Small Pox Vaccination.

It had been for centuries known in the Orient that the severity
of small-pox was much diminished by the actual transfer of the
specific virus from one patient to another ; that individuals so inocu­
lated suffered less severely from the ravages of the disease than those
who acquired it in the usual way of exposure. This practice of in­
oculation had been long and extensively employed in Turkey, when
in 1718, an English lady, Lady Mary Wortley Montague, visiting
Constantinople, became personally convinced of the value of this
measure. She had the courage to submit her own son to inocula­
tion, and was the means of introducing the practice into England,
whence it spread over various parts of the Continent. It might be
proper to add, though not exactly pertinent to the present topic,
that the same principle—inoculation from a diseased to a healthy
animal—has been since, and still is, extensively employed to
diminish the ravages of certain diseases which afflict domestic
animals. In the latter half of the same century, Edward Jenner,
an English physician, arrived at a most important discovery on the
same subject. It had long been reported among the peasantry that
individuals who had contracted from cows a certain pustular disease
—cow-pox—remained ever after insusceptible to small­pox. Jen-
ner investigated by a series of observations extending over twenty
years the actual facts in the case. He found that the pustular dis­
ease to which cows are subject could be communicated to man by
simple contact; that the result was the production of a few vesicles
resembling those of small­pox, and that individuals so inoculated
resisted all attempts at inoculation with the virus of small­pox. In
1798, Jenner published this discovery to the world, and commenced
public demonstrations of the truth of his conclusion. His discovery
was* bitterly contested and ridiculed, as discoveries have always
been, and will continue to be, in conservative England. The prac­
tice, however, was soon extensively tried in other countries ; vac­
cination was first performed in America and in Austria, in 1799.
Even before Jenner’s death, sufficient evidence had accumulated to
convince the world that his was the greatest and most valuable dis­
covery up to that time recorded in the annals of medicine. “ The
fruits of this transcendantly important discovery have been the
saving of an incalculable number of lives, which would otherwise
have been destroyed by one of the most loathsome of diseases, and  
the prevention, to an extent which cannot be computed, of the dis­
figurement and other distressing effects which small-pox is apt to
produce, when it does not prove fatal. Of all the benefactors who
have ever lived, no one has conferred on mankind such immense,
palpable and timelasting benefits, “—Flint. The investigations of
the present century have shown that Jenner’s belief of the identity
of small-pox in the human subject and in the cow, was correct ;
furthermore, that horses and sheep are subject to essentially the
same disease, which may be communicated from one species to the
other, or to man. The facts, as at present ascertained, are that
inoculation of the cow with small-pox virus produces in that animal
a modified form of small­pox, and that the inoculation of the human
subject again from such an animal produces a modified small­pox—
that is, vaccination. As to the importance and value of vaccination,
there can be and is no question whatsoever ; there are, it is true,
certain fanatics in England who decry the practice, because instances
occur in which the vaccination of one individual from another has
resulted in the transfer, not only of the vaccine material, but also
of a contagious disease. It should be remarked that, while such an
occurrence is possible, while indeed several well authenticated
instances are reported and acknowledged, yet this occurrence is so
rare as to be almost without significance ; thus, Auspitz reports that
only two instances of such transfer of contagious disease occurred
in 12,000,000 of vaccinations performed in Germany. It is further
evident that the exercise of proper care on the part of the physician
in the selection of the subject from whom he takes his vaccine
matter would obviate the danger ; and, furthermore, that there can
be no possibility of such transfer when the material is obtained
directly from the cow. There are, it is true, certain disadvantages
in the employment of animal virus ; the sore produced is usually
more severe and painful than that produced by human virus. On
the whole, the most desirable material is, doubtless, that obtained
by one or two transmissions from the cow, through healthy human
subjects.

Vaccination may be performed either with the fresh matter
or with the same after it has dried, or, finally, with the scab from
the arm of the human subject or from the udder of a cow. The
matter, technically called lymph, may be taken from the vesicles
from the fifth to the eighth or ninth day after vaccination. The
lymph is usually kept on ivory points, or in quills ; but, treated in  
this way, the lymph, as well as the scab from the arm, lose their
specific power in a month or so. In order to preserve this power,
the lymph has been drawn into capillary tubes and then sealed; it
has also been preserved by admixture with glycerine and water.
The best, because the surest, method consists in transferring the
lymph directly from one arm to another; in this way, too, it is
possible to inspect the source and to avoid the transfer of any con­
tagious disease. For the introduction into the system, several
methods have been used; the exact manner is not important, since
the object is to introduce the material under the skin without draw­
ing blood enough to flow. One way is to make a series of shallow
scratches, linear and transverse, with a lancet previously dipped in
the lymph ; or, such scratches can be made with a clean lancet, and
a paste made of the scab can be rubbed over the surface. Another
way is to introduce the point of the lancet, held parallel zvith the
arm, just far enough to deposit a particle of the lymph, or scab,
under the skin, but not fkj ;; ^ugh to provoke a flow of blood. The
position usually selected—on the outside of the arm—is preferable
for many reasons; not the least of which is the facility afforded for
subsequent inspection of the scar in after years. It is desirable to
vaccinate at two or three points so as to afford a greater chance for
success. The age at which vaccination should be first performed
may, of course, vary somewhat with circumstances. If the child
be in good health, the vaccination may be made in the third month
of life ; if there be especial danger of exposure to small­pox, the
vaccination may be made even earlier; under these conditions, too,
slight indisposition on the part of the child should not be per­
mitted to postpone this act of protection. The period during
which a single vaccination affords protection against small-pox
varies extremely. Instances are known in which, after a single
successful vaccination in early life, the individual has remained in­
susceptible to the disease, as well as to subsequent vaccination ;
on the other hand, cases are known in which small-pox has been
contracted within three or four years after vaccination. Generally
speaking, it may be advisable to attempt a revaccination at periods
not greater than five years ; in cases of unusual exposure to small­
pox—as during epidemics of this disease—this period may be
abbreviated. Some physicians submit themselves to vaccination
every year, usually without success, though occasionally the vac­
cination will quite unexpectedly “ take. “ It is evident that noth- 
ing is to be lost, though much may be gained, by vaccination at
comparatively short periods. It is also important that the vaccin­
ation should be intrusted to a competent person. Although so
simple an operation, it requires, nevertheless, considerable skill to
insert the material under the skin without causing the flow of so
much blood as to wash away the lymph. Then, again, the quality
of the virus is all important, and should be vouched for by a relia­
ble person. Much of the dissatisfaction consequent upon vaccina­
tion, doubtless, results from the fact either that the operation was
improperly performed, or that the material used was not of the
proper quality.

On the third day after vaccination (the operation being
usually performed on the arm near the insertion of the deltoid
muscle) red points, slightly elevated—that is, small papules—are
apparent at the spots where the vaccine virus was inserted. On
the fourth day the papules are more developed and reddened.
On the fifth day vesicles are discovered. The vesicles increase,
presenting an umbilicated appearance, and on the eighth day they
attain their full development, being elevated from two to three
lines, and measuring one-third of an inch in diameter. The
vesicles, like those of small­pox, are multilocular (flattened at the
summits), and contain a transparent viscid liquid, called the vaccine
lymph. On the seventh or eighth day a red areola is apparent,
extending from one to three inches around the pocks, increasing in
redness until the ninth or tenth day, and the contents of the vesi­
cles become more or less purulent. At this time there is usually
slight fever, with some local pain and itching ; the vessels of the
arm become swollen, and the glands in the arm­pit may become
enlarged and tender. On the tenth or eleventh day the fever
subsides, and the redness around the pocks diminishes. A dark
spot soon appears on the center, and gradually extends over the
whole of the pocks. The pustules dry up, and by the fifteenth
day they are converted into black, hard scabs, which fall off,
usually, by the twenty-fifth day from the date of the vaccination.
During the progress of the vaccine affection, vesicles, having the
distinctive characters of cow-pox, have sometimes been observed
on other parts of the body. It is probable that these are caused
by the patient scratching the vesicles on the arm, and carrying
thereto lymph containing the virus, on the finger nails, to parts
where, owing to abrasions of the skin, self-vaccination is the result  
Experiments show that between the fourth and the ninth or tenth
day, the characteristic vesicles may be multiplied at will, by
revaccinating with lymph from the vesicles produced by the
primary vaccination. Permanent scars denote the situation of
the vaccine pocks. The scar, provided the vesicles have pursued
a regular course, and subsequent ulceration has not occurred, is
characteristic, presenting a series of depressions, or pits, each of
which represents the site of one of the cells composing a vaccine
vesicle. “—Flint.

Several of these features are important, as indicating a success­
ful vaccination, and constitute a permanent record of the operation.
Thus, on the fourth day, there should be a small, red elevation;
this should become a vesicle on the fifth day and depressed in the
center — ttmbilicated—on the tenth or eleventh day. The scabs
should not fall off before the eighteenth or twentieth day. The
separation of the scar into compartments is also an important
feature. There is a prevalent belief among physicians, supported
by certain observations, that the security against small-pox is
increased by several inoculations at the same time; in other words,
that the protection increases with the number of the vesicles formed
up to four or five. Simon reports that of nearly 6,000 cases of
small-pox contracted after vaccination, the mortality among those
who asserted that they had been vaccinated, but who could exhibit
no scar, was 21 ¾ per cent.; among those with one scar, 7*^ per
cent.; among those with two scars, 4 per cent.; among those
with three scars, 1 ^ per cent.; among those with four or more
scars, ¾’ per cent. It is a prevalent belief among physicians
that vaccination affords briefer security against small-pox now­
adays than was the case eighty years ago; and it is supposed
that the explanation of the fact lies in the general use of humanized
virus—that is, virus which has passed through several human sub­
jects since leaving the cow, and has been thereby somewhat weak­
ened. This belief has led to a general employment of animal virus,
and the establishment of numerous depots for this material. That
vaccination should become the universal practice is unquestionable;
though there may be individuals who, though unvaccinated, have
never contracted small­pox, yet there are also individuals who
escape cholera and yellow fever. The security of a few does not
alter the fact that the vast majority are susceptible, and that protec­
tion is afforded by vaccination. 

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