188 ACTIVE IMMUNIZATION 



is completed the arm is usually left exposed until the lymph has 

 dried, so far as this is possible in the presence of glycerin. In Vienna 

 it is customary to cover each scarification with a so-called tegmin 

 dressing, which may be removed the following day or the day after. 

 Subsequently the entire area may be dusted once or twice a day 

 with a powder composed of 10 grams each of oxide of zinc and starch 

 and 40 parts of talcum. This, however, is not necessary. 



The appearance of the arm illustrating the results of a typical 

 vaccination is shown in the accompanying illustrations (Figs. 12, 13, 

 and 14). 



The Protective Value of Vaccination. This is now so generally 

 recognized that it scarcely seems worth while to enter into a dis- 

 cussion of the question. Smallpox, which up to the time of Jenner 

 was one of the worst scourges of the civilized world, has now become 

 so rare a disease in those countries where vaccination is thoroughly 

 carried out that the majority of physicians and medical students 

 have not seen even a single instance of the disease. In Berlin, 

 where the annual death rate from smallpox before the introduction 

 of vaccination varied between 250 and 400 per 100,000 inhabitants, 

 the aggregate death rate from the disease in entire Germany, even 

 including imported cases, is now less than 0.1 per 100,000. An 

 excellent idea of what systematic vaccination can accomplish may 

 also be formed from the accompaning table, which indicates both 

 the morbidity and the mortality from smallpox in the German army, 

 as contrasted with the results in the armies of Austria, France, 

 and Italy, in which no systematic vaccination had been attempted : 



Morbidity Average Morbidity Average 



(No. of per (No. of per 



Army. Period. cases). year. cases). year. 



German . . . 1875 to 1892 13 0.7 1 0.05 



Austrian . . . 1875 to 1886 9864 896.7 595 54.0 



French. . . . 1875 to 1892 8356 491.5 705 41.4 



Italian . 1875 to 1894 2565 135.0 193 10.1 



The same point is also well illustrated by comparing the number of 

 deaths during the Franco-Prussian War in the entire German army 

 -^59, with that of the French 24,469. 



In the face of such evidence a country that will not or can not 

 enforce systematic vaccination evidently courts the disease, and 

 hardly merits a place in the rank of civilized nations. 



