If the benefits were confined to the small ones, it would be of practically no value; but it is in the larger cases that I have seen the best results. I remember one involving the entire forehead, the nose, one eye and extending down to the lip. The results of treatment were very satisfactory.

My method of treatment is different from some. I do not guarantee that I can cure an epithelioma in three weeks.

In the beginning I was greatly impressed by the danger of the X-rays. I used it with great caution. I have since occasionally departed from that caution but have found that my judgment was safe. I treat my patients with a small amount of light. I have seen many of these cured without producing any definite reaction.

I remember one woman with a large epithelioma on her face whom I treated very cautiously and, as I thought I saw signs of dermatitis, stopped the treatment for sometime; subsequently however, I learned there had been no X-ray action at all. Later, after further treatment, I got a symptomatic cure. It is only after I fail in getting results that I go ahead and produce a burn.

As to exposing probably operable cases of carcinoma. I do not believe in it. It is better in my judgment to do it afterwards. There is nothing more liable to be abused than operative measures in carcinoma or sarcoma. I would not use X-ray before operation except where operation at the time was impossible. If the operation must be put off then you might use the X-ray. After the operation however, it should be used.

Now, as to the prevention of burns, it is my experience that nothing will prevent burns excepting a lack of the use of enough rays to produce a burn.

"SMALL-POX AS OBSERVED IN ALABAMA IN RECENT YEARS."

BY STEPHEN C. HENDERSON, M. D., Brewton, Ala.

Senior Counsellor of the Medical Association of the State of
Alabama.

The prevalence of small-pox in the State of Alabama during the past few years, the modification of its symptoms, and the variation from its regular course have caused me to write this brief article.

In the capacity of County Health Officer, it has been my duty for several years past to see many cases of small-pox, to aid in its treatment, and to devise measures by which its spread might be prevented. It is unnecessary to enter into a discussion of the etiology, symptoms and pathology of small-pox, as every physician is familiar with these, but rather to note the deviations from its normal course which have taken place in the last few years.

But a few years ago, the very mention of small-pox struck terror to the hearts of all members of any community in which it occurred, and justly so, for it was once the scourge of the world, and death and desolation were the inevitable results of an epidemic of the disease.

This dread of it can be readily understood when we remember that the death rate averaged 35 per cent.

Before the introduction of vaccination, over 400,000 persons died annually from the disease in Europe, and since that time, from neglect of vaccination, the population of many countries has been decimated. The disease was originally among the most loathsome known, and its victims, when they escaped death were often disfigured for life.

The most prominent feature of the disease, as observed in Alabama during the past few years, is its extreme mildness, and the almost total absence of any death rate whatever. I have had the opportunity of studying the disease, personally, in but one county, but, from reliable information, its manifestations have been much the same throughout the entire State.

To illustrate the mild nature in which it has occurred in recent years, I have but to mention the mortality in three local epidemics in which I kept strict account of the deaths.

In an epidemic in the year 1896, there were 30 cases with one death. In the years 1900 and 1901, there occurred an epidemic in a town of a population of 2,000, in which there were 528 cases with but two deaths.

In a small outbreak in 1905, there were eleven cases with one death, this being an infant, which was born with the disease and died when only a few days old.

To call a disease small-pox and report such a death rate as this in connection with it seems unreasonable in the light of the experience of former years, and it has caused as many controversies as to diagnosis, as there have been epidemics of the disease; but it has been critically examined by some of our ablest diagnosticians and pronounced small-pox, and I do not think there is now any doubt as to the nature of the disease which is continually making its appearance in some part of our state, and from which it seems impossible to entirely free it.

In making a comparison of the disease as it has occurred in recent years with its former history, it is noted that the period of incubation, the period of invasion, and all other manifestations are the same except as to the severity of all symp

toms.

The patient is rarely taken with a pronounced chill, but suffers in the outset from chilly sensations. These are followed by more or less headache, backache and neuralgic pain, but rarely of sufficient severity to cause the patient to go to bed. The eruption usually occurs on the third or fourth day, as is typical of the disease, but in the majority of cases it is limited to only a few lesions, which however, are characteristic; appearing first as a macular eruption quickly changing to papular then to vesicles with umbilication and finally to pustules about the 8th day; the final dessication and falling of crusts proceeding in keeping with the natural history of the disease.

The constitutional symptoms are usually exceedingly mild, the temperature rarely rising above 100 to 102 Fahr. The mucous membranes are rarely affected, or if so, to a very mild degree and the sufferings of the patient are so insignificant that many of them would not remain indoors unless compelled to do so.

Did every case follow this mild course the diagnosis of smallpox could reasonably be doubted. But occasionally I have seen in the same home, several cases, most of them being of the mild nature described, but others presenting the semi-confluent or confluent type of the eruption which could not be mistaken, and yet all had been exposed to the same source of infection. Again, it has been conclusively proven that the disease is prevented and controlled by vaccination, and that one attack grants immunity against others.

This mild form in which the disease has manifested itself in recent years, while it has spared many lives, has thrown difficulties in the way of enacting laws by which it can be controlled.

It is true that small-pox may be controlled by isolation of the patient, and proper fumigation of infected houses, but at least nine tenths of all cases occur among negroes, and it is impossible to control their movements or to disinfect properly the poorly constructed houses in which they live, without resorting to greater expense than the authorities are willing to grant for the purpose.

This leaves the problem of eradicating the disease dependent upon general vaccination, which is the only practicable and efficient means of obtaining the desired result.

It is unnecessary to enter into a discussion of the efficiency of vaccination as a prophylactic measure, as statistics proving that the mortality of small-pox was by general vaccination reduced from 35 per cent. to about 5 per cent, are well known. Before Jenner made his great discovery, small-pox was looked upon as the scourge of the world and was the cause of more deaths than any other disease, but after its general application the mortality of the disease was reduced to an insignificant figure, and it was no longer looked upon in hopeless dread.

The claims of the anti-vaccinationists based upon isolated unfortunate occurrences, or to accidents due to improperly performed operations, or to neglect, are unworthy of consideration.

My observation of the disease justifies the opinion that the only practicable method by which small-pox can be controlled and eradicated, is general vaccination, and that the only way in which this can be accomplished is to make it compulsory.

On account of the mild nature in which the disease has occurred during the past few years, the argument of anti-vaccinationists, and the severity of the symptoms in some cases of vaccination, there is great opposition to its general application,

and in advocating the wisdom of vaccination, we are often met with the assertion that the suffering from vaccination is worse than that of small-pox.

Unfortunately, this sentiment is often shared in by those on whom the enactment of measures for general vaccination depends, and in this way the obstacles to a law authorizing general vaccination are greatly increased.

Had we any guarantee that the disease would continue to manifest itself in the mild form in which it has existed in this state for the past few years, we might well ignore any action in this direction, but we know that at present, infection from the mildest case, sometimes, produces the most severe type of the disease, and we know not how soon it may revert to its original terrible type.

This would indeed be a calamity and without the influence of vaccination would be a repetition of the experience of former times, when neglect of this precaution caused, in many instances, untold human suffering, the loss of thousands of lives, the complete paralysis of business and the expenditure of millions of dollars.

Without entering minutely into statistics regarding the history of small-pox or of the blessings conferred by vaccination, I feel that my position will be endorsed by every one who has observed the course of the disease, and that I will be sustained in the following conclusions.

That the only practical and possible method of controlling the spread of small-pox is by vaccination, and this, to be efficient, must be universal. The only manner in which this can be accomplished is by the enactment of laws making vaccination compulsory, and that every member of this Association as well as every other citizen who has the good of humanity at heart, should lend his most strenuous efforts to the attainment of this end.

And secondly, that the operation of vaccination should by law be entrusted only to those who are competent to perform it properly. We cannot deny that there have been bad results from vaccination, but as inferred from the foregoing statement, this has been due in the vast majority of instances to the unscientific method in which the operation has been performed. While therefore it should be made compulsory, it should also be compulsory that it be done in accordance with the principles of modern aseptic surgery.