324 ACUTE EXANTHEMATA. 



lated by the vaccinator. The sharp edge of the scalpel is 

 passed gently to and fro over the skin until the tops of the 

 papilla in the skin begin to appear. The scarification is cov- 

 ered with the oozing serum, but no blood is drawn. The 

 method is absolutely painless in fact, it is accompanied by a 

 rather pleasant sensation. It is not necessary to make a deep 

 gash or a number of scratches that draw blood, because those 

 vaccinations usually do not take. No blood should ever be 

 drawn, as it hinders absorption of the lymph, i. e., vaccine. 

 The flow of blood does not permit of entrance of the lymph, 

 and when the blood coagulates it forms an effectual barrier to 

 the entrance of the lymph into the lymph-channels. 



The scarification, when properly performed^ is then covered 

 with a very thin layer of serum, and into this the ivory point 

 is gently rubbed, after having first been dipped into warm 

 water, until all the lymph on the point is rubbed off. 



If the capillary tube is used, the ends are broken and the 

 contents of the tube blown on the scarified area and rubbed 

 in with the scalpel ; or even this is not necessary, as the glyc- 

 erinized lymph is rapidly absorbed. The serum remains on 

 the wound for a long time afterward, even after all the lymph 

 has been taken up by the lymph-vessels : so that when the 

 moisture persists the scarification can be covered with a piece 

 of sterile absorbent cotton ; or a vaccination shield can be 

 applied, and over this a dressing. The wound should be 

 protected from infection, and for this reason it is well to keep 

 a protective dressing on until it has healed. 



It is not necessary to scarify a large area, because a vacci- 

 nation will take just as well in a small spot as in one the size 

 of a silver dollar. It is not necessary to have the "taking" 

 ot the vaccination accompanied by terrific suffering because 

 of a large abraded surface. A scarification about one-quarter 

 of an inch square suffices. 



In from one to three days a small red papule appears. 

 This is followed by a vesicle, and this by a pustule which is 

 surrounded by a bright-red areola. All the stages of a typi- 

 cal variolous eruption are represented in this vaccination area. 

 Ordinarily only slight constitutional symptoms follow a vac- 

 cination, but occasionally there may be high temperature, 



