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Vaccination for the 
 Prevention of Smallpox 
 
 By Dr. Alvah H. Doty 
 
 Medical Director of the Employees* BeneBt Fund Committee 
 of the American Telephone and Telegraph Compcmj, 
 
 The Western Union Telegraph Company, and 
 The Western Electric Company 
 
 Number 12. Supplement to Western Electric News. Feb., 1914 
 
This is one of a series of monthly bulletins on Hygiene^ San- 
 itation, and the Prevention of Disease. It is suggested that the 
 articles be kept for reference, as in this way a hand-book on 
 the subject of Hygiene may be secured. 
 
G ! "FT! 
 
 I ) 
 
 Vaccination for the 
 Prevention of Smallpox 
 
 By DR. ALVAH H. DOTY 
 
 Eef erence is constantly being made in the public press and other cur» • 
 rent literature to the use of vaccine, anti-toxin, and serum in connection 
 with the prevention and treatment of disease. While the terms are more 
 or less familiar to all the means by which these agents are obtained, the 
 theory regarding their action and the results that are expected are not 
 clear in the public mind. 
 
 Vaccination for the prevention of Smallpox is the protective measure 
 ^of the above group best known and most commonly employed and will 
 therefore be dealt with in this article. Similar preventive measures will 
 subsequently be considered. 
 
 Many years before vaccination was thought of, a means of modifying 
 Smallpox or rendering it mild known as “inoculation” was exten- 
 sively practiced in the East, particularly in Constantinople. This was in 
 active operation about 1700 and a century later was introduced into 
 England. Inoculation consisted in obtaining fluid or lymph from the 
 little vesicles which form during the early stage of the eruption of this 
 disease and introducing it under the skin of those who desired or were 
 forced to receive this form of protection. While Smallpox was pro- 
 duced in the one inoculated, it was usually of a very mild type, and pro- 
 tected against the danger of contracting the disease in the regular way 
 with the possibility of causing a great disflgurement or a fatal result. It 
 was found, however, that although inoculation extended protection in 
 the way described, a person thus treated became a medium of infection 
 and transmitted Smallpox to others, often in its severest form, and in 
 England its further use was prohibited by an Act of Parliament in the 
 ' early part of the last century. 
 
 Inoculation may appear to us an exceedingly drastic method of pro- 
 i tection, but it must be remembered that at the period it was employed the 
 
 f public was almost helpless in preventing the ravages of Smallpox and 
 
 were willing to take advantage of almost any measure which provided 
 even partial defense against it. There is probably no subject the statis- 
 tics of which are more voluminous and more convincing, than those which 
 
 J 
 
 3 
 
 UNIVERSITY OF 
 ILLINOIS LIBRARY 
 AT URBANA CHAMPAIGN 
 
relate to the destruction which followed in the wake of this disease before 
 vaccination was discovered, for one-tenth to o le-half of all deaths which 
 occurred were caused by Smallpox, and one-third of the number of babies 
 born died from it within a year, and many of those who recovered were 
 either made blind or otherwise disfigured. In 173d two-thirds of the 
 entire population of Greenland died from this disease, therefore, it is not 
 strange that the public mind was constantly disturbed regarding the 
 danger from this source. 
 
 During the latter part of the 18th century. Dr. Edward Jenner, a 
 young English physician who had given this subject careful and exhaus- 
 tive study, had learned of the tradition existing among employes of 
 dairies that those whose hands became infected while milking cows having 
 a disease known as ‘‘ Cowpox,” which caused an eruption about the udder 
 or teats of the cow, were protected against Smallpox. It seems strange 
 that this alleged immunity had not before received earnest attention, bi?t 
 the indifference of the public to traditions and the reticence on the part 
 of dairy owners to furnish information which might unfavorably affect 
 their business, may partly account for this; however, it did not escape 
 the careful observation of Jenner who, for almost thirty years, investi- 
 gated this subject and then having demonstrated satisfactorily to him- 
 self the protective power of the method afterwards known as ‘‘vaccina- 
 tion,’’ he presented to the world a minute and extensive description of 
 his work and his conclusions relative to this protective measure. 
 
 Jenner did not try to conceal his discovery, but freely discussed it and 
 invited aid, but for a long time met with nothing but indifference and 
 discouragement. Even Dr. John Hunter, one of the greatest physicians 
 of his time and under whose care Jenner studied as a favorite pupil, was 
 at first but little impressed with the importance of vaccination, although 
 he frequently referred to it in his lectures. Still undaunted, Jenner 
 continued his investigation and on May 14th, 1796, was allowed to “vac- 
 cinate” a boy eight years Of age with some lymph or fluid taken from 
 a vesicle on the hand of a dairy maid who had contracted the so-called 
 “cowpox.” In July of the same year this boy was inoculated with 
 Smallpox in the manner already described and, as Jenner predicted, the 
 latter disease did not occur. Jenner afterwards vaccinated others with 
 similar successful results. The account of his discovery soon became 
 known through the world and vaccination spread with great rapidity, 
 being introduced into the United States about 1800. 
 
 Jenner believed that the protective power of “vaccination” depended 
 upon the fact that the disease known as “cowpox” was really Smallpox 
 in the cow, but the infection in passing through the system of this animal 
 became greatly modified or changed in character, although it afforded 
 protection against Smallpox when introduced into the human being. 
 This belief is still maintained, although the practical disappearance of 
 cowpox has made it impossible for the scientists of the present time to 
 continue the investigation begun by Jenner. 
 
 4 
 
It is reasonable to assume that the hands of the milker through cracks 
 or minute openings in the skin became infected by contact with the vesi- 
 cles on the udder or teats of the cow and that this infection upon entering 
 the system provided protection against Smallpox, the original cause of 
 the disease in the cow. Jenner very properly argued that the same result 
 would be secured, but in a much more satisfactory, effective and practical 
 manner if the contents of these vesicles were obtained in a more scientific 
 way, in order that the lymph could be conveniently and at any time intro- 
 duced under the skin of those who were to receive the benefits of this pro- 
 tection. This was done by opening the vesicles on the udder or teats of 
 the cow and removing their contents on various articles possibly of ivory, 
 glass, or quills, etc., from which it could easily be transferred to a scari- 
 fied or exposed surface of the skin. This was the origin of vaccination^ 
 The lymph or virus, as it is called, is interchangeable between the cow 
 and the Wman being, i. e., the lymph taken from the vesicles on the cow 
 will successfully vaccinate a human being, and that removed from the 
 human vesicle can be used for vaccinating the cow, or the virus may be 
 transferred directly from one person to another. In this way the supply 
 of vaccine matter may be perpetuated. A fresh supply has been obtained 
 by inoculating cows with the lymph taken from the Smallpox vesicle. At 
 the present day the supply is maintained by vaccinating young calves 
 with the vaccine matter from other calves or from children. At the 
 proper stage the lymph or fluid in the vesicles on the cleanly shaven 
 abdomen of the calf is removed and taken to the laboratory, where it is 
 examined to detect the presence of contaminating organisms and also 
 carefully tested, the latter is then mixed with glycerine or some other 
 agent placed in small vials and hermetically sealed and is then ready 
 for use. 
 
 When a vaccination is successful or ‘‘takes” a very characteristic 
 vesicle appears within a few days after the operation at the point 
 of introduction of the virus ; this passes through various stages, becomes 
 dried and the scab afterwards drops off at varying periods, leaving a 
 characteristic depression or scar which to those who are practically 
 familiar with its appearance indicates the success of the vaccination. 
 
 Until about twenty years ago vaccination was performed chiefly by 
 what is known as “arm to arm” vaccination. This consisted in taking 
 lymph from the vaccine vesicle on the arm (or other part of the body) 
 of a recently vaccinated healthy child and immediately transferring it 
 to the scarified arm of the children or adults brought together for this 
 purpose. 
 
 Another former method of vaccination consisted in collecting the scabs* 
 from the arms of children known or believed to be in good healthy con- 
 dition, mixing it with glycerine or some other fluid and using it for vac- 
 cination. While these methods were very successful it was feared that 
 they constituted a possible medium of transmitting diseases from one 
 person to another, although the danger from this source is greatly ex- 
 
aggerated; however, to prevent any possible danger in this way these 
 methods of vaccination have been practically abandoned and the method 
 just referred to has been substituted, that is, the virus is secured from 
 calves in the manner already described. 
 
 Those who are practically familiar with vaccination recognize that it 
 does not confer immunity or protection in every case; still, this in no 
 way alfects the inestimable value of this form of protection for, as a 
 rule, it can be depended upon, if not always to prevent the disease 
 at least to render it mild. In some instances the primary or first 
 vaccination will protect throughout life, in other cases it may not insure 
 immunity for more than two or three years; however, it is believed by 
 those who are competent to judge, that if a person is successfully vac- 
 cinated in infancy and again about ten or twelve years of age, immunity 
 is generally conferred throughout life. This course has been strictly 
 followed in Germany and there is probably no country where fewer cases 
 of Smallpox occur; however, it is generally believed that vaccination 
 should be performed every seven to ten years. There is scientific evidence 
 to support this view and it should be regarded as an extra precaution, 
 particularly in the presence of an outbreak of Smallpox. 
 
 There are some who do not approve of vaccination, chiefiy among those 
 who have had little or no personal experience with this means of protec- 
 tion, some of whom it is alleged not only deliberately distort statistics 
 relative to this subject to suit their purpose, but present all sorts of 
 theories other than vaccination to account for the decline of Smallpox. 
 While it is not the object of this article to discuss this point, it may be 
 said that in the ranks of anti-vaccinationists there are found but few, 
 if any, of the leading practical sanitarians of the day who, from long 
 personal experience, know the value of vaccination as a protection against 
 Smallpox. 
 
 Vaccination is often objected to on the ground that danger may follow 
 its use. Unpleasant results rarely occur ; when they do it is usually the 
 result of carelessness or uncleanliness. These conditions also present 
 themselves in instances where simple wounds are not properly protected. 
 
 For various reasons vaccination, although a simple operation, should! 
 be performed by physicians and not laymen, except in instances where 
 emergencies exist; besides, those vaccinated should be kept under pro- 
 fessional observation until the arm heals and the scab falls off. This is 
 not only for the welfare of the person vaccinated, but also to determine 
 if the vaccination proves successful. 
 
 In order to secure successful vaccination it is exceedingly important 
 that great care be taken in the production of the lymph or virus. Vac- 
 cine matter is now prepared largely by state and municipal laboratories, 
 and free vaccination is generally preformed. This insures without 
 expense the best virus and most effective means of performing the oper- 
 
 6 
 
ation. Health authorities throughout the country should be equipped to 
 offer free vaccination in order that it may be properly and fully carried 
 out, and it should be without expense to the individual, for it is a general 
 protective measure. 
 
 A very simple, practical and sanitary method of vaccination which is 
 at present employed consists in the scarification of the skin with the point 
 of a needle in order that too much blood may not be drawn, the lymph 
 being transferred from the vial to the skin by wooden tooth picks, both 
 the needle and picks having been purchased in unopened packages and 
 therefore new and clean. These are io he used hut once and then thrown 
 away. 
 
 The character or appearance of a successful vaccination depends upon 
 whether or not it is a primary or a first vaccination, or a secondary or re- 
 vaccination. A primary vaccination may easily be detected by a white 
 pearly ring which surrounds the vesicle in its early stage ; this does not 
 appear in the revaccination, the latter having no special characteristics, 
 which as a rule a layman would recognize. It is to properly determine 
 the success of this operation that the observation of a physician is neces- 
 sary for, while a revaccination may be quite sore and painful and asso- 
 ciated with considerable inflammation, it does not necessarily follow that 
 it is successful or confers immunity; this is decided largely by the ap- 
 pearance of the scar. Many persons vaccinate themselves or members of 
 their family, or after having been vaccinated by a physician, do not see 
 him again in order that the result of the operation may be determined, 
 and therefore cannot be sure that protection is conferred and may be 
 susceptible to Smallpox. Therefore, it is necessary that the result of 
 every vaccination should be examined by a physician. 
 
 The outside of the left arm is usually chosen for vaccination for, as 
 a rule, it is used less than the right one, and therefore subjected to less 
 movement. For appearance sake some are vaccinated on the leg, al- 
 though this is less desirable. The local symptoms are apt to be more 
 severe and locomotion is not infrequently interfered with. 
 
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