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tically disturbed in its action by stomach difficulties. Allopathic diagnosis had been at fault, and Dr. Holland's more accurate diagnosis had enabled him to cure a disease readily which had been wrongly pronounced incurable.
NOTES ON RE-VACCINATION.
(Eead before the British Homoeopathic Society.)
In the years 1864 and 1865, in consequence of the presence of smallpox in the neighbourhood of Manchester, I had occasion to re-vaccinate a number of children and adults; and again in the epidemic of 1871 a much larger number were re-vaccinated by me. In the first period from 60 to 80 patients passed through my hands, and in the latter period from 250 to 300. These varied in age from six years up to eighty, and were, as a matter of course, in different conditions of health and of very varied constitutions.
In ordinary vaccinations I had often noticed a marked difference in the action of lymph of the same kind and quantity, and it occurred to me that it might be useful to ascertain the cause of the different amount of irritation produced in different cases. It seemed to me quite possible for this to be due either to an extra degree of susceptibitity, to the extent of surface laid bare, to the quantity of lymph applied, or to all of these combined.
In private practice the number operated upon at one time is rarely large enough to enable us to make experimental observations from which we can draw trustworthy conclusions; and indeed in the present state of opinion upon the subject of vaccination anything which has the appearance of pure experiment on children would in most instances be strenuously objected to, however harmless it might be. A good opportunity, however, for making observations upon re-vaccinated patients did occur in 1864 and 1865, and although at the time these were commenced I had no expectation of being able to make other observations by way of comparison, if such an opportunity did occur, it seemed to me quite possible to determine whether the degree of susceptibility varied in different years in the subjects re-vaccinated. It also seemed possible to ascertain the relative number of those operated upon, in whom the susceptibility to the action of lymph was perfectly exhausted by a previous vaccination.
Although the two periods named have furnished as favorable an opportunity as may perhaps ever occur for making such inquiries as those I have indicated, I do not know that I can answer any of the questions suggested in as complete and satisfactory a manner as I should wish.
I have, however, thought it worth while to record my experience on these and other points connected with revaccination, so as to be able to compare notes with some of my colleagues.
At different times several methods of preserving lymph were tried, namely, by keeping it in capillary tubes, on slips of glass, on ivory points, and lastly on slips of paper. The capillary tubes, in which the lymph was kept moist, proved with me wasteful and uncertain; and from the experience obtained on these occasions I do not think moist lymph keeps as well as dry lymph. From the circumstance also that in using this there is always a small portion left in the tube which no ordinary force can drive out, it is a wasteful method of using lymph. For ordinary use I prefer the ivory points, and have found that when Jthese are quickly and carefully dried, if they are tightly corked up in a small glass tube and excluded from the light, the lymph will often be found to be active at the end of four months.
The paper alluded to above was used to enable me to determine, with some slight approach to accuracy, the relative quantity of lymph applied in those cases I wished to have under observation. A strip of highly glazed thick cream-wove note-paper, two lines wide, was charged with lymph on one surface by being drawn across a vaccine vesicle after the lymph had been made to flow by puncturing it on the eighth day. By allowing this to dry and then drawing it across the vesicle again a layer of lymph of double the thickness a single charge would give was placed on one surface. Some of the strips of paper had a single and some a double charge given to them. In using these a piece two lines long was cut off and laid on the abraded spot after being moistened. Where I wished to apply a single charge of lymph to the arms of different individuals whilst this was quite moist a piece of the paper two lines square was charged with the fresh lymph as it flowed and was applied to the abraded surface, which latter was made as nearly as possible to correspond to the size of the paper.
When a double charge was applied the first square of paper, after being allowed to remain on the abraded spot for a given length of time, was removed and another piece, freshly charged, was applied. Small squares of thin ivory were used in a similar manner, but on the whole I prefer the paper.
The object of this mode of proceeding was to ascertain what difference there was in the amount of susceptibility in different individuals and also to determine whether the degree of irritation varied according to the quantity of lymph applied to an abraded surface of a given area. It was for the time being assumed that the power of vaccine lymph did not vary when used whilst fresh. No attempt was made to determine the difference which small variations in the quantity of lymph used would make in the effect produced.
The abrasion of a portion of the skin so as to lay bare, in each case, an area of exactly the same dimensions—or, in other words, an area supplied with a similar number of capillary vessels—proved to be an exceedingly difficult task. So difficult indeed was it that only a very moderate approach to uniformity could be attained. The lancet was the instrument which in most cases had to be used. In some of the cases, however, where I wished to be as exact as possible in the size of the area operated upon, and where the patients were liberal enough to permit the use of a novel apparatus, the cuticle was punctured by a small instru* ment formed by having a number of needles laid together so that the points spread over an area the size of the squares of paper mentioned above, but this method I found was very uncertain. The application of Cantharides to a small portion of the skin might have given uniform results, but I believe that the use of this substance would have been attended with the risk of inducing a greater amount of inflammatory action than could be easily controlled.
As I shall have to show further on, it is not so much the quantity of lymph applied as the more or less perfect manner in which the capillaries are laid bare that determines the degree of inflammatory action!
In both the periods named I was myself a patient, so that I had the opportunity of studying some of the phenomena alluded to a little more closely than I otherwise could have done. The average quantity of lymph used for one vesicle was about jigth of a grain (estimated as dry lymph), but I have found that so small a quantity as 5~th of a grain would, if used whilst fresh, produce a full-sized vesicle; but if the lymph is diluted I believe it is possible to make a much smaller quantity than this to suffice.
In operating with the lancet a slip of thin wood, in the centre of which an opening two lines square had been made, waa pressed upon the arm, and the lancet was drawn across the skin shown in this opening a given number of times so as to penetrate the cuticle with lines crossing each other at right angles. With a little care, and by using a sharp lancet, tolerably even results could be obtained. Slips of paper perforated in a similar manuer answered equally as well as the wood, but were of course not permanent. The squares of paper charged as previously described were applied to these abraded spots.
In the first period the number of persons on whom a normal vesicle was formed was very small. I believe not more than four out of the whole number, and in not one instance do I remember the vaccine fever being set up.
The irritation generally commenced in a very few hours after the lymph had been applied, but in some cases it would not be felt for two or three days. In the latter case the irritation was generally more severe and more widely spread, and indeed made a nearer approach to the ordinary course of a primary vaccination than is usually seen in re-vaccination. In most instances the vesicles, if such they might be called, arrived at maturity on the fourth or fifth day, and in some few cases as early as the third day.
A curious circumstance occurred in my own case in this first period. I re-vaccinated myself with fresh lymph at the same time that three or four others were operated upon, but whilst in these cases vesicles of a more or less perfect character were formed, no effect was produced upon me. I concluded from this that in all probability I was not susceptible, and that I had to thank the vaccination of my childhood for this immunity. In about four weeks, however, I tried the operation again with lymph obtained from another child, and found that, although the vesicles were very imperfect, I was still susceptible to the action of lymph. In two other instances I have known the same thing to occur. In one of these the patient was suffering from a slight feverish attack of an indefinite character, but of which I was not aware at the time I vaccinated.
From these cases I conclude that there may be a condition of the organism which at times renders the patient unsusceptible to the action of lymph for the time being, whilst there are other patients who are susceptible to the action of one lymph and not to another. Of the exact nature of the condition which gives these results I can offer no explanation, and it is important to mention here that it is only in re-vaccinated cases that this condition has been seen.
In this first period fully one fourth of those operated upon seemed to be quite insusceptible to the action of vaccine lymph; whilst about an equal number were very slightly susceptible. In all these cases it was the rule to make two abrasions, and curiously enough whilst one vesicle would, in some cases, be more or less perfect, the other would be quite abortive although both abrasions had been treated in exactly the same manner. In some few cases a single charge of lymph was applied to one abrasion, whilst a -double one was applied to the other, but not in any case