SMALLPOX. 323 



These findings have been confirmed, but the bacterial origin 

 of vaccine and smallpox is doubted by many investiga- 

 tors. 



Vaccination : It is advisable to vaccinate at least once in 

 every seven years, and oftener in case of an epidemic of 

 smallpox. Unless smallpox is epidemic, it is not necessary 

 to vaccinate an infant at the time of its birth. Neither is it 

 desirable to vaccinate babies during the first or even second 

 summer of their existence. On the whole, it is better not to 

 vaccinate the infant until it has passed through the periods 

 of stress which it must encounter during its first years of 

 life. In case of a smallpox epidemic, however, the child 

 should be vaccinated immediately. 



The usual site for vaccination in boys is the skin over the 

 insertion of the deltoid muscle of the left arm. In girls, for 

 aesthetic reasons, the skin on the back of the calf, or on the 

 inner side of the thigh near the knee, is chosen. Other 

 portions of the body may be selected. Some one has pro- 

 posed to vaccinate over the epigastrium, because that part of 

 the body is more easily protected from injury. 



In performing a vaccination, we should keep in mind that 

 it is a surgical operation, and that the strictest antiseptic pre- 

 cautions should be observed. Everything the site of vac- 

 cination, the hands of the operator, and the instrument used 

 should be thoroughly cleansed and disinfected. Unfortu- 

 nately, vaccination is too often looked upon as a trivial pro- 

 cedure. It is done in a hurry, and without regard for either 

 asepsis or antisepsis. Most, if not all, of the disastrous 

 results which follow vaccination can be ascribed to improper 

 methods and carelessness. It is customary to blame the vac- 

 cine, but more often it is the fault of the vaccinator. 



After everything is ready the sldn is scarified. This scari- 

 fication may be done with the vaccine point (a barbarous 

 method) ; a sterilized needle ; or a special scarifier ; but the 

 best results are obtained with a sharp scalpel. 



The scalpel can be sterilized or disinfected each time it is 

 used, and it does not cause so much pain as either the needle 

 or the other scarifiers. The vaccination can be done more 

 accurately, because the pressure on the scalpel can be regu- 



