VACCINATION. 



of ivory, (Viaped like the tooth of a comb, and properly 

 pointed, are the moll convenient inilruments ; and to render 

 them more certain, they fliould be charged repeatedly. 



In order to preferve lymph for a long period, the beft 

 method is by two bits of fquare glafs. The lymph is to 

 be received on the centre of one of them, by applying it to 

 a pundtured veficle. When fully charged and dry, it is 

 to be covered with another bit of glafs of the fame fize, 

 and wrapped up in paper or in gold-beater's flcin. 



In whichever way the lymph is taken, it (hould be allowed 

 to dry without heat, in the fhade, and be kept in a dry and 

 cool place. When inclofed in a letter, if great care is not 

 taken, it may be injured by the heat of the melted wax in 

 fealing the packet. 



The Mode of Vacciimling. — Liquid lymph is better than 

 dry, becaufe it feldomer fails, and the operation is more 

 lightly and quickly performed. Therefore in every inftance, 

 where it is prafticable, the patient from whom the lymph 

 is to be taken fliould be prefent, and the lymph fhould be 

 transferred immediately from him to the perfon who is to 

 be inoculated. 



Vaccination is generally performed in the arm, near the 

 infertion of the deltoid mufcle ; but in order to hide the fear, 

 and in adults who are likely to ufe the arm much, it may 

 be advifeable to vaccinate the outfide of the leg, a little 

 above or below the knee. 



The lancet being charged, the flcin (hould be ftretched, 

 and a fmall fuperficial pundlure made with the pomt of 

 the lancet, held nearly in a horizontal diredlion. 



The lancet fhould be dipped in water and wiped after 

 each operation, even when feveral fucceflive inoculations are 

 to be performed. 



Dry lymph on glafs may be moiflened with a very little 

 cold, or tepid water, on a point of a lancet, allowing it fome 

 time to dilTolve, and blending it by a little friftion with the 

 lancet. It muil not be much diluted, but ought to have a 

 a thick confiftence ; it is to be inferted in the fame manner 

 as the recent fluid. 



When quills, ivory lancets, or tooth-picks charged with 

 dry lymph are ufed, the lymph fhould not be diluted, but 

 a punfture having been firfl made with a common lancet, 

 the point of the inflrument is to be inferted, and held in 

 the punfture half a minute or more, that the lymph may 

 gradually diffolve and remain in the wound. If the part of 

 the inftrument which is charged be afterwards wiped re- 

 peatedly upon the edges of the pundlure, it will tend ftill 

 farther to enfure fuccefs. 



Vaccinated patients mufl be cautioned not to wear 

 tight fleeves, nor to injure the vcficle by preffure, friftion, 

 or any other violence, left inflammation or ulceration fhould 

 enfue. 



One perfeft vaccine veficle is fufficient ; but for various 

 reafons it may often be prudent to make two or three punc- 

 tures, efpecially when the danger of receiving the fmall-pox 

 !S imminent, the lymph dry, or the patient's refidence diftant. 

 Befides, greater fecurity is obtained againft a chance of 

 tailure from the derangement or deftrudlion of one veficle 

 by accidental injury, or by the taking of matter for vac- 

 cination. When two punftures are to be made in one limb, 

 they fhould be at leall two inches afunder, on account of 

 the irritation they may occafion. And one of them (hould 

 be always permitted to go through its courfe undifturbed. 

 Lancets for vaccination fhould be kept clean and bright. 



Conjlitullonal Symptoms Conftitutional fymptoms fome- 



times occur at a very early period, but more commonly 

 from the feventh to the eleventh day. Thefe are drowiinefs, 

 reftlefsnefs, a chillinefs fucceeded by heat, thirft, head-ache, 



and other marks of febrile affedlion. Now and then fick- 

 nefs or vomiting takes places, efpecially in infants. 



The conftitutional fymptoms are in general flight and 

 tranfient, and fuch as require no remedy. 



In a great proportion of cafes, there is no perceptible 

 indifpofition ; neverthelefs, the perlon vaccinated is not 

 the lefs fecure from the future infeflion of the fmaU-pox, 

 provided the progrefs of the veficle has been regular and 

 complete. 



Care fhould be taken not to confound the fymptoms of 

 other difeafes with thofe produced by vaccine inoculation. 



Meilical Treatment. — In general, no medicine is required in 

 this mild afleftion ; but if the fymptoms happen to run a 

 little higher than uiual, the fame remedies are to be applied, 

 as if they proceeded from any other caufe. 



No preparatory medicines are necelTary before vaccinat- 

 ing, and commonly no cathartics need be given afterwards. 



Should the local inflammation exceed the ufual bounds, 

 which rarely happens, unlefs from tight fleeves, preffure, or 

 friftion, it may foon be checked by the frequent applica- 

 tion of compreffcs of linen dipped in water, in aqua lithar- 

 gyri acetati compofita, or in a folution of one drachm of 

 cerufla acetata in a pint of water. Thefe are to be applied 

 cold. 



If the fcab be rubbed off prematurely, and ulceration take 

 place, cooling and aftringent applications may be ufed ; fuch 

 as a drop of aqua lithargyri acetati, which fhould be allowed 

 to dry on the part, and then be covered with compreffes 

 dipped in water, or in either of the preparations of lead above- 

 mentioned, and frequently renewed. 



When the ulceration is deep or extenfive, a poultice either 

 of bread and milk, or of bread with any of the preparations of 

 lead, may be applied, as the cafe feems to require. They 

 mull never be applied till they are nearly or quite cold. 



In fuch foul and obftinate fores as refift the foregoing ap- 

 plications, the unguentum hydrargyri nitrati, mixed with an 

 equal quantity of unguentum cerse, or other fimilar applica- 

 tions, may fometimes be reforted to with advantage. And 

 at other times, thefe fores may be healed with the unguentum 

 ceruffas acetata;, or the mildeft appUcations. 



The irregular veficles and puftules are frequently followed 

 by ulceration at an early period, and this ulceration is to be 

 treated in the fame manner, as if it proceeded from the regu- 

 lar veficle. 



When the patient has been previoufly expofed to the 

 infcftion of fmall-pox, this difeafe will be either fuperfeded 

 or not, according to the time which may have elapfed before 

 vaccination. 



Ohjerniattons on the occajional Incjficacy of Vaccination. — 

 When the vaccine veficle pofleffes the above -defcribed cha- 

 racfers, and pafles through the regular gradations, whether 

 accompanied with any perceptible diforder of the conftitu- 

 tion or not, it effeftually and permanently fecures the indi- 

 vidual from the danger, and almoft univerfally from the con- 

 tagion of the fmall-pox. 



It is now nearly twenty years fmce the firft promulgation 

 of Dr. Jenner's difcovery ; and yet the truth of the preced- 

 ing obfervation remains unimpeached. As a well-informed 

 phyfician has remarked, the very exceptions to this ftate- 

 ment may be faid, without a folecifm, to corroborate it. 

 For, in the very fmall number of cafes, (fuch as that of the 

 fon of earl Grofvenor), where an extenfive eruption of fmall- 

 pox has occurred fubfequently to vaccination, the controlling 

 influence of the cow-pox has been invariably and ftrikingly 

 manifefted, by the fudden interruption of the fmall-pox 

 in the middle of its courfe, and the rapid convalefcence of 

 the patient. See Bateman's Synopiis, p. 2i6. 



With 



