This paper is offered with apologies. Just why it was deemed proper that I should discourse on this subject, I do not know. My limited experience has yielded nothing new or interesting to pass on to you, but I have tried to arrange the findings and experiences of others in such a manner that this period on the program will not prove entirely without profit.

The history of variola is that of one of the most constant, extensive, and malignant scourges with which man has been afflicted. It is extremely difficult to visualize a period when smallpox was much more prevalent than measles. For centuries, however, this was true. It depopulated cities and exterminated nations. The tremendous number of persons marked by this disease is evidenced by the following lines from an “Ode to Smallpox" written, I think, by Samuel Johnson:

"Oh! Loathsome and foul disease,

cal literature. According to this account, the disease was introduced into China about 1122 B. C., and since about 590 B. C. had been controlled by the inoculation of smallpox material. In India variolation was likewise practiced in early times, entirely by the priest accompanied by all sorts of incantations. Smallpox is also supposed to have been prevalent from time immemorial among the natives of Central Africa from where it spread by way of the Red Sea to the Arab Tribes. After the introduction of variola into Arabia, it became endemic there, and spread to neighboring regions and thence to Europe.

It appeared in what is now known as France in about the year 541. From the 11th century on, there are increasing numbers of records of smallpox epidemics. The Crusades did much to spread the disease, and the epidemics of that period had a peculiar virulence.

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Nor was the disease a respector of persons. Louis XV, of France, died most pathetically and miserably of smallpox, shunned as a thing unclean. Smallpox took 60,000,000 lives in the 18th century. In Boston, in 1752, which then had a population of 15,000, an epidemic of smallpox left only 174 persons who had not had the disease.

Probably the first definite mention of smallpox is found in early Chinese medi

in San Domingo, whence it spread to Cuba and the Antilles. From Cuba it spread to Mexico, through the medium of a negro slave among troops captured and landed in Mexico as prisoners of Cortez. The epidemic started in this way beggars description. In a short time 31⁄2 million people succumbed to the disease. In 1710 about 60,000 persons are reported to have died of the scourge in the capital of Ecuador.

A comparison of these records with

those of modern times, however discouraging the latter may be, shows that "vaccination," the modern method of smallpox control, ranks very high among the beneficial gifts of science to humanity.

Although writers as late as the sixteenth century failed to clearly distinguish smallpox, they recognized the contagious nature of the disease. Isolation Isolation in those days was not largely practiced, nor was it carefully carried out, yet it did afford a degree of control for the disease. The laws of Rhode Island provided that all sufferers from smallpox be isolated on the Island of Coasters Harbor, with the result that from 1740 to 1765, no epidemic of smallpox was known in that state. But, on the whole, quarantine has never proved of great avail when used alone, in the general control of smallpox.

As has already been mentioned, variolation was practiced in various forms for centuries, but this method fell far short of the ideal one, for it not only produced the disease with most of its serious symptoms, but also, at times, proved the starting point for an epidemic of disastrous results.

It was reserved for Edward Jenner to give to the world the ideal prophylaxis against the dread disease, which as heretofore stated, represents one of the great triumphs of preventive medicine, the benefits of which can never be estimated.

The story of Jenner's work on vaccination is too well known to repeat in detail, but in 1798 he was able to publish results which proved that the inoculation of cow pox virus into the human produced a "vaccinia" which gave a protection against smallpox. Since then the benefits to be derived from vaccination have been experienced more or less extensively in practically every part of the globe.

Vaccination was introduced into the United States during the year 1800. In July of that year Dr. Benjamin Waterhouse, of Harvard University, vaccinated his own children, and at about

the same time Dr. John Redman Coxe of Philadelphia, vaccinated his oldest son and then boldly exposed him to smallpox contagion. The exhibition of the child's total immunity did much to establish confidence in Jenner's method throughout the country.

So much for the past and its problems. Now it might be interesting to note how the present day officials take knowledge of and profit from the experiences of those generations that have preceded them.

It is a somewhat discouraging fact that in spite of what one might expect, the American public has too often hindered rather than abetted the control of smallpox. As a consequence the health bulletin of the League of Nations announces that there were more smallpox cases reported last year in the United States than in any other country; California of all states, did most to make this true.

About one year ago, Fresno and its environs was in the midst of a rather severe epidemic of smallpox. Dr. A. F. Gillihan, District Health Officer, of the State Board has given me access to his records and allowed me to quote from his resume.

"The first appearance of smallpox in the region around Fresno was in the town of Clovis. The Health Officer of that town, some six weeks after the disease had appeared, described an epidemic that had broken out among itinerant fruit pickers, which was decidedly more virulent than any type of smallpox that had been seen before. The first cases occurred in August. There were 21 in all. The Health Officer of Clovis promptly instituted a vaccination campaign, doing at least 300 himself, and the other physicians doing about 400, so that about 50 per cent of the town was immunized. No further cases appeared.

"Following the Clovis outbreak, smallpox appeared in Fresno City. Cases were quarantined as soon as they were

"Of those cases listed in this table as 'never successfully vaccinated,' many had been discovered as smallpox contacts and promptly vaccinated on discovery. But, unfortunately, their discovery and vaccination had occurred several days after their contact with the disease and their infection. Consequently the rash of smallpox developed at the same time as vaccination in about 20 cases. The smallpox did not seem to have exerted any influence upon the normal progress of these vaccinations, and vice versa. It is well known that had these vaccinations been made two or three days sooner than they were, immunity would have had time to develop before the smallpox could have incubated, and the disease. would have been arrested or aborted.

"A vaccination clinic was opened in the Fresno City Hall, Sept. 29, 1924, under the supervision of the City Health Officer, Dr. C. Mathewson. This clinic was maintained until the end of November. Two other sub-clinics were opened for a while and altogether over 20,000 vaccinations were done. This does not count the vaccinations done by physicians in their own practice. VacciVaccinating was begun under the County

Health Officer, Dr. G. L. Long, early in October. October. It was continued until the end of November, and nearly 27,000 vaccinations were done outside of Fresno City, mostly through the district schools.

"Under the direction of Dr. Telfer, District Health Officer, 37,000 vaccinations were secured in the counties surrounding Fresno County, thus establishing a zone of immunized people.

"A Fresno contact who took sick in Sacramento with virulent smallpox on October 27, and died on Nov. 11, instigated the inauguration of a vaccination campaign in Sacramento which during November secured 2,730 vaccinations.

"In summary. The situation in Fresno was responsible for stimulating vaccinations throughout the entire state in fact, but not taking those into account, it is calculated that the epidemic near Fresno was controlled through the securing of 102,622 vaccinations in the immediate vicinity.

"This of course constituted the main measure of control, but other measures were not neglected. As soon as a case of smallpox was reported, strenuous efforts were made to get those who had been in contact with the patient, vacci