Who should not be Vaccinated.—Unless exposure to smallpox is believed to have taken place or likely to take place, teething children, pregnant women, persons suffering from measles, scarlet fever, erysipelas, or susceptible to and recently exposed to one of these diseases, persons suffering with skin diseases or eruption, and in general feeble persons not in good health, should not be vaccinated. In all cases in which there is any doubt as to the propriety of vaccinating or postponing vaccination the judgment of a good physician should be taken. The restriction, as to vaccinating teething children makes it important that children should be vaccinated before the teething process has begun, because smallpox is very much more dangerous than vaccination. Smallpox is exceedingly dangerous to pregnant women.
When should a person be Vaccinated.—The sooner the better as a rule, and especially whenever there is much liability of exposure to smallpox. Children should be vaccinated before they are four months old; those who have never been vaccinated, should, except teething children, be vaccinated at once. Because the vaccination often loses its protective power after a time, those who have been vaccinated but once or twice should, in order to test and to increase the protective power of the former vaccination, be vaccinated again, and as often as the vaccination can be made to work. In general, to insure full protection from smallpox, one should be vaccinated as often as every five years. It has been found that of those who have smallpox the proportion of deaths is very much less among those who have three or four good vaccination scars than among those who have but one scar.
Vaccination after exposure to Smallpox.—Vaccination as late as the second day after known exposure to smallpox is believed to have prevented the smallpox; vaccination the third day after exposure has rendered the disease much milder than usual, and in a case in Iowa, vaccination on the seventh or eighth day after exposure to smallpox ran a partial course and was believed to have modified the attack of smallpox, which, however, it did not wholly prevent. A recent case in Michigan was vaccinated three days after exposure, as were also the wife, mother, and two children, both under five years of age; all vaccinated again six days after the exposure. The health officer reported as follows: "The results were gratifying. During the first week of the eruption it was evidently aborting and without doubt as the result of vaccination eight days before the eruption. A complete and fine recovery. Certainly an aborted course, with scarcely a mark left, and not another case in the above family, whom necessity compelled to occupy the same house, the same rooms, continual contact with the contagion, scores one more big credit mark for vaccination."
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With what should one be Vaccinated.—Because the potency of virus depends largely upon its being fresh, and it is so easy to obtain pure and fresh bovine virus, and because such bovine virus is efficient it is better in all cases to use only the pure and fresh bovine virus.
Where should Vaccination be Performed.—In a room or place free from persons suffering from disease, and from dust which may convey to the scratched surface germs of any communicable disease; certainly not in or near a room where there is erysipelas or consumption, nor in the presence of one who has just come from a person sick with erysipelas, diphtheria, or scarlet fever.
By whom should one be Vaccinated.—The operation of vaccination should be performed always by a competent and responsible physician. To try to vaccinate one's self or one's family is poor economy, for it often results not only in a waste of money and of time, but in a false and dangerous feeling of security. To trust to vaccination by nurses and midwives is equally foolish. A well-educated and experienced physician has the skill, and the special knowledge necessary to the best judgment on all of the questions involved, without which the operation may be a failure or worse than a failure. In work of this kind the best is the cheapest, whatever it costs.
After Vaccination.—Let the vaccinated place alone. Do not scratch it or otherwise transfer the virus where it is not wanted. Protect it by a bandage, or cloth which has been boiled and ironed with a hot iron. Try to keep the pustule unbroken, as a protection against germs of diseases and against unnecessary discomfort. A bad sore arm may not be and probably is not true vaccination, but may be due to lack of care during and after vaccination to keep out septic germs.
Common appearances after Vaccination.—For a day or two nothing unusual should appear. A few days after that, if it succeeds regularly, the skin will become red, then a pimple will form, and on the pimple a little vesicle or blister which may be plainly seen on the fifth or sixth day. On the eighth day the blister (vesicle) is, or should be, plump, round, translucent, pearly white, with a clearly marked edge and a depression in the center; the skin around it for about half an inch is red and swollen. This vesicle and the red, inflamed circle about it (called the areola) are the two points which prove the vaccination to be successful. A rash, and even a vesicular eruption, sometimes comes on the child's body about the eighth day, and lasts about a week; he may be feverish, or may remain quite well. The arm may be red and swollen down as far as the elbow, and in the adult there will usually be a tender or swollen gland in the arm-pit, and some disturbance of sleep for several nights. The vesicle dries up in a few days more, and a crust forms which becomes of a brownish mahogany color, and falls off from the twentieth to the twenty-fifth day. In some cases the several appearances described above may be delayed a day or two. The crust or scab will leave a well-marked, permanent scar.