176 ACTIVE IMMUNIZATION 



by the aid of the tiny rubber nipple, which is sent out by most of 

 the manufacturers with each set of tubes. When the vaccination 

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

 dried, as 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 twive 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 accompanying table, which 

 indicates both the morbidity and 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 Mortality Average 



(No. of per (No. of per 



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



German 1875 to 1892 13 0.7 \ 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 

 459, with that in the French 24,469. 



