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Affection of the arm, resembling malignant pustule, after removing the placenta of a patient who died from puerperal fever. Reference to cases at Wurzburg, as proving contagion, and to Keiller's cases in the Monthly Journal for February, 1846, as showing connection of puerperal fever and erysipelas. Kneeland. Contagiousness of Puerperal Fever. Am. Jour. Med. Sc., January, 1846.
Noguchi has made an emulsion of dead spirochætes which he calls luetin, and which gives a specific reaction resembling that of tuberculin in tuberculosis, a papule or a pustule forming at the site of the intra-dermal injection. It is said to be most efficacious in the tertiary and latent forms of syphilis, which are precisely those forms in which the diagnosis is surrounded with difficulties.
This mild affection of the system happens when the disease makes but a slight local impression on those who have been accidentally infected by cows; and, as far as I have seen, it has uniformly happened among those who have been inoculated, when a pustule only and no great degree of inflammation or any ulceration has taken place from the inoculation.
"P. S. I think it necessary to observe that I can pronounce, with the greatest certainty, that the matter with which the Arlingham patients were inoculated was taken from a true smallpox pustule. I took it myself from a subject that had a very full burthen."
10th: The spots on the arms have disappeared, but there are three visible in the face. 11th: Two spots on the face are gone; the other barely perceptible. 13th: The pustule delineated in the second plate in the Treatise on the Variolae Vaccinae is a correct representation of that on the child's arm as it appears at this time. 14th: Two fresh spots appear on the face.
There was no apparent deviation in the ordinary progress of the pustule to a state of maturity from what we see in general; yet there was a total suspension of the areola or florid discolouration around it, until the scarlatina had retired from the constitution. The case of Miss H R is not less interesting than that of her sister, above related.
On the sixth day the arm of the boy appeared as if inoculated with variolous matter, but the pustule was rather more elevated. On the ninth day he complained of violent pain in his head and back, accompanied with vomiting and much fever. The next day he was very well and went to work as usual.
Although it has not been in my power to extend the inquiry into the causes and effects of the variolae vaccinae much beyond its original limits, yet, perceiving that it is beginning to excite a general spirit of investigation, I think it of importance, without delay, to communicate such facts as have since occurred, and to point out the fallacious sources from whence a disease imitative of the true variolae vaccinae might arise, with the view of preventing those who may inoculate from producing a spurious disease; and, further, to enforce the precaution suggested in the former treatise on the subject, of subduing the inoculated pustule as soon as it has sufficiently produced its influence on the constitution.
The reader of the Tessaradecas will recall Luther's statement there, that it is of God's great mercy that man is able to see but a very small portion of the sin within him, for were he to see it in its full extent, he would perish at the sight. The physician need not count every pustule on the body to diagnose the disease as small-pox. A glance is enough to determine the case.
Another well authenticated instance of the same fact, occurred in the early part of the present year, in the family of a respectable Nova Scotian settler; other cases of a similar nature have been reported by the inhabitants; but I do not consider that, in these cases, the proofs of a pure previous vaccine disease have been satisfactorily established; when vaccination has been carried on for some time, from the same stock of lymph, the disease is apt to degenerate and become spurious, from which cause we require a frequent renewal of lymph from England, in order to keep it in continuous and successful operation; the spurious disease, on the fifth day, generally shews itself in the form of a small globated papula; on the eighth day, it presents sometimes an ash-coloured pustule, containing purulent matter; at other times, and less frequently, a brown-coloured scale, having a small quantity of purulent matter under it, capable of producing, by innoculation, a disease similar to itself; the great prevalence of a disease among the negro population, called "craw craw," is considered as materially influencing that change in the properties of the pure vaccine lymph, which has been just noticed: that apathy and indolence of which I have already accused the negro population, leads them to consider the appearance of disease in the arm, after vaccination, as the test of safety from small-pox, great as the difficulty sometimes is, in getting them to bring forward their children for vaccination, it is still greater to procure the examinations in its progress and maturation; the mere appearance of disease in the arm, is supposed to carry along with it immunity from small-pox; and, on the occurrence of the epidemic at an after period, it may be easily foreseen how wretchedly and how fatally this confidence in the spurious disease may be misplaced; I, therefore, do not consider, that, in all the cases spoken of among the inhabitants, as cases of small-pox occurring after vaccination, there existed satisfactory proofs of the patient having previously undergone the genuine vaccine disease; yet, I am sorry to say, that from such occurrences as these, vaccination has rather lost ground in the opinion of the negro population.
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