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toms than those we have enumerated, that is to say, slight inflammation
of the arm, swelling of the axillary glands and fever.
These symptoms
require no treatment; the children should be kept cool, the quantity
of their food moderated, and some baths made use of. If the
inflammation of the arm is very intense, emollient lotions or poultices
should be prescribed, which will suffice to diminish the pain and the
inflammatory swelling of the skin.

The protecting power of vaccination against small pox is indubitable. It was much more manifest formerly than in our times, when it appears that the vaccine virus is weakened and sometimes powerless as a preservative against this disease. In fact, we observe, in very rare cases, in proportion to the number vaccinated, small pox become developed in subjects who have been submitted to vaccination.

However, whatever may be the value of vaccination, it cannot be denied that it has nevertheless rendered immense service to humanity. it must however be admitted that it is less efficacious than it was at the first period of its discovery; and this will readily be admitted, for it is known that all kinds of virus become weakened in proportion as they are inoculated and as new generations are made virulent; but such as it is, this means is still excellent.

We may, by renewing the vaccine virus, give it all the desirable properties; thus practitioners have several times made use of new cow pox in order to regenerate the vaccine matter. Consequently, this preservative means resumes all its importance.

For those who cannot procure this new vaccine matter it may be very advantageously replaced by revaccination at the end of fifteen to twenty years with the old vaccine matter. If the vaccination succeeds, then was the patient liable to contract small pox; if on the other hand it does not succeed, then the previous vaccination has lost nothing of its properties.

Besides, the new vaccine matter will be rapidly disseminated in France, thanks to the zeal of the vaccination board of Paris, which responds to all the demands of the most distant practitioner, and which sends, on application, vaccine matter which possesses all the desirable preservative qualities.

3rd. On secondary vaccinal eruptions. Vaccinal pustules have been sometimes observed to become developed on parts of the body where the vaccination has not been at all practised. It is always, as M. Rayer remarks, on surfaces inflamed or deprived of the epidermis, on chronic eczemas, on excoriated lichens, &c., that these secondary pustules become developed. They are sometines produced by an accidental and posterior inoculation which the vaccinated person has performed with his fingers, after having scratched the pustules when the constitution has only been incompletely modified by the

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first eruption. More often the supernumerary pustules are the result of a secondary eruption, analogous to that which is so often observed upon in inoculated small pox. The secondary vaccinal eruptions are in general of an erythematous Thus the vaccinated arm becomes the starting point of an erysipelas, sometimes serious, which extends over the whole body and causes the death of the children if they are very young. Roseola very frequently covers the body at the period when the inflammatory areola of vaccination is at its highest degree. This eruption is not Arrole is serious, it may momentarily slightly disturb the health of the children by giving them an intense fever; but it only lasts a short time and becomes dissipated without leaving any traces.

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Erysipelating

The treatment of these secondary eruptions is very simple. When & erysipelas is present, the means recommended in the chapter devoted to this disease must be made use of. As to roseola, it may be allowed a to progress, administering emollient or diaphoretic drinks to the patient, Relaand placing him in a well-warmed apartment, protected from the influence of cold and damp.

[A paper has just been published by M. Bossu (Journal Hebdom.; March 17th, 1854) upon inoculation, with a mixture of milk and variolous pus to supersede vaccination. M. Thield (of Kassan), and M. Robert (of Marseilles), have proposed to blend variolous matter with milk, for the purpose of weaking the poison attenuating it, and localising its effects upon the economy. This proceeding, justified by some success, has attracted considerable attention, because it furnishes the means, in the event of small pox invading any locality, of replacing the vaccine matter, which may be defective in quality, or deficient in quality, with a prophylactic furnished by the epidemic itself. In 1832, M. Brachet (of Lyons), starting with the idea that the vaccine eruption probably owed its properties to the milk contained in the breast where it was developed, inoculated three young children with a mixture, in equal parts of milk and variolous pus. These three patients cat were put in a ward where a girl infected with confluent small pox had just been admitted. The infants escaped; but each became affected round the punctures with an eruption precisely similar to that produced by the vaccine virus, and wine. which remained local..

New experiments have been recently tried at La Charité, at Lyons, by M. Bouchacourt, surgeon in chief, and to these we shall direct attention.

Equal parts of cold milk and variolous pus taken from the pustules in the vesicular stage of naturally-developed small pox, were mixed upon a piece of glass. Punctures were made in each arm with a clean lancet charged with this liquid. Five infants were directly inoculated. Three were inoculated successively from arm to arm with the liquid contained in the pustules resulting from the first inoculation: primary

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transmission. Three were inoculated from arm to arm with the liquid obtained Eik

from these new essays: secondary transmission. Four were inoculated from arm

to arm with the liquid coming from this second indirect inoculation: tertiary trans-ult

mission; success, as with the preceding. Three were inoculated with the liquid collected from the pustules produced by the first transmission, and preserved eight days; two with the liquid preserved eleven days, and finally, one infant was inoculated with the liquid coming from the pustules produced by this last experiment.

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Of these twenty-one children, of ages varying from eight days, five months, and 2/ Eq

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eleven years, eighteen presented pustules precisely similar in character and duration to those of cow pox, limited to the seat of puncture.

In two newly-born infants the circumference of each pustule offered, about the sixth day, one or two smaller pustules, but these disappeared as the mark of inoculation faded.

In another child, aged five months, there followed four pustules scattered over the neck and shoulders. They were small, vesicular, and not depressed, and disappeared with the pustules produced by inoculation. This infant was very susceptible, and the poison had been taken from a case of confluent small pes; thus the phenomena were not more serious than those resulting from ordinary vaccination.

It then became necessary to test its power as a prophylactic.

Three of the children above mentioned were vaccinated in the usual way eight or ten days after the disappearance of the phenomena, resulting from the lactovariolic inoculation; and at the same time two other children about the same age, but who had neither had small pox or cow pox, were vaccinated with matter coming from the same pustule. Vaccination developed itself in the last in its common form. In the first no effect ensued. A child previously vaccinated was inoculated with the lacto-variolous pus. The result was negative.

Commencing with this equivalence between vaccine virus and the lacto-variolous fluid M. Bossu proposed a series of inquiries to determine-1st. From what form of small pox should the virus for inoculation be taken. 2nd. At what phasis of pustulation should it be collected? 3rd. At what age the operation is most fitted. 4th. What conditions ensure success? 5th. Does the fluid coming from the lacto-variolous pustule admit of being preserved in an efficient state!

The interest attached to this subject, and the able manner in which it has been treated by M. Bossu are acknowledged; but further investigations are required before the practice can be sanctioned by the profession.-P.H.B.]

[On the influence exerted on small pox by vaccination during the incubative period. After a brief recapitulation of opinions, M. Barthez relates two observations bearing on the effect of vaccination at the commencement of small pox, and thus concludes-1st. That if vaccination be practised during the incubation of variola, so that the vaccine eruption precedes the variolic, this latter will be almost always modified. 2nd. That in the great majority of cases, this modification will be favourable. 3rd. That if the variolic fever does become severe, this is to be attributed to the previous impaired state of health, and to the youth of the patient. 4th. That in this last case, the vaccinea, the third malady, added to the two former, does not exert a favourable influence on small pox.-(British and Foreign Med. Chir. Rev.; January, 1854.)—P.H.B.]

CHAPTER II.

ON SMALL POX.

Small pox is a contagious, eruptive fever, characterized by the appearance of centrally depressed pustules on the surface of the skin. It is the result of the infection of the body by a fixed or volatile

inappreciable virus, which propagates itself directly from one individual

to another, or indirectly by the medium of the air and of certain ortus foreign bodies as the crust of pus, linen, clothing, &c. This is what is termed the variolic virus. It does not act with equal force on all subjects; some resist its action, others are liable beyond all that we could foresee. There is here, as in all diseases, a kind of very evident aptitude to contract this disease, an aptitude which depends on individual more lik idiosyncracy and which may be neutralized or destroyed by means of vaccination. The aptitude to contract small pox is greater in the

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foetus in the womb of the mother, than in the newly-born. It is the diminishes after birth, and returns in a very evident manner towards

the age of five or six years. It again disappears in the aged, who he manly.

are very seldom attacked by small pox. Lastly, it is the same in the two sexes and in all the human races.

Small pox is contagious, epidemic, and often congenital. Small pox is regular or irregular, discrete or confluent, benign or malignant.

[The infection of the foetus in utero does sometimes unquestionably happen;

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in one instance, related by Mr. Flinders, the disorder was eight or ten days later in 67russ

the foetus than in the mother. A woman, near her full time, took small pox. The pustules were mature about the 10th or 11th of June. On the 18th she gave birth to a full-grown boy, upon whose face and body there were many pustules, discrete, and nearly ripe. The child died the same night. In the American Journal of Medical Science is mentioned the case of a foetus which was born completely covered with discrete variola in the pustular stage, apparently about the eighth day of the Jula disease. The mother had been vaccinated when a child; had never had small pox; but was very fearful of it, and had a very mild attack of the disease. But the foetus may catch the disease through the medium of the mother, although she, having had it previously, may be unaffected by the contagion. Dr. Mead relates the case of a woman, near her reckoning, who attended her husband in this distemper. She was delivered, at the full time, of a dead child, which was covered all over with the pustules of small pox. Dr. Jenner gives an account of an infant who, upon the fifth day of its age, became indisposed, and on the seventh exhibited the eruption of small pox, so that the contagion must have been communicated to it while yet in the womb. A few days before her confinement, the mother of this child had seen, in the street, a person covered with small pox pustules, the smell and sight of whose body had sensibly affected her. Sir William Watson describes an instance in which the scars left by the pustules were visible upon

an infant at its birth. This child was afterwards inoculated without taking the Cen

disease. Its mother, who had formerly had it, nursed, when far advanced in pregnancy, a servant ill of small pox. Dr. Pearson met with a similar example: Mary Spooner was inoculated by him in her sixth month of utero-gestation, and had the disease severely. Her child was twice inoculated with small pox matter, but without effect. Watson's Lectures.-P.H.B.]

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ANATOMICAL ALTERATIONS.

When the specific cause of small pox has determined the organic

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ul reaction which favours the development of this eruptive fever, red, slightly projecting papula, more or less numerous, appear on the surface of the skin; their redness disappears under the pressure of 10.144 the finger and assumes its colour as soon as the pressure has ceased; the epidermis becomes softened at this spot in its deep layer, and thus permits the effusion of a very small quantity of transparent serosity, which is alkaline according to M. Petzholt of Leipsic, and thence AA1 ¿er small whitish resicles result. The vesicle quickly increases and becomes depressed at the centre so as to form a kind of disc. According to M. Rayer, this central depression depends on the formation of a small deposit of fibrine perforated at the centre, and according to M. Petzbolt, on the presence of a glandular conduit, which, under the form of an epidermic filament, is attached at one end to the epidermis, and at

the other to the surface of the skin.

Mas At the fourth or fifth day, the vesicle becomes increased and changed into a centrally depressed projecting pustule, white towards the centre, red at the circumference; the fibrine, under the form of a perforated pseudo-membranous disc, is observed in the interior, the papillary body becomes the seat of a more or less decided erosion.

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The pustule is at first filled with an opaque serosity which augments and soon becomes converted into pus; this becomes fused around the pseudo-membranous disc, detaches the epidermis, which it raises, causing the central depression to disappear. The pustule then is observed under the form of a large whitish vesicle, red at the circumference. It soon becomes lacerated, causing the escape of the pus which it encloses; at first it is covered with yellowish, soft, and transparent crusts, which are termed melicerous, then with dense, blackish crusts, which become detached at the end of twenty-five or thirty days, leaving behind them, for two months, red stains upon the body, and

i. reddish excavations on the face.

Similar pustules are observed on the roof of the palate and on the surface of the tongue, but they never acquire much volume and never become covered with crusts.

The same is the case with the cutaneous pustules which become developed on the child in the womb of the mother, that is to say, on the foetus bathed in the liquor amnii. Here the pustules are always in small number, whitish, flattened, and become cured without the formation of crusts, in consequence of the lubrication of the diseased parts.

The mucous membrane of the nasal fosse is usually inflamed, red, softened, and sometimes ulcerated.

The intestinal mucous membrane presents some traces of inflammation, judging from the hyperemia of which it is the seat in several parts, and sometimes from the apparent development of several of the glands of Peyer.

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