Part 25 (1/2)
Now that the relation between fleas and their hosts and the transmission of the disease is known, there need be but little fear in the future of this old enemy of man again getting control and spreading without hindrance throughout a whole country.
CHAPTER XX
_DISEASES CONTROLLED BY ANt.i.tOXINS (SMALLPOX, RABIES, TETa.n.u.s)_
_Smallpox._
A hundred years ago, the most dreaded disease in this country or in Europe was smallpox; and even yet writers of fiction, when they desire to expose their hero to the most harrowing conditions possible, leave him in a deserted hut with a man dying of smallpox. But to the educated person of to-day smallpox is encountered absolutely without dread, since it has been robbed of its terrors by the introduction of vaccination. As far back as 1717, Lady Mary Montague, writing home to England, described the eastern method of taking smallpox deliberately, under comparatively agreeable conditions, in order that severe cases of the disease might be prevented.
Why one attack of the disease should prevent a subsequent case was not known, nor why inoculation with other virus than that of the disease itself should be efficient was not known. But the fact was thoroughly established then that in some way, in the process of the disease and recovery, there was left in the body some substance or agency which was sufficiently powerful to ward off subsequent attacks.
In 1796, Dr. Jenner discovered that a disease very similar to smallpox existed in the cow, and that if the scab from a pustule on the cow was used for inoculation instead of similar material from a smallpox patient, the resulting disease would be less severe and the protection against subsequent attacks equally efficient. Since that time, therefore, cowpox matter or vaccine has been used to develop a mild form of disease for the express purpose of preventing subsequent attacks.
This is the fundamental principle involved in all ant.i.toxin treatment, and the only difference between vaccination and the injection of diphtheria ant.i.toxin is that with vaccination the disease and the consequent protection is developed in the individual during the course of the disease, while with diphtheria the first attack of the disease and the resulting protective agencies are developed first in the horse and then the essential elements of the blood are introduced into the patient, thereby increasing his resistance to the disease. Smallpox, of all diseases, formerly claimed the largest number of deaths. A hundred years ago, persons marked with smallpox were a common sight. Among the Indians, whole tribes were wiped out with it. It is computed that in Europe, during the eighteenth century, 50,000,000 people died of smallpox. In England, the death-rate was 300 per 100,000. As late as 1800, Boston was visited by severe epidemics of smallpox.
_Value of vaccination._
Owing to vaccination, the extent and intensity of the disease has continually grown less until to-day attacks of smallpox are not serious and the results are seldom fatal. For this reason and because of the chronic objection of uneducated persons to submit to governmental or outside restrictions, there has been, in recent years, a serious outcry against vaccination, with the result that in New York State, during the year 1908, there were in certain parts of the state epidemics of smallpox with, however, but two deaths. The disease may, however, at any time become serious, and, because of its virulent contagiousness, no objection ought to be made to reasonable requirements in the matter of vaccination.
Vaccination is usually not the cause of any serious inconvenience or illness, and, while some slight swelling of the arm may result, the protection afforded is so great in comparison with the temporary inconvenience that the latter ought not to be even considered. The protection afforded by a successful vaccination lasts usually from two to seven years, and it is understood that after ten years the protection is certainly lost, and in the presence of a smallpox epidemic one ought to be re-vaccinated after the minimum time named. Whether every person always ought to be vaccinated at intervals of five years or so is open to discussion. If one were on a desert island in a large or small community without intercourse with the outside world, vaccination would be of no value since smallpox would be impossible. There are communities where smallpox has been for years unknown, and consequently where the need for vaccination is not apparent. On the other hand, where smallpox is prevalent in the vicinity, and the disease is continually recurring, it is of the greatest importance, in order that it may be promptly suppressed, that every individual lend himself readily to vaccination.
Whatever harmful results formerly came from vaccination were due to a lack of cleanliness on the part of the person vaccinated or in the vaccination material itself. More care is now used in disinfecting the surface of the arm and in protecting the exposed skin after the inoculation. If the vaccination ”takes,” a certain amount of inflammation follows, the spot on the arm suppurates, the suppuration, however, disappearing at the end of about three weeks. If this does not occur, that is, if the vaccination does not take, it may be either because the vaccine was not good or because of the unsusceptibility of the person. In the largest proportion of cases, however, the difficulty is with the vaccine or with the doctor who does the inoculating, and when smallpox is prevalent in the vicinity a person should be re-vaccinated until the vaccination does take. The disease itself, while disagreeable, is not as hopeless as was formerly thought. There is no particular heroism in being physician or nurse to a smallpox patient now, inasmuch as vaccination absolutely prevents contraction of the disease, and the isolation practiced is the most serious objection from the standpoint of the attendants.
_Characteristics of smallpox._
The disease first shows itself as does measles and scarlet fever, with the appearance of a severe cold accompanied with a high fever. On the second day a rash resembling that of measles and scarlet fever breaks out on the body; this preliminary rash almost immediately disappears and is followed by the real characteristic smallpox eruption, usually about the fourth day. This eruption appears first on the forehead or face and then on the other extremities, the hands and feet.
In mild cases, it is very difficult to distinguish between smallpox and chicken pox, and the only safe measure is to consider all cases of chicken pox in adults to be smallpox, as they probably are, since the former disease almost never attacks grown-up people. The pustules which form in smallpox are first hard and red, and then two or three days later they are tipped with little blisters which later fill with pus and appear yellow. About the tenth day of the eruption this yellowish matter exudes, forming the scar or scab which later dries up and falls off.
Often this eruption is accompanied by excessive swelling of the face, so that the eyes become closed, it is impossible for the patient to eat, high delirium prevails, and the task of the nurse in such cases is an unenviable one. Although usually the pustules are separate and distinct, sometimes in severe cases they run together, so that the hands and face present one distorted ma.s.s of suppuration and crust.
The disease is particularly prevalent among negroes, perhaps because they are seldom vaccinated, and in recent epidemics in New York State it has been chiefly through negroes that the disease has been kept alive.
The method of prevention for this disease is almost entirely vaccination. Just how the disease spreads is not clearly understood, although it is supposed that it is transmitted chiefly by clothing, dishes, and other articles in contact with the infection. These should, therefore, be thoroughly disinfected. The hope of eliminating the disease, however, comes rather in the use of vaccination. In New York State, in 1908, only two deaths from smallpox occurred, although twenty years before, with the smaller population, the number of deaths ran up into the hundreds.
_Treatment of smallpox._
The actual treatment of a case of smallpox consists in little more than providing suitable food, in sponging the body to reduce the fever, and in anointing the skin to allay the irritation of the pustules. As in measles, the eyes are badly affected, and a darkened room is essential for the comfort of the patient as well as for the avoidance of permanent injury to the eyes. Carbolic acid solutions or ointments are to be used continually on the surface of the body, relieving the irritation and to some extent preventing pitting, which is a lasting mark of the disease.
_Diphtheria._
Diphtheria was also formerly a much-dreaded disease, physicians standing helpless before severe attacks and in all cases unable to do more than suggest ameliorating remedies.
The disease usually begins with a cold, sore throat, and local inflammation, which develops sometimes with alarming rapidity. In the days of our grandmothers, the first thing that the anxious mother did when a child complained of sore throat was to get a spoon and look for white patches in the back of the throat. With severe cases of diphtheria which these white patches foretold, the growths of membrane would be so rapid as to obstruct the breathing, and the child--for the disease is preeminently one of childhood would be in danger of dying of strangulation. The doctor's remedy for this condition was to make an incision in the throat below this acc.u.mulation and insert a tube through which the breathing might continue. The writer will never forget having lived through a sickness and death of this sort in his family, seeing as a boy a bottleful of the membrane which the doctor was taking away after the death of the victim, and, while doubtless the size of the bottle and the amount of the membrane has been magnified by the lapse of years, it still remains to him as a terrible visitation and an inevitable cause of death.
_Cause of the disease._
The immediate cause of diphtheria has been known only within recent years. Sewer air was for a long time thought to be responsible, and overcrowding or congestion in tenements was believed to be a fruitful source of the disease. Some years ago, when diphtheria had been epidemic in one of the state inst.i.tutions and when experts had been called in to suppress the disease, the elaborate reports which they made dwelt on the quality of the drinking water and on the method of disposal of the sewage as if those factors would account for the disease. About twenty-five years ago, it was shown definitely that the disease was due to certain bacteria, and that while the membrane in the throat was the result of the rapid development of these bacteria, yet the mortality from the disease was not due to the suppression of the act of breathing, but to the development of a poison by the bacteria which went into the circulation of the body and produced death, just as any poison, as strychnine, for example, would do.