1494 



COSMOPOLITAN FEVERS 



Lanolated lymph, not being sterile, is more apt to contain a large number 

 of micro-organisms. Dried lymph has been placed upon the market, and 

 is now on trial on a large scale. 



In vaccinating natives the left arm should be used about the middle, and 

 not near the shoulder. --^ 



Vaccinia. — The only modifications in vaccinia between the Native and the 

 European is the difference produced by the colour of the skin, and the greater 

 risk of septic sequelae; therefore the area of skin should be carefully cleansed 

 before being utilized for vaccination. 



The slight redness and swelling due to the scratches disappear in twenty- 

 four hours, while the papules appear on the third to fourth day, and are 

 succeeded by the vesicles, which become umbilicated pustules about the 

 eighth to ninth day. These quickly begin to dry in the centre and form 

 a scab, which falls off about the fourteenth to twenty-first day and leaves 

 a scar. 



VACCINATION RASHES. 



Generalized Vaccinia. — This eruption is rare, but has been reported upon 

 in natives by Hill and Ross in Natal, and by Chalmers and Archibald in the 

 Anglo-Egyptian Sudan, It appears some twelve to twenty- two days after 

 vaccination, associated with fever, in the form of a generalized papular rash, 

 which as a rule comes out during several days. The papules form vesicles 

 which become umbilicated, and then the case resembles closely a very mild 

 attack of varioloid. The vesicles pass on to pustules, and these to scabs, 

 which eventually leave small depressed scars. 



Fig. 68i. — Generalized Vaccinia, 



In a typical case the rash appears twelve to twenty- two days after vaccina- 

 tion, requires some six days to reach its full development, and another eight 

 days to decline to the stage when the scabs are thrown off and the patient 

 is convalescent. 



Localized Gangrenous Vaccinia. — Fortunately this is a very rare disease, 

 but has been met in the tropics by Chalmers and Archibald. It occurs in 

 cases in which no reasonable precaution has been omitted to guard against 

 septicity in the performance of the vaccination, and, indeed, there may be 



