VACCINATION. 788 VACCINATION. of every 1000 children who had evidence of vacci- nation, only 1.78 on an average had any such traces: and with regard to the quality and amount of the vaccination, it was found that, of children having four or more cicatrices, only 0.62 ])er 1000 had any trace of smallpox.; while of those who had a single bad mark, 19 per 1000 were scarred by smallpox. Jlarson, of Lon- don, learned from the study of more than 15.000 cases at the smallpox hospital, that while the unvaceinated died at the rate of 37 per cent., the vaccinated have died at the rate of only 6Ti per cent., the mortality among those with four or more scars being only 0.55, while that among those with only a single scar was 7.7.3 per cent.: so that, while the average risk which vaccinated persons run if they do catch smallpox is about 1-6 of the risk run by unvaceinated persons, well-vaccinated per.sons run less than 1-70 part of the risk. Dr. S. ^Y. Abbott, of the Massachusetts Board of Health, states that in 1721 nearly 8 per cent, of the population of Boston died of smallpox. From 1800 to 1.S40 vaccination limited the disea.se so far that not over 20 deaths resulted from smallpox in that time. Relaxation of the vacci- nation law in 1836 led to a larger death rate in 1839 to 1841, when 232 died from the disease in Boston. Thej'e Avere no deaths from variola in that city in 1886 or 1895. The control or eradi- cation of the disease, as the statistics show, bears an exact proportion to the thoroughness of vac- cination and revaceination. The preceding table, taken from T)ic ijelboiirne Argus, shows very ett'ectively the conditions in Prussia, Holland, and Austria. Technique akd CornsE of Vaccination. Virus for vaccination should be procured from well-developed typical vaccine pocks on the abdo- men of a healtliy young heifer, while they are still in the vesicular stage. The virus may be received upon ivory points or split quills. An- other method consists in removing the whole vesicle entire by scraping it from the imder- lying coriuni with a spoon, and rubbing this mass with glycerin. The resulting emulsion of pulp is much more active than the dried lymph upon quills. In making use of it, after the per- son to be vaccinated has taken a bath, the arm or leg chosen for the place of inoculation is washed with carbolic or salicylated cotton, and then with sterile water. Two or three shallow scarifications are made with as many crossing them, the surgeon cutting as deeply as the derma without necessarily drawing blood. After the lymphatic fluid begins to flow from the.se in-- cisions the vaccine virus is worked into the in- cisions with the point of the knife or with a very small sterile wooden spatula. After drying thoroughly, the surface is covered with a layer of borated or salicylated cotton, which is to re- main on for three days. In the course of 3 to 7 days elevated papules appear, oval or oblong, over the scarifications. These papules are firm, hot, and tender. They are surrounded by a red halo or areola. About the fifth day after their appearance they become vesicles, containing clear fluid, which is' vaccine lymph. When human- ized virus was used, this was taken from the patient to be used in inoculating another case. Tliese vesicles are called Jenner's vesicles, and somewhat resemble the vesicles of smallpox. Like them, also, they shrink and become unibilicated after the seventh or ninth day: the halo grows darker; pus takes the place of the lymph; pain, itching, swelling, and heat are troublesome. A general fever may be experienced on the fifth day with rapid pulse, rarely slight nausea, and very rarely general malaise. About the ninth or tenth day the pustule dries, and a crust forms. The areola fades. The axillary glands enlarge early at this time and arc tender and pain- ful on pressure. Children's symptoms are more pronounced than those of adults. They are fret- ful, tlieir sleep is broken and their appetite diminished. They have fever, headache, pains in the back, and rarely nausea. The temperature during vaccinia reaches 102.5° F., and rarely runs higher. The crust separates from the arm in 14 days. If the crust be detached by scratch- ing or the chafing of the clothing a second one forms. In all cases scrupulous care must be exercised lest the wound become infected with germs in dust or clothing, or under finger-nails. Serious consequences follow such infection. The wound may be infected with erysipelas, or gan- grenous inflammation may set in, causing a very large ulcer. These are not the results of the vaccination, but of subsequent infection; and the same results are often seen following any scratch with a needle or an abrasion upon the hand. Danger op Vaccination. There is no danger in proper vaccination, if infection is avoided thereafter. AU inflammatory reaction beyond that described as occurring in the course of regu- lar vaccinia is due to the introduction of micro- organisms by means of dirty instruments or through the admission of dust. There is abso- lutely no danger of transmitting disease by means of bovine virus. When humanized virus was used there was some danger of transinoculat- ing with syphilis or tuberculosis. Yet this danger was remote, for Councilman is authority for the statement that in the whole histoiy of smallpox there have been collected records of only 50 cases of the conveyance of syphilis through vaccination, with about 700 cases of re- transference of the disease. When these figures are compared with the millions of vaccinations performed, the danger may be correctly computed. CoMPfLSOKY Laws. Xaturally. vaccination, in order to protect, nmst be universal. All foci from which the disease might spread must be destroyed, and immunity must be secured round about each focus. Every child should be vac- cinated during its first year, and all adults sliould be vaccinated on entering the country, unless presenting sufficient evidence of success- ful protection previously. Several years after •Tenner's discovery, public interest was aroused to a complete understanding of the necessity of compulsory vaccination. Bavaria established a law making vaccination compulsory in 1807. Other States of the North German Confedera- tion followed, and between 1815 and 1832 simi- lar .statutes were enacted in Oldenlnirg. Baden, 'iirtteniberg, Saxe-Gotha, Saxe-Meiningen, and Brunswick. Austria in 1801 made vaccination compulsory for school children, but not generally so till 1886. In 1816 Prussia also enacted an indirectly compulsory law. Sweden's compulsory
