SMALL-POX AND VACCINATION IN BHUKTPOOR. Bx Eobeet
Surgeon
Haevey, M.B., &c.,
Majpootana Political Agency. CContinued from page 10.J
to the Eastern
attend the first introduction The many difficulties which chief of which are district?the Indian an in of vaccination the and and careignorance the operators the inexperience of to a percentage of doubtful and lessness of unsuccessful cases unknown in Europe. The failures cannot to vaccination on the be accounted for by any insusceptibility of the native children. I have little belief in such in-
parents?lead
part
susceptibility
at
all:?I have
never
met with
a
case
in
an
THE INDIAN MEDICAL GAZETTE.
52
experience of many thousand vaccinations, ninety-nine out of every hundred cases, in
and I believe that in which it is
the failure is due either to some fault in the
inactive
operator
alleged, or
to
an
Howsoever produced, the natural result of a small proportion of success is that considerable numbers of children who have undergone a vaccine operation remain unprotected against small-pox; and these contracting the disease on exposure to infection, are cited ns instances of the failTire of vaccination, to the discredit of the prophylactic, and the or
effete virus.
opposition to its propagation. already mentioned that during the season of 1865-66, only 7r80 per cent, of the Bhurtpoor cases were returned as successful, and when the present epidemic began I was quite prepared to expect a large number of so-called post-vaccinal I say so-called, because in the absence of cases. any result from an attempted vaccination the person unsuccessfully operated on has no right to throw blame on the prophylactic, and no increase of the I have
claim to be looked upon as a vaccinated person. operation of vaccination itself, as some
It is not the
nine of the cases were
proved by the statecents which have from time to time been made in England as to the failure of vaccination in this country. Copland, for instance, says*?" Vaccination has been demonstrated to be inconcerned, they have
not been set aside is
"
Of
genuine post-vaecinal small-pox there were thirty.two patients (two excepted) having a scar or scars on arms;?just four per cent, on the total number seen. This gives one case of small-pox in the vaccinated to 24 among the unprotected, and as I have shown that at the beginning of the epidemic the protected out-numbered the unvaccinated children, it is a striking testimony to the protective power of vaccination. That power, as well as the advantages of vaccination in modifying and controlling when it cannot altogether prevent the disease, is, however, much more clearly seen, and stands out in higher relief when the post* vaccinal series of cases is analysed, as in the accompanying cases, the their
table. ?-.b
T3
Number
-g 3
consequent security from small-pox, rather than a larger numoperations, that vaccination will make head against the apathy and prejudices of the natives of India.
ber of indifferent
Thirty-five children were successfully vaccinated,
been
stated
by
but bore
their parents to have marks of the opera-
no
their arms. As the cicatrix of a true Jennerian tion vesicle remains for life, or only fades slowly after tho lapse of manv years, this could not have been the case. Some of on
the children had no doubt been unsuccessfully operated on, but I believe that in the majority of the cases the parents made a deliberately untrue statement in order to avoid a dreaded vaccination. In many other cases a similar declaration was made at first, but retracted, and the children admitted to be unvaccinated, when it had been explained that the vaccination unnecessary ; presence of small-pox had rendered in arriving at the was sometimes
.great difficulty experienced truth, but a little patience and a second visit generally brought it out. In these 35 cases I could not ignore the positive statements made, but them, from the absence of
believing
any trace of scars, to have been most of them, unvaccinated and all unprotected, I could not admit them into the postvaccinal series, and have, therefore, classified them separately ; *
Dictionary of Practical Medicine, Art. Small-pox, Sec. 110.
O
I
* "X
3
None?A doubtful case None?Disease modified One bad
.
good ,, bad, one good
,, ,,
Two bad
scara
pood
?
Three bad ?
,
scar
Bad scars Good ,,
expected from the operation. Still some harm was done, and the lesson was impressed on me more forcibly than ever, that it is by good work, with large percentages of success and
a
CICATRICES.
Bhurtpoor cases, 50 children were met with who had been operated on without result, their parents admitting that no vesicles had risen at the points of puncture. All these children are included in the 728 cases returned as unprotected by vaccination," and analysed in my last paper. I do not think
to be
G
a,
and character OP YACCINB
good good
,, ,, ? ,,
Total
the 802
that any material discredit attached to vaccination from the occurrence of small-pox in them, as we are always careful to explain that without the eruption of the vesicles no benefit is
and 11
unmodified in all.
quite
Six
"
semi-confluent,
and 7 died; a mortality which confirms my belief that none of the number had been vaccinated with success. The disease was watched throughout in 34 of the cases, and was
efficacious in hot climates and among the dark varieties of the species, an assertion that could hardly have been made but for such sources of fallacy as that just mentioned. In
15
1870.
distinct,
ignorant persons seem to imagine, but the maturation and due sequences of the disease vaccinia, which give protection against small-pox, and a person ?who has been operated on without result stands in identically the same position as regards liability to contract small-pox, as one who has remained unvaccinated. "When, therefore, smallpox occurs in such persons, their cases should be set aside in estimating the value of vaccination. That so far as India is
confluent,
[March 1,
13
Total Not
31
single case is confluent., and only three semi-confluent; equal number of cases in unprotected children would given 17 in these two categories. Of the three semi-con-
while have
32
a
an
fluent cases, one had no scars, and was admitted into the series because the child's father, a very intelligent man, described the
course of the vesicle with great precision, and produced two other children vaccinated at the same time who had one bad cicatrix each. The other cases had each one scar?small and indistinct, irregular, non-depressed, neither radiated nor fovc-
ated?wanting, mark left "
by
in short, all the proper characteristics of the vesicles. Eight of the cases were
normal
distinct"
small-pox, and the disease, though slight in all, quite unmodified in three of them. The other five had no secondary fever. In the remaining 21 cases the pocks were so sparsely sprinkled, that it is better to class them separately than where the pustules, to include them among ?the distinct cases, though quite separate, were yet numerous. In one case only three pocks were present, though the initiatory fever had been was
well-marked.
after tion.
In anothor there were but ten, which dried up the vesicular stage without going on to suppuraand another similar case, where the points of
reaching This
were more numerous, might have passed for chickenpox, but for the presence of the epidemic, and careful inquiry into the premonitary symptoms which seemed to indicate the existence of small-pox poison. In only one of the 21 did the pocks exceed two hundred in number, and in this case, which
eruption
scabbing had commenced, the crusts were superficial and exceedingly small ; few being larger than pellet of No. 3 shot, and the great majority much smaller.
was
very a
not met with till
jVTaecii 1,
1870.]
SMALL-POX & VACCINATION IN BIIUETPOOE.?BY E. IIAEVEY.
Most of the children, continued to play about during the whole of the disease, and in none of them was there any secondary fever. Of the whole post-vaccinal cases only one was fatal. The child had one bad scar, but the pustules were distinct and few in number, and I fully expected that it would recover. I saw it on the 7th day, and going on the ninth to enquire whether it liad any secondary fever, learned that it liad died the preceding evening. This is, so far as I know, the only death which occurred during the epidemic in any child bearing marks of vaccination. The number of post-vaccinal cases is too few to draw absolute conclusions from, yet so far as they go, they show that while each vaccinated child had, as compared with the unvaccicourse
nated,
24 chances to one of
escaping small-pox altogether,
lie
had 138 to 1 that lie did not die of it; the death-rate in the vaccinated being 3'22 per cent., and in the unprotected 18"55, 5'76 times greater. By facts like these, and I have spared no pains to ensure their accuracy, vaccination is " demonstrated" to be not ft inefficacious" but of the very highest value in India:?of a ?value I believe as high of the same kind and in the same degree as in the colder climates of the continent of Europe. The actual number of post-vaccinal cases is perhups larger than might have been cxpccted, considering the rarity of the affection in children, and the short time that had elapsed since the vaccinations had been performed?the time varied from one
to seven years, and the average age of the children was a over four;?but it must be remembered that the poison was everywhere prevalent and much concentrated, that the
little
produced by the vaccine operation had been very imperfect in many of the children, and that those with good cicatrices, though exposed to strong infection, had the disease so slightly as to run almost no risk of a fatal termination. The remaining seven cases on the list are cases vaccinated while incubating small-pox, too late to prevent its manifestation, yet early enough for the vaccinia to modify and control to some extent the action of tlio variolous poison. It may be well to mention, for the benefit of the unprofessional reader, that after exposure to smalL-pox infection twelve days elapse before the manifestation of the disease, while the protection conferred by vaccination is attained on the development of the areola in from eight to nine days after the vaccine operation. If, therefore, a person exposed to the contagion of small-pox be vaccinated within three days of his exposure, the vaccine disease, getting the start of the variola, prevents its development. If vaccinated on the fourth day he will contract small-pox, but the diseace will be modified by the vaccination, but if more than four days have elapsed the vaccination will be of none effcct, and the small-pox, having the start of the vaccinia, will run its natural courso as if no operation had been performed. In the Bhurtpoor epidemic 41 cases were noted of concurrent variola and vaccinia. It is, of course, im? posible to say how many more were vaccinated while incubatin
Surgeon
Haevey, M.B., &c.,
Majpootana Political Agency. CContinued from page 10.J
to the Eastern
attend the first introduction The many difficulties which chief of which are district?the Indian an in of vaccination the and and careignorance the operators the inexperience of to a percentage of doubtful and lessness of unsuccessful cases unknown in Europe. The failures cannot to vaccination on the be accounted for by any insusceptibility of the native children. I have little belief in such in-
parents?lead
part
susceptibility
at
all:?I have
never
met with
a
case
in
an
THE INDIAN MEDICAL GAZETTE.
52
experience of many thousand vaccinations, ninety-nine out of every hundred cases, in
and I believe that in which it is
the failure is due either to some fault in the
inactive
operator
alleged, or
to
an
Howsoever produced, the natural result of a small proportion of success is that considerable numbers of children who have undergone a vaccine operation remain unprotected against small-pox; and these contracting the disease on exposure to infection, are cited ns instances of the failTire of vaccination, to the discredit of the prophylactic, and the or
effete virus.
opposition to its propagation. already mentioned that during the season of 1865-66, only 7r80 per cent, of the Bhurtpoor cases were returned as successful, and when the present epidemic began I was quite prepared to expect a large number of so-called post-vaccinal I say so-called, because in the absence of cases. any result from an attempted vaccination the person unsuccessfully operated on has no right to throw blame on the prophylactic, and no increase of the I have
claim to be looked upon as a vaccinated person. operation of vaccination itself, as some
It is not the
nine of the cases were
proved by the statecents which have from time to time been made in England as to the failure of vaccination in this country. Copland, for instance, says*?" Vaccination has been demonstrated to be inconcerned, they have
not been set aside is
"
Of
genuine post-vaecinal small-pox there were thirty.two patients (two excepted) having a scar or scars on arms;?just four per cent, on the total number seen. This gives one case of small-pox in the vaccinated to 24 among the unprotected, and as I have shown that at the beginning of the epidemic the protected out-numbered the unvaccinated children, it is a striking testimony to the protective power of vaccination. That power, as well as the advantages of vaccination in modifying and controlling when it cannot altogether prevent the disease, is, however, much more clearly seen, and stands out in higher relief when the post* vaccinal series of cases is analysed, as in the accompanying cases, the their
table. ?-.b
T3
Number
-g 3
consequent security from small-pox, rather than a larger numoperations, that vaccination will make head against the apathy and prejudices of the natives of India.
ber of indifferent
Thirty-five children were successfully vaccinated,
been
stated
by
but bore
their parents to have marks of the opera-
no
their arms. As the cicatrix of a true Jennerian tion vesicle remains for life, or only fades slowly after tho lapse of manv years, this could not have been the case. Some of on
the children had no doubt been unsuccessfully operated on, but I believe that in the majority of the cases the parents made a deliberately untrue statement in order to avoid a dreaded vaccination. In many other cases a similar declaration was made at first, but retracted, and the children admitted to be unvaccinated, when it had been explained that the vaccination unnecessary ; presence of small-pox had rendered in arriving at the was sometimes
.great difficulty experienced truth, but a little patience and a second visit generally brought it out. In these 35 cases I could not ignore the positive statements made, but them, from the absence of
believing
any trace of scars, to have been most of them, unvaccinated and all unprotected, I could not admit them into the postvaccinal series, and have, therefore, classified them separately ; *
Dictionary of Practical Medicine, Art. Small-pox, Sec. 110.
O
I
* "X
3
None?A doubtful case None?Disease modified One bad
.
good ,, bad, one good
,, ,,
Two bad
scara
pood
?
Three bad ?
,
scar
Bad scars Good ,,
expected from the operation. Still some harm was done, and the lesson was impressed on me more forcibly than ever, that it is by good work, with large percentages of success and
a
CICATRICES.
Bhurtpoor cases, 50 children were met with who had been operated on without result, their parents admitting that no vesicles had risen at the points of puncture. All these children are included in the 728 cases returned as unprotected by vaccination," and analysed in my last paper. I do not think
to be
G
a,
and character OP YACCINB
good good
,, ,, ? ,,
Total
the 802
that any material discredit attached to vaccination from the occurrence of small-pox in them, as we are always careful to explain that without the eruption of the vesicles no benefit is
and 11
unmodified in all.
quite
Six
"
semi-confluent,
and 7 died; a mortality which confirms my belief that none of the number had been vaccinated with success. The disease was watched throughout in 34 of the cases, and was
efficacious in hot climates and among the dark varieties of the species, an assertion that could hardly have been made but for such sources of fallacy as that just mentioned. In
15
1870.
distinct,
ignorant persons seem to imagine, but the maturation and due sequences of the disease vaccinia, which give protection against small-pox, and a person ?who has been operated on without result stands in identically the same position as regards liability to contract small-pox, as one who has remained unvaccinated. "When, therefore, smallpox occurs in such persons, their cases should be set aside in estimating the value of vaccination. That so far as India is
confluent,
[March 1,
13
Total Not
31
single case is confluent., and only three semi-confluent; equal number of cases in unprotected children would given 17 in these two categories. Of the three semi-con-
while have
32
a
an
fluent cases, one had no scars, and was admitted into the series because the child's father, a very intelligent man, described the
course of the vesicle with great precision, and produced two other children vaccinated at the same time who had one bad cicatrix each. The other cases had each one scar?small and indistinct, irregular, non-depressed, neither radiated nor fovc-
ated?wanting, mark left "
by
in short, all the proper characteristics of the vesicles. Eight of the cases were
normal
distinct"
small-pox, and the disease, though slight in all, quite unmodified in three of them. The other five had no secondary fever. In the remaining 21 cases the pocks were so sparsely sprinkled, that it is better to class them separately than where the pustules, to include them among ?the distinct cases, though quite separate, were yet numerous. In one case only three pocks were present, though the initiatory fever had been was
well-marked.
after tion.
In anothor there were but ten, which dried up the vesicular stage without going on to suppuraand another similar case, where the points of
reaching This
were more numerous, might have passed for chickenpox, but for the presence of the epidemic, and careful inquiry into the premonitary symptoms which seemed to indicate the existence of small-pox poison. In only one of the 21 did the pocks exceed two hundred in number, and in this case, which
eruption
scabbing had commenced, the crusts were superficial and exceedingly small ; few being larger than pellet of No. 3 shot, and the great majority much smaller.
was
very a
not met with till
jVTaecii 1,
1870.]
SMALL-POX & VACCINATION IN BIIUETPOOE.?BY E. IIAEVEY.
Most of the children, continued to play about during the whole of the disease, and in none of them was there any secondary fever. Of the whole post-vaccinal cases only one was fatal. The child had one bad scar, but the pustules were distinct and few in number, and I fully expected that it would recover. I saw it on the 7th day, and going on the ninth to enquire whether it liad any secondary fever, learned that it liad died the preceding evening. This is, so far as I know, the only death which occurred during the epidemic in any child bearing marks of vaccination. The number of post-vaccinal cases is too few to draw absolute conclusions from, yet so far as they go, they show that while each vaccinated child had, as compared with the unvaccicourse
nated,
24 chances to one of
escaping small-pox altogether,
lie
had 138 to 1 that lie did not die of it; the death-rate in the vaccinated being 3'22 per cent., and in the unprotected 18"55, 5'76 times greater. By facts like these, and I have spared no pains to ensure their accuracy, vaccination is " demonstrated" to be not ft inefficacious" but of the very highest value in India:?of a ?value I believe as high of the same kind and in the same degree as in the colder climates of the continent of Europe. The actual number of post-vaccinal cases is perhups larger than might have been cxpccted, considering the rarity of the affection in children, and the short time that had elapsed since the vaccinations had been performed?the time varied from one
to seven years, and the average age of the children was a over four;?but it must be remembered that the poison was everywhere prevalent and much concentrated, that the
little
produced by the vaccine operation had been very imperfect in many of the children, and that those with good cicatrices, though exposed to strong infection, had the disease so slightly as to run almost no risk of a fatal termination. The remaining seven cases on the list are cases vaccinated while incubating small-pox, too late to prevent its manifestation, yet early enough for the vaccinia to modify and control to some extent the action of tlio variolous poison. It may be well to mention, for the benefit of the unprofessional reader, that after exposure to smalL-pox infection twelve days elapse before the manifestation of the disease, while the protection conferred by vaccination is attained on the development of the areola in from eight to nine days after the vaccine operation. If, therefore, a person exposed to the contagion of small-pox be vaccinated within three days of his exposure, the vaccine disease, getting the start of the variola, prevents its development. If vaccinated on the fourth day he will contract small-pox, but the diseace will be modified by the vaccination, but if more than four days have elapsed the vaccination will be of none effcct, and the small-pox, having the start of the vaccinia, will run its natural courso as if no operation had been performed. In the Bhurtpoor epidemic 41 cases were noted of concurrent variola and vaccinia. It is, of course, im? posible to say how many more were vaccinated while incubatin
