506 PROCEEDINGS OP SECTION H. 



the disease was remarkable. I therefore examined her myself, 

 and I found in the usual position on the upi^er arm one oval, 

 indistinct scar, entirely wanting in foveolation, and having a very 

 ill-defined edge. She knew nothing about its history ; and from 

 the objective signs alone it was impossible to ascribe it to vac- 

 cination. How was the case to be classified ? I communicated 

 with the patient's mother, and she replied " that she thought her 

 daughter had been vaccinated." Then, and then only (to my 

 mind), it seemed just to conclude from all the circumstances 

 together — the position of the scar, its faint resemblance to a 

 vaccine scar, the verbal evidence of the mother — that the patient 

 probably had been vaccinated. Another test applied itself at the 

 outset of this necessarily careful and systematic observation of 

 alleged vaccine scars. As an Englishman accustomed to have 

 shown him as vaccine scars always two, three, or more cicatrices 

 in a particular situation, and arranged there with uniformity of 

 figure, I found it extremely puzzling at first to pronounce to my 

 own satisfaction — thatis to say from the objective signs — onsolitary 

 scars pointed out on several unusual parts of the body ; on the 

 leg, the thigh, the forearm, the abdomen, and even the back of 

 the hand or foot. In fine, I am not at present ready to admit 

 that a scar can be certainly attributed to vaccination by exami- 

 nation of the objective signs alone. I am prepared to find that 

 perfectly typical cicatrices can thus be diagnosed ; but as yet I 

 have not, I feel, examined with a sufficiently critical eye a 

 sufficient number of scars undoubtedly otherwise produced and 

 more or less closely resembling vaccine scars. I arrive, however, at 

 this important conclusion : That in a very large proportion of cases 

 the question — Has this person been vaccinated at all ? can be 

 answered only with the assistance of such indirect evidence as 

 position and a verbal statement affiDrd. But if the answer be in 

 the affirmative, it is not difficult to classify by character cicatrices 

 thus admitted to be due to vaccination. The essential charac- 

 eristic of a scar known to be due to vaccination is, I believe, its 

 foveolation ; neither recently nor in former years have I had 

 sufficient experience of the radiated variety to say anything 

 about that. It is rare. Now, I believe that all scars may 

 and should be divided into only two classes ; " good " and 

 "bad." I do not for the present purpose admit Marson's rather 

 dubious term " indifferent." If after consideration it seems 

 that the subject has really been vaccinated, then if there is 

 anything characteristic about the cicatrix at all — and that I 

 submit practically means if there is any foveolation at all — I 

 classify it as a " good " scar ; for I believe that a more or less 

 foveolated scar alone constitutes evidence of a vaccinia which has 

 run a tolerably normal course, which may be relied upon therefore 

 for the production of some constitutional protective change. These 

 are broad lines of judgment, and they are so designedly. A 



