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Prevention of Communicable Disease: Vaccination

The practice of vaccination up to a comparatively recent date was not always surrounded by proper sanitary safeguards. The vaccine was sometimes impure and sufficient care was not always taken to prevent infection of the sore with the germs of tetanus (lockjaw) and other dis- The progress of modern science has now overcome all these dangers. Vaccination at the hands of a competent physician is not only an entirely safe and almost painless operation: it is an absolute preventive of smallpox and the only possible safeguard against its ravages. Vaccination against smallpox is compulsory upon all inhabitants by law in Germany and Japan. In both countries it has been practically stamped out. The vaccination of school children is compulsory by regulation of the school board or board of health in many American cities, but is not enjoined upon the general public by state or national legislation. Hence sporadic outbreaks are constantly occurring. The disease invariably attacks persons who have never been vaccinated and may also attack those who were vaccinated in childhood, but have not been revaccinated after an interval of ten or more years. In such cases, however, the disease assumes a milder form.

Opposition to compulsory vaccination when not due to mere ignorance or prejudice is based upon one of the following grounds: i. e., (1) that vaccination does not protect, (2) that it may transmit other diseases or is otherwise harmful or dangerous, or (3) that compulsory vaccination is an invasion of the rights of an individual. The experience of Japan and Germany, and especially the immunity of the German army as the result of vaccination during the Franco-Prussian war, 1870-1 (when the opposing French army was ravaged by smallpox), and the universal testimony of expert sanitarians, proves that the first of these objections is totally unfounded. The chance that vaccination may transmit other diseases, or otherwise prove injurious to the patient has now been entirely overcome. Arm to arm vaccination was formerly the custom, i. e., the scab from a successful vaccination was used as a vaccine for others. Occasionally such diseases as tuberculosis and syphilis were transmitted in this way. But this method is a practice of the past.

The only vaccine now employed is prepared from healthy young calves under Government supervision. It is true that there is the possibility of blood poisoning or lockjaw if the sore become infected. But this will not occur if the vaccination is properly performed and protected by a suitable dressing. The danger from this source is much less than that from pricks and scratches from thorns or minute splinters, or the claws of domestic pets. In a word, the possible danger from vaccination PREVENTION OF COMMUNICABLE DISEASE 167 is grossly exaggerated. Pure vaccine is harmless and it is doubtful whether a single death has been caused by vaccination conducted in a proper manner.

The notion that compulsory vaccination is an invasion of the rights of an individual might be sustained if a person could suffer from the disease without requiring the care of other members of society, and subjecting them to the dangers of infection. The loathesomeness of smallpox, the helplessness of the sufferer and the necessity of providing pesthouses for the treatment of patients of this disease bring the subject of vaccination well within the police power of state and nation.

Every effort should be made to arouse public sentiment in favor of a state and national compulsory vaccination law. - A Vaccination Creed. Seven years ago the Department of Health of Chicago made the following declaration of their faith in vaccination: "First. That true vaccination-repeated until it no longer 'takes'-always prevents smallpox. Nothing else does. "Second. That true vaccinationthat is, vaccination properly done on a clean arm with pure lymph and kept perfectly clean and unbroken afterwards-never did and never will make a serious sore. "Third. That such a vaccination leaves a characteristic scar, unlike that from any other cause, which is recognizable during life, and is the only conclusive evidence of a successful vaccination. "Fourth. That no untoward results ever follow such vaccination; on the other hand thousands of lives are annually sacrificed through the neglect to vaccinate-a neglect begotten of lack of knowledge." How to Vaccinate. -Vaccination should, as a rule, be performed only by a competent physician, but may be safely performed by anyone if the following instructions are carefully observed: Secure the pure vaccine from a first-class drug store, or if there is no drug store in the vicinity, write or telegraph the state board of health at the capital city of your state, and ask them to forward through the mails enough vaccine for the required number of persons. If buying from a drug store ask for glycerinized lymph. It is both safer and more reliable than the vaccine from dried points. A good plan is to make the inoculation on the inside of the arm above the elbow where the scar will be out of sight.

But if preferred, the wound may be made on the leg or, indeed, on any part of the body. The part should be thoroughly washed with soap and hot water. Then rinse with a 50 per cent solution of alcohol. But this must be allowed to fully evaporate. Otherwise it may kill the vaccine. The operator's hands should be thoroughly scrubbed with hot water and soap, preferably carbolic or green soap, with especial attention to the finger nails. If the virus comes on bone points, it is best not to use a knife at all. Scrape the parts with the point over a spot about as large as the little finger nail, until the upper layers of the skin have been rubbed away and serum appears and mingles with the virus which thus gains entrance into the system. If a knife is used for scarifying the parts thoroughly disinfect it in standard solution No. 4, carbolic acid (5 per cent) and afterwards rinse free of the antiseptic solution in boiling water. In either case dry the parts thoroughly before the operation is attempted. If the knife is used, scarify very lightly and stop as soon as the serum appears and before the red blood commences to flow. If the wound is deep enough to draw blood there is much more danger of infection and, moreover, the flow of blood tends to wash the virus away.

When the serum begins to run, rub in the vaccine with the knife or vaccine point. If the virus is dry, first dip the point in tepid water which has been freshly boiled. After the virus has been thoroughly rubbed in, leave the scar uncovered until it is dry. Now cover the wound with antiseptic gauze or sterilized gauze, or cotton, and bandage with great care so that the bandage will not get out of place and the wound become infected. The best plan, after covering the wound with gauze, is to cover the gauze and adjacent parts with strips of adhesive surgeon's plaster. The dressing should be changed every day or two until the scab falls off. Sanitary precautions must be taken at every dressing to avoid infecting the wound.

If the vaccination "takes" a small red spot appears at the site of inoculation on the third day. The temperature rises slightly on the third or fourth day, and may continue a little above normal until the eighth or ninth day. On the eleventh or twelfth day the soreness begins to subside and a brownish scab forms over the wound. This becomes dry and hard and falls off on the twentyfirst to the twenty-fifth day. It leaves a circular pitted scar. The sore must be kept clean and free from irritation and disturbance. must not be rubbed or scratched. If, after six or seven days there is an undue degree of inflammation, physician should be consulted. Practically every case of ill effects from vaccination is due to scratching or picking at the sore, or otherwise handling or dressing it with dirty hands or fingers.

It a A successful vaccination usually confers immunity from smallpox for life. In other cases the power of resistance seems to decrease with time. Hence adults vaccinated in childhood should be revaccinated if exposed to smallpox or if an epidemic of the disease breaks out in a community.

The second vaccination will "take" only on those who need it.