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vaccinated spots presented the exact appearance of true Hunterian chancre. He treated them with wet lint and small doses of Mercurius vivus, and in a week or two the sores were healed, and up to this time no perceptible morbid effects had followed, except that the lady had a sort of serpiginous eruption on the forearm of the vaccinated arm, which soon went off. He concluded that these sores, though they looked syphilitic, could not have been truly syphilitic, though, of course, he might be mistaken in this. His experience of vaccination and smallpox in his own person differed from Dr. Teldham's. He was originally vaccinated successfully in 1820, re-vaccinated unsuccessfully in 1831, had a smart attack of smallpox in 1838, tried to vaccinate himself in 1864 without effect, and was successfully vaccinated in 1871, the vaccination running a regular course and leaving two wellmarked cicatrices. He thought the method of vaccinating by the pin-head-sized blister was generally followed by bad inflammation of the arm. He preferred scratching with a lancet and inserting the matter from ivory points. Ignorant people were often much alarmed by observing the occurrence of eruptions of various kinds on their children after vaccination. But such eruptions occurred frequently after any exanthematous fever and were not brought into the system by the vaccination, but brought to the surface by the peculiar febrile disease.
Mr. Engail said, One of the most important things was the purity of the lymph employed in vaccination; and, for this reason, he thought the use of either the thread, or the paper referred to was objectionable, as there was a risk of taking up some of the blood; that this waB obviated by the use of the capillary tubes, for in these if anything but pure lymph existed, it was made evident to the sight. Unlike some of the speakers, the points had uniformly failed with him, but the use of lymph taken from the arm in the tubes (with one exception) had always succeeded. This one failure he attributed to the quantity being too small, as a repetition of the process produced good vesicles. His mode of vaccinating differed somewhat from those already mentioned. He broke off the ends of the tube and blew the lymph upon the arm, which formed a globule of lymph, into the centre of which he placed the lancet and made the scratch, taking care not to cause any blood to flow. By this means he caused no pain to the child, excluded the air from the wound, and secured the immediate absorption of the lymph. The superfluous lymph—if any—could then be taken up by the tube and be blown upon the other part where the second scratch would have to be made. He generally used two tubes, each of which he had previously supplied with the quantity necessary for one puncture. By this procedure he got a healthy vesicle, which he thought was not obtained when blistering of the cuticle was first employed, since in the latter case there would be two actions set up,—that of the blistering vesicle, and that of the vaccine virus. Now, that of the blistering, it had been shown (if too much were used), would produce swelling of the whole arm, which pure vaccine virus alone does not produce; and, therefore, the action of the blistering is stronger than that of the vaccine virus, and must modify it accordingly. Even when this swelling is not produced there are still the two actions going on, which must modify in some degree the result; hence, he thought that the lymph from such vesicle could not represent normal vaccine lymph, and from such causes might arise those failures which were so rife. Again, the object aimed at should be the introduction of the lymph into the absorbent system in such manner that the result might be due solely to its influence. Therefore, he thought that an incision made deeper than just to indicate by the presence of a red line that the absorbents were reached was objectionable, because, as each tissue has its specific inflammation the deeper the cut the more likelihood for these several structures to be involved, and (as in the case before cited) other modifying inflammations to be set up. This might also be the case with the irritation produced by the points acting as local irritants. If these deeper structures were involved, and another action set up, this would manifest itself in a deeper cicatrix; and therefore he was of opinion that a deep-seated cicatrix did not indicate protection so well as one which indicated that the absorbents alone had been reached.
Dr. Dbtjey called attention to some coloured drawings of arms, showing the effects of re-vaccination; one, that of a butler, that had the appearance of rupia. In this case the vaccination apparently called into action disease that was lurking in the system. Another drawing was that of a bad arm following vaccination, the remarkable feature of which was that the lady was attacked with smallpox several weeks after, but before the arm was quite well. The arm of a young woman, said to have had smallpox when two years old, went through the stages of vaccination perfectly; this was done with vaccine four removes from the cow. Dr. Drury said that in vaccinating he always adopted the nick mode of scratching the arm with a lancet, and, if possible, rubbing in the fresh lymph off his lancet, either direct from a child or from a tube, Failing such a supply he rubbed in the dry points, and when vaccine was scarce had more than once used one point to do two places. He was aware that at the Smallpox Hospital Mr. Marson always liked to vaccinate in five places. He very much questioned if one small place took if the system was not as effectually protected, and that the real advantage of a number of places was to secure a good supply of lymph and to ensure a successful operation if possible. As regarded the size of the cicatrix he thought far too much importance was attached to it; the operation might have been perfectly successful when only a small one was to be found, while a large cicatrix might result from the arm being allowed to get rubbed and ulcerated. As regarded the risks of re-vaccination there was no doubt that in a certain number of cases bad arms were to be expected, but the fact that the same lymph was used in several cases without any such result following showed that the vaccination merely called out mischief ready to show itself on provocation. Of course, it was possible that disease might be conveyed by the lymph, but the facts that he had mentioned showed that it was not the cause in the majority of cases. Bad arms were not often seen after first vaccination, and in the cases where eruptions appeared, on careful inquiry, it could often be ascertained that some eruption had appeared before vaccination, or that any connection with vaccination was very remote. As a large number of children came under his observation, he took some trouble to inquire about these matters when cases came before him where vaccination was blamed. A gentleman, who had Buffered from eczema, applied to him to be vaccinated; he told him that he could not guarantee that the operation might not be followed by a return of his attack, his patient preferred this risk to the risk of taking smallpox; the result was one of the most severe attacks of eczema he had ever seen. His practice was to advocate vaccination, while he strongly objected to its being made compulsory; he did not think that the controversy for and against vaccination had been carried on with fairness by either its friends or its opponents. He wished to point out one peculiarity of the recent epidemic of smallpox, which was this, that formerly children who had been vaccinated were almost absolutely safe from an attack of smallpox till the age of fourteen, as strongly insisted on by the late Dr. George Gregory and Dr. Copland, whereas in the last epidemic vaccinated children had not this same universal protection.
Dr. J. Galley Blackley. begged to add his testimony to the value of vaccination, both primary and secondary. During the epidemic of smallpox in Liverpool in 1871 out of 150 cases which had passed through his hands tbe speaker only remembered one fatal case, where there was distinct evidence of vaccination having been previously properly performed, whilst in those who had been revaccinated not a single case of smallpox occurred. He thought that the protective influence certainly diminished with lapse of time, and instanced three cases of smallpox occurring in one family. The first, a child of three months old who had not yet been vaccinated, had a most severe attack of confluent smallpox and died; the second was a boy of seven who had been successfully vaccinated in infancy; in this case the attack was a remarkably mild one, whilst in the third case, which was that of a girl of fourteen, who also had been vaccinated in infancy, the attack was much more severe, but terminated favorably. Beferring to the question of the transmission of disease by means of vaccination, Dr. Blackley thought this had been very much exaggerated, as well-authenticated cases were really very rare. As to the mode of transmission, we had as yet no proof that the bloodcorpuscles alone were the agents, there being just as great a probability in favour of the lymph itself being the vehicle. In conclusion, the speaker expressed his preference for the ivory points, which when used to a scarified surface seldom failed.
Dr. Bayes (Vice-President) said that he had wished to add a few remarks to those already expressed, but that owing to the lateness of the hour he would only express the satisfaction which he felt at the turn the discussion had taken, as, although many different opinions had been expressed as to the best mode of preserving lymph and of vaccinating, yet there was perfect unanimity, on the part of all the members present, as to the value of vaccination as a prophylactic against smallpox,
Memoir of Sir James Y. Simpson, Bart. By J. Duns, D.D., F.E.S.E., Professor of Natural Science, New College, Edinburgh.
Evek since the death of Sir James Simpson the profession, and indeed the general public, have been eagerly looking forward to some biography which should give a fair view of the life, labours, and character of that distinguished man. It was reasonably anticipated that the career of one who, from comparative obscurity, had, in virtue of his own genius and diligence, come "to stand before kings rather than before mean men"—whose name had become a household word in thousands of families, the members of which had shared the blessings of that anaesthetic which his labours principally contributed to bring into common use—who, while by general consent facile princeps in his own special department, had yet found time to linger in nearly every province of the healing art, and in each had left imperishable traces of his presence behind him—who had thrown considerable light upon the interesting but obscure subject of medical antiquities—who, during nearly thirty years, had lectured to perhaps the most numerously attended medical class in the University of Edinburgh, and who in private life attracted the admiration and warm personal regard of the thousands with whom his princely hospitality brought him into contact, must necessarily interest not his professional brethren alone, but also those of the community at large who had profited by his benevolence, industry, and skill, and indeed all who find pleasure