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    "title": "SMALLPOX",
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    "verified_text": "since about 1910 much knowledge of the nature of this disease has accrued in the course of attempts to discover the causal organism. this has been sought, though fruitlessly, in many direct investigations of the rash and of the blood by microscopical examination and by attempts to inoculate animals. the failure is explained, in part, by the discovery that the virus of vaccinia and, by analogy, also that of smallpox belong to the group of filter-passing viruses (see filter- passing microbes). jenner believed that cowpox (vaccinia) and smallpox (variola) have the same origin and nature. but attempts to inoculate the cow with smallpox matter failed and jenner’s opinion was not substantiated until monckton copeman and others proved that the virus of smallpox can be inoculated in the cow by a process of transmission or passage and that in the cow, under these conditions, typical lesions of vaccinia are produced. but although vaccinia is the same disease as smallpox, during its passage through the cow it has lost the power of producing a generalised septicaemic infection in man though it induces the typical lesion at the site of inoculation and by means of this local lesion, pro- tects the vaccinated individual against the major infection from which the vaccine matter was derived. slesvig—smallpox use of lymph.—establishment of the homologous relationship between variola and vaccinia widened the field of investigators into the nature of the contagium of smallpox by providing a material, viz., vaccine lymph, which is at once abundant and easily produced. by experiments in the rabbit, which is sus- ceptible to vaccinia, the immunity conferred by vaccinia has been studied and it has been shown that certain specific sub- stances or antibodies are produced in the blood and tissues of the vaccinated animal similar to those produced in typhoid fever and cholera, and that the antibodies in vaccinia and variola are apparently identical. it has been claimed, though on insufficient grounds, that this identity affords a means of certain diagnosis of the disease in doubtful cases of smallpox. serum therapy—yln so far as the therapeutic application of the knowledge thus acquired is concerned, it has been shown that the serum of animals which are immune to vaccinia not only has protective power against vaccinia but also is possessed of curative properties because it destroys the virus of vaccinia in vitro. whether this curative property is susceptible of increase by means of a graduated increase of dose of virus has not been investigated. in france, the serum of convalescent smallpox patients has been used in treatment and it is claimed that an undoubted curative result was obtained in cases which from clinical experience would almost certainly have proved fatal. but so far the virus of smallpox has not been obtained in quantity sufficient to permit of the attempt to manufacture a therapeutic serum, nor has it been shown that the immunity of an animal to vaccinia can be raised to a degree which might make its serum of value in the treatment of smallpox. polyvalent vaccines and serum prepared from pyogenic organ- isms have been used with some success in the treatment of severe confluent smallpox. this treatment is based on the assumption that the severity of the later stage of the illness in confluent smallpox, i.e. the stage of maturation or pustulation of the rash with the secondary fever of the disease, is closely associated with a secondary pyogenic infection. history of the disease the mode of spread of smallpox may be illustrated by a short account of the incidence of the disease in europe since 1910. it is convenient to divide the period into three quinquennia:— 1. 1910-4, the period preceding the war; 2. 1915~9, the period of the war; 3. 1920-4, the period of gradual recovery from the war. pre-war incidence —during the first quinquennium no satisfactory arrangement existed among the european powers for the interchange of information concerning the incidence of epidemic diseases, and particularly from large areas where the disease is endemic and vaccination negligible, such as spain, the balkan states, turkey and russia, information concerning the rise and fallin incidence or even of serious epidemic extensions of the disease was scanty and unreliable. during this quinquen- nium the disease was very prevalent in italy where a severe epidemic occurred in 1911-2. on the other hand, in france, belgium, austria, germany, denmark, holland and the scandi- navian countries, smallpox was a rare disease as it had been since the beginning of the century. in england and wales no extensive epidemic had occurred since the outbreak of 1002-3-4 and in the five years period before the war only 88 deaths from small- pox were recorded in great britain. the war period.—with the outbreak of war in 1914 the de- cline was arrested and the movement of armies and migration of civil population to and from the endemic centres in the east of europe rapidly made itself felt by an uncontrolled and in- creasing spread of smallpox which reached its greatest intensity in rorg. in the end of 1914 and throughout 1915 severe epidemic smallpox carried by prisoners of war from russia and refugees occurred in the states of the old austrian empire which bordered on russia and also in the balkans. similar agencies scattered the infection throughout germany and in 1916-7 there were out- breaks in hamburg and other western towns. the incidence of the disease in germany rose continuously throughout the smedley—smetona years of the war. over 2,000 cases were recorded during 1917 and upwards of 5,000 during 1o19. the infection reached sweden on more than one occasion and a few cases occurred in norway. in the netherlands at least one serious outbreak occurred. | the experience of france during the war period was remarka- ble. the serious epidemic which swept over the country during the war of 1870-1 had not been forgotten and the french army of the world war was efficiently protected by vaccination. the invading german troops were also protected and no doubt acted as a screen to france on the east. throughout the country, with the exception of districts on the mediterranean coast and border- ing on the spanish frontier, the incidence amongst the civil population was low during the war. the freedom of france was reflected in the freedom of england during this period. the british army, like the french, was vaccinated and therefore in contrast to the experience of england in 1870-71, and in spite of the enormous volume of cross-channel traffic, only a small amount of smallpox infection reached england through france. in the later years of the war the revolution in russia sent many refugees into this country who brought the infection via scandi- navia and the murmansk coast. but the close guard maintained on the north sea ports of britain and the vigilance of her public health authorities prevented any serious attack on the civil population in spite of the increasing neglect of vaccination among the people. post-war incidence-—in the third quinquennium, 1920-4, the bureau for the service of epidemiological intelligence and public health statistics was initiated under the authority of the league of nations for the purpose of collection and interchange of information concerning epidemic diseases. the annual report from this source for 1924 deals with 29 european, 17 african, 20 american, 16 asiatic countries and australasia, and shows that in europe smallpox incidence has diminished year by year since 1919. the effects of the war on the incidence of the disease in russia and neighbouring countries, viz.: czechoslovakia, rumania, austria, poland, finland and germany reached their culminating point in 1919 and since that year the decline in prevalence in all these countries has been continuous and rapid. similarly in italy, where 34,365 cases were recorded in 1919, only 190 cases occurred in 1924. although spain continues to be the chief endemic centre in the west of europe, the recorded deaths from smallpox in that country fell from 3,620 in rgrg to 1,214 in 1924. during the quinquennium england and switzerland were the only european countries in which the incidence rose. in switzerland the figure for 1924 shows a fall but in england the increase was progressive to the end of the period as seen by the following table :— number of cases of smallpox record- ed in in england and wales . in switzerland 3 2 596 | 1,153 in both countries the mild type of the disease associated with the almost complete absence of fatality, led to the concealment of cases and an increasing neglect of vaccination. variation of epipemic type outbreaks of smallpax, like those of other infectious diseases, vary in their lethal power. in 1789 jenner described an outbreak which occurred about seven years before in gloucestershire, “ of so mild a nature that a fatal instance was scarcely ever heard of ... i watched its progress upward of a year without per- celving any variation in its general appearance. i consider it then as a variety of smallpox.” , observers in different parts of the world have directed atten- tion to the occurrence of outbreaks which apparently resemble the one described by jenner. an outbreak in south africa was described by de korte in 1904, under the name of amaas or 999 kaffir-pox, another by ribas in brazil in 1910, under the name of alastrim, and others of a similarly mild character have been recorded in the united states, the west indian islands, aus- tralia, and, as mentioned above, in england and switzerland. the opinions of many modern observers differ from that of jenner who was satisfied in calling his outbreak a “ variety of smallpox.’ that the form of disease observed in so many parts of the world belongs to the smallpox group is common ground. but some observers hold that it is more closely allied to chickenpox than to smallpox; others differentiate it from both diseases and regard it as a newly identified member of the group, while others maintain that it is a hybrid of smallpox and chicken- pox, a true varioloid-varicella. on the other hand the weight of medical opinion in england inclines to the view that the disease is simply a mild type of smallpox. chnical—differentiation of the smallpox eruptions similar in type has become more certain and rapid through the work of ricketts. ricketts’ thesis is that the focal rash of smallpox has a characteristic distribution governed by two complementary factors, viz.: exposure to irritation and protection against irritation, which determine a relative increase and decrease of the incidence of the rash on any part of the skin surface. these factors are independent of the course of the disease and of the evolutionary changes which constitute the features of the rash. they are also independent of modification of these changes re- sulting from variation in immunity possessed by the patient or of variation in the toxic power of the infecting virus. ‘they have the further advantage of being objective and therefore less liable to confusion in interpretation than any others. they begin to be established with the beginning of the outcrop of the rash, are fully established when eruption is completed ‘and remain unchanged as long as the rash lasts. experimental —blaxall, cleland and ferguson, green and gordon in england, and leake and force in america, have ex- perimented on lower animals with material from the mild disease and also with material from severe cases of acknowledged smail- pox, in order to determine what differences, if any, exist between the two conditions and in their immunological relations to each other and to vaccinia. the results of these investigations have been summarised by ledingham, and confirm the opinion that the mild disease as it exists in england is smallpox of which the virus has lost a degree of its toxicity for man but retains its important properties for other animals. the distinction between the two viruses is one of lethal power only and the factors which govern this property are unknown. over five years’ experience in england of a widespread infection by the mild type of smallpox has afforded very little, if any, evidence of a tendency to increase in virulence. but in the absence of knowledge of the cause of variation in lethal power or of the natural conditions which may favour its occurrence, it is unsafe to assume that a low degree of virulence is a permanent feature of this type of small- pox and on that assumption to relax the stringency of administra- tive precautions against the disease. bibliograpity.—a. beclere, chambon and menard, ‘‘ etudes sur immunite vaccinate,” slunales de l’instit. pasteur (1899); s. m. copeman, ‘ the inter-relationship of variola and vaccinia,’”’ proc. roy. soc. (1902); t. i. ricketts, the diagnosis of smalipex (1908); epidemiological intelligence no. 9, statistics of notable disesases for the year 1924 (geneva, june 1925); m. h. gordon, * studies of the viruses of vaccinia and variola,’”” report to the medical research council (1925); j. c. g. ledingham, lancet (jan. 24 1925); s. b. woodward, boston medical and surgical jour. (1925). (\\. facs*) smedley, william thomas (1858-10920), american artist (see 25.251), died at bronxville, n.y¥., march 26 1920, smetona, antanas (:874- ), lithuanian politician and journalist, was born aug. 10 1874 in the ukmerge district, lithuania. in 1897 he went to the university of st. petersburg (leningrad) as a law student, and received his diploma in 1902. smetona edited the first lithuanian daily, velntaus zinies (vilna news), and the democratic party organ lietuvos ukinin- kas. in 1905 he was elected a member of the presidium of the vilna (wilno) diet, which proclaimed lithuanian autonomy, but 560 he continued his journalistic activities as editor successively of vilfts and vairas. during the world war smetona acted as chairman of the lithuanian war relief committee. on the con- vocation of the tautos taryba, or national council, during the german military occupation of the country, he was unanimously elected its president, and in the spring of 191g first president of the newly-proclaimed independent state of lithuania, a post which he held till the spring of 1920, when the constituent assembly was convened at kaunas (kovno). after his retire- ment from the government smetona returned to journalism as editor of balsas, vairas and lietuvis, which represented the national progressives. in 1921 he served as chairman of the lithuanian delegation at riga during the negotiations on the settlement of the latvian-lithuanian boundary dispute. early in 1923, when the insurrection broke out in the memel territory against the german directorate, smetona was requested by the lithuanian govt. to compose the trouble in co-operation with the allied representatives. in the same year he joined the teaching stafi of the newly established university as lecturer on philosophy. smillie, robert (1850- ), british politician, was born on march 17 1859 in belfast, of scottish parents. he left school when only 14 and worked first in a clyde shipyard and later as a miner in the lanarkshire pits. in 1894 he became president of the scottish miners’ federation, and later formed the miners’ federation of great britain. under his leadership the great strike of coal miners of 1912 was conducted and a national minimum wage secured. he was a member of the royal commission on mines set up in 1919 and presided over by mr. justice sankey. he resigned the presidency of the miners’ fed- eration in 1921. though best known as a miners’ leader, smillie possessed strong internationalist sympathies, and was an ardent pacifist during the world war. after seven unsuccessful con- tests he was elected m.p. for morpeth in 1923. in 1924 he pub- lished afy life for labour. smith, alfred emanuel (1873- ), american politician, was born in new york city dec. 30 1873. the son of humble parents, his father being a truck driver, he was educated in the st. james parochial school, and for several years was employed in the fulton fish market. he was very popular with his associates, and at the age of 29 was offered the democratic nomination for the new york state assembly by the tammany leader of the district in which he lived. he was elected for 1903, and by re-elec- tionserved for 12 years. in 1911 he became democratic leader in the assembly, and was appointed vice-chairman of the factory investigating committee, which made a searching inquiry into industrial conditions in the state, resulting in remedial legisla- tion. in 1913 he was speaker of the assembly. in 1915 he was chosen a delegate to the state constitutional convention, taking an active part in its proceedings. he opposed the consti- tution as finally revised, one reason being that it contained a provision designed to prevent new york city from having a majority of legislators. he “stumped” the state against its adoption, and it was overwhelmingly rejected. the same year he was elected sheriff of new york county, then a lucrative post because of the system of fees (later abolished), and in 1917 president of the board of aldermen of new york city. in 1918 he was elected governor of the state of new york. he had been a strong supporter of woman suffrage, and in june 1919, as governor, called a special session which ratified the woman suf- frage amendment to the federal constitution. the constructive legislation passed during his first term, including emergency rent legislation and the codification of the child welfare laws, established him as a progressive leader. in 1920 he was again the democratic nominee for governor, but was beaten in the overwhelming republican landslide of that year; he lost, how- ever, by only 73,000 votes, whereas the democratic candidate for president was at the same time defeated by 1,000,000 votes in new york state. in 1922 smith was renominated by the democratic party for governor, and was elected by the largest majority ever given to a candidate for the office, receiving 1,397,633 votes as against smillie—smith, theobald 1,011,725 for n. l. miller. at the democratic national conven- tion of 1924 he received strong support for the presidential nomination, dividing the votes with w. g. mcadoo so as to produce a deadlock, until, on the 1o3rd ballot, j. w. davis was nominated as a compromise. at the state election in nov. 1924 he was re-elected governor, receiving 1,627,111 votes as against 1,518,550 for theodore roosevelt, the republican nominee. ‘this was the first occasion in one hundred years that a governor had been twice re-elected. this was another striking demonstration of governor smith’s popularity, especially as the republicans carried every other state offce by large majorities. his record of constructive legislation has continued throughout his three terms, and includes housing legislation, a state park system, improvements in child welfare and labour laws, the recommendation and adoption of bond issues for the construc- tion of state hospitals and other public buildings, and the final adoption of the hughes plan to reorganise the state government, including the adoption of an exccutive budget. smith, alfred holland (1863-1924), american railway official, was born in cleveland, o., april 26 1863. he began work on the new york central railway system as & messenger- boy in 1879. after serving in various capacities he was in 1890 appointed superintendent of the kalamazoo division of the lake shore and michigan southern railway. he was successively division superintendent, assistant general superintendent and general superintendent of the lake shore road. in 1902 he became general superintendent of the new york central railroad, in 1906 vice-president of the new york central system, and in ror4 president. when the american railways were taken over by the u.s. govt., dec. 27 1917, he was appointed assis- tant director-general and worked out the form of central and regional administration under which the railways were managed during the 26 months of government operation. he was re- elected president of the new york central lines in june rorg. he died in new york city march 8 1924. smith, francis hopkinson (1838-1915), american author, artist and engineer (see 25.260), died at new york city april 8 iqi5. smith, jeremiah, jr. (1870- ), american lawyer, was born at dover, n.i., jan. 14 1870. he graduated at harvard university (a.b., 1892) and the harvard law school (ll.b., 1895). in 1895 he became secretary to mr. justice gray of the u.s. supreme court, but in 18906 commenced the practice of law in boston. ie was a captain in the quartermaster corps a.e.f. in france 1918. at the conclusion of hostilities he was appointed counsel to the treasury dept. in europe and was associated in that capacity with the u.s. peace commission, acting also as an adviser in financial matters. on the conclusion of peace he resumed practice in boston. in april 1924 he accepted the position of commissioner-gencral of the league of nations in hungary, and took up his duties in budapest may 1. he was successful in stabilising the currency and placing hun- garian finance on a sound basis, his report of july ro25 for the fiscal year showing a surplus, instead of the deficit anticipated in the league’s reconstruction plan. on the completion of his work, july 1926, he again resumed practice in boston. smith, theobald (1850- ), american pathologist, was born at albany, n.y., july 31 1859. he was educated at cornell (ph.b., 1881) and at the albany medical college (m.d., 1883). in 1884 he was appointed director of the pathological laboratory of the bureau of animal industry, in washington, where for 11 years he investigated infectious animal diseases. at the same time he was professor of bacteriology at columbian, later known as george washington university. from 1895 to 1915 he was director of the pathological laboratory of the massachusetts state board of health, and after 1896 was professor of com- parative pathology at harvard. in 1915 he was appointed director of the department of animal pathology of the rocke- feller institute of medical research, at princeton, new jersey. his numerous scientific papers include investigations into the nature, causation, and prevention of texas or southern cattle fever (1893); the relation between bovine and human tuberculosts smith college—smokh, (1896-8); the immunizing effect of neutral toxin-antitoxin mixtures in diphtheria (1909); mitk-borne epidemics of human streptococct (1915); the protective value of colostrum (1922); the relution of bovine infectious abortion to malia fever (1925).",
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