National Vaccine Establishment < 311 



tient from whom the lymph is to be taken should be present, 

 and the lymph should be transferred from the one to the other. 



Vaccination is generally performed in the arm near the 

 insertion of the deltoid muscle ; but in order to hide the 

 scar, and in adults who are likely to use the arm much, it 

 may be adviseable to vaccinate the outside of the leg, a little 

 above or below the knee. 



The skin being stretched, a lancet charged with vaccine 

 lymph should be held with its flat surface to the skin; and 

 the point insinuated slantingly through the cuticle till it 

 touches the cutis. It should be retained there for a few 

 seconds. 



The lancet should be dipped in water and wiped after each 

 operation, even when several successive inoculations are to 

 be performed. 



Dry lymph on glass may be moistened with a very little 

 cold or tep>id water on the point of a lancet, allowing it 

 some time to dissolve, and blending it by a little friction 

 with the lancet. It must not be much diluted, but of a 

 thick consistence : it is to be inserted in the same manner 

 as the recent fluid. 



When quills, ivory lancets, or toothpicks charged with 

 dry lymph are used, the lymph should not be diluted ; but 

 a puncture having been first made with a common lancet, 

 the point of the instrument is to be inserted, and held in 

 the puncture half a minute or more, that the lymph may 

 gradually dissolve and remain in the wound. If the part of 

 the instrument which is charged be afterwards wiped re- 

 peatedly upon the edges of the puncture, it will tend still 

 further to ensure success. 



Vaccinated patients must 'be cautious not to wear tight 

 sleeves, nor to injure the vesicle by pressure, friction, or 

 any other violence; lest considerable inflammation or ul- 

 ceration should ensue. 



One perfect vaccine vesicle is sufficient ; but. for various 

 reasons it is always prudent to make two or three punc- 

 tures, especially when the danger or receiving the small-pox 

 is imminent, the lymph dry, or the patient's residence di- 

 stant. Besides, greater securitv is obtained against a chance 

 of failure from the derangement or destruction of one ve- 

 sicle by accidental injury, or by the taking of lymph for 

 vaccination. When two punctures are to be made m oue 

 limb, they should be at least two inches asunder, on ac- 

 count of the irritation they may occasion. 



One vesicle should be always permitted to go through its 

 course without being punctured. 



Lancets for vaccination should be kept clean and bright. 

 U 4 Constitutional 



