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 EDWARD JENNER, M. D., LL. D., F. R. S., &c. 
 
VARIOLA 
 
 AND 
 
 VACCINIA. 
 
 History and Description. 
 
 Hints Relating to the Propagation of Vaccine Virus. 
 
 Certain Anomalies in the Course of the 
 
 Vaccine Disease. 
 
 WITH ILLUSTRATIONS. 
 
 ISSUED BV 
 
 THE NEW ENGLAND VACCINE COMPANY, 
 
 294 Broadway, Chelsea Station, 
 
 boston, mass. 
 
 wm. c. cutler, m. d. j. f. frisbie, m. d. 
 
 copyrighted. 
 
//Vf 
 
VARIOLA. 
 
 NO definite knowledge of the origin of the destructive 
 plague, small-pox, has been discovered bv writers 
 on the subject, but histories and traditions of East- 
 ern nations, especiall}^ of China and Hindostan, refer its 
 commencement to a remote period before the Christian era. 
 ]\Iost authorities place the date of its appearance in Egypt 
 about A. D. 544, although it is believed by some writers 
 that Philo, a Jewish philosopher, mentioned it in a work 
 on the Ivife of IMoses, written in the first centurv. It 
 spread into x'Ysia and Africa during the sixth and seventli 
 centuries, and into the countries of Europe in the ninth 
 and tenth centuries. The Spaniards carried it into Cuba 
 and San Domingo soon after the discover}^ of America. 
 It raged in Mexico in 1527, its victims numbering millions. 
 From that date it graduall}- extended over the whole 
 American continent. 
 
 The first accurate and scientific description of the 
 disease came from Rhazes, a celebrated Arabian phj^sician, 
 A. D. 925-926. Records of historians and travellers from 
 the earliest ages teem with dismal details of the destruc- 
 tion of human life bj- this contagion. Its aAvful visitations 
 seem to have been common throughout the world. 
 
 The annual mortality from small-pox in England is 
 said to have averaged about three thousand to each million 
 of inhabitants. 
 
 In France thirty thousand victims perished each year. 
 
 In the Russian Empire it is reported to have been so 
 malignant as to have cut off two millions of inhabitants in 
 a single year. 
 
During the years from 1783 to 1799, inclusive, one- 
 tenth of the entire death-rate of Berlin was from this 
 disease alone. 
 
 Dr. Lettsom, of London, calculated that in Europe, 
 annually, two hundred and ten thousand beings were by 
 this means deprived of life. 
 
 In Ceylon its appearance caused whole villages to be 
 abandoned. 
 
 More than one hundred thousand Indians were 
 destroyed by it in one year in the province of Quito, 
 South America. 
 
 It was no respecter of persons. Kingdoms and 
 empires were thrown into confusion by the death of 
 crowned heads. Among its royal victims history mentions 
 five descendants of Charles I., of Great Britain, viz. : 
 Henr}^, Duke of Gloucester; Mary, wife of the Prince of 
 Orange and mother of William III. ; Charles, Duke of 
 Cambridge, in 1677 ; Mary, Queen of England and wife of 
 William III., in 1694; and the Princess Mary Louisa in 
 1712. Also five descendants of Louis XIV., of France, 
 and in the same period Joseph I., Emperor of Germany, 
 in 1711; Peter II., Emperor of Russia, in 1730; a queen 
 of Sweden in 1741 ; Henry, Prince of Prussia, 1767; 
 Maximilian Joseph, Elector of Bavaria, in 1777. 
 
 Macaula}^, the English historian, did not exaggerate 
 when he called the disease "the most terrible of all the 
 ministers of death," and said, in describing its ravages in 
 the seventeenth century, "Small-pox was alwaj^s present, 
 filling the churchyard with corpses, leaving on those 
 whose lives it spared the hideous traces of its power," for 
 two-thirds of the pauper blind in England were made so 
 by this cause. 
 
Dr. Cyrus Hdson, Chief Inspector of Contagious 
 Diseases, New York Health Department, in his Annual 
 Report of 1S90, saj's: "Small-pox is fatal to a very large 
 proportion of those whom it attacks. It kills from thirty 
 to forty per cent, of its victims. It has been described 
 with great accuracy by very early writers ; nevertheless, 
 its history previous to the seventeenth centurj^ is obscure, 
 and must be regarded as defective on account of its having 
 been confounded with measles and other forms of eruptive 
 disease. 
 
 " During the seventeenth and eighteenth centuries not 
 a decade passed without an occurrence of fearful epidemics 
 of small-pox. In England from seven to nine per cent, of 
 all the deaths were due to it. It was one of the most 
 destructive diseases, attacking, as it did, persons in everjr 
 station in life. 
 
 " During the sixteenth century, in Alexico, 3,500,000 
 persons died of small-pox. In 1734 nearly two-thirds of 
 the population of Greenland were swept away by an 
 epidemic of the disease; and in Iceland 18,000 persons 
 died out of a population of 50,000. 
 
 " Its ravages among savage nations are not less disas- 
 trous than among the civilized. Whole tribes have been 
 exterminated. Washington Irving and other writers have 
 graphically described the horrors it wrought among our 
 North American Indians. 
 
 " One of the most vivid pen-pictures of the devastation 
 wrought by small-pox before the introduction of vaccina- 
 tion is given by Professor Wernher, in his work entitled 
 'Zur Impffrage.' It is as follows 
 
 " ' Before the introduction of vaccination small-pox had 
 become a permanent disease Avhich never entirel}^ ceased 
 
in any one year, and every three or five years became a 
 great epidemic. 
 
 " 'In non-epidemic years one-tenth of all mortality was 
 from variola ; in epidemic years, one-half. 
 
 " ' Very few men escaped small-pox till old age ; almost 
 every one sickened at least once in his life of this horrible, 
 murderous disease. 
 
 " ' Countless mortals were maimed by loss of sight. 
 Of new-born children one-third died of small -pox 
 before their first year; one-half before their fifth year 
 of life. 
 
 " ' There was no family which had not heavy losses to 
 deplore. 
 
 " ' In the country the mortality was greater than it was 
 in the city. 
 
 "'Physicians and government possessed no means 
 against this abominable evil. Isolation was impracticable, 
 from the wide-spread nature of the disease. Men accepted 
 the pest as an unavoidable fate. 
 
 " 'The loss which Europe suffered from this one disease 
 amounted to many millions. It was the principal factor 
 which deterred or kept back the population from progress ; 
 and to lead us back to these conditions are the efforts of 
 many ignorant mortals directed.' 
 
 " Comparing the present conditions with those just 
 stated, the author goes on to say: 
 
 " ' We now find no child mortality among vaccinated 
 children. Also among adults, whenever vaccination and 
 revaccination are maintained, mortality from small-pox is 
 at an end,' 
 
 "The following table is compiled from the 'Report of 
 the Epidemological Society of London,' and shows the 
 
mortality from small-pox during periods before and after 
 the introduction of vaccination. The periods are not in 
 each case the same, but they are those of which it was 
 possible to obtain reliable information. 
 
 APPROXIMATE AVERAGE ANNUAL DEATH-RATE BY SMALL-POX 
 
 PER MILLION. 
 
 Period Rei^ative to 
 WHICH Data are Given. 
 
 Country or City. 
 
 Before 
 Vaccina- 
 tion. 
 
 After 
 Vaccina- 
 tion. 
 
 1777-1806 and 1807-1850. 
 
 Lower Austria, 
 
 2,484 
 
 340 
 
 1776-1780 and 1810-1850. 
 
 Prussia, Eastern, 
 
 3.321 
 
 56 
 
 1780 and 1810-1850. 
 
 Prussia, Western, 
 
 2,272 
 
 356. 
 
 1781-1805 and 1810-1850. 
 
 Berlin, 
 
 3,422 
 
 176 
 
 1774-1801 and 1810-1850. 
 
 Sweden, 
 
 2,050 
 
 15S 
 
 "In the table, of which the foregoing is a part, twenty-one 
 other cities or States are given, each of which shows the 
 same remarkable reduction. I would call your attention 
 particularly to Berlin. The death-rate from small-pox 
 there was 3,422 per million living inhabitants during the 
 twenty-four years before the introduction of vaccination, 
 and 176 per million in the forty years after that time. 
 
 " In the city of New York the following table, compiled 
 from the yearly records of the Health Department, shows 
 the death-rate from small-pox from 1869 to 1888, inclusive: 
 
DEATHS FROM SMALL-POX. 
 
 Year. 
 
 DUATHS. 
 
 Population. 
 
 Ratjj per 
 
 100,000. 
 
 Year. 
 
 Deaths. 
 
 Population. 
 
 Rate Per. 
 100,000. 
 
 1869 
 
 203 
 
 927,728 
 
 21.90 
 
 18S0 
 
 31 
 
 1,206,299 
 
 2.57 
 
 1870 
 
 805 
 
 942,292 
 
 31.08 
 
 1881 
 
 453 
 
 1,242,533 
 
 33-30 
 
 1871 
 
 805 
 
 954,636 
 
 84.32 
 
 1882 
 
 259 
 
 1,279,560 
 
 20.34 
 
 1872 
 
 929 
 
 967,142 
 
 96.16 
 
 1 1883 
 
 12 
 
 1,317,691 
 
 0.91 
 
 1873 
 
 117 
 
 979,811 
 
 11.94 
 
 i 1884 
 
 
 
 1,356,958 
 
 0.00 
 
 1874 
 
 484 
 
 992,646 
 
 48.75 
 
 1885 
 
 26 
 
 1,397,395 
 
 1.86 
 
 1875 
 
 1,280 
 
 1,041,886 
 
 122.85 
 
 1886 
 
 31 
 
 1,439,037 
 
 2.15 
 
 1876 
 
 315 
 
 1,072,934 
 
 29.36 
 
 1 1887 
 
 99 
 
 1,481,920 
 
 6.68 
 
 1877 
 
 14 
 
 1,104,907 
 
 1.27 
 
 1888 
 
 81 
 
 1,526,081 
 
 5-31 
 
 1878 
 
 2 
 
 1,137,833 
 
 0.18 
 
 ; 1889 
 
 I 
 
 
 
 1879 
 
 25 
 
 1,171,740 
 
 2.13 
 
 1890 
 
 
 
 
 
 "The results of the work of the Vaccination Corps did 
 not become apparent until 1876. 
 
 "The death-rate from small-pox previous to 1876 was 
 59.57 per 100,000. Since that year it has been only 8.38 
 per 100,000. 
 
 "In Paris, where vaccination is not energetically en- 
 forced, the death-rate from small-pox ranges from 136 to 
 10. 1 per 100,000 inhabitants. 
 
 "In the principal German cities, where vaccination laws 
 are enforced with rigor, the death-rate from small-pox is 
 1.44 per 100,000 inhabitants. 
 
 "In London, where compulsory vaccination is rigidly 
 enforced, the death-rate from small-pox is only 0.6 per 
 100,000. 
 
 " In the Canton of Zurich, Switzerland, since the com- 
 pulsory vaccination law was repealed, the mortality from 
 small-pox has risen from 8 to 85 per 100,000 inhabitants. 
 
 "When small-pox prevails in a community where some 
 
are protected by vaccination and others are not, the in- 
 fluence of vaccination is strikingl}' exhibited. 
 
 "In observations shown for twenty-one A^ears on 4,000,000 
 people in Bohemia, it was discovered that the death-rate 
 among vaccinated persons, in whom the protected power 
 had diminished b}^ reason of age, was 5 1-16 per cent., 
 while among those who had never been vaccinated it was 
 29 4-5 per cent. Illustrations of this kind could be multi- 
 plied, as almost countless authentic statistics exist. 
 
 "In New York the first question asked by the Inspector 
 of Contagious Diseases of a person sick with a doubtful 
 case of small-pox is, 'When were you successfully vaccin- 
 ated ? ' And if the answer indicates it was done a period 
 of five or six years before, the disease is believed not to 
 be small-pox. 
 
 "During over nine 3'ears of service in the Health Depart- 
 ment of New York I have never seen a case of small-pox 
 in a person who had been vaccinated successfully' within 
 five years, and the number of cases I have seen mount 
 into hundreds. 
 
 "During that period, I have seen only one Inspector of 
 Contagious Diseases contract small-pox, and he was the 
 only Inspector who disbelieved in vaccination, and refused 
 to have it performed on himself." 
 
 INOCULATED VARIOLA. 
 
 From a very early period in the history of small-pox, 
 inoculation had been extensively performed in Eastern 
 countries, particularly in China, India and Turkey, and 
 in 1722 the practice was adopted in England and America. 
 
 To mitigate the loss of life and contagious effects of a 
 
disease so generally feared because of its malignity, many 
 individuals, in the hope of gaining securit}' against future 
 attacks, submitted to inoculation, which produced the 
 malady in a less severe form. 
 
 The virus from small-pox was introduced into the 
 circulation through the skin, this process resulting in a 
 comparatively mild form of the disease. It proved to be a 
 benefit to those inoculated, but a constant source of conta- 
 gion was established. Small-pox propagated in this 
 manner convej^ed infection to such an extent that the 
 general mortality was greater than before the practice 
 was known. 
 
 In 1840 an Act of Parliament was passed, rendering 
 small-pox inoculation unlawful in England. 
 
 In many of the older towns in New England, the ruins 
 of hospitals, for the isolation and inoculation of small-pox 
 can be seen to-day. 
 
 MEASLES. 
 
 Among the eruptive diseases most similar in their 
 early stages to variola, the correct differential diagnosis of 
 which has often puzzled men of experience, may be 
 mentioned measles, varicella, and, in rare cases, the 
 papular form of secondarj^ sj^philis. This last, however, 
 is of so infrequent appearance and is attended with so 
 slight general fever that little need be said of it. 
 
 In measles, each erythematous patch will be found to 
 cover a larger area than variola. A case of variola with 
 erythema as extensive as is seen in measles would be 
 attended with a temperature as high as 104 or 105, with 
 pulse correspondingly high, while in measles the tempera- 
 
II 
 
 ture seldom rises above loi or 102. In measles the 
 catarrhal symptoms, sneezing, increased lachrymal secre- 
 tions, suffused conjunctivse, and an obstinate cough, 
 precede the eruption, or appear at the same time. So 
 important a symptom is the cough, that it is often said 
 that an eruption having the appearance of measles should 
 not be diagnosed as that disease if the cough is not 
 present. In variola this symptom is usually absent, or 
 may appear at a later stage of the disease. In measles 
 the eruption pales and begins to fade on the second or 
 third day. In variola it becomes intensified, with a slowly 
 forming vesicle in its centre. 
 
 VARIOLA AND VARICELLA. 
 
 The following extract from the writings of Dr. John D. 
 Fisher, of Boston, gives an admirable comparative descrip- 
 tion of the two diseases. 
 
 "In most cases the chicken-pox is, by the experienced 
 observer, easily and readily distinguished from the small- 
 pox. When, however, the former is extraordinarily violent, 
 and the latter unusually mild, the distinguishing marks 
 are obscure, and the two diseases are therefore frequent!}- 
 confounded. To render the distinctions as clear as possible, 
 the more prominent symptoms of the two diseases are here 
 contrasted with each other. 
 
 " In small-pox the fever is ushered in hy a cold stage, is 
 severe and continues three or four days, and if it declines 
 or ceases during the eruptive process, it commonlv reap- 
 pears during the suppurative stage, or between the fifth 
 and eighth day of the eruption. 
 
 " In chicken-pox the fever is not often preceded by a cold 
 
VARICELLA. 
 Third Day of the Eruption. 
 
^ 
 
 VARIOLA. 
 Third Day of the Eruption. 
 
14 
 
 Stage, is uniformly light and is frequently insensible; it 
 seldom continues more than two days and never reappears 
 after it has once ceased. When, however, the vesicles 
 appear in successive crops the fever lasts longer and rages 
 until the eruption is completed. 
 
 "In small-pox the eruption is often preceded or accom- 
 panied by an erysipelatous efflorescence. 
 
 " In chicken-pox this efflorescence does not take place. 
 
 "In small-pox the eruption does not break out until the 
 third or fourth day of the fever; it appears first on the 
 face, then on the neck, chest, trunk and extremities, and 
 is completed in the course of two days. 
 
 " In chicken-pox the eruption breaks out by the termi- 
 nation of the first or on the second, and almost invariably 
 before the end of the third day of the fever; it usually 
 appears first about the breast and shoulders, afterwards 
 on the face and extremities. It often, however, follows a 
 different order, and is never so uniform in the method of 
 its invasion as the eruption of the small-pox ; it frequently 
 appears in successive crops for four or five days. 
 
 "In small-pox the eruption presents itself in the form 
 of small red circular points or papulae; these are hard, 
 resisting and movable, and communicate to the finger a 
 shot-like sensation. They scarcely project above the 
 surface, but are easily and distinctly felt by drawing the 
 finger over them. 
 
 "In chicken-pox the eruption likewise breaks out in 
 small inflamed spots, but these are not papular in their 
 origin, and are not exactly circular, but tend to an oblong 
 figure. They may be distinctly felt by the finger, but 
 they are yielding under it and are destitute of the tuber- 
 
VARIOLA. 
 Fourth Day of the Eruption. 
 
i6 
 
 cular hardness and rolling motion which characterize the 
 variolous eruption at the same period, 
 
 "In small-pox the eruption seldom becomes vesicular 
 before the end of the second or the commencement of the 
 third day, and the vesicles are confined to the summits of 
 the pocks. 
 
 "In chicken-pox the eruption is vesicular from the 
 beginning, or from the early part of the first day, and 
 by the second day the whole surface of the pocks are 
 converted into vesicles which resemble little bladders of 
 transparent fluid. 
 
 "In siiiall-pox the pustules at first have acuminated 
 summits; they afterwards become rounded, and at an 
 early period present slight depressions in the centre of 
 their surfaces. 
 
 "In chicken-pox the vesicles are usually lenticular in 
 form, but are sometimes conoidal or globate, and preserve 
 one shape through their course, or until they become 
 ruptured. 
 
 " In small-pox the eruption is situated in the substance 
 of the cutis, as has been proved by dissection, and as is 
 evident from the sensation which the pustules communi- 
 cate to the finger. 
 
 "In chicken-pox the vesicles are not formed in the 
 true skin, but are situated upon its surface in the cellular 
 tissue between the skin and cutis. 
 
 "In small-pox the pustules after they have become 
 vesicular are distinguished by hard, unyielding bases. 
 
 "In chicken-pox the vesicles are destitute of such 
 tubercular bases. The}^ are yielding and easil}^ give way 
 under pressure, and communicate to the finger a soft, 
 elastic sensation, or a feeling similar to that which a 
 
1^ 
 
 ir 
 
 i 
 
 VARIOLA. 
 Fifth Day of the Eruption. 
 
minute globule of fine sponge softened with water would 
 give rise to when pressed. 
 
 " In small-pox the pustules are composed of little cells, 
 all of which, however, communicate with each other; and 
 the cuticular coverings of the pocks are opaque, tough and 
 not easily broken. 
 
 "In chicken-pox the vesicles are composed of a single 
 cavity, and the coverings are extremely thin and fragile, 
 are diaphanous and are very easily broken. 
 
 "In sniall-pox the pustules are, at an early stage, 
 filled with a serous secretion ; this after a time becomes 
 converted into a purulent matter that exhales a very 
 unpleasant and peculiar odor. 
 
 "In chickenpox the vesicles contain, when fully 
 matured, only a whitish, transparent and serous fluid ; 
 this never, except through accident, becomes pus, and is 
 destitute of any ungrateful odor. 
 
 " In smallpox the pustules remain whole till they 
 are six or seven days old, when some of them commonly 
 become ruptured, and permit a little of the virus to ooze 
 out upon their surface; but they still retain their form 
 and prominency. 
 
 " In chickenpox the vesicles often become broken in 
 two or three days after their appearance, and permit the 
 whole of their contents to escape. Their coverings then 
 sink down and collapse, and the vesicles become flattened 
 and lose their original form. ■ 
 
 "In s7nall-pox the pustules . break out simultaneously, 
 pursue a regular march and arrive at maturity at about 
 the same time. 
 
 " In chicken-pox the vesicles generally break out in 
 successive crops for a number of days, in which case a 
 
VARIOLA. 
 Sixth Day of the Eruption. 
 
20 
 
 great variety may be observed among them; some are 
 appearing, whilst others are fully formed, shrivelled or 
 crusted. 
 
 " In small-pox desiccation does not commence till about 
 the eighth day from the appearance of the eruption. 
 
 " In chicken-pox when the vesicles run their course 
 without bursting, desiccation commences in them as early 
 as the fifth day of their age, but it always begins as soon 
 as the vesicles are ruptured, and consequently it more 
 usually commences on the third or fourth day, and some- 
 times as early as the second day after they appear. 
 
 " In small-pox the processes of eruption, of suppuration 
 and of desiccation constitute three successive periods, 
 rendered distinct from each other by their duration; the 
 first occupies about three days and the other two about 
 five days each. 
 
 "In chicken-pox these three periods seem to be 
 confounded in consequence of the pocks appearing in 
 successive crops, and even when they are distinguishable, 
 the sum of their duration seldom exceeds eight days. 
 
 " In small-pox the scabs fall off in a single piece. 
 
 "In chicken-pox the scabs do not usually fall off in a 
 single piece, but in small fragments of different forms and 
 sizes. 
 
 "The small-pox even when distinct and of moderate 
 mildness, is a disease of fifteen or twenty days in duration, 
 and it often proves fatal. 
 
 "The chicken-pox^ on the contrary, runs its course and 
 is completed in five or six days, or in eight or ten at most, 
 and it never, of itself, proves fatal. 
 
 "The distinctions between the chicken-pox and the 
 varioloid disease, or the small-pox in its modified form, are 
 
VARIOLA. 
 Seventh Day of the Eruption. 
 
less striking, and less easily recognized. The following 
 peculiarities, however, may generally be observed in the 
 two diseases, and will, in most cases, lead to a correct 
 discrimination. 
 
 "The chicken-pox^ as has already been stated, is 
 distinguished by the eruptive fever being generally light. 
 
 "In the varioloid disease the precursory fever is com- 
 monly sharp and of several da3's' duration. 
 
 "In chicken-pox the eruption appears in the form of 
 vesicles, or it is vesicular, at least, from an early period 
 of the first da3^ 
 
 "In the varioloid disease the eruption is always papular 
 in its origin, and seldom becomes vesicular before the 
 second or third day. It appears all at once and seldom 
 breaks out in successive crops. The pocks are, in the first 
 instance, elevated on solid tubercular bases, and their tops 
 are resisting and not easil}^ broken. The eruption, as in 
 the unmodified variola, is formed in the substance of the 
 true skin, as is evident from the hard and elevated bases 
 which remain after the lymph is removed from the pustules 
 by puncture and pressure, and by the kernels or tubercular 
 elevations which remain in the skin after the scabs have 
 fallen off. The pocks from their first formation are hard 
 and unyielding, and are movable and rolling under the 
 finger. 
 
 "To these distinguishing characteristics, all of which 
 have been noticed by various writers, the author would add 
 the following: 
 
 "In chicken-pox^ if, during the first day of the eruption, 
 the parts on which it exists be embraced with the thumb 
 and finger and gently distended by them; or if a single 
 finger be drawn over them with a force just suf&cient to 
 
VARIOLA. 
 Eighth Day of the Eruption. 
 
24 
 
 cause the little rugae of tlie cuticle to become smootli, the 
 inflamed spots, in which form the vesicles first present 
 themselves, readily disappear and leave no discoloration or 
 induration in the skin. 
 
 "In the varioloid disease^ if a like distention of the 
 parts occupied by the eruption be made at the same date, 
 the inflamed spots disappear less readily and, even when 
 the distending force is sufficiently great to make them 
 disappear, a dim discoloration can be perceived and a 
 distinct shot-like hardness may be felt at the points upon 
 which they were planted. 
 
 "In chicken-pox the scars left in the skin after desqua- 
 mation are destitute of any peculiar hardness, and are, in 
 the space of a few days, entirely erased. 
 
 " In the varioloid disease the eruption, for a considerable 
 time after the scabs have fallen, leaves little kernels, or 
 tubercular elevations, in the skin. The varioloid disease 
 has the power of communicating the unmodified and 
 modified small-pox." 
 
 In addition to a careful study of these distinguishing 
 features, the physician should as'^ertain if the patient has 
 been successfully vaccinated within five years; if so, the 
 probability is in favor of varicella, particularly if the 
 subject is a child, as varicella rarely affects an adult. 
 
 As an aid to the physician in making his diagnosis of 
 variola, the photographs shown may be valuable, as 
 they are the only known photographs of this disease in 
 existence. 
 
VARIOLA. 
 Tenth Day of the Eruption. 
 
 J 
 
VARIOLA. 
 Eleventh Day of the Eruption. 
 
VARIOLA. 
 Eleventh Day of the Eruption. 
 
 Actual size of the pustules. 
 
28 
 
 VACCINIA, 
 
 In 1798, Edward Jenner, M. D., F. R. S., a surgical 
 practitioner of Berkeley, Gloucestershire, England, in a 
 pamphlet entitled "xVn Inquiry into the Causes and Effects 
 of the Variolas Vaccina," made known to the world the 
 discoveries, investigations and experiments which he had 
 heen conducting for twenty j^ears, in the hope of proving 
 theories the successful practice of which would secure 
 immunit}^ from this pestilence without endangering life. 
 He had observed that the dair^- folk in that section of the 
 countr}^ were generallj^ exempt from small-pcx, and, from 
 the casual remarks of a milker, had learned that this was 
 supposed to be due to the fact that man}' of them had 
 accidentally contracted cow-pox from "sores en the cows' 
 teats,'' and, in this wa}-, became insusceptible to the 
 contagion of small-pox. Experiments proved the correct- 
 ness of this theorj^, for in two 3^ears Jenner inoculated 
 over six thousand subjects with the virus of cow-pox, and 
 those persons were afterward exposed to small-pox without 
 ■effect. 
 
 Vaccinia, or cow-pox, is a specific eruptive disease 
 which occurs as the result of transmission among young 
 cows and milch heifers. It was by no means uncommon, 
 and after attention was called to it by Jenner, the disease 
 was known to have existed in at least eighteen counties in 
 England. There are recorded discoveries of cow-pox in 
 the cow in other European countries, and in South 
 America, Asia and Russia. In 1809 it was said to have 
 been observed bj- ph^-sicians in Massachusetts and Connect- 
 icut. In many cases, stocks wxre raised from these and 
 passed more or less into general use, but in America the 
 Jenncrian stock was all that could be depended upon. 
 
29 
 
 Dr. Samuel A. Green, the able historian of the Massa- 
 chusetts Medical Society, in his centennial address, has 
 given the following valuable information in regard to the 
 early history of vaccination in this country. "The pro- 
 tective power of vaccination was discovered in England by 
 Edward Jenner, near the end of the last century, and the 
 news of its discovery was soon brought to this country. 
 Among the first persons here, and perhaps the first, whose 
 critical attention was called to its importance, was Dr. 
 Benjamin Waterhouse, of Cambridge, an early Fellow of 
 this Society. Its introduction, like that of variolous inocu- 
 lation, was destined to meet with many difficulties and 
 obstacles, and Dr. Waterhouse was to be the champion. 
 He wrote much as an advocate of the cause, and, against 
 popular ridicule and prejudice, he succeeded in carrying 
 the day. A communication, signed with his initials and 
 dated at Cambridge, March 12, is found in the Columbian 
 Ccntinel oi March 16, 1799. It is headed, 'Something 
 Curious in the Medical Line,' and is the first account of 
 vaccination that was given to the public in this country, 
 
 "He printed the account in a newspaper in order to 
 excite ' the attention of our dairy farmers to such a 
 distemper among their cows,' and to inform the profession 
 generally of this security against small-pox. Massachu- 
 setts was the first colou}^ to introduce small-pox inoculation, 
 and she was also the first State to adopt kine-pox vaccina- 
 tion. During the summer and autumn of 1802, some 
 interesting experiments were conducted under the direction 
 of the Boston Board of Health, whose unremitting exertions 
 at that time, to prevent contagious diseases, entitle them to 
 the highest praise. The Board fitted up a hospital on 
 Noddle's Island, now known as East Boston, and invited a 
 
30 
 
 number of physicians to co-operate with them in an under- 
 taking to diffuse knowledge and dispel prejudice in regard 
 to vaccination. 
 
 Some bold experiments were tried at this hospital, and 
 fortunately all were successful. On August i6, nineteen 
 boys were vaccinated, and all passed through the regular 
 stages of the cow-pox; and on November 9th, twelve of 
 these children, together with the son of Dr. Bartlett, who 
 had previously had the cow-pox, were inoculated for the 
 small-pox, with matter taken from a patient in the most 
 infectious state of the disease, and no trouble whatever 
 followed. They had, moreover, been exposed to infection, 
 most of them for twenty days, by being in the same room 
 with the two lads who had the small-pox; and all nineteen 
 escaped. These and other facts are given in a report which 
 was made and signed by eleven physicians, James Lloyd 
 and Benjamin Waterhouse appearing at the head of the 
 list. A full and official account of the whole affair is found 
 in the Columbian Centinel^ Dec. 18, 1802." 
 
 Vaccination, as originally practised by Jenner, was 
 performed with the cow-pox lymph direct from the animal 
 on a few selected cases only, the humanized vaccine virus 
 so produced being subsequently transmitted from one 
 person to another, through many generations. In this 
 arm-to-arm vaccination, the lymph probably passed through 
 millions of human systems, and very naturally the efficacy 
 decreased, owing to its continued use for over seventy 
 years. 
 
 The marked increase in mortality from small-pox among 
 the vaccinated seemed to indicate that repeated human 
 transmissions had so deteriorated the old Jennerian stock 
 as to render it of little value as a prophylactic. The 
 
consequences might have been disastrous to the cause, had 
 not new cases of vaccinia been opportunely discovered. 
 
 In April, 1866, a case of cow-pox occurred in Beaugency, 
 France, which, by transmission through successive heifers, 
 was perpetuated by the French government, with the aid 
 of the French Academy of Medicine. Four years later, in 
 1870, this stock was brought to America by Dr. Henry A. 
 Martin, of Boston. 
 
 Among dairy herds in this country, the development of 
 an occasional case of vaccinia is not rare at the present 
 time and has not been for the last fifteen or twenty years. 
 The prevalence of this disease has become more noticeable 
 in later years on account of infection from the mature 
 heifers and milch cows frequently vaccinated by propa- 
 gators. There is great difficulty in preventing the spread- 
 ing of cow-pox among unvaccinated animals that come in 
 contact with the vaccinated. Were it not for the most 
 scrupulous care on the part of the vaccinators, a large 
 proportion of animals would leave the operating rooms 
 with well-developed pustules upon their udders, thus 
 furnishing a ready means of infecting, through the medium 
 of the milkers' hands, the various herds among which they 
 may be distributed. 
 
 Many propagators have announced the discovery of 
 entirely new stocks of lymph purporting to be from spon- 
 taneous cases. The spontaneous nature of cow-pox is 
 doubted by the best observers and writers of the present 
 day, therefore, it remains an open question whether all 
 these so-called spontaneous cases did not originate from 
 infected animals sent out from the operating rooms of 
 propagators. Taking this view of the subject, it becomes 
 evident that the only existing stock of lymph now in use 
 
32 
 
 in this country is, by hereditary descent, still the Beau- 
 gency, which was imported in 1870. Suffice it to say, 
 experience in all recent epidemics of small-pox has proved 
 the efficacy of this stock as a prophylactic, as no case of 
 variola following a recent vaccination or re-vaccination has 
 been reported for several j^ears. 
 
 The discoveries of Jenner, his experiments, the use of 
 the S(? -called Jennerian lymph for a period of nearly 
 seventy years, the development of the Beaugency stock 
 and its important service in the epidemics of the past 
 twenty-seven years, are familiar to all practitioners of 
 medicine. 
 
 That vaccination is the only preventive of small-pox, 
 very few at this time doubt. 
 
 That small-pox may, as an exception to the rule, attack 
 a well vaccinated person, all must admit ; for it is a matter 
 of medical history, often repeated, that small-pox may 
 attack a person twice and sometimes thrice. Many 
 eminent observers, before and since the discovery of 
 vaccination, have noted recurrent cases of small-pox. 
 Jenner alludes to the death of Louis XV. from a second 
 attack of the disease. 
 
 An interesting case was observed in the small-pox 
 hospital in Boston in 1875. A patient, who, while conva- 
 lescing, was temporarily filling the position of nurse, 
 became a victim a second time, and proceeded regularly 
 through the disease, all the stages being just as severe 
 as at first. On recovering, he was again exposed, and 
 contracted the disease, making a series of three attacks in 
 the course of eight months. 
 
 A similar case is noted as having occurred in a small- 
 pox hospital in San Francisco in 1S76. 
 
33 
 
 These, and many other cases, lead to the conclusion 
 that small-pox occurs after vaccination no more frequently 
 than the disease is repeated in the same individual. It 
 should be remembered, however, that at the present time 
 the opportunities for observing instances of small-pox 
 following vaccination are greater, for the reason that a 
 large proportion of the population have been vaccinated, 
 while but a limited number have had small-pox. 
 
 There exists in the system of all persons, to a greater 
 or less degree, an undefined element-principle, which may 
 be called pabulum, upon which the disease germ of small- 
 pox subsists. All the protection known to science consists 
 in the destruction and elimination of this pabulum. The 
 vaccine germ, as well as the germ of variola, subsists upon 
 this and consumes it. It is evident that in many persons 
 pabulum is slowly reproduced, in others, rapidly. The 
 primary, infantile vaccination of some individuals con- 
 tinues to protect them through life. This seems peculiar 
 to whole families, while others respond, in some degree, to 
 vaccinia or variola, as frequently as once in ten years. 
 Such persons should be vaccinated at least every five 
 years. 
 
 GROWTH OF THE VACCINE VESICLE. 
 
 In primary vaccinations, running a normal course, a 
 slight papular elevation will be observed about the third 
 day after the insertion of the vaccine lymph. In excep- 
 tional cases it may be seen on the evening of the second 
 day. On the fourth or fifth, and, in rare cases, the sixth 
 day, it becomes a distinct vesicle of a pearly color, with 
 edges a little elevated, and by the eighth day it has 
 
34 
 
 attained its height and is filled with clear lymph, its 
 elevated margin and depressed centre being more marked. 
 About this time the commencement of umbilication, due 
 to the drying of the lymph contained in the central cells, 
 is observed. The areola, or pink circle around the vesicle, 
 begins to be more prominent and continues to extend for 
 two or three days, being attended by more or less indura- 
 tion and swelling of the axillary glands. When the 
 areola is at its height, the constitutional symptoms, fever, 
 headache and backache, are more or less severe. After 
 the tenth day, the areola begins to fade, and by the four- 
 teenth, a hard, brown scab has formed, w^hich, if left to 
 mature, falls from the twentieth to the twenty-seventh day, 
 leaving, in many cases, a depressed, foveolated scar, 
 having small pits, or apparent pin-holes, in its centre. 
 The pitted scar does not always exist. The areola and 
 constitutional symptoms are the only sure conditions 
 warranting a favorable decision. This is the usual course 
 of a normal vaccination. Should, however, the action of 
 the lymph be delayed even until the eighth day, before 
 any sign of vesication takes place, and then go regularly 
 through its course, it does not change the protective nature 
 of the vaccination. Many deviations from the normal 
 course of the vaccine disease may occur. 
 
 It is well to note- that secondary vaccinations seldom 
 run a uniform course of development. The stages are 
 usually of shorter duration. Local irritation often com- 
 mences within twenty-four hours after the initial operation, 
 the subject feels ill at this early date, and by the fifth day 
 the topical inflammation and constitutional sj^mptoms have 
 entirely disappeared. The same variation will be noticed 
 in varioloid, as distinguished from variola, the former 
 
35 
 
 running through its entire course, to the falling of the 
 crusts, in half the time required for the latter. 
 
 It is not unusual for the areola accompanying a vacci- 
 nation to extend far below the elbow and even to the wrist, 
 giving rise to the often reported instances of erysipelas. 
 Many of the older vaccinators called this erysipelas, but 
 according to later observations, the constitutional symp- 
 toms of that disease, such as rigors, rapid pulse and high 
 temperature, are not found present. Therefore, the 
 conclusion that the case is simply intensified areola and 
 nothing more should be formed. 
 
 True erysipelas will, in a certain very small proportion 
 of cases, follow vaccination, regardless of the purity of the 
 lymph used, or the care the surgeon may have taken in 
 applying it. The history of vaccination has always 
 furnished reports of such cases. If this complication 
 arises within twenty-four hours from the time the lymph 
 is inserted, it may reasonably be attributed to septic 
 germs introduced into the circulation with the lymph ; if 
 later in the course of development, it must be attributed 
 to atmospheric germs entering after the vaccination. 
 
 Vaccine roseola and lichen are so often seen in the 
 practice of all physicians that it is unnecessary to describe 
 them. 
 
 Vaccine exanthema, or general eruption, is either 
 erythematous, lichenoid, or vesicular in form, and is 
 recognized by all experienced vaccinators, but it has often 
 puzzled young physicians, and caused apprehensions of 
 approaching variola, blood-poisoning, or other frightful 
 results of the use of vaccine virus, described in newspapers 
 by the opponents of vaccination. 
 
 These erythematous eruptions, which are likely to 
 
VACCINE ROSEOLA. 
 
 Appearing on the ninth, tenth or eleventh day after vaccination. 
 
VACCINE ERYTHEMA OR DISTRIBUTED AREOLA. 
 
 Appearing: on the eleventh day after vaccination and disappearing on the thirteenth. 
 
38 
 
 appear on, or about, the ninth, tenth, or eleventh day, and 
 continue from two to three days, may be called distributed 
 areolae, and should be classed with the general constitu- 
 tional sj-mptoms of the vaccine disease. When the areola 
 is extensive and at its height, it becomes, by reason of its 
 intensit}^, diffused or distributed over a portion of the 
 cutaneous surface, or over the entire body. This erythema 
 always subsides gradually, together with the local areola. 
 It may attend the normal course of the vaccine disease. 
 
 Another apparent deviation in the course of the vaccine 
 vesicle is often seen in cases of intense inflammation, 
 resulting in ulceration, man}- times indolent and slow in 
 healing. 
 
 This condition is, no doubt, governed largely by the 
 extent of the cutaneous surface upon which the vaccine 
 lymph is applied. An extended, broad pustule is always 
 attended with more or less topical inflammation, which, in 
 many cases, leads to sloughing. When the Ij^mph used is 
 plentifully^ supplied wdth vaccine germs, in other words^ 
 when it is very active, it will invariably' produce a confluent 
 vesicle, W'hich may naturally be attended with intense 
 inflammation and increased local temperature, sometimes 
 resulting in a destruction of the surrounding tissues. The 
 same condition follows, in many cases, a confluent patch 
 of variolous eruption. It readily j'ields to mild, stimulat- 
 ing, local treatment, with due attention to cleanliness. 
 
 It is the large, confluent vesicle which alwaj'S leaves a 
 large, deep, shining scar, with none of the characteristic 
 indentations or pits so commonly mentioned as proof of a 
 perfect cicatrix. It is not conclusive that the smooth, deep, 
 shining scar may not, and does not frequently exist after 
 a good and protective vaccination. The vaccinator would 
 
39 
 
 not be warranted in pronouncing sucli a patient unpro- 
 tected; for it is certain that the areola and constitutional 
 symptoms afford the only positive evidence of perfect 
 protection. 
 
 Re-vaccination of all such cases readil^^ proves that 
 they are protected. 
 
 It appears, by the recent writings of some authors, that 
 all these deviations must be due entirely to the character 
 of the Ij^-mph introduced, but, the works of older vaccina- 
 tors show that at no time in the history of the practice of 
 vaccination has the surgeon escaped these occasional 
 results. Such developments will occur as exceptions to 
 the rule. Injury to the maturing pustule, personal idio- 
 syncrasies of the patient, and, without doubt, the use of 
 virus prolific in vaccine germs, applied over too extensive 
 a surface, are among the common causes of degenerating 
 vesicles. 
 
 Many cases of suppurating, slowly healing ulcers are 
 due wholly to an injury to the vaccine vesicle in the course 
 of its development. The removal, by accident or otherwise, 
 of any portion of the capsule, or crust, allows the injured 
 surface to become infected by the entrance of atmospheric 
 germs. 
 
 Much has been said and written concerning a certain 
 peculiar, eccentric action of animal lymph, described as 
 "raspberry mark," or "excrescence," "red papule," "nanee- 
 vus," etc. This is not a result known to modern vaccina- 
 tors alone, nor existing only in cases where animal U'mph 
 has been used, as it was well known to the earlier vac- 
 cinators, and followed the use of humanized as well as 
 bovine vaccine virus. It Avas often observed during the 
 extensive vaccinations of 1872-3. It seems to be an 
 
VACCINE VESICLES. Tenth Day. 
 
 Exact size of original scarifications shown, to illustrate tiiat tiie extent of the scarified 
 
 surface governs the size of vaccine vesicles. Both vesicles produced 
 
 with the same lymph. 
 
% 
 
 m i 
 
 TYPICAL VACCINE VESICLES. 
 Tenth Day. 
 
42 
 
 exuberant granulation of the nature of Keloid, stimulated, 
 no doubt, by the application of serous fluid to the corium. 
 It is needless to say that serum does not possess vaccine 
 germs in an active condition, therefore, the results are 
 irregular and unprotective. 
 
 That septic matter may obtain admission into vaccine 
 lymph, prepared without aseptic precautions, is not ques- 
 tioned, but the cases of so-called septicaemia, which 
 commence late in the course of the vaccine disease, and 
 are sometimes reported as the result of septic matter exist- 
 ing in the lymph before it is introduced into the system, 
 are from infected vesicles, acquiring the infection from 
 atmospheric organisms, which have found their way into 
 the pustule during its incubating period. In such cases, 
 were the sepsis introduced with the lymph, septicaemia, 
 with its usual train of symptoms, rigors, high temperature, 
 gland infection, or erysipelas at the point of the local 
 wound, would develop within a few hours. 
 
 A very rare, and, to the physician, interesting, case of 
 eccentric action of animal vaccine virus occurred in a ward 
 in Boston in 1882, and since no parallel case can be found 
 in any ancient or modern writings on this subject, it seems 
 to be of suf&cient importance to merit description. 
 
 The following, from the pen of Dr. J. H. McCollom, 
 appeared in the Boston Medical and Surgical Journal of 
 October 12, 1882. 
 
 "The case about to be reported is entirely unique; the 
 record of a similar one I have been unable to find any- 
 where. Mrs. B., a healthy woman, the mother of two chil- 
 dren, was vaccinated February 13th, with bovine virus, by 
 her family physician, Dr. Harris, of Roxbury, through 
 whose kindness I saw the case, and to whom I am indebted 
 

 GENERAL VACCINIA. 
 
 Contracted through the medium of the mother's milk. 
 
44 
 
 for the following notes. On the fifth day after vaccination 
 the patient complained of headache, was feverish, and in 
 fact had the usual amount of discomfort that attends a 
 successful re -vaccination, Mrs. B. was at this time 
 nursing her infant, a child about six months old. The 
 child had not been vaccinated on account of eczema from 
 which it was suffering at that time. On March 9th, as 
 nearly as the mother can remember, an eruption appeared 
 on the head, thorax, and the legs of the child, who had 
 been feverish and irritable for two or three days previous. 
 On some portions of the body the eruption w^as confluent, 
 but on the arms and thighs it presented the characteristic 
 appearance of cow-pox. It was not an instance of acci- 
 dental inoculation, for there was no possible way by which 
 the child could have introduced the virus at so many 
 different points. The disease must have been contracted 
 from the mother through the medium of her milk. The 
 child was not very sick, although there was considerable 
 discomfort from the eruption. The drawing gives a 
 remarkabl}^ good idea of its appearance. In order to test 
 the matter more thoroughly. Dr. Cutler, of Chelsea, charged 
 a few points with the lymph, and inoculated a cow on the 
 vulva. On March 15th, I received a note from him in 
 which he sa3^s, 'I send you points taken to-day from a 
 perfect vesicle planted upon the vulva of an animal seven 
 days ago. The vesicle has an elevated base, a smooth, 
 regular, perfectly spherical margin, is not yet umbilicated, 
 and has all the characteristics of a pustule resulting from 
 a series of human transmissions. This puts bej^ond cavil 
 the question of identity in the Roxbury case.' " The final 
 proof of the accuracy of the diagnosis, namely, vaccinat- 
 ing a human being with this virus, was not attempted. 
 
45 
 
 COURSE TO BE TAKEN BY PHYSICIANS 
 WHEN VARIOLA IS DISCOVERED. 
 
 The following extract from Seaton's Handbook of 
 Vaccination treats tlie subject in a forcible and lucid 
 manner. 
 
 "No question in medical practice may be regarded as 
 more completely settled than the course which a practi- 
 tioner should take when there are persons of any age 
 whatever, unvaccinated or not otherwise protected against 
 small-pox, in a house or family in which that disease 
 breaks out. At once, and without any dela}-, the vaccina- 
 tion of all such persons should be performed; the loss of a 
 day may be the sacrifice of a life. It does not follow that 
 because a person has been exposed to the infection of 
 small-pox that he has, therefore, received the infection, and 
 the vaccination may be in time to prevent the disease 
 altogether; but supposing that before the vaccination is 
 performed, the variolous infection has actuall}^ been taken 
 up by the system (of which, of course, during the stage of 
 incubation we can know nothing ) , unless that infection have 
 so far got the start that the small-pox symptoms appear 
 before the vaccination reaches the stage of developed 
 areola, the vaccine process will either prevent or modify 
 the small-pox eruption; if, on the other hand, the variola 
 manifests itself before the vaccination has reached its 
 protective stage, its stage of areola, the vaccination, 
 though it will have done no good, will most certainly have 
 done no harm — the small-pox will simply go on as though 
 it had never been performed. Now, whether the vaccina- 
 tion shall reach the stag^e of areola or not before the small- 
 pox appears, depends entirely on the length of time which 
 
46 
 
 Tiad elapsed between the reception, by the system, of the 
 ^•ariolous poison and the performance of the vaccination. 
 As the incubative period of small-pox is twelve days, while 
 the time requisite to bring vaccination to the stage of 
 areola is only nine da3'S, vaccination performed any time 
 within the first three days will reach areola soon enough 
 to produce its protective power ; after this, whatever the 
 local success of the vaccination, no constitutional protec- 
 tion will be imparted. 
 
 "If there were only any means of ascertaining whether 
 a person exposed to small-pox infection had actually 
 received it, and, if so, at what moment this had taken 
 place, we should know exactly whether it were worth while 
 to vaccinate or not; but as no such means exist, the 
 obvious rule of practice is to assume that the poison has 
 not been inhaled, or has only recently been inhaled, and to 
 give our patient the chance. But no prudent practitioner, 
 vaccinating under these circumstances, will commit him- 
 self as to the protective value of his vaccination until he 
 has seen the areola completely formed. 
 
 "For want of knowledge or of consideration of these 
 simple facts, practitioners have repeatedly compromised 
 their credit, many lives have been lost that should have 
 been saved, and erroneous entries are daily made in our 
 death-registers. Seeing perfect vaccine vesicles on the 
 eighth day, the practitioner who was not aware of the 
 necessity of waiting for areola has promised safety, and 
 heen cruelly disappointed; his credit and the credit of 
 vaccination have equally suffered. The occurrence of 
 three or four cases together of unmodified, and perhaps 
 fatal, small-pox in persons having well-formed and com- 
 plete vaccine vesicles on their arms, has at times led the 
 
47 
 
 practitioner, not to the true explanation, viz., that his 
 vaccination in these cases has been too late, but to the 
 notion that vaccination was always useless when small-pox 
 was incubating, and even to the absurd and totally 
 unfounded supposition that it might increase the danger ; 
 so he has shut up his vaccine lancet, and children have 
 been allowed to perish from non-performance of vaccina- 
 tion, whose deaths were clearly chargeable to his error. 
 Our death-registers contain innumerable entries of deaths 
 from 'small-pox after vaccination,' which were simply cases 
 of death from small-pox in children in whom vaccination 
 was performed during the incubation of small-pox; and 
 heaps of published and other records are quite unusable 
 for any statistical purposes, because cases of this kind are 
 not distinguished from the cases in which sma^.-pox really 
 did occur in persons who had properly received the consti- 
 tutional infection of vaccination. 
 
 "The practice, which I have known at times adopted, 
 of vaccinating a person after symptoms of small-pox have 
 actually manifested themselves, is utterly absurd ; so far 
 as the patient is concerned, the effect, of course, is 7iil-, but 
 on account of the discredit it tends to bring upon vaccina- 
 tion with the public, it is a practice which should be 
 strongly discountenanced." 
 
 CULTIVATION OF VACCINE VIRUS. 
 
 Animal vaccination has been successfully practised in 
 the United States for more than twenty years, and experi- 
 ence has proved it to be the only method by which a large 
 supply of vaccine lymph, equal to the demands of a general 
 epidemic of small-pox, can be furnished. During this 
 
48 
 
 period, nearl}^ all the methods of vaccinating animals, and 
 collecting and storing vaccine h'mph, now practised in the 
 older countries, have been thoroughh^ tested, and finally 
 abandoned in this country, until now the pure h^mph taken 
 from thoroughly cleansed, open vesicles, and stored by 
 dr^nng upon ivory points, is admitted to be the safest, 
 most reliable and convenient form. 
 
 The technique of bovine vaccination b}^ different opera- 
 tors varies to such an extent, in so many essential features, 
 that space will not admit of descriptions in detail. There 
 is a wide difference of opinions as to the age of animals 
 best adapted for the cultivation of vaccine h^mph, some 
 propagators choosing nursing calves, others 3'earlings, and 
 many, mature young heifers, preferabl}^ from two to four 
 3^ears old. Ideas also vary as to the proper period for 
 opening the vaccine vesicles. It is certain, however, that, 
 in most cases, the pustules yield a much larger quantity 
 of Ij^mph after one hundred and sixtj^-eight hours of 
 incubation than when opened earlier in the course of devel- 
 opment. It ma}^ be claimed, perhaps with some degree of 
 reason, that h'mph taken twenty-four hours earlier will 
 give better results and a much larger percentage of 
 successful vaccinations, in which case one hundred, 
 and fort3^-four hours should constitute the incubating 
 period. 
 
 An operating room for the propagation of vaccine virus 
 should be arranged, as far as possible, with a view to 
 complete asepsis. The same maj^ be said of the stables in 
 which the animals are kept during the incubating period. 
 All floors, ceilings and walls should be made of non-absorp- 
 tive materials, so constructed as to admit thorough flushings 
 of boiling water and antiseptic solutions. All forms of 
 
c 
 
 a, 
 
 g 
 o 
 
 C3 
 
 c 
 
 m 
 
 a 
 O 
 
50 
 
 beddiiig for the animals should be regarded as vehicles for 
 the lodgement and cultivation of microbes. 
 
 Asepsis in the cultivation of vaccine lymph must be 
 applied to the surroundings of the animals during the 
 incubating stage of the pustules and in the operating 
 rooms, where the lymph is extracted from the vesicles and 
 stored. The product of the vesicles, after it is taken from 
 the animals, if not aseptic, cannot be sterilized nor purified 
 by any antiseptic agent, without destroying also the life of 
 the active principal of the lymph. All forms of vaccine 
 virus, except the pure exuding lymph, should be classed 
 as possibly infected matter, having remained on the animal 
 for a full week, meanwhile accumulating dust from the 
 stable and atmospheric germs. Dried lymph in the form of 
 crust has generally passed out of use in this country. The 
 quantity of this crust which exists on vaccinated animals is 
 very tempting to propagators. It enters very largely into 
 the glycerine pastes and vaccinating fluids stored in glass 
 tubes, and issued in France, Italy and Germany under 
 the name of aseptic, sterilized vaccine virus. The operators 
 lay great stress upon the sterilization of all vehicles in 
 which the lymph is stored, but the fact remains that this 
 product is that portion of the vesicle, formed from the 
 debris of broken-down tissue, cell detritus and an admix- 
 ture of pus, which has not been and cannot be sterilized. 
 
 METHODS OF VACCINATING. 
 
 Cleanliness of the cutaneous surface upon which the 
 vaccine virus is applied and of the instruments employed 
 in, making the necessary scarifications is of the utmost 
 importance. 
 
>> 
 
 c 
 
 a 
 
 E 
 
 o 
 o 
 
 > 
 c 
 
 C3 
 Ml 
 
 e 
 z 
 
The vaccinator should always avoid all forms of vacci- 
 nating instruments, or any instrument which is designed 
 for successive cases. A common sewing needle is a con- 
 venient scarifier used by many operators, one for each 
 subject. When once used, it is throAvn aside, and a new 
 one applied to the next in order. Physicians who use 
 lymph stored upon ivory lancet points will find nothing so 
 clean and convenient for the purpose of scarifying as^he 
 ivory point, and it has the advantage of always being at 
 hand. It should not be applied to more than one person. 
 
 The scarification should be on the left arm at a point 
 near the insertion of the deltoid muscle, and should be 
 just deep enough to bring into view the fine net-work of 
 capillary vessels. A little bleeding is of no consequence, 
 an excess should be avoided. 
 
 The too common practice of vaccinating the lower limbs 
 should be avoided. Vaccinations upon the leg below the 
 knee have often produced serious results. The constant 
 movement of the muscles in locomotion and the irritation 
 from the clothing serve to inflame the maturing vesicle. 
 The oedema which often attends a vaccination on the leg 
 obstructs the venous circulation and favors slow healing 
 and indolent ulceration, especially if the subject has passed 
 middle life. In such cases, similar unfavorable results 
 may follow simple abrasions of the skin or any slight 
 injury. 
 
 Many vaccinators cover the scarification and its applied 
 lymph with surgeon's plaster, but this should not be 
 countenanced, as it confines the secretions and favors 
 septic formations. 
 
 All careful physicians require their vaccinated patients 
 to return for inspection and advice on the fifth or sixth 
 
> 
 
 T3 
 C 
 s« 
 
 Ml 
 
 C 
 
54 
 
 day. Dressings, like poultices, oil, tallow, vaseline, or 
 water, tending to soften the capsule of the pustule, should 
 never be applied to an unbroken vesicle. Every application 
 or treatment which may deprive the vesicle of its natural 
 protection, the scab, serves only to prolong the healing 
 processes and furnishes a free entrance to microorganisms. 
 If, by accident or suppuration, the crust or capsule has 
 been sacrificed, then the surgeon is warranted in the use 
 of any remedy which his judgment dictates. 
 
 AGE FOR VACCINATING. 
 
 The vaccine disease is well borne by ver}" young 
 infants prior to dentition. The preferable age is from one 
 to two months. 
 
 This age was usuall}- selected bj^ the older vaccinators, 
 for the reason that the vaccine disease appears more violent 
 in proportion to the increased age of the child. 
 
 Physicians would follow the right course now, should 
 they vaccinate all infants before making their last visits 
 to convalescent mothers. 
 
 There is a growing tendency-, on the part of physicians 
 as well as of parents, to neglect vaccination until compelled 
 by school regulations. 
 
 RE-VACCINATION. 
 
 The best authorities advise re-vaccinating at puberty. 
 
 On the approach of an epidemic, or whenever a case of 
 small-pox is discovered, re-vaccination becomes imperative 
 in that locality. 
 
C 
 
Physicians, as a class, are notably exempt from small- 
 pox, although very often exposed. It is their custom to 
 re-vaccinate themselves whenever a case of variola appears 
 in their vicinity. Should this be practised by all persons, 
 an epidemic of small-pox would be unknown. 
 
 COMPULSORY VACCINATION. 
 
 To a superficial investigator, compulsory vaccination 
 may appear to be an infringement upon the personal rights 
 of an individual, but when his relations to society are such 
 that he becomes dangerous to the life and health of others, 
 he should then be considered a nuisance, and legally 
 treated as such. A law which compels vaccination reaches 
 beyond the personal question, and affects the interests of 
 the community, for every unvaccinated person contributes 
 to the material that increases great epidemics. No city 
 with a large unvaccinated population is ever safe from the 
 ravages of small-pox. 
 
 Dr. Carpenter, whose efforts in behalf of the hygienic 
 good of man have been both earnest and successful, was a 
 zealous advocate of compulsory vaccination. He main- 
 tained that it is the right and the duty of the State to act 
 for the good of the public in matters of health as well as 
 of education ; that society should be protected against 
 disease and death as well as against illiteracy. 
 
 The ef&cacy of vaccination as a preventive of small- 
 pox is doubted by no unprejudiced person. Small-pox will 
 never be blotted out of the list of existing diseases until 
 the practice of vaccination and re-vaccination is extended 
 and enforced. 
 

 ^ii ^ y V 
 
INDEX TO ILLUSTRATIONS. 
 
 Bust of Edward Jenner, frontispiece. 
 
 
 
 
 
 Varicella, third daj^ . . . . . . 12 
 
 Variola, third da^^ 
 
 
 
 
 13 
 
 " fourth day, 
 
 
 
 
 15 
 
 , " fifth day, 
 
 
 
 
 17 
 
 " sixth day, 
 
 
 
 
 19 
 
 seventh day, 
 
 
 
 
 21 
 
 " eighth day, 
 
 
 
 
 23 
 
 ' ' tenth day, 
 
 
 
 
 25 
 
 i " eleventh day, 
 
 
 
 
 26 
 
 " " " actual size, 
 
 
 
 
 27 
 
 Vaccine Roseola, 
 
 
 
 
 36 
 
 " Erj'thema, 
 
 
 
 
 37 
 
 Vesicles, tenth daj', 
 
 
 
 
 40 
 
 Typical, 
 
 
 
 
 41 
 
 General Vaccinia, 
 
 
 
 
 43 
 
 Operating Room, 
 
 
 
 
 49 
 
 Section of Stable, 
 
 
 
 
 51 
 
 Office Interior, 
 
 
 
 
 53 
 55 
 
 Caricature by Gillray . 
 
 
 
 
 57 
 
INDEX. 
 
 Histor}' of Variola, .... 
 
 Inoculated Variola, . . . . 
 
 Measles, ..... 
 
 Variola and Varicella. Comparative Description, 
 
 Vaccinia, ..... 
 
 Growth of the Vaccine Vesicle, 
 
 Vaccine Roseola, .... 
 
 Vaccine Erythema, .... 
 
 Course to be taken when Variola is Discovered, 
 
 Cultivation of Vaccine Virus, 
 
 Methods of Vaccinating, 
 
 Age for Vaccinating, 
 
 Re- Vaccination, .... 
 
 Compulsory Vaccination, 
 
 3 
 9 
 
 lO 
 
 II 
 
 28 
 
 33 
 36 
 37 
 45 
 47 
 50 
 .54 
 54 
 56 
 
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