinued very prevalent in many neighboring cities where there had 

 been no determined effort to stamp it out. One result of this varia- 

 tion in practice was that New York was constantly visited by spo- 

 radic outbreaks of small-pox, brought from other cities. Fully half 

 the 100 cases in 1903 were either of immigrants newly arrived from 

 Europe or visitors from infected cities in the interior of the United 

 States. 



I believe that compulsory vaccination, so-called, is not neces- 

 sary in most parts of our land. It may be demanded in countries 

 having a less intelligent population than ours; but we of New York 

 have found that we needed only to arouse public opinion on the 

 necessity of vaccination to secure the results we wanted without 

 any compulsion. Vaccination is a requirement of entrance into 

 our New York public schools, and we have not, in my recollection, 

 had a single case of small-pox in the schools so protected; but 

 compulsion exercised' upon adults often serves unnecessarily to arouse 

 public feeling against the sanitary authority, and gives a handle to 

 those ostrich-like scorners of facts, the anti-vaccinationists. 



If we compare the variation in methods of contagious disease 

 prevention as between the large cities and the small towns and 

 rural districts, we find that in the latter few of the precautions 

 taken in the cities are exercised in the country. This results from 

 lack of proper facilities for isolation, and this lack is due to public 

 indifference on the subject; for if the public realized how much 

 the spread of disease could be checked by these means, provision 

 for isolation hospitals and competent medical inspectors would 

 be one of the first items of expenditure in their annual budgets. 



As it is now, only the most intelligent of our secondary city gov- 

 ernments make adequate provision for their contagious sick. Many 

 others, of course, have buildings intended for that purpose, but 

 these buildings too often consist of miserable shanties in the outer- 

 most confines of the city or village, and the inhabitants complete 

 an ill-conceived work by calling these buildings "pest-houses" 

 and thus branding them as places of horror to be avoided by every 

 possible means. Such isolation hospitals destroy the value of pro- 

 perty in the neighborhood. 



