strengths and time commonly employed. It succumbs in fact before. the average non-spore-bearing bacteria.

There is a probable exception to this statement in the case of carbolic acid and the coal-tar disinfectants. McClintock and Ferry 1 have shown that such germicides as carbolic acid, cresols, and the like do not destroy the virulence of vaccine virus in 0.5 per cent. solutions in five hours' exposure. In this strength and time almost all non-spore-bearing bacteria would be destroyed. The inference is allowable that this class of disinfectants cannot be relied upon to prevent the spread of smallpox.

SMALLPOX IN THE VACCINATED AND UNVACCINATED

The experience of over one hundred years offers convincing proof of the pronounced difference in the mortality and morbidity from smallpox in the vaccinated and the unvaccinated. The following table from Schamberg shows that, among thousands of cases of smallpox occurring in cities all over the world, the death rate from smallpox has been from five to sixteen times greater among the unvaccinated than among the vaccinated:

TABLE 2-DEATH-RATE FROM SMALLPOX AMONG VACCINATED AND UNVAC CINATED IN VARIOUS COUNTRIES"

Jour. of the Amer. Public Health Assn., June, 1911 (Vol. I, No. 6), p. 418. Extract from papers prepared in 1857 by Sir John Simon, Medical Officer of the General Board of Health of England, and at that time laid before Parliament with reference to the History and Practice of Vaccination. Published in first Report of the Royal Commission on Vaccination, 1889, Appendix 1, p. 74.

Jour. of the Amer. Public Health Assn., June, 1911 (Vol. 1, No. 6), p. 418.

TABLE 3-ANNUAL SMALLPOX DEATHS IN SWEDEN BEFORE AND AFTER THE INTRODUCTION OF VACCINATION 1

1 The population in 1751 was 1,785,727: in 1855 it was 3,639,332.

2 From 1749 to 1773, inclusive, deaths from measles are included. 3 First successful vaccination in Stockholm.

In countries like Germany, Sweden, Ireland, Scotland, and England, where vaccination is more or less compulsory, there is comparatively little smallpox. In countries like Belgium, Russia, Austria, and Spain, which have no compulsory vaccination laws, smallpox yearly claims many victims. See table 1, page 23.

THE RESULT OF VACCINATION IN GERMANY

April 8th, 1874, Germany passed a general compulsory vaccination and revaccination law. The law requires the vaccination of all infants before the expiration of the first year of life, and a second vaccination at the age of twelve. Since this law went into effect there have been no epidemics of smallpox in Germany, despite the fact that the disease has been frequently introduced from without. In 1897 there were but 8 deaths from smallpox in the entire German empire-population 54,000,000. Since then long periods have passed without a single death from smallpox. From 1901 to 1910 there were only 380 deaths from smallpox in Germany; during the same period there were 4,286 deaths from smallpox in England and Wales, with only about half the population of Germany; furthermore, many of the deaths in Germany were in foreigners: Thus in 1909, out of 26 deaths from smallpox, 13 were foreigners, 11 of whom were Russians. In the huge German army there have been only two deaths from smallpox since 1874. One of these was a reservist who had not been successfully vaccinated. Germany has taught the world how to utilize Jenner's great demonstration.

ISOLATION AND DISINFECTION

Isolation and disinfection are only secondary measures in preventing smallpox. They cannot be regarded as substitutes for vaccination. Isolation should be carried out with strictness for the reason that smallpox is one of the most contagious of the communicable infections. While the patient should be isolated, it is not necessary to isolate the hospital by banishing it to an inconvenient or undesirable location. There is, in fact, no good reason why a smallpox hospital should not be one of the units of the general hospital for communicable diseases. any event, there is no danger from a smallpox hospital situated upon a high road or near other habitations, provided always proper precautions are taken to prevent the spread of the disease.

In

The smallpox hospital should not be a pest house, but should be as inviting and attractive as economic conditions justify. Smallpox should not be treated in the home. From the standpoint of prophylaxis the hospital is the logical and best place to care for this and other communicable infections. If smallpox is treated in the home, this should