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14
those countries where vaccination has not been
generally adopted, small-pox has continued its
ravages. The decline of this disease has, in every
country, followed the introduction of vaccination,
those countries in which vaccination has been most
carefully and thoroughly carried out, showing the
greatest decline of small-pox, and because there is
not any other influence to which this decline can be
reasonably attributed. Medical Officers of Health
whose duty and interest it is to promote sanitation in
every way, are in fact equally unanimous as other
medical men are in recommending and using vaccination
as the only reliable protection against the
ravages of small-pox. It has been alleged that the
diminution of small-pox is due to improved sanitation
generally. If this were so, all other infectious diseases
ought to have decreased in the same way. However,
they have not. Some, such as typhoid or enteric,
and typhus, which are spread by contaminated water
or milk, or in the latter by overcrowding, have
decidedly decreased in proportion as these sanitary
defects have been removed, whilst others which
resemble small-pox in being spread by personal
infection, such as measles and whooping cough, in
which isolation is equally difficult as in the case of
small-pox, have not decreased in the same degree
that the latter has, whilst diphtheria has really
increased. More than 1,100 Medical Officers of
Health have recently signed a declaration in which
they express their belief that "sanitation," apart
from vaccination, cannot be relied on to prevent or
stamp out epidemics of small-pox, and that the only
trustworthy protection at present known against
small-pox is efficient vaccination in infancy, and