456 SEROTHERAPY 



particles, is made into a smooth emulsion with a glycerin solution. It 

 is usually marketed in capillary tubes or as glycerinated points. 



Vaccination against small-pox is the most thoroughly tried and prob- 

 ably the most efficient method available for immunization against an in- 

 fectious disease. There is no better substantiated fact in medicine than 

 that vaccination protects against variola. In return for an inconvenience 

 of a few days, protection for years is given. The length of the protection 

 varies with individuals, but attacks of the disease long after full immunity 

 has passed are much milder than in the unvaccinated. 



Infants should be vaccinated during the first months of life (except 

 in the presence of eczema or marasmus), at school age and every seventh 

 year thereafter or oftener if small-pox is present in the community. Ex- 

 cessively sore arms, formerly due to high bacterial content of the virus 

 at times, are now due usually to vaccination by scarification with the 

 formation of a large crust, to the use of vaccination shields or to lack of 

 appropriate after-care. 



The skin of the upper arm at the insertion of the deltoid or other suit- 

 able site should be cleansed with soap and water or with ether. The 

 glycerinated virus should be placed on the skin, which may be drawn taut 

 by grasping the arm beneath, and with a needle or other sterile instrument 

 one incision made through it an inch long parallel with the arm and pene- 

 trating to the papillary layer, but preferably not drawing blood. The 

 lymph may be rubbed into the incision with a smooth sterile instrument. 

 No other incision or cross-scratching should be made unless there will be no 

 opportunity for re vaccination; in such cases similar single incisions may 

 be made on either side of the first and at least an inch away. The vac- 

 cination site should dry for a half hour before being covered with clothing. 

 The arm must be kept clean, dressed aseptically when the vesicle appears, 

 and, when pustulation ensues, treated antiseptically. No dressing should 

 be allowed to remain on the arm more than two days. Vaccination is a 

 surgical procedure and is worthy not only of the painstaking asepsis of -a 

 skilled physician at the operation, but of this intelligent after-care as 

 well. 



ANTIRABIC VACCINE. Antirabic vaccine or antirabic virus is the 

 virus of rabies rendered practically non-virulent for man by passage 

 through a long series of rabbits and treated in various ways to decrease the 

 infectivity still further. The method commonly in use in the United 

 States is that of Pasteur as modified by the Hygienic Laboratory, Public 

 Health Service: The spinal cords of the infected rabbits are dried over 

 caustic potash at constant temperature for one to eight days, then cut 

 into 0.5 cm. pieces and preserved in glycerin. For use, one of these 

 pieces is emulsified in physiological saline solution and injected into the 

 subcutaneous tissue of the anterior abdominal wall. Injections are con- 

 tinued daily for twenty-one days. Other methods of treating the virus 



