VACCINA. 611 



through an incision, there is an elongated depression along the middle 

 of the oval pock. The changes that occur at the point of vaccination, 

 in persons whose susceptibility to vaccina is diminished, are very varied. 

 They always take place sooner, and run then* course more rapidly, than 

 in normal vaccina. In some cases we see nodules, or wart-like swell- 

 ings, surrounded by a dark-red and infiltrated areola, which either do 

 not develop further, or else change to vesicles, whose contents quickly 

 dry up. In other cases, on the reddened and infiltrated spots we see 

 no efflorescence ; in still other cases, there is a furuncular inflammation 

 of the skin, resulting in superficial ulceration. To determine, in 

 any case, whether this inflammation be modified vaccina, we would 

 have to vaccinate a child, who has not yet been vaccinated, with the 

 products. 



SYMPTOMS AND COUESE. Regarding the symptoms and course of 

 normal vaccina, a short description may suffice. There is no premoni- 

 tory stage. In the eruptive stage, the anatomical changes in the skin, 

 above described, are the only symptoms of the disease. In the stage 

 of maturation the inflammation causes severe tense pains, and hinders 

 motion of the affected arm. The lymphatic glands in the axilla often 

 swell. Sometimes an eruption, resembling lichen, or eczema, instead 

 of the pock eruption, appears in the vicinity of the vaccina pustule and 

 at other parts of the body. While fever never occurs at the com- 

 mencement of vaccina, the stage of maturation is always accompanied 

 by a secondary fever. In incomplete, modified vaccina, the inflamma- 

 tion of the skin sometimes causes insupportable itching, sometimes 

 tense or burning pain. From numerous measurements of temperature, 

 I have satisfied myself that the patients have a fever which is not at 

 all in proportion to the intensity and extent of the dermatitis. Where 

 the local symptoms were very slight, I have noticed a temperature of 

 104. But, from the less extent of the dermatitis, the fever never be- 

 comes so high as in variola ; it can only prove dangerous to very weakly 

 children, and even then only in rare caes. It is rare also for danger- 

 ous erysipelatous or pseudo-erysipelatous inflammation of the arm to 

 occur during the stage of maturation. 



TREATMENT. In the following paragraphs we have to treat not so 

 much of a cure of vaccina, as of conducting the disease to a proper 

 termination. The most important rules to follow, in vaccinating, are : 

 1. To take the lymph from a healthy child, who has not previously 

 been vaccinated. Little as we believe in the transfer of dyscrasias by 

 vaccination, we still consider it foolhardy and improper to make use- 

 aess experiments- as to whether this view is correct. Experience shows 

 that the lymph taken from the vesicles of revaccinated persons ia 

 much less certain to produce normal pocks than that taken from pe^- 



