COMMUNICABLE DISEASES. 211 



though the results are far from satisfying to the majority of those who have 

 tried it. Dr. Shafer has recently recommended a mixed bacterin (com- 

 posed of disease exudate and pure pneumonic bacterin) which has been used 

 with some success. 



It is important to guard against exposure to wet and cold, particularly 

 when the vitality of the body is lowered, as through lack of sleep, lack of 

 food, over-exertion, etc. The sputa of patients should be disinfected at 

 once. Well persons having good resisting power may carry the germs and 

 convey the disease to those who have a lower vitality. The room occupied 

 by the patient should be thoroughly fumigated as soon as possible. 



D. Small-poz. — ^Also known as variola and pest. This is a well-known 

 disease which has occurred epidemically from time to time throughout all 

 ages and in all lands. It is most highly infectious and contagious. In spite 

 of all investigations, the primary cause has not yet been discovered. The 

 contagion is carried by the breath of the patient, is wafted from- the skin 

 eruptions, is carried in clothing and by everything used or touched by the 

 patient. The contagion may lie dormant in clothing for months. 



All excreta from the patient should be disinfected vsdth bichloride of 

 mercury (i-iooo) or a 5 per cent, solution of carbolic acid or other con- 

 venient disinfecting agents as lime, formalin, etc. Bedding, mattresses and 

 other material used in the sick-room should be burned as soon as the patient 

 does not need them any longer. 



As the result of the general practice of vaccination (with the modified 

 cow virus) small-pox is no longer the dread disease that it once was. In 

 Germany, where vaccination is carried out with greatest strictness, the 

 mortality rate from small-pox is about o.i per cent. In the United States 

 where vaccination is laxly enforced, the mortality rate is about 3 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 vacci- 

 nation does not establish life immunity, as is popularly believed. The rule 

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

 in early adult life. This will usually insure immunity for life. However, 

 vaccination should be carried out after every exposure or whenever small- 

 pox exists in the vicinity, no matter how many good " take " scars there 

 may be. Nurses and physicians in pest hospitals are vaccinated once a 

 year, or oftener, to insure immunity. In the navy it is customary to vac- 

 cinate 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 effect from vaccination, in spite of the 

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

 one case in a mUlion, tetanus or severe septicemia may be traceable to the 

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



