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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." [206 MOTHERS' REMEDIES]

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.

[INFECTIOUS DISEASES 207]

What to do during and after Vaccination.—Do nothing to irritate the eruption, do not pull the scab off, when it drops off throw it in the fire. When the eruption is at its height show it to the doctor who performed the vaccination. If it is satisfactory, ask him for a certificate stating when and by whom you were vaccinated, whether with bovine or humanized lymph, in how many places and with what result at each place. When the arm is healed, if the vaccination did not work well, be vaccinated again as soon as possible, and in the best manner possible. This will be a test to the protection secured by the former vaccination, and will itself afford increased protection. Do not be satisfied with less than four genuine vaccine scars, or with four if it is possible to secure more than four. This vaccination a second or third time in close succession is believed to be hardly less important than vaccination the first time, and hardly less valuable as a protection against smallpox. Without doubt many persons are living in a false sense of security from smallpox because at some time in their lives they have had a little sore on their arm caused by a supposed or real vaccination, or because an imperfect vaccination failed to work, or because they were successfully vaccinated, or had the varioloid, or the unmodified smallpox many years ago. Until smallpox is stamped out throughout the world so that exposure of the disease shall be practically impossible, the only personal safety is in such perfect vaccination that one need not fear an exposure to smallpox through the recklessness of the foolish.

Make a record of your Vaccination.—Do not fail to procure and preserve the certificate mentioned in the preceding paragraph, and also to make a personal record of the facts with regard to any vaccination of yourself or in your family. From it you may sometime learn that it is ten years since you or some member of your family was vaccinated, when you thought it only five.

Lives saved from smallpox in Michigan.—Since the State Board of Health was established, many thousands of people in Michigan have been vaccinated because of its recommendations; and the statistics of deaths, published by the Secretary of State, show that at the close of the year 1906, the death rate from smallpox in Michigan had been so much less than before the board was established as to indicate that over three thousand lives had been saved from that loathsome disease. The average death rate per year, for the five years, 1869-1873, before the board was established, was 8.5 per 100,000 inhabitants, and since the board was established, for the thirty-three years, 1874-1907, it was only 1.5. Since 1896 an uncommon mild type of the disease has prevailed very extensively, but the death rate has been exceedingly low, being for the eleven years, 1897-1907, slightly less than one death for each 100,000 inhabitants. The great saving of life from smallpox in civilized countries has been mainly because of vaccination and revaccination.

[208 MOTHERS' REMEDIES]

VACCINATION, Symptoms.—At first a slight irritation at the place of vaccination. The eruption appears on the third or fourth day as a reddish pimple surrounded by a reddened surface. On the fifth or sixth day this pimple becomes a vesicle with a depressed center and filled with clear contents. It reaches its greatest size on the eighth day. By the tenth day the contents are pus-like and the surrounding skin is more inflamed and often quite painful. These symptoms diminish, and by the end of the second week the pustule has dried to a brownish scab, which falls off between the twenty-first and twenty-fifth days, and leaves a depressed scar. Fever and mild constitutional symptoms usually go with the eruption and may last until about the eighth day.

Reliable lymph points should always be used. Clean the skin near the insertion of the deltoid muscle on the arm, and with a clean (sterile) knife or ivory point, a few scratches are made, deep enough to allow a slight flow of liquid, but no bleeding. The vaccine virus moistened, if dried on a point, is rubbed into the wound and allowed to dry. A piece of sterile gauze, or a "shield," is used as a dressing. This shield can be bought at any drug store. One vaccination may give immunity for ten to twelve years, but it is better to be vaccinated every six years at least.

DENGUE. Break-bone Fever, Dandy Fever.—This is an acute infectious disease characterized by pains in the joints and muscles, fever, an initial reddish swollen eruption and a terminal eruption of variable type. It occurs in the tropical regions and the warmer portions of the temperate zone. The disease appears in epidemics, rapidly attacking many persons.

[INFECTIOUS DISEASES 209]

Symptoms.—Incubation lasts from three to five days without any special symptoms. The onset is marked with chilly feelings, an active fever with temperature gradually rising. There is severe pain in the muscles and in the joints which become red and swollen. There is intense pain in the eyeballs, head, back and extremities. Face looks flushed, eyes are sunken, the skin looks flushed and mucous membrane looks red. This is the beginning rash. The high fever falls quickly after three or four days, sometimes with sweating, diarrhea or nose bleed. The patient feels stiff and sore then, but comparatively well. A slight fever returns after two to four days, although this sometimes remains absent. Pains and eruptions, like scarlet fever or hives, appear. An attack usually lasts seven to eight days. Convalescence is often long and slow, with stiffness and pain in the joints and muscles and great weakness. A relapse may return within two weeks.

PHYSICIANS' TREATMENT for Dengue.—An anti-plague serum is sometimes used, though with doubtful results. The pain is controlled by doses of morphine of one-eighth to one-fourth of a grain every four or five hours. Hyoscin, one hundredth of a grain, is also given for the pain. The high temperature can be relieved by cold and tepid sponging. Tonics are given during the convalescence and continued for some time.

CEREBRO-SPINAL MENINGITIS.—This is an acute infectious disease. It comes in epidemics, when there are many cases, or appears here and there as a separate case (sporadic). It is caused by a specific organism (germ) and the disease attacks the membranes of the brain and spinal cord.

Of late years great progress has been made by patient investigation, and a serum is now prepared for the treatment of this disease. The results of this treatment are better than the treatments formerly used, and there is good reason to believe that in a few years this treatment will be as effective in this disease as antitoxin is in diphtheria.

Cause.—Young adults and children are affected most often. Bad surroundings and over-exertion are predisposing factors.

Conditions.—There is congestion of the membranes of the brain and spinal cord which are covered with an exudate confined on the brain, chiefly to the base.

Symptoms. Ordinary Form.—Incubation is of unknown length and occasionally marked by want of appetite, headache, and pain in the back. The invasion is usually sudden, chill, projectile vomiting, throwing forward, severe headache, pain and rigidity of the back of the neck, pain in various parts of the body, skin over-sensitive, irritable, and temperature about 102 degrees, with all symptoms of an active fever. Later, pains are very severe, especially in the head, neck and back; the head is drawn back; often the back is rigid; the muscles of the neck and back are tender and attempts to stretch them cause intense pain. The vomiting now is less prominent. Temperature is extremely irregular, 99 to 105 degrees or more. Pulse is slow, often 50 to 60, and full and strong at first. The delirium is of a severe and variable type in common, alternating with partial or complete coma, the latter predominating toward the close of fatal attacks. Stimulation of nerve centers causes cross-eyed look, drooping of upper eyelid, movement of eyeballs unequal, contracted, dilated, or sluggish pupils; acute and painful hearing, spasmodic contractions of the muscles followed by paralysis of the face muscles, etc. The disease may last several hours or several months. Many die within five days. In fatal cases the patient passes into seemingly deep sleep with symptoms of a very prostrating and weakening fever, and often retention of urine. Mild cases occur with only a little fever, headache, stiff muscles of the neck, discomfort in back and extremities. The malignant type occurs epidemically or sporadically.

[210 MOTHERS' REMEDIEs]

Malignant type.—Sudden invasion with severe chills, slight rise in temperature, pain in the back of

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