Acute contagious diseases / By William M. Welch ... and Jay F. Schamberg ... Illustrated with 109 engravings and 61 full-page plates.

Welch, William Miller, 1837-

Date:: 1905

Credit: Acute contagious diseases / By William M. Welch ... and Jay F. Schamberg ... Illustrated with 109 engravings and 61 full-page plates. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$TECIINIQIJI': OF VACfUNATION \\\\ Asepsis.- It is, of course, dcsirahlc that the vaccine lynipli he free of foreign bacteria. In oi'der that all wcjurui infections niay be avcjifled it is advisable that the arm of tlu; vaccinae, the instrutiKint to be em- ployed, and the hands of the vaccinator 1)6 perfectly clean. Further- more, the vaccine vesicle must l)e so y)r()te(-ted as to prevent subsecjuent infection at the site of vaccination. Disinfection of the Skin. Some difference of ojjinion exists as to the thor()U(>;hness with which disinfection of the j)roj)()sed vaccination area should be carried out. Some writers urj^e such a preparation of the skin as is practised prior to an ordinary surgical operation. Others believe that the use of strong antiseptics is to be avoifled, inasmuch as they may destroy the activity of the vaccine material when placed upon the skin. We would counsel the following techni(jue: It is advisable for the patient to take a tub bath on or before the day on which the vaccination is to be performed, and to put on clean undergarments. fUnfoitunately, it is difficult to have these measures carried out in the very people who most need them.) The vaccination area, usually the arm, is to be thoroughly washed with potash soap and hot water, some friction being used so as to dis- tend the cutaneous capillaries. Personally, we prefer to follow this cleansing with the application of alcohol, although in cleanly persons this is perhaps not necessary. The arm is then to be dried with sterile absorbent cotton, or, when this is not available, a perfectly clean towel. The operator may employ an ordinary lancet or a needle to produce the necessary abrasion. If the former is used it should be previously disinfected by boiling, immersion in an antiseptic solution, or thorough cleansing with soap and water or alcohol. It is perhaps better to employ a needle for the purpose, inasmuch as a new and clean one can be used for each vaccination. The insertion of the deltoid muscle is the site usually selected for the introduction of the virus. The skin is made tense through the grasping of the inner side of the arm with the left hand. The epidermis is then abraded over an area of a third or a half inch; this is done either by vertical or cross scarification with a needle or simple scraping with a lancet or scalpel. It is important that the ahrasion he not too deep. The drawing of blood is to be avoided, inasmuch as it may float away the lymph and prevent absorption; it is further claimed that the deep scarification is more likely to be followed by an excessive degree of inflammation. It is not desirable to abrade deeper than is necessary to see the little red- dish points which represent the loops of the papillary bloodvessels. It is a matter of some importance to rub the virus well into the abraded surface. The hasty smearing of the hiiiph upon the arm with no further manipulation is probably responsible for a certain percentage of failures. Some writers have advocated vaccination by hypodermic or, rather, intradermic puncture. This is accomplished by expelling the iMnph upon the previously cleansed vaccination site, and then passing a thoroughly$