In performing the operation the common lancet does very well; but two or three forms of narrow-grooved lancets are employed by surgeons for this purpose. The operation is most successful when the lymph is transferred direct from arm to arm; the lancet making the puncture is then charged at the vesicle of a child vaccinated a week before, and points are unnecessary. When making the puncture the surgeon grasps the child’s arm in his left hand, puts the skin on the stretch over the insertion of the deltoid with his left forefinger and thumb, pushes the lancet downwards between the cutis and cuticle, about 1-10th of an inch, to raise the latter in a little pocket; he then charges his lancet with lymph and inserts it in the pocket, or if using points, inserts the moistened point for a minute, taking care as he withdraws the point to press the skin down on the point with his left thumb, that the lymph may be well wiped off the point and left in the wound. This process is repeated four or five times and the operation is complete. The corium should not be penetrated, or it will bleed freely and the blood will wash away the lymph; one drop of blood is of little consequence; indeed, it shows that an absorbing surface has been reached.
The phenomena following the insertion of the vaccine virus in an infant’s arm are as follows:—On the second day the puncture is slightly elevated; on the third it begins to grow red; on the fifth it is marked by a distinct vesicle with a depressed centre and red areola; on the eighth the vesicle is perfect, of pearl-like aspect, full of clear lymph; the areola, often little marked by the eighth day, rapidly increases on the ninth and tenth days, and reaches an inch or more in diameter. This bright-red inflammatory action in the skin is essential to show the system is properly infected with the vaccine disease; by the twelfth day the areola has lessened, the lymph is yellow, and often escapes by rupture of the vesicle; on the fourteenth day the vesicle has dried to a scab, that falls on the twenty-first day, leaving a dotted cicatrix, the vestige of the multilocular structure of the vesicle. The three important marks diagnostic of the vaccination being satisfactory, are—1, the pearly multilocular vesicle of the 8th-9th day; 2, the widely-spread areola on the 9th-12th day; 3, the well-marked foveated cicatrix after the scab has fallen.
Observation shows that the number of people who take small-pox after vaccination is very small indeed, when more than three well-marked scars exist; and this number at least should be secured by making five insertions of lymph at the time of vaccination.
FOOTNOTES:
[1] Lister’s shell-lac plaster can be obtained of the Glasgow General Apothecaries’ Company, and the sheet tin of Messrs. Compton & Co., 148, Fenchurch Street, E.C.
LIST OF THE INSTRUMENTS AND APPLIANCES REQUISITE, OR OCCASIONALLY USEFUL, IN MOST OF THE IMPORTANT AND ORDINARY OPERATIONS IN SURGERY.
PREPARATIONS AND REQUISITES FOR OPERATIONS IN GENERAL.
| The Operating Room. | Sedatives and Restoratives. |
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