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reason, also, why bile is more co 3d. The solid aliments thus piously elaborated, from the time rendered semifluid on reaching that digestion commences. It the duodenum, and having been also enables us to explain the va- acted on by the hepatic and panriable nature of this fluid, and al- creatic secretions, are absorbed so the fact, that its constituents by the lacteals, not becoming cannot all be detected in the cir- chyle, however, till they have culating blood. Thus, too, we entered these small vessels. confer on the liver an office so Thus, the constituents of the long denied to it, corresponding to blood, as furnished by digestion, its magnitude, complexness of are immediately derived from structure, and pathological im- two sources, a circumstance by portance ; for, if our inferences no means inconsistent with the are correct, it is one of the most compound nature of this fluid. important of the assimilating organs, since the elaboration of bile, from the fluids absorbed, is especially subservient to their animal HINTS ON VACCINATION. ization.
By D. FRANCIS CONDIE, M.D. It will be recollected by those Daily complaints are made by into whose hands an Essay on Di- physicians, in different parts of gestion, published by me a short our country, of the difficulties time since, may have fallen, that, they experience in preserving, in it, and in the supplement which throughout the year, a supply of followed it, I advocated the fol- genuine vaccine matter, and also lowing principles in regard to this of their frequent failures, in atfunction :
tempts to communicate the con1st. That, of the substances tagion, in a satisfactory manner, taken into the stomach, some, and to their patients. Being fully especially the fluid aliments, are persuaded, that both these cirtaken up by the veins and convey- cumstances may be avoided, by ed to the liver, where they are the observation of a few simple further assimilated previous to rules, I have taken the liberty of being added to the circulating offering to the profession, for the blood.
use, more particularly, of its 2d. The solid aliments which younger members, some hints in remain are slowly macerated and relation to the points referred to, dissolved in the stomach, not by a –the result of considerable exchemical agency, since the con- perience and many comparative stitution of the secreted fluids of experiments. Even should the this organ does not warrant the directions I propose laying down, supposition, and because, also, be found inconsistent with the exthe solution is not effected when perience of some, it is trusted, the nerves of the stomach are di- that this little essay may do some vided, nor when these Auids are good, by calling forth the remarks removed from the stomach. It of others, on questions of imporis accomplished probably by a vi- tance, as well to the medical protal influence, conferred on its flu- fession as to the community at ids by the nerves of the sto- large :-For on the purity of the mach
vaccine matter we employ, and
our facility in placing under its resist any change in its properties, influence the system, will very is of a very dark mahogany or much depend the certainty of our walnut color, -hard and perfectly patients' security, against the ef- opaque ;--it is somewhat thick at fects of the most loathsome and its centre, or approaches to a codestructive of maladies, “the pic form, and is nearly level on scourge of infancy and terror of its under side or base ;—when beauty."
cut into thin slices it presents a 1. Of the Scab.—The experi- dirty white, or somewhat brownence of the great body of Ameri- ish appearance ;--it is rather can practitioners has confirmed tough, or, in other words, is more them, in giving to the dry crust, readily dissolved in water, than or scab, which forms on the arm reduced to a powder. I have after vaccination, a preference frequently had presented to me, over the recent lymph, as a means as genuine vaccine scabs, those of propagating the disease. This of a light brown, or an ami er scab, while equally efficacious color, thin, semitransparent, eawith the latter, is much more sily fractured, and as it were, manageable, and more readily concave, or excavated, at their preserved ; while, at the same lower surface. Now, though I time, its use obviates the neces am not prepared to say, that a sity of interfering with the regu- crust, presenting the last menJar progress of the vaccine vesi- tioned characters, is never genucle,-a circumstance of very con- ine, yet so frequently will such a siderable importance in reference one be found to fail in communito the certainty of the child's se- cating the disease, that I would curity.
advise it invariably to be rejected. In regard to the appearance of A scab also, formed from a vethe scab, when we are certain sicle, the regular progress of that it is the product of the gen- which has been interfered with, uine disease, nothing of course by the irritation of the clothing, need be said; but as this cannot accidental violence, or other always be the case, and as I have cause, should never be made use observed, that crusts furnished, of for vaccinating, as the disease even by children who had the communicated by it will seldom disease most effectually, have, in be found genuine. Neither should consequence of some change any scab be preserved for use, which they have undergone whilst that has been taken from a child on the arm, failed in producing affected at the time with any disgenuine vaccination, some re- ease of the skin. Some, as Wilmarks in relation to the general Lan, believe the virus furnished characters presented by those by children under such circumscabs most to be depended on, stances will communicate a sputhough of themselves far from rious disease, not preservative being absolutely conclusive, will from the smallpox ; whilst others nevertheless aid very considera- conceive, that the cutaneous afbly the physician in his selection. fection may be propagated with
The scab I have found the the cowpock. The truth of eimost seldom to fail, and which ther of these opinions I can neihas also appeared the longest to ther affirm nor deng, but certain
ly, till points of so much impor- keep a sufficiency for the supply tance are fully determined, the of my friends, at all seasons of caution referred to should on no the year. account be lost sight of.
When the scab is carried about II. Preservation of the Scab.- the physician's person, great care This is with many a subject of should be observed to guard it great, and, in some degree, unne- from the influence of the heat and cessary anxiety,—the virus in this perspiration of the body. form being much more easily, and
It has been lately proposed by for a longer period of time, pre- some, to reduce the vaccine scab served pure than is generally im- to a fine powder, and in this state agined." The great object in the to preserve it in a small ivory preservation of the scab should tube ; but matter kept in this be, to keep it perfectly dry, par- manner will, I am convinced, ticularly to secure it from the in- much more frequently fail in comfluence of any undue degree of municating the disease, than when moisture in the atmosphere. This the scab is retained entire. WhoI conceive to be of greater impor- ther the process of powdering it tance than the mere exclusion of has any effect on its composition, the atmospheric air,—though, at or whether, simply, in a state of the same time, the latter should minute division it is more liable not be neglected.
to a spontaneous decomposition, I The best means, probably, for pretend not to determine ;-the securing the scab from undergoing fact, however, of its diminished any change, is to have a circular efficiency I have tested by expepiece of ivory, on the upper sur- riment. face of which, a number of small III. of the insertion of the Viexcavations have been formed, rus into the System.—Previous to each accurately adapted for con- its insertion, it is necessary that taining a single scab, the whole a small portion of the dry scab be to be covered with a common lid, reduced, by means of pure cool which fits on in the manner of a water, into a paste, of about the
But even this precaution consistency of cream ;--for this is not absolutely necessary. I purpose, the bottom of a china have been in the habit, for many plate or saucer, and a penknife or years, of simply wrapping each lancet, constitute everything that crust, carefully, in a portion of is necessary. It is, however, clean writing paper; and in this very customary, and perhaps conmanner, deposited in a close box venient, for the physician to carry turned out of solid wood, or in my
with him a small square of compocket book or lancet case, I mon window glass, on which to have kept vaccine matter, with- form the paste,—but when this is out experiencing in it the least done, two cautions are absolutely deterioration, for upwards of a necessary, namely, that after twelvemonth. The fact is, I have each time the glass is used, it be never known myself to be without made perfectly clean and dry, genuine matter,--on the contrary, before it is put by; and secondly, besides what was necessary for that on no account whatever, the my own use, in the above simple dissolved matter remaining from manner. I have been enabled to one vaccination be preserved for
another. Virus thus kept, will an examination of all the plans be a constant source of disap- which have been proposed for pointment to the physician, and of vaccinating, -many of them being danger to the patient.
unnecessarily tedious, and others After the matter has been dis- productive of no inconsiderable solved, the common practice is, pain, while all of them are, in evto dip into it the point of a lancet, ery point of view, inferior to the which latter is then introduced method now to be described. obliquely, for a short distance, This method consists in making, beneath the skin. From my ex- on the part at which the matter perience with this method of vac- is to be inserted, several straight cinating, I have found, that, how- incisions, with the blade of a ever pure and fresh the matter common spring, lancet, taking employed, the disease, in a ma- care, however, that each incision jority of instances, was not com- shall penetrate no deeper than is municated by it on the first at necessary merely to divide the tempt, and frequently not till af- cuticle ; and then crossing these, ter several trials. The failures at right angles, by others of a sihave appeared to me to arise from milar depth. This operation, one of two causes ; either, that, when properly performed, will in passing the lancet under the be found to have occasioned a skin, the matter is entirely wiped slight blush of red on the part, off from its point, and not a parti- and most commonly, a number of cle is introduced, or that, by the extremely minute specks of blood; puncture, so much blood is caused the less blood, however, that is to flow, that the matter is washed thus occasioned to flow the betout, even after it has been depo- ter. A portion of the dissolved sited beneath the cuticle. No crust, being now taken on the one of the methods proposed to point of the forefinger, is to be obviate these causes of failure rubbed gently over the incisions, have been found very generally and the remainder may be then successful. I believe that every spread on the part and allowed to candid physician, who has follow- dry. This mode of vaccinating I ed the above plan of vaccinating, have been in the habit of followwill acknowledge bis very fre- ing for several years, and am conquent want of success; and it is vinced, that, when it is performthis circumstance, no doubt, that ed with the least degree of care, has given rise to the invention of it will seldom, if ever, fail of at numerous instruments, for insert- once communicating the disease. ing the matter into the system, by To render it still more effectual, the aid of which, it is proposed to it has been proposed to smear the render the communication of the arm with the matter previous to vaccine disease, at once, more dividing the cuticle : either meeasy and certain. Such of these thod may be pursued. One reinstruments, however, as have commendation in favor of the come under my inspection, I foregoing plan, independent of its should consider to be mere en- certainty, is its being productive cumbrances to the physician's of so little pain, that it may be pocket case.
performing while the infant is It would be useless to enter into asleep without awaking it, or
even when it is awake, almost cumstances proper for the perwithout its knowledge,-a cir- formance of vaccination, the recumstance, however trivial it may marks of CAPURON appear to be appear, by no means beneath the so extremely judicious, that I notice of the practitioner. shall take the liberty of quoting
Subsequent to vaccination, the them here, with but little or no arm should be guarded from irri- alteration. tation by the fingers of the pa
The vaccine disease is of so tient, its clothing, or accidental mild a nature, that we may disviolence, · To effect this, the pense with every preparation of best means is to enclose the the system' previous to its comwhole arm in a wide sleeve of li-munication, and with every spenen or fine muslin, drawn at the cies of medical treatment during shoulder and wrist. This is a its course or subsequently. Neicaution of some importance, as ther the season of the year, the well to obtain a genuine scab, as age, temperament, nor sex of the from the fact that the very secu- little patient, not even the disrity of the child against the small- eases with which it may be accipox may be jeopardized by its dentally affected, have been found neglect.
to produce any change in the chaÎy. Subsequent Attendance.- racter of the vaccine influence. To decide on the certainty of the In general, however, vaccination child's security, after whatever is postponed till the patient is manner it may have been vacci- from six weeks to two months old. nated, it is absolutely necessary Some, however, have imagined, that the physician should watch that the disease is more regular, attentively the progress of the and accompanied with less febrile arm, from the insertion of the vi- irritation, in children from two to rus till the formation of the scab; six months old, and hence they the appearances presented on the recommend this period as better third, sixth, ninth, and twelfth, or adapted for vaccination than any the fourth, eighth, and twelfth other; but experience has fully days, being particularly noted. proved, that the operation is as No one, indeed, should be pro- successful and the disease pronounced vaccinated, and secure, duced equally mild, in the newin consequence, from the effects born infant, or in those but a few of smallpox, unless the physician days old. In all cases, wbere it is absolutely certain, from his can be done conveniently, it is own observation, that the progress proper to wait till the rigors of of the arm, the form and appear- winter have been moderated by ance of the vesicle produced, and the influence of spring, or till the its regular and successive grada- heats of summer have given way tions, correspond with those which to the coolness of autumn: in a mark the genuine vaccine disease, word, whenever there is no ur-a correct description of which gent necessity for the immediate being contained in every systema- performance of vaccination, we tic work, need not be repeated endeavor, previously, to remove here.
from the child every circumstance V. General Remarks.--With capable of influencing its health. respect to the age and other cir- But, should the prevalence of