Page images
PDF
EPUB

material from a human subject; otherwise the practical disappearance of cow-pox would be a serious matter, should the present "strains" of vaccine die out.

At present the production of vaccine virus in the United States is under Government control. The laboratories where it is produced are frequently inspected, and their products are tested for strength and freedom from infection by the Hygienic Laboratory of the Public Health and Marine Hospital Service, at Washington. Since this law went into effect a marked improvement in the character of the vaccine virus on the market has been observed. In cases vaccinated more good takes are obtained, and fewer infected arms are seen.

In accordance with an additional regulation issued by the Secretary of the Treasury, March 13, 1906, each and every lot of vaccine virus must be examined bacteriologically by the manufacturer to determine its freedom. from pathogenic micro-organisms, and a special examination is required of each and every lot to determine the absence of tetanus. Permanent records of these examinations are also required.

How and When to Vaccinate-Infants of any age may be vaccinated if small-pox is prevalent. If there is no danger of exposure to the disease, vaccination should be delayed until the child is from 4 to 6 months of age -in sickly babies it may be delayed until the child is 1 year old.

The best place to vaccinate a baby is on the outer side of the left leg, about 3 or 4 inches below the knee. All right-handed mothers and nurses carry the child upon their left arms. This brings the vaccination sore away from the body of the nurse and in little danger of being hit or rubbed. The leg is to be chosen rather than the arm when vaccinating children, as the abundant lymphatics of the groin better control the inflammatory reaction following vaccination than the relatively fewer lymph nodes in the axilla. In female children the leg should also be chosen, as scars upon the arm are often unsightly. In right-handed male adults the left arm is the site usually chosen for vaccination, at a spot on the outer side of the arm, 5 or 6 inches below the top of the shoulder.

The place chosen for vaccination should be well scrubbed with sterile soap and water, a soft sterilized brush being used. After scrubbing, wash off with alcohol and allow skin to dry. A fine cambric needle mounted in a short wooden handle or a small cork is the best scarifier. The point of the needle is sterilized by passing it through the flame of an alcohol lamp. The spot upon the arm or leg selected should be cross scratched over a surface about half the size of a dime. No blood should be drawn. It is sufficient if a small amount of serum appears. Upon this surface is spread the contents of one tube of glycerinated vaccine virus, which should be allowed to dry in before any dressing is applied. Then apply a shield or a simple dressing of sterile gauze held in place by 2 narrow strips of zinc oxide adhesive plaster.

After-Cure-This first dressing, if not soiled, need not be removed until the "take" occurs, on the third or fourth day. The skin around the "take" is generally reddened and inflamed and burns and itches. This should be smeared over with an ointment of zinc oxide and a sterile dressing reapplied. If signs of infection of the "take" appear, a wet dressing of warm 1-2,000 bichloride of mercury solution, frequently changed, should be applied. Great care must be taken to avoid infection of the vaccination wound, and protective dressings should be used until healing takes place.

What Is a Good Take?-It is hard to verbally describe a good take. The physician doing the vaccination should see and pronounce upon each

case.

What Is a Good Scar?-"A perfect scar is round or oval, below the level of the skin about it, with well-defined margins, pitted or reticulated, and looks as though it had been stamped into the skin. Large flat scars are not signs of a good take, but of infection of the vaccination wound; large pits about the edges of a scar are a good sign of a take; the smaller pits scattered over the surface of a large flat scar are generally the dilated mouths of hair follicles and sebaceous glands."

Revaccination-A vaccinated person is protected from small-pox in all cases for a period of six or seven years, in many cases for a far longer time. Children should be revaccinated at the age of 10 or 12 years. The compulsory vaccination law of the German Empire requires vaccination of every child before the end of the year following the year of its birth. and revaccination during the twelfth year. After a second successful take revaccination is not necessary, unless in time of epidemic of smallpox or in those directly exposed to the disease, when revaccination from time to time is a wise precaution against infection.

OPPOSITION TO VACCINATION.

Opposition to vaccination rests on 5 fundamental declarations:

1. It is dangerous. 2. It is useless. 3. It is an invasion of the right of the individual. 4. Doctors favor it for the fee for vaccinating. 5. All statistics about small-pox are false.

I. The Dangers of Vaccination-The dangers of vaccination exist at present chiefly in the minds of the opponents to vaccination. The chief source of danger remaining is an accidental infection of the wound caused by the vaccination. In this a vaccination wound but shares in the danger to any wound of infection. This in vaccination wounds amounts to I case of infection with fatal results in 65,000 vaccinations. Voight2 reports 2,275,000 vaccinations in Germany, with a total of 35 deaths. Re

1 Adapted from Welch and Schamberg.

2 Voight. History of small-pox and vaccination (1901).

cently he reports a series of 100,000 vaccinations with but I death. Hodgetts reports 40,000 vaccinations done in the Province of Ontario, Canada, without a death. Therefore, while we do not deny that there remains some danger to life in vaccination, we claim that with the exercise of due care it may be reduced to a point where vaccination is far less dangerous than the extraction of a tooth or the taking of an anesthetic.

2. It Is Useless-This statement is based largely on the fact that vaccinated persons do have small-pox. That we do not deny. The protection of vaccination becomes exhausted, and the disease is contracted, or a person is exposed to small-pox, is vaccinated, and has the disease in spite of the vaccination. In Prussia, between the years 1847 and 1873, vaccination was voluntary, and only a small part of the population was vaccinated, and during these years there died of small-pox an average of 42.1 persons per year per each 100,000 of the population. In 1873 a compulsory vaccination law was passed and enforced, and from 1874 to 1901 there died of small-pox a yearly average of 1.3 persons per each 100,000 population. Roughly estimated, deaths from small-pox were 40 times more frequent before than after vaccination became compulsory. The claim that improved sanitation has reduced the death rate from small-pox can not be proved. Austria is practically as far advanced in sanitation as Prussia, but has no compulsory vaccination law, and small-pox is widely prevalent and as fatal as ever. There has never occurred a case of small-pox in a person recently vaccinated successfully. The attendants at small-pox hospitals are vaccinated and revaccinated from time to time, and small-pox is unknown among those so protected.

At the Highgate Hospital, near London, where hundreds of small-pox cases are treated, but one attendant in the past sixty years has taken small-pox, and that attendant was a gardener who was not vaccinated because he did not come in contact with the patients. In Boston during the 1900-1903 epidemic of small-pox no attendant at the various small-pox hospitals took the disease. Facts as to reduction of the death rate and immunity to the disease might be multiplied indefinitely, but enough has been said to prove that vaccination does protect. Even in those contracting small-pox years after having been vaccinated a certain factor remains which modifies the virulence of the disease and makes the death rate far lower than in the unvaccinated. The mortality among the vaccinated is as I to 7 among the unvaccinated, as shown by the following table from Reports of British Royal Vaccination Commission:

Vaccinated
Unvaccinated

Cases. Deaths. Per cent.
.8,744 461 5.0
.2,321
822 35.1

3. It Is an Invasion of the Right of the Individual-There is no answer to this argument if its premise be granted that the individual has a right to do as he pleases. This may be granted if the individual lives

alone and comes in contact with no other human being. Life in communities invades and restricts the right of the savage, and community life is impossible on any other terms. The police power of a community rests on either the public-nuisance or the public-welfare ideas in common law and constitutional law; i. e., an individual may not maintain a public nuisance and groups of individuals may act together for the public welfare. Therefore we find today the savage rights of the individual lessened in number and invaded on every hand. Compulsory vaccination laws, where they exist, have been upheld unanimously by all courts of appeal before which they have been tested, and the right of the community to enforce vaccination for the public welfare has been established. The individual who, in exercising his right to do as he pleases, contracts small-pox, is conveyed to a pesthouse as a public nuisance, and his family are quarantined and vaccinated for the public good.

4. Doctors Favor It for the Fee They Get for Vaccination-This trifling argument may be answered by the statement that vaccination is performed free of charge by Government officials, and the cost thereof is borne by the city or State wherever vaccination is compulsory.

5. All Small-pox Statistics are False-Whether or not records are kept, small-pox does exist and kills or scars its victims, and the fact of its existence and its danger remains, even if the disease is disguised under the name of measles, chicken-pox, Philippine itch, or any other designation.

CONCLUSION.

During the past five years small-pox in the United States has shown a steady and gratifying decrease. In 1902 there were reported 54,014 cases with 2,083 deaths; during 1906 there were reported 12,503 cases with 90 deaths. This decrease has doubtless been brought about by increased vigilance on the part of State and national authorities and the wide dissemination of information in regard to the prevention of the disease. Many cities and States have enacted ordinances requiring the vaccination of all children before they are allowed to attend the public schools. In Germany, where vaccination is compulsory and universal, during the year 1906 there were, according to reports received by the Public Health and Marine Hospital Service, in the whole Empire but 26 cases of small-pox with 5 deaths, and these cases were largely imported from neighboring countries, where small-pox is prevalent and unchecked by general vaccination. The experience of Germany, where compulsory vaccination has been in force for thirty years, proves conclusively that small-pox as existing in the United States is entirely unnecessary, and vaccination and revaccination can not be too strongly urged as the only means of removing this pest from our midst.

EDITORIAL

THE ETHICS OF JOURNALISM AS SEEN BY THE EDITOR OF AN ASSOCIATION ORGAN.

The first issue of the Journal of the Indiana State Medical Association made its appearance January 15th. It is a monthly publication, and contains forty-eight pages of reading matter with eighteen pages of advertising. In the matter of editorial and mechanical make-up, it is uniform with the other State Association journals, and hence, from the very nature of the case, it does not and can not possess any particular character or individuality of its own. Its editorials, indeed, might have already done service in some one of the other organs of its class, and no one except the editors of the respective journals would have been the wiser for their second publication-so much alike in thought, tone and temper are the opinions expressed therein to those which have been so frequently set forth by the editors of the other association organs. For instance, this editor perches himself on a high ethical eminence, and from his superior position looks down in contempt and hatred upon the "privately-owned medical journals," which, he tells us, "have prostituted their pages to the interests of dishonest advertisers for the profit to be obtained, while the rank and file of the profession, with nothing to guide them, have been the victims of the grossest deception." He then goes on to say that with the establishment of the association organs, physicians need no longer suffer from the cupidity of the independent journals, since the society organs will look out for their interests, tell them what literature they may read, and what medicines they may prescribe, direct them in the proper paths, and shield them from all harm which may come from their own guilelessness or stupidity.

After delivering himself of all these high-flown moral sentiments; after promising all this paternalistic care and protection to the physicians of his State who, he evidently thinks, have not sense enough to look out for themselves; after charging that the independent journals have prostituted their pages to the interests of the dishonest advertisers, this mentor of the medical profession, this self-assumed guide and guardian of the doctors of Indiana, wraps about him his robes of authority and thus gives orders to the members of his association:

"IF YOU ARE ABOUT TO PURCHASE OR PRESCRIBE any pharmaceutical specialty, instrument, appliance or office equipment, see if it is advertised in the Journal. If it is not advertised in the Journal, find out why it is not. Let those you are dealing with know that we have a medical journal which is owned, published and controlled by the medical profession of Indiana, and that the Journal will give value received for every

« PreviousContinue »