The first and chief protection against smallpox is vaccination. Vaccination does not always prevent infection by smallpox, but it does prevent it in more than 90 per centum of exposures to the disease. Welch reported in 1894 that the death-rate in one series of 5,000 cases of smallpox was 58 per centum in the unvaccinated, and 16 per centum in the vaccinated, but the vaccinated took the disease in less than 10 per centum of the exposures. During the Franco-German War in 1870-1871, the Germans who had a million vaccinated men lost 458 soldiers from smallpox while a great epidemic of smallpox was existing in Germany; the French, who were indifferent to vaccination, during the same time lost 23,400 men from this disease alone. In the United States, where there is no compulsory vaccination except such attempts as school boards make, there were between July and December, 1903, 13,739 cases of smallpox; in Germany, where there is a compulsory {174} vaccination law, there was no smallpox at all, during the same time, except 14 cases in two seaports, Bremen and Kiel, whither the infection had been brought from without. Before 1874 there had been no compulsory vaccination law in Germany except for the army. In 1871, 143,000 Germans died of smallpox. Since the law went into effect in 1874 the disease has been stamped out, until there was between July and December, 1903, only one death from smallpox in Germany. The chart on page 175 will show very graphically the effect of vaccination upon smallpox. In October, 1898, smallpox was endemic in Puerto Rico; in December, 1898, it was epidemic; in January, 1899, it was all over the island and spreading rapidly. In February, 1899, compulsory vaccination was begun and carried out for only four months, when 860,000 vaccinations had been made in a population of about 960,000 people. The death-rate from smallpox dropped from 621 a year to 2. During the century preceding Jenner's discovery of vaccination, according to Neimeyer's calculation 400,000 people died of smallpox each year in Europe. Bernouilli, a trustworthy statistician, says that during that same century, "Fully two-thirds of all children born in Europe were, sooner or later, attacked by smallpox, and on an average one-twelfth of all children born succumbed to the disease." Early in the sixteenth century 3,500,000 people in Mexico had smallpox (Prescott's _Conquest of Mexico_). In 1707, in Iceland, 18,000 of the population of 50,000 died of smallpox; and in 1891, 25,000 persons in Guatemala died of this disease. In 1875 there were anti-vaccination riots in Montreal, and as a consequence most of the younger inhabitants of that city were not vaccinated. In 1885, smallpox was brought in from Chicago; 3,164 persons died of the disease; of these 2,717 were children under ten years of age, and thousands had the disease. {175} [Illustration: ] PRUSSIA.--With compulsory vaccination and compulsory revaccination at the age of 12.