VACCINATION
Time for Vaccination.—The best time to vaccinate a child is during the first three months if he is healthy. The reason for selecting so early a period is because the constitutional disturbances are much less at this time than in later childhood. It should not be done during active dentition. If the child is delicate if his nutrition is bad it should be deferred until a later time. Children suffering from eczema or from any skin disease or those syphilitic should not be vaccinated until it is compulsory, or until exposed to small-pox.
Methods of Vaccinating.—It is customary in America to vaccinate at one point rather than to make a number of inoculations as is the custom in some other countries. The leg or the arm is the usual location selected. In infants the sore can be protected better on the leg; in children of the run-about age, the arm is the better location because it can be kept at rest easier.
Before vaccinating the skin should be rendered surgically clean; this can be done by washing with soap and water, drying and then rubbing with alcohol. The wound should be left uncovered for about twenty minutes to dry, it may then be covered with a bandage, or with a vaccine shield. The part should not be washed for twenty-four hours.
The Symptoms of Successful Vaccination.—Nothing is noticed until the third or fourth day, when a red papule appears. In the course of the following day a vesicle appears; this vesicle enlarges until it reaches its full development on the ninth day. The size of the vesicle is about one-half inch in diameter; it is surrounded with a reddish inflammatory area for about two inches. The vesicle begins to dry and is shortly a dark crust which remains from one to three weeks and then falls off. It leaves a bluish scar which soon turns white and the part is roughened and honeycombed. During the period when the vaccination is at its height the child suffers from fever and irritability and loss of appetite.
If vaccination does not "take" in an infant it should be done two or three times and if then unsuccessful it should be repeated every year until it takes. The fact that vaccination does not take does not imply that the child would not take small-pox but rather that the vaccine used is not suitable. There are some children, however, who seem to be immune to vaccination.
Sometimes the symptoms are more severe than those enumerated; this seems to depend upon the susceptibility of the child. The vesicle may be much larger and the area of inflammation much more dense and angry. The fever may be higher and may last longer; there may be a general rash and the degree of depression more profound. Vesicles may be produced on other parts of the body as a result of scratching. Mothers must always remember that vaccination is a surgical wound to begin with and that it is capable of infection in the same way as are other wounds, and that any result coming from such an infection is not due to the vaccine or to the process of vaccination, but to the infection. Many people get unjust ideas about vaccination from just such cases. If the mother is not cleanly or neglects the vaccinated area and permits it to become infected she must not and others should not decry vaccination as a consequence. Anyone who doubts the virtue of vaccination is condemning himself; he is simply ignorant of the accumulation of evidence in favor of it and assumes a position without any possible justification. The mortality of vaccination is stated by Voigt from statistics to be 35 in 2,275,000 cases. In fact, all the deaths are from causes which are preventable and no doubt the result of direct carelessness on the part of the operator or the mother.
Treatment.—The mother must understand in what way she may contribute to the successful termination of a case of vaccination. She should see that the part upon which the child is to be vaccinated is absolutely clean so far as she can make it with soap and water. She should see that the part is allowed to dry thoroughly after vaccination. She should not wash the part for at least twenty-four hours. If a vaccine shield is put on she should not disturb it. If the mother is prepared to do her part faithfully a vaccine shield is not necessary from a medical standpoint and in some cases it is objectionable. A simple, clean bandage is all that is necessary. It is very important that the child be kept from scratching the part; most of the troubles of vaccination come from this habit. It is desirable that the limb should be kept at rest during the stage when the process is at its height. If the vesicle discharges it is necessary that the area should be kept clean and dusted with boracic acid. If the wound becomes infected it must be treated by a physician. The mother must not resort to home remedies in such cases unless she is prepared to take the consequences, which may be serious.