The Prophylaxis of Small Pox-S. II. Stout, A.M., M.D., LL.D., Cisco, Teras.

and of unprotected persons, who have been in contact with them, for a period of at least seventeen days, is an obvious and proper precaution against the risk of the multiplication of sufferers. All exposed persons, who have not previously been successfully vaccinated, should be required by law to at once submit to the operation. Those who give unmistakable evidence of having been successfully vaccinated, need not in all cases be required to submit to it; for there are considerations pertinent to the state of health of the subject that may justify us not to insist upon his revaccination. Indeed, revaccination should never be heedlessly practiced. I am satisfied that I have seen much unnecessary suffering inflicted by revaccination. The vaccine virus, if carefully selected, and for the first time inoculated upon a healthy subject, has never, in my experience, produced other than a typical case of mild vaccinia. On the contrary, I have seen many healthy subjects of revaccination seriously afflicted by constitutional symptoms and local lesions, resembling those produced by septic poisoning, as in the case of dissecting wounds. These facts can be rationally explained. If the inoculation of vaccine virus is followed by the development of a typical case of vaccinia, no harm is done the patient. But if the virus is inoculated upon a person who, owing to a previous vaccination, cannot take on true vaccinia, the vaccine virus, after lying for a considerable time in contact with the capillaries, may go

APPENDIX-Section on Practice of Medicine, etc.

through the putrefactive process and be absorbed in a septic condition.

Prior to the late war of the States, I had never met with a case of so-called "spurious vaccination," which often inflicts serious constitutional and local injury upon the organism of many of the subjects of it. The first cases occurring in the Confederate army were claimed to have originated from the use of virus imported from the North; and many were so uncharitable as to attribute its importation to the malignity of the enemy. It became my duty, as medical director of the hospitals of the Confederate Army, and Department of Tennessee, to investigate the subject of "spurious vaccination," and, if possible, to devise preventive meas ures. I found the so-called "spurious vaccination" manifested in a variety of types and degrees of malig nancy. There were no cases of subjects, healthy at the time of their first vaccination, by medical officers who were careful in the selection of the virus used. A large majority of the cases were those of soldiers who had been unnecessarily revaccinated, and that, too, by their unprofessional friends or fellow soldiers. Nearly all of those who claimed to have been inocculated with syphilitic virus, and had syphilitic symptoms and lesions unmistakably manifest, were proven to have previously been victims of lues veneria contracted in the natural way." Some cases had been revaccinated just after recovering from measles, or protracted attacks of other diseases, or were scorbutic. Of these, many suffered

The Prophylaxis of Small Por-8. H. Stout, A.M., M.D., LL.D., Cisco, Texas.

from gangrene or erysipelas. There were a few cases of erysipelas and gangrene in patients who were vaccinated while occupying wards in which erysipelas and gangrene soon afterward prevailed. Many cases were plainly cases of septicemia, proven to have originated in the silly practice of soldiers and other laymen igno rantly inoculating with putrid pus, presuming it to be vaccine virus.

Injudicious revaccinations were often performed in hospital, in obedience to orders issued by the commanding officers, upon the occasion of every small pox scare, requiring every soldier in hospital to be revaccinated before returning him to duty.

The foregoing facts being observed, I recommended. that no virus should be used in the field service or in the hospitals, save that which was collected under my direction. Soldiers were forbidden to vaccinate each other; and medical officers were required to carefully consider the state of health of every soldier presented for revaccination, and abstain from performing the operation on unfit subjects, except in rare cases of exposure to small pox contagion. At every hospital post in the department, a surgeon was detailed to scour the country for many miles around his station, in search of healthy children, and vaccinate them, collect the crusts at maturity and send them to me for distribution. A supply of these crusts was secured and maintained until the end of the war. Spurious vaccination soon became, in that army, "a thing of the past," no new cases occur

APPENDIX-Section on Practice of Medicine, etc.

ring, within my knowledge, in the last twenty months of the war.

My experience in private and public practice has led me to the following conclusions on the subject of vaccination as a prophylactic of small pox:

Carefully selected humanized vaccine virus, inoculated by an intelligent and judicious physician, upon properly selected subjects, never produces serious injury to the patients; that a mild type of vaccinia results therefrom, as effectively protective against small pox as is the inoculation of small pox itself, or a previous attack of the disease, taken in the "natural way." I have met with no case of death, and never had one officially reported to me, from small pox or varioloid, of a patient who had previously been successfully vaccinated. But an Irishman, badly marked with small pox, who voluntarily sought service as a nurse, in Atlanta, Ga., in the small pox hospital there, took confluent small pox and died. This case was officially reported to me by one of the ablest medical officers in the service.

The experience above stated is given for what it is worth. Doubtless the experience of others differs from it. By itself, it does not justify the deduction of inferences convincing of a general principle or law.

Of the thousands of subjects I have personally vaccinated, none ever exhibited symptoms or lesions of abnormal or mild vaccinia except those in which I was compelled to use virus procured from a bovine source.

So unpleasant has been my experience with the bovine.

The Prophylaxis of Small Por-S. H. Stout, A.M., M.D., LL.D., Cisco, Texas.

virus, that I have resolved never again, on my own responsibility, to use it, as vended by the vaccine farmers. During the late small pox scare in Cisco, growing out of the existence of small pox in Fort Worth, to gratify my clients, I used the unhumanized virus, purchased in Dallas and Fort Worth. In no instance did the disease produced by its inoculation produce the mild features of a typical case of Jennerian vaccinia. In every case, there was some departure from the normal course of the disease, and, in a large majority the vesicle was unusually large. In many cases, it was not umbilicated, and the surrounding inflammation of the skin and cellular tissue was alarmingly severe, disabling the patient two or more weeks. In some cases, there was sloughing of the dermis and the cellular tissue beneath it, causing me much anxiety and trouble to stop it. All were healthy subjects.

One of the cases inoculated with the original bovine virus proved of a moderately mild type. I used the lymph of this case to inoculate a number of other cases. All of these developed a mild type of vaccinia, thus proving the superior safety of the humanized virus over that obtained directly from the kine.

The abnormities observed in those cases inoculated with the virus as obtained from the vaccine farms, were, no doubt, due to the intermingling with the genuine vaccine lymph, of putrid pus, serum or blood (or several or all of these fluids), in collecting the virus. I had never before used the bovine virus, and never before had any