COMMUNICABLE DISEASES 381 



from the first, this disease is practically non-existent. In fact so rare, is 

 the disease that the medical society of Berlin some years ago, elected one 

 member each year who shall give a lecture on this disease in order that 

 the fraternity might retain some idea as to the nature of this disease. In 

 Austria, in France and in the United States where anti-smallpox vaccina- 

 tion is less rigidly enforced the case rate is occasionally high, and lesser 

 epidemics appear from time to time, with varying mortality rates. One 

 minor epidemical outbreak in Berkeley (California) of the confluent 

 hemorrhagic type of the disease gave a mortality rate of 100 per cent. 

 Since vaccination is almost an absolute safeguard, there is no need of fear- 

 ing this disease, even when brought in direct contact with it. One vaccina- 

 tion does not always establish life immunity, as is popularly believed. 

 The rule is to vaccinate in infancy, again about the time of adolescence 

 and aeain in early adult life. This will usually insure immunity for life. 

 However, vaccination should be carried out after every exposure or when- 

 ever smallpox exists in the vicinity, no matter how many good "take" 

 scars there may be. Nurses and physicians in pest hospitals are vacci- 

 nated once a year, or oftener, to insure immunity. In the navy it is 

 customary to vaccinate every man every time a port is entered where 

 small-pox is suspected. Small-pox is 'a quarantinable disease. 



There is absolutely no danger or ill effects from vaccination, in spite 

 of the popular newspaper and popular verbal reports to the contrary. In 

 perhaps one case in a million, tetanus or severe septicaemia may be traceable 

 to the use of an impure virus. Septic infection of the scarified area may 

 take place, due to carelessness on the part of the patient, and not due to the 

 virus used, but even this is an extremely rare occurrence. Since the 

 incubation period of small-pox is about twelve days and that of vaccinia 

 (cow-pox) is only five or six days, it is evident that the vaccination will 

 establish immunity even in those who were actually exposed, provided 

 vaccination is done within a few days after exposure. 



Primitive (savage) races are very susceptible to small-pox, with a 

 very high mortality rate. This is in part due to the total ignorance 

 of sanitary measures, resulting in the more ready spread of the contagion. 

 Entire savage tribes have been exterminated by this disease. Negroes 

 are far more susceptible than Caucasians. Indians have spread the infec- 

 tion in blankets after having been exposed. 



E. Malaria. This familiar disease, commonly known as ague, the 

 shakes, chills and fever, and intermittent fever, prevails in many areas in 

 the United States and is limited to swampy wet countries. It gradually 

 disappears with the tilling and the draining of soil which remove the breed- 

 ing places of the only carriers of the disease, namely the mosquitos (An- 

 opheles). The primary causes is the Plasmodium malarias (Hamatozoa 



