Vaccination / by W. Harrison Martindale.

  • Martindale, W. Harrison (William Harrison), 1874-1933.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: Vaccination / by W. Harrison Martindale. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Vaccination. By W. Harrison Martindale, Ph.D. THE terrible severity of variola, or smallpox, now threaten- ing the largest centre of population in the world, is practically unknown to the present generation, yet it has been estimated that 60,000,000 human beings died of small- pox in the eighteenth century. In Iceland, where the disease had previously not been known, during the years 1707 to 1709 18,000 of the population of 50,000 were swept away by its ravages. In Ware, in an epidemic in 1722, the few who escaped attack did so only with the firm conviction that they were to “have the smallpox.” With this conviction, that sooner or later every human being must pass through the disease to either die or remain on earth hopelessly pitted and disfigured, there grew up a practice of inoculating the system with variolous matter, and nursing the patient carefully—as things were in those days—through the disease thus com- municated. This idea of inoculation is probably of very ancient origin, having been in vogue, it is said, in India in ancient times; and similarly a method of communicating the infection was employed in China by placing a small quantity of smallpox crust in the nostrils. The method, like present- day vaccination, was not conducted gratuitously—it was known as “ buying the smallpox.” In more recent times it was practised in Turkey, whence, through the instru- mentality of Lady Mary Wortley Montagu, it was introduced into England. Whether this inoculation did more harm |than good has always been a debated question — it was satisfactory to the individual but by no means so to the community, and there is every reason for the belief that though the inoculated disease was usually of a mild character, infection was spread throughout the country and many persons took smallpox who otherwise would not have had it. Tracing events further, we come to May 14, in the year 1796, on which Edward Jenner, a Gloucestershire practitioner, “ vaccinated ” a youth of 8 years of age with “ lymph ” taken directly from a pustule of a dairy-maid who had become accidentally infected with a disease prevalent at the time amongst cattle, termed cow-pox. This accidental infection is termed “ casual ” to distinguish it from the intentional form which is the subject of these notes. Though giving Jenner all honour, it is possible the idea was not absolutely new on earth. There exists, I understand, in the British Museum, a Sanskrit document, according to which a priest is said to have been called to a prince who was sick unto death with smallpox. He told the prince that had he been summoned earlier, he could have overcome the evil by inserting under the skin a thread steeped in the matter of a cow with pox. He would, the priest stated, have passed through a slight fever, to be restored to health and strength again. The prince died. Jenner had long been making observations on the pre- ventive power exercised by this cow-pox over smallpox. The fact that having been previously thus infected conferred immunity to smallpox was, indeed, commonly known amongst the Gloucestershire farmers, and it was a country girl who taught Jenner this—to us now—simple lesson, some time prior to the date mentioned. True to his expec- tations, all went well with Jenner’s first “ vaccinated ” patient, and the next point was to ascertain whether the “ vaccination” really prevented smallpox. After waiting six weeks he was able to satisfy himself as to this by inocu- lating the youth with variolous matter—without any result. Later, on the occasion of a further outbreak of natural cow- pox, he was able to transfer vaccinal infection from one human subject to others, which, speaking briefly, clinched the matter. In 1798 Jenner published his epoch-making “ Inquiry,” and in a little while be became famous throughout the civilised world. Continuing on these results, attention was drawn to a similar disease in other animals—eg., “grease” in horses and swine-pox. Jenner was doubtless slightly in error in thinking that “ grease ” was in reality an antecedent of the bovine form, and that it was communi- cated probably by human aid from the horse to the cow. Investigations proved equine and bovine forms of the disease to be of common origin, if not identical, and, in addition to the now customary “calf-lymph,” many strains of equine vaccine have been raised and used for vaccination. With the appearances of the arm on vaccination all are well acquainted; but it may here be stated that three or four distinct stages are claimed—firstly, there is a traumatic reaction, which subsides ; then the papule is produced by an increase of intercellular fluid, which is specific, and from which it is possible to vaccinate; vacuoles gradually appear in the centre, by the extension of which the papule becomes the vesicle; and, finally, the pustule, containing purulent matter, is produced. It may be mentioned that the aim of modern vaccinators is not so much to produce the old-time inflammation, but to procure a small typical “ pock ” in due course, thereby discomforting the patient as little as possible. Although authorities differ as to the conduct of some of the details, the following procedure is a well-recognised method of vaccinating. One should be vaccinated every fourteen years. Rules for Vaccinating. 1. Sterilise a small lancet just before use by holding in the flame of a spirit-lamp. 2. Clean the arm by means of a little ether soap or absolute alcohol, or both (no antiseptic is necessary), and blow out the contents of a tube of lymph on to the surface, using a small rubber syringe ball, which fits on the tube. Avoid the older method of ejecting the lymph by the mouth, as this, besides being entirely foreign to modern principles of asepsis, may result in an unfortunate vaccination of the lips of the operator. 3. Scarifications are made in four or five sets, each set having an appearance similar to two “ sharps ” on a sheet of music, and being not larger in diameter than \ inch. They should also be placed an inch or so apart from each other, to prevent the possible confluence of the resulting vesicles. 4. The lymph is rubbed and pressed into the skin at these points, stretching the skin the while. 5. The arm is kept exposed for a little time. Thi3 may favour absorption. Wrap with a pad of antiseptic dressing. 6. Though the lymph will keep well for months in the sealed tube, it should be used at once when opened. 7. Make it a rule to again sterilise the lancet after each vaccina- tion, Variola and Vaccinia Compared. At the commencement of vaccination by means of calf- vesicle pulp, there arose naturally a sceptical community who questioned the preventive power which mere “vaccina- tion ” with the product of an animal infected with cow-pox could possess over smallpox, as the two diseases were thought by many to be distinct, and in spite of numerous and indefatigable investigations there exist to this day a faction who maintain that this is so. These experiments, having for their aim the production of cow-pox in the cow or calf by inoculation of variolous matter from the human being, have been attempted in Great Britain with consider- able success (by, eg., Badcock, Simpson, Copeman, Klein), in Germany (by Voigt and Fischer), in Switzerland (by Haccius and Eternod), and in India (by King and Simpson). The order mentioned is not chronological. The first-named —a Brighton chemist—succeeded in variolating a cow, and supplied large quantities of lymph to the medical profession from his result. Copeman was successful in one instance out of four. Together with Klein, his results differed from, those of the other investigators mentioned, in the respect that they obtained no vesicles in the animals, at any rate, none in the first inoculation (but on one or two removes, however) ; whereas the other workers—Badcock, Haccius and Eternod, King, Simpson, &c.—claimed to have obtained, at or near the seat of inoculation, a vesicle resembling the vaccine-vesicle. Hence the conclusion is that variola has been altered and modified, by passage through the calf, to vaccinia causing the typical vaccine-vesicle, yet without producing a general eruption. Furthermore, as vaccinia so produced can be transferred again to the human being without serious results, this ground is even more tenable. The most reasonable assumption, as Copeman states, is probably that variola and vaccinia have a common ancestor. The Variolous Test. Inoculation with smallpox in the times of Jenner, as has already been pointed out, was a general routine method of protection, and we may regard as an indirect outcome of it what is known as the “variolous test,” consisting simply of inoculation with variolous material to test the