The Press., 1894-06-14
CAUSES OF SMALLPOX EPI-
 DEMOS.

Tn answer GO a request IfOIl one OI the editors of the local press, for information concerning the smallpox epidemic, Dr. A.. R. Reynolds, health commissioner of Chi cago, has furnished 8 lengthy paper, which is, in effect, an argument and an appeal for continuous and general vaccination, as applicable to the country at large as to the city of Chicago.
 Such passages in the answers to ques- tions as are of general interest are here given:
 | 1. As to causes It is unfortunately the fact that in this country general vac cination is secured only through the inn mediate dread of smallpox, as during a widespread outbreak of the disease-a so- called "epidemic." The last general vac- cination, not only in Chicago, but through out the United States, was during the cpl demic of 1881-3. About ten years prior to that-namely, during the epidemic of was also general, as it was during the epidemic following the close of the civil war. In the intervals between these periods smallpox occurred only sporadically and caused little or no alarm. In the absence of this menace,
 
 general outbreak caused it to be resorted | to. $5eE stt While it is incontestably true that vac cination secures immunity from smallpox in an immense majority of cases, it is also true that the degree of susceptibility of the smallpox contagion varies with the individual. This is shown by the. fact, | observed long before the days of Jenner, l that while, as rule, one attack of small pox secures against subsequent attack nevertheless there are persons so suscep- tible to the contagion that they are at. tackled second or third time, or even of | tener. ..
 l What is true of these exceptions to the I rule that one attack of smallpox is a pre- ventive of 8 subsequent attack is also true of vaccination-with this additional lim- I itation: That the protective power of vac- cination is impaired by the lapse of time | in a large number of individuals. As the result of experience and observation the best authorities have fixed the period of five years as the practical limit beyond which it is not safe to rely upon given vaccination.
 | During the intervals between these gen. eral vaccinations there is a steadily in creasing number of individuals suscepti- ble to smallpox, made up of those born during during the interval and not vacci- hated, of those in whom vaccination has lost it's protective power and of unvacci. mated immigrants and others coming into the community. Added to these are the lhypersusceptible individuals whom neith. CT repeated vaccinations nor previous attack of smallpox will protect. \ The first cause, then, of the present Ioutbreak, was a ten years aggregation oi Individuals susceptible to the smallpox eontagion, and the second cause was tht Introduction of the contagion-the appli cation of the spark to the magazine.
 3. Were these causes avoidable? IT the absence of general and continuous vaecination-no. Without such stringent governmental control of the individual as obtains in some European countries, vac cinatiOn can not be made compulsory, ex cept during an alarming prevalence O. smallpOx-when, indeed, vaccination be comes voluntary and not compulsory. In this country the extent of the vac cinal protection of community is thu measure of it's intelligence. It is not thu better sanitary environment of our bes residence districts alone that secures prac tical immunity from smallpox to their in habitants; it is their active appreciation of the virtue of vaccination. The diseas, is as virulent and as deadly to-day anon, the vaccinally unprotected of all classe as it was before the discovery of Jenner when the pock-marked face, the hideou deformity of eye and nose, and every feat ure, was as common among the nobilit, as among the denizens of the slums.
 Only by general and continuous vacci nation can any community hope to escap outbreaks of smallpox. 1t is one of tn oldest known diseases afflicting mankind it is one of the most widely diffused, be ing epidemic in Africa and thence carrie, by commerce to every quarter of tn glObe it is one of the most virulent an' one of the most consistently contagious o diseases. Therefore we are likely to hay it's contagion, like the poor, always wit us; and wherever the contagion finds sufficient number of @eceptibles ther will be set up an epidemic outbreak. The only known means to prevent sue disaster is by preventing the aggregs tion of susceptibles, and that this can b done by general and continuous vaccina ' tion is a demonstrated fact. 1t has bee abundantiy proven that just in proportio as vaccination is efficiently and properl pefformed-which implies its necessar , repetition-it markedly diminishes mo ! taiity from smallpox; it renders smallpo