VACCINATION. 
ADVICE ON THE NECESSITY OF VACCINATION/ THE VALUE OF 
VACCINATION; THE TESTS OF SUCCESSFUL VACCINATION; 
HOW OFTEN RE VACO/NATION SHOULD BE DONE; 
THE QUALITY OF VACCINE; THE BEST WAY TO 
USE VACCINE; HOW TO PREVENT AND EN- 
TER MINA TE SMALL-POX; THE CONS EDUC- 
TION OF SMALL-POX HOSPITALS, 
ISSUED GRATUITIOUSLY BY THE 
North Carolina Board of Health. 
RALEIGH; 
Ashe & Gatling, State Printers and Binders.. 
Presses of Edwards, Broughton & Co, 
1882. Vaccination, 
Advice from the North Carolina Board of Health on 
the Necessity of Vaccination; the Tests of 
Genuine Vaccination; and the 
Quality of Vaccine. 
No argument is so potent in influencing the people to 
vaccinate, as the presence of small-pox. Even those who 
calmly discuss the question when at a distance from the 
disease, and are inclined rather to take issue against the 
preventive power of vaccination, easily take the benefit 
of the doubt, when a case of small pox comes close to them, 
and procure vaccination without delay. This is deemed 
an opportune time to issue a circular of warning and advice, 
on the subject of Vaccination, because of the appearance of 
small-pox in several States. Only a few cases are known to 
exist in one locality in this State, but its prevalence else- 
where, and the facility of communication of remote towns 
with each other, makes it highly probable that it will 
spread to a considerable extent. 
The Value of Vaccination.—Vaccination, if done with 
genuine fresh vaccine matter, is absolutely protective against 
small-pox. The hundreds of physicians and nurses who 
have been repeatedly exposed to small-pox, and have time 
and time again escaped from having even varioloid, attest its 
potency. In countries where compulsory vaccination has 
been enforced, the number of deaths from small-pox is in- 
significant. American opinion is little divided on the effi- 
caciousness of vaccination, and it is not deemed necessary to 
enter into an argument on the subject. 4 
Vacgination. 
It is well known, though, that during the war and for a 
few years after the war, the protective power of vaccination 
was very seriously doubted by many, and dreaded by a great 
many more, because it seemed that the dangers of vaccina- 
tion were as much to be dreaded as small-pox. It may be 
necessary, therefore, to explain the reasons of this eclipse 
which darkened the brilliant reputation of this great proph- 
ylactic, for it is still fresh—painfully fresh—in the minds 
of some. 
The source of vaccine in this country was very variable 
and uncertain up to the year 1870. Vaccine crusts of hu- 
manized voxcine, (that is, vaccine procured by inoculating 
persons from arm to arm during man}*- generations) furnished 
the entire country with virus. Those persons who paid the 
most attention to its propagation, observed the utmost care 
that vaccine cultivated upon the arms of the healthiest chil- 
dren should only be employed and distributed as seed. When 
the warbroke out, and large numbers of soldiers were brought 
together in camps, it became necessary to vaccinate and re- 
yaccinate the most of them. There was no known adequate 
source of vaccine at the time. In the Southern army any- 
thing went for a vaccine scab. Every soldier and every 
soldier’s wife was a vaccinator. Without any knowledge 
of the condition of health of the person furnishing the scab, 
and without any knowledge of how a genuine scab should 
look, so-called vaccine matter was selected for seed, which 
was nothing but dried pus, and spurious vaccination was 
scattered broadcast. The exceedingly filthy sores produced 
by this matter was popular evidence that the vaccination 
had “taken” very well, and served to recommend it to neigh- 
bors who had not had the good fortune to be inoculated 
with it. 
The spread of spurious vaccine among the soldiers and 
citizens of the Confederacy caused serious trouble to very 
many, several persons losing their arms, and many being 
sadly maimed by it, and of course none of them were pro- Advice from the N. C. Board of Health. 
5 
tected by it. Indeed the so-called vaccination was practi- 
cally nothing but the transplantation of purulent “matter” 
from one person to another, yielding crops of foul ulcers, and 
skin diseases of many degrees of severity from conlageous 
porrigo to syphilis.* 
The two causes, therefore, which brought vaccination 
into disrepute, were the ignorant selection of seed, and its 
transplantation from one bad soil to another, until it at last 
bore no resemblance to the original seed planted and many 
times was fraught with the severest calamity to the patient. 
Fortunately now we are enabled to clear up all this histo- 
ry of vaccine disaster, thanks to the unremitting zeal of Dr. 
Henry A. Martin, of Boston. 
Dr. Martin had been a student and propagator of vaccine 
for many years previous to tire war, but the extensive field 
of study which the army put within his reach, had impelled 
him toward a solution of the difficulties he had encountered 
in bis army experience of procuring reliable vaccine. It is 
not necessary to relate the whole story, hut suffice it to say 
that he conceived the idea of importing the natural, spon- 
taneous virus, which had made its appearance at Beaugency. 
This was successfully done in 1870, (Sept. 23) and from that 
day can be dated the beginning of a radical reform in the 
practice of vaccination, a reform that can hardly be over- 
estimated. 
The practical results which issued from the introduction 
of animal vaccine f may be summed up as follows : 
1. Vaccine has been restored to all of its original activity and 
'purity. 
2. As it is propagated from one healthy heifer to another, by in- 
* Or. Joseph Jones, of New Orleans, by direction of Surgeon General 
Moore, of the Confederate States, investigated spurious vaccination, and 
found that the foul ulcers called vaccination were due to the spurious 
matter transplanted from one scorbutic soldier to another for the most 
part. 
j Animal vaccine is a term applied to vaccine directly from the cow. 6 
Vaccination. 
oculation, the seed is propagated in its original soil, and does not 
degenerate. 
3. It can he said that animal virus, (-unlike the virus obtained 
from the human subject,) never imparts any of the diseases (such as 
erysipelas, syphilis, porrigo, See., See.,) that humanized virus has 
been known to communicate. 
4. That animal virus in the hands of experienced propagators 
can be supplied in quantities equal to the greatest demand, at rea- 
sonable notice. 
5. That it is possible to procure enough original virus direct from 
the heifer to avoid the harmful practice of tapping forming vesicles, 
from which to inoculate others. 
6. The expensiveness of the outfit necessary to carry on 
successfully the propagation of animal virus is so consider- 
able that it is more likely that but few persons will under- 
take to propagate it, and that the warrant of the genuineness 
of virus these propagators are able to give is worth some- 
thing. 
7. The proportionately large number of cases of revacci- 
nation which take shows the potency of this virus, as com- 
pared with humanized virus, of many generations of atten- 
uation. 
Having explained how the degeneration of vaccine mat- 
ter took place in the South during the war, and having 
pointed out the regeneration of the virus and its restoration 
to its pristine purity, clearing up all the doubtful points 
raised in the minds of the people, we will next consider 
WHAT IS A SUCCESSFUL VACCINATION ? 
It is a matter of the utmost importance that there should 
be some definite meaning attached to the phrase “successful 
vaccination.” Many ask the question anxiously about 
themselves. We answer, that the best evidence of success- 
ful vaccination is the possession of a good vaccine scar. This 
is not absolutely sure but it is the best we have. A vaccine 
scar from a recent vaccination will be proportionately fresh- Advice from the N. C. Board of Health. 
7 
er ana more distinct than from a vaccination more remotely 
done. It should be wheel-shaped, or oval, about the size of 
a three-cent nickel; it is usually whiter than the surround- 
ing skin ; it may be either depressed, with radiating lines; 
or it may be elevated slightly, except the periphery which 
is somewhat depressed. The scars from animal virus spoken 
of above are more sharply cut, larger, with more distinct 
radiations, and, of course, more conspicuous. The old stock 
of humanized virus gives us a superficial, small, white, scar, 
witlq slight indentations over it, these indentations answer- 
ing to the follicles of the skin. Really no vaccination is 
absolutely certain that has not been put to the test, but it is 
a good criterion to go by that a person in the possession of a 
clear-cut, well formed vaccine scar, will hardly get the small- 
pox in an intense degree, even though the operation may 
have been done many years previously. With animal virus, 
we frequently get successful vaccinations in the persons of 
those having good marks, and in cases in which long hu- 
manized virus has failed. 
It is held in Great Britain and Germany that the num- 
ber of scars is the best evidence of protection. But this does 
not hold. For the writer of this has recently seen a German 
sailor marked by many beautiful and typical vaccine scars, 
so clean cut that it wvas possible to get an impression in wax 
from them, but who yielded a good vaccination from ani- 
mal vaccine, the interval from the first to the second vacci- 
nation being fifteen years. 
The theory that the protective influence dies out every 
seven years has no foundation. 
How Often should one be Vaccinated ?—The pru- 
dent man always takes the benefit of the doubt, and before 
running the risk of small-pox has recourse again to revac- 
cination. Experience shows that an infant vaccinated at 
the usual time, from two months to one year old, will re- 
quire revaccination on arriving at puberty—say from twelve 
to sixteen years of age. Some will become susceptible be- 8 
Vaccination. 
fore that, but many more will resist all future attempts at 
revaccination, especially if the primary vaccination was 
thorough. It is better to be revaccinated on every appear- 
ance of an epidemic. There is no greater risk during an 
epidemic, than at any other time, of having bad results from 
vaccination. It is best, as a general rule, to vaccinate a 
child at from two to twelve months, revaccinate at puberty, 
and then be guided by the character of the scar whether it 
is further necessary, unless an epidemic approaches; then 
revaccinate without delay. While it is a fair inference that a 
person susceptible to vaccination is also unprotected from 
small-pox as long as vaccination will take, it is not abso- 
lutely certain that this is so. 
A Primary Vaccination.—lt is very necessary that the 
first vaccination,—the primary vaccination,—should be done 
with great care. A failure in the first attempt casts doubt 
on all subsequent operations, and dangerously misleads. 
We often hear persons declare that they were vaccinated, 
whereas, when we come to examine their arms we discover 
that the scar or mark is not as it should be, but still the 
person is relying upon its protective power because the vac- 
cination was done during infancy, and the tradition about 
it may be that it was so good that some doctor desired the 
scab. A primary or first vaccination should be exhibited 
to the physician who performed the vaccination, during the 
next six or seven days, for his inspection and approval. If 
the resulting vaccination is not satisfactory, it should be 
repeated without delay. So very few infants are really in- 
susceptible, that a failure suggests forcibly that the opera- 
tion was not thorough, or that the vaccine used was not 
active. 
A Revacctnation.—Persons vaccinated for the second or 
third time, should be vaccinated zuith animal virus, for if hu- 
manized vaccine is used the chances of getting a genuine 
result are not so good. Revaccinations are done generally in 
times of alarm, or upon persons about to travel, or upon Advice from the N. C. Board op Health. 
9 
persons about to join a life insurance society. In either 
case a good vaccine vesicle will be very desirable, and the 
operator will get considerable credit for making it “ take ” 
well. Successes will be accomplished in far more than half 
the vaccinations done with animal vaccine.* 
The Use of Scabs or Crusts.—lt is still very much 
the custom to use vaccine scabs or crusts taken from the 
arms of vaccinated persons. This method was introduced 
by Dr. Boyce, a Scotch physician, and has served a most 
admirable purpose for half a century. A vaccine scab is 
composed of dried lymph, pus, epithelium, and some trace of 
blood. If we give credence to the dangers pointed out by 
the most eminent surgeons as to the danger of septicaemia 
or blood-poisoning from the inoculation of purulent matter, 
and consider how many times crusts are used that have 
been exposed to heat and moisture sufficient to set up par- 
tial decomposition, and furthermore remember how many 
physicians dissolve or make a paste of these crusts and carry 
them between glass pieces and so put the “ matter ” in a fa- 
vorable state for alteration and decomposition, the wonder 
is that we do not see a great many bad vaccinations from 
“ scabs.” 
There is certainly a considerable degree of danger from 
this source, as we have already mentioned in account of 
that sort of vaccination during the war, but it would still be 
by far the best vaccination we could obtain, had not the cul- 
tivation of vaccine been reduced to a rational system by Dr. 
Martin. In the hands of a careful physician, vaccine from 
one to ten removes from the heifer will give excellent re- 
sults. It is cheaper ; the resulting vesicles are by no means 
to be despised. 
But we surmise that few persons who are w’ell informed 
about the possible dangers of vaccination from a scab, and 
the absolute freedom from danger by the use of animal 
’The successes reach nearly 70 per cent. 10 
Vaccination. 
virus, would not greatly prefer the latter when it could be 
obtained. 
We take this occasion to say that a vaccine crust should 
not be prepared for vaccination in larger quantities than 
are needed for immediate purpose. That it should never 
be moistened with saliva, but always with pure water or 
glycerine. Glycerine has the advantage of being a pre- 
servative fluid. 
The Use of Quills ok Ivory Slips.—Quills prepared 
by scraping or boiling, and lancet shaped ivory slips, are 
smeared with vaccine virus in a thin film, and in this way 
it is preserved very well for a longer time than when the 
fluid is collected in glass capillary tubes. In this way the 
vaccine fluid dies rapidly, and is thus preserved ready for 
use. The great advantage of the ivory point is that it is 
shaped in such a way as to be used as a lancet, and is so 
cheap that it may be thrown away after once using. Its use 
avoids the risk from using a dirty lancet, and leaves no 
room for the patient to charge the physician with careless- 
ness if any unusual course follows the vaccination. The 
ivory slip charged with vaccine directly from the cow is 
used to complete the entire operation of vaccination, ena- 
bling the physician to assure his patient that the pedigree 
of the vaccine is good, and that the instrument was never 
before used on any one. 
Other Methods.—The old fashion of impregnating 
threads with vaccine virus, and inserting it under the skin 
is no longer used, although it is a good plan if we did not 
have superior resources. 
A method employed by President Thomas Jefferson (see 
Dr. Martin’s excellent historical account of Jefferson as a 
vaccinator in the January number (1881) North Carolina 
Medical Journal) was novel, and may be turned to good use 
now where animal virus cannot be had. Prepared crusts or 
threads or quills were put in a bottle and hermetically 
sealed, and this bottle placed in a larger one containing Advice from the N. C. Board of Health. 
11 
water, and the whole tightly corked. We have not spoken 
of all the devices for the preservation of vaccine, but enough 
has been said to convince the reader that vaccine virus must 
be kept with care, in order for it to produce a good result. 
How to Prevent and Exterminate Small Pox. 
Vaccination in infancy, revaccination at puberty, and 
where there is not a distinct vaccine scar, revaccination on 
the importation of small pox into a community is the well 
proven plan to prevent small pox. None should be allowed 
to escape the vigilance of the health officers. The greatest 
danger in every community is from the more ignorant, and 
consequently the more prejudiced classes. Compulsory vac- 
cination should be attempted by every town, village and 
hamlet. It is cheaper to furnish vaccination at a great ex- 
pense than to allow one case of small pox to get into a com- 
munity. The city of Wilmington has spent as much as- 
five hundred dollars a case for the care of small pox, and 
during the epidemic of 1865-66 as much as $12,000 were 
expended before we were rid of the vile disease. Thorough: 
vaccination, which was then impossible, would have saved 
it all. 
A lesson of the expeditious management of small pox is 
fresh in the minds of some of us. Last year a sick sailor 
came into the port of Wilmington, and three days after he 
was sent to the Seaman’s Home Hospital, (on Dock Street, 
in a thickly settled portion of the city) small pox broke out 
on him. At 11 o’clock the disease was recognized. All the 
sailors, fourteen in number, in the same ward with him, 
were vaccinated, and in four hours from the time the disease 
was recognized, the patient was carefully and comfortably 
transported four miles down the river to the dismantled pest 
house, with a nurse and provisions, bedding, furniture and 
medicine necessary for his comfort. Vaccination was 
promptly done at the expense of the city, and quietly and 12 
Vaccination. 
without panic or mishap, the disease was stifled in the very 
outset. No other case occurred. 
This lesson in preventive medicine we like to hold up to 
the people of the State, to show what can be done by quiet, 
energetic action. This example also serves to answer the 
question how can small pox be exterminated ? 
Small Pox Hospitals.—The best plan for the construc- 
tion of a hospital for the reception of small pox patients is 
the pavilion plan. Large tents, with flies, furnished with 
board floors, warmed by small sheet-iron stoves, fulfils the 
requirements necessary for the successful treatment of these 
cases. When the cases are ended, all the material should 
be destroyed by fire. Small pox patients require well ven- 
tilated, cool, airy apartments. 
The Duties op County Superintendents of Health 
about public Vaccination.—Superintendents of Health 
are required by law to vaccinate all persons applying, free 
of charge, and they are also required to vaccinate all per- 
sons admitted into jails, poor-houses and work-houses, if 
they find it necessary. Unfortunately for this demand of 
the law, no means are provided for the Superintendent of 
Health by the State, to purchase vaccine. The modest sum 
of Two Hundred Dollars was asked for, but the last Legis- 
lature did not feel able to provide the State Board of Health 
with this small sum to meet the emergency that is now upon 
us. The requisitions therefore that have been made upon 
the Secretary of the Board cannot be filled unless accompa- 
nied by the cash. The command made by the State law 
that “ the Secretary of the State Board of Health shall keep 
a supply of fresh animal vaccine virus at his command ” has 
been complied with, but no thanks to the State of North 
Carolina for his ability to do it. 
It will save the Secretary of the Board some trouble and 
expense, by replying at this place to the numerous enquiries 
addressed to him for information about where to get vaccine 
virus. Advice from the N. C, Board of Health. 
13 
There are many vaccine farms in the country. Two in 
Boston, one in Philadelphia, two at Chambersburg, Pa., one 
at Fond du Lac, Wisconsin, one at St. Lous, Mo,, and per- 
haps others. We have had experience with vaccine from the 
Vaccine Company, Chambersburg, Pa., and 
that of Dr. Martin, of Boston, (27 Dudly St.) 
One last word of advice about the use of animal 
vaccine.—The vaccine directly from the heifer is slower in 
its course than the old humanized virus. Frequently it 
does not produce a vesicle earlier than the sth day, and 
sometimes as late as the 7th, and the crust is not dropped 
until from the 21st to the 24th da}c It will also be ob- 
served that there is greater constitutional disturbance, and 
that now and then a general eruption will follow, 
€aution about the management of the Vaccinated Arm. 
There is good reason to believe that a vaccination that 
runs its course undisturbed, affords the best protection. 
Vesicles should not be tapped to furnish vaccine for other 
persons. The vesicle should be protected by a “ vaccine 
protector ” (sold in dry goods shops) or by a loosely fitting 
sleeve, the vesicle being covered with a cloth greased with 
suet, and all covered with a fold of cotton batting. Some- 
times it is necessary to treat the sore resulting after the scab 
drops. A weak solution of white vitriol (sulphate of zinc) 
five grains to the ounce, applied several times daily, will 
generally suffice. 
*The Pennsylvania' Yaeeine Company sends out quills, five for $l.OO. 
Each quill will vaccinate two persons. Dr. H. A. Martin & Sons sell 
seven ivory points for $l.OO, or fifteen for $3.00,