(VACCINIA; COW-POX)
=Definition.=—=Vaccinia= is an eruptive disease of the cow,
communicable only by inoculation and causing, when transmitted to the
human being, local reaction in the form of a pock and constitutional
disturbances which are followed by a more or less lasting immunity
against smallpox. =Vaccination= is the artificial inoculation of
vaccine virus for the purpose of producing an immunity against smallpox.
Arm to arm vaccination was formerly very generally practiced but has
been practically discontinued because of the possibility of infection
from syphilis and other infections. When it is necessary to use the
human lymph it should be taken upon the eighth day from a typical
unbroken vesicle in a perfectly healthy child at least three months
old. The vesicle must be pricked at several points, care being taken
not to draw blood. The bovine vaccine lymph is now in general use
because it practically eliminates the possibility of syphilis and other
infections. Also because it is more easily transported.
It is thought best by many authorities to vaccinate in infancy
after the sixth month, at the seventh and eighth year, at puberty,
and thereafter at intervals of about seven years, but depending
considerably on the prevalence of small pox. The virus is prepared
under sterile conditions from carefully selected and tested calves. It
is put up under aseptic conditions in hermetically sealed capillary
tubes or, in the old style, on ivory points.
There is a great variety of opinions as to the efficacy of vaccination
in producing immunity against small pox, this variety of opinion being
very prevalent among representatives of the medical schools. Dr. F.
P. Millard of Toronto says the lymphatic system is the keynote, and
that vaccine virus poisoning spreads through the lymphatics, causing
diphtheria and allied throat affections. Dr. A. T. Still said, “We are
opposed to vaccination.” He repeatedly emphasized the fact that “Nature
furnishes within the body all the remedies necessary to cure disease.”
In the recent Canadian epidemic (1919-1920) the medical authorities
have met with a most strenuous opposition. The Homeopathic profession,
almost to a man, went on record as opposed to compulsory vaccination.
The Illinois Supreme Court has ruled that compulsory vaccination is
unconstitutional.
=Technic.=—The area usually selected is the left arm at a point above
the insertion of the deltoid muscle. Some prefer the leg over the
junction of the two heads of the gastrocnemius muscle, because it is
more easily cared for, and, because of the style of wearing short
sleeves among women, it does not expose the scar which results from the
vaccination.
The surface must be washed, dried, with a soft towel, and then
sterilized with alcohol. With a sterilized needle or lance scratch
an area about a quarter of an inch in diameter, being careful not to
produce bleeding but merely an oozing of pinkish lymph. A drop of the
virus should be deposited upon the abraded surface, rubbed in with
the side of the needle and let dry. A thin layer of sterilized gauze
should be lightly applied and held by means of adhesive plaster, not
encircling the limb. This should be occasionally removed and redressed.
The pock should be kept dry and clean, and may be lightly dusted
with starch or toilet powder. “Persons exposed to the contagion of
small pox should be immediately revaccinated. The immunity conferred
diminishes with time.” It is the writer’s personal opinion that, with
the amount of complications that so frequently follow vaccination and
with the fact that “it is necessary to revaccinate during an epidemic
or after exposure,” it were better to defer vaccination, if parties are
favorably inclined to the practice, until such time as the presence of
small pox in the community make it apparently necessary.
=Typical Vaccination.=—The period of incubation varies from three to
five days. At the end of this time local reaction shows itself in the
form of reddish papules at the point of inoculation. In about five days
these develop into compound vesicles, which at first have clear and
then later opaque contents. About the eighth day the vesicle is fully
developed and is round or oval with prominent and well defined edges
and a depressed center. An erythematous areola usually appears about
the tenth day and the contents are purulent. The surrounding skin is
swollen and tender, and a scab now begins to form in the center of the
pock and rapidly extends toward its edges. About the end of the second
week the areola fades, and the pock is changed into a thick brownish
crust which becomes dry and hard, and comes off between the twentieth
and twenty-fifth days after vaccination. A dusky red scar is left and
this gradually becomes white and pitted. During the evolution of the
pock the glands through which lymphatic drainage takes place become
slightly enlarged and tender.
The constitutional reactions are usually moderate fever, restlessness
at night, irritability and loss of appetite. These symptoms usually
appear about the fourth day and continue about three to five days. At
any time during the vaccinia erythema, roseola or urticaria may appear.
The constitutional reaction in revaccination is sometimes very severe.
There are many atypical symptoms following vaccination as variation
in the number of the pocks, in the size, in the severity of the
constitutional symptoms, in the contents of the pock, in the healing
and formation of the scar and in the transmission of specific diseases
as syphilis, tuberculosis, leprosy, cancer and tetanus.
=Complications.=—All cases are not benign, as due to impurity of
vaccine, carelessness in technic, improper care in dressing, handling
of the wound by the patient himself, scratching it with the finger
nails, and other accidents of like nature, infections may set in
and very serious complications arise. These result in abscesses,
erysipelas, tetanus and various eruptions. Otitis media may leave
deafness.
The writer knows personally of a young man in the Army during the World
War who was vaccinated while in the Army and two abscesses developed
which ate entirely through the arm, one abscess passing through the arm
just anterior to the humerus and the other just posterior to it. It was
many, many months in healing, and nearly caused loss of the arm.
There are many cases of record where vaccination was followed, directly
or indirectly, by paralysis, deformities, and chronic constitutional
diseases. It is usually claimed these conditions were due to accidents
following the vaccination and not due to the vaccination itself.
However, it can not be denied that the vaccination was at least the
indirect cause of these deplorable conditions.
=General Vaccinia.=—(Vaccinal eruptive fever; Vaccinola). This consists
of a vaccine rash, developing usually from the fourth to the tenth day
following vaccination, and appearing in various parts of the body,
particularly about the wrists and on the back. The secondary pocks
usually develop about the eighth or tenth day after vaccination and are
usually more abundant on the vaccinated limb than on any other part of
the body. As the pocks appear in successive groups, all stages of the
disease may be seen at one time, and the condition may last for many
weeks. Fever may be absent or present, but is usually proportionate to
the extent of the eruption and the associated complications.
=Treatment.=—After vaccination, the patient should be told to return
in seven days, when the dressings should be removed, and if the
vaccination has been successful, a pearl-like vesicle will be present.
If the vesicle has been broken by accident or by rubbing of the gauze,
the free portions of the dressing should be cut away and the adherent
part left undisturbed. A new gauze should be applied in any case, and
in five or six days more, the dressing should be again changed, and
this changing continued at intervals until the crust falls, which is
usually during the third or fourth week.
If no vesicle forms by the tenth or twelfth day, the vaccination has
not been successful. It is suggested by the vaccination advocates that
another attempt should be immediately made.
=Prognosis.=—Uneventful recovery is to be usually expected. Pitting
from generalized vaccinia; various constitutional diseases; paralyses
and other maiming disabilities sometimes occur. While it is not
usually considered dangerous to life, there are nevertheless many
cases of record where death has resulted. It is not wholly unattended
with danger.
The best of care should always be taken following vaccination to
prevent the possibility of complications, though even then they do
occur.