used, popularly, with perfect safety, others are only admissible in medical hands. Counter-irritants may simply produce reddening of the skin, or they may blister, or they may cause discharge of purulent matter, or even mortification of the surface. Heat, according to the temperature at which it is used, may give rise to any or all of these effects: mustard will redden smartly, and may blister; ammonia will do the same, according to strength; camphor in solution, either in spirit or oil, will redden. Of the blistering counter-irritants the Spanish fly is the best, and almost universally employed. Boiling water, or its steam, or metal heated in boiling water, have all been used for the purpose, and might be, on emergency. Counter-irritation by tartar emetic, or tartarized antimony, takes the form of pustules or pimples. The salt is applied either in the form of ointment, or as a saturated solution, used as hot as can be borne, and rubbed upon the skin by means of a piece of flannel. The pustules formed by the latter mode are said to heal speedily, and to leave no scar, which sometimes happens after the ointment. When a common blister is irritated, "kept open," secretion of purulent matter takes place; but the system is a bad one, and is productive of much unnecessary pain and irritation. Issues and setons cause discharge of matter. Counter-irritation, by means of galvanic agency, has recently attracted notice. As regards the use of counter-irritants generally, it is often serviceable to excite the skin by friction, or heat, before using Iron heated to a red or white heat, moxas, them. When fever is present and inflammaand other applications which destroy the tion going on, non-professional persons will texture to which they are applied, fall do quite as much, if not more good, and be under the head of cauterants, and can never much less likely to do harm, by using the be used as domestic remedies. There is, mild counter-irritation of moist heat, than however, one application of the hot iron, by applying blisters, mustard, &c., particuintroduced by Dr. Corrigan, of Dublin, larly close upon the seat of the disease. If which might safely be used by the non- a blister is put on in these cases, it should professional, and as the instrument can be be a large one. For further information made by any blacksmith, might prove a respecting the counter-irritants individually, valuable resource in remote districts, for the the reader is referred to the various articles relief of nervous and rheumatic pains, such-Antimony-Blister-Mustard, &c.* as lumbago, sciatica, &c., &c., in which it is often of essential service. The instrument-fig A-consists of an iron portion-1-about four inches and ahalf long, which ends in a disk-2-half an inch in diameter, and quarter of an inch thick, and a wooden handle-3. When it is used, it is grasped so that the point of the fore-finger may rest upon the bend at 4. The disk is then to be introduced into the flame of a spirit lamp, or of a piece of burning paper, and held till the metal-at 4-becomes uncomfortably hot; the handle is then to be grasped, and the disk applied COUNTENANCE.-The expression and aspect of the human face is much and peculiarly affected by the various diseases which affect the body, and the first view o a countenance often conveys to a physician who has studied the subject, immediate, valuable, and certain prescience as to the nature of the disease for which his patient is about to ask advice. The indications are partly due to the changes of complexion which are associated with different forms of disease; but expression is equally significant. The physiognomical evidences have been classed by a writer, Mr. Corfe, who COUNTER-IRRITATION.-An excellent counter-irritant liniment is made by mixing one drachm of croton oil with seven drachms of soap liniment. A teaspoonful rubbed on the skin quickly brings out a crop of eruption. The person who rubs it on should wash the hands at once. enjoying abundant scope for such observations, has made them an object of special attention. The following is a summary of Mr. Corfe's arrangement :— Countenance in A.-BRAIN AFFECTIONS. characters, nor follow the same course as the genuine cow-pox: which is, moreover, a constitutional disease, sometimes extremely severe, and even fatal to the animals. The name of Dr. Jenner, who discovered this inestimable boon, and introduced the 1. Lethargic, in disease causing insen- practice of vaccination—as the inoculation sibility. Examp.: Apoplexy. 2. Livid, in disease causing deficient change in the blood. Examp.: Suffocation and Coma. 3. Distressed, in disease causing mental disturbance. Examp.: Paralysis and Fever. B.-CHEST AFFECTIONS. 1. Dusky, in disease interfering with blood changes. Examp.: Bronchitis. of cow-pox matter is termed-must be known to all. His attention was first directed to the subject from the known circumstance, that when the cow-pox had prevailed among the cows of a particular district or farm, many of those connected with the management of the animals, likewise became affected with the disease, and therefrom a certain number were protected against small-pox. The value of this circumstance, seemed at first to be materially impaired by the fact, that the 2. Anxious, in disease, impeding res- protection was neither universal nor cer piration. Examp.: Croup. C.-ABDOMINAL AFFECTIONS. tain, until the investigations of Dr. Jenner made it clear, that the protection or nonprotection depended upon the stage which the disease had attained in the animal at the time it was contracted by the human D.-NUTRITION AFFECTED.-EMACIATION attendant; that is to say, if the vaccine 1. Pinched, in painful seizures. Examp.: Colic and Cholera. GENERAL. 1. Wan, in diseases of debility. Examp.: Consumption and Cancer. 2. Hue peculiar, in diseases affecting the blood. Examp.: Heart disease and Jaundice. E-ENLARGEMENT OF ORGANS, GLANDS, &c. 1. Disturbed, in diseases causing continued uneasiness. Examp.: Sore-throat, Rheumatism, &c. F.-VASCULAR DISTURBANCE. 1. Flushed, in febrile disease. Examp.: Hæmorrhage, &c. COUP DE SOLEIL, or SUN-STROKE. See Heat, effects of. COW-POX is the disease affecting the cow, which, transferred to the human subject, confers in the majority of cases immunity from attacks of small-pox, and in those in which it does not give complete protection, renders the attack of that usually virulent disease comparatively mild.* Cow-pox shews itself upon the teats of the cow in the form of blueish or lividlooking vesicles, surrounded by a ring of inflammation, whilst at the same time, the animals are feverish, and the milk diminished. At first the vesicles contain clear fluid, but ultimately become pustular, or filled with matter. The cow is liable to other forms of pustular disease affecting the teats, but they do not present the same disease advanced into the stage of maturation, or that in which the contents of the vesicle, which forms its outward manifestation, had become converted from a limpidlooking fluid, into matter, although sores were produced upon the hands of the milkers, that certain protection was not afforded which ensued when the sores were produced by the fluid from the vesicle in an earlier stage. Following up his investigations, Dr Jenner clearly demonstrated, that when the human subject was properly inoculated with virus taken from the cow-pox vesicle, at the proper stage of its progress, and when in consequence of that inoculation the disease was regularly produced, and went through its proper stages, both locally and constitutionally, the individual thus affected was thenceforth all but certainly protected from the contagion of small-pox. These circumstances call for particular attention at the present time, when the value of vaccination and its protective power is becoming much disputed. It is unquestionable, that within the last few years, small-pox has prevailed much more extensively, and been more fatal, than was the case some time previously, also, that many persons who had been vaccinated have taken the disease, and that a certain proportion of that number have died from it. As regards the complete protection of every individual who is vaccinated, against the contagion of small-pox, it could never be expected-for the simple reason, that one * The fact that not a few severe cases of small-pox have recently occurred even after vaccination, has led many to doubt whether its protection was so certain as believed; but the rule holds good, when all precautions are taken, as stated below. formance is entrusted, some will prove careless, nay, that it is not unfrequently performed by those who are ignorant of the distinctive characters of the true cow-pox disease. This is not said in condemnation of the performance of vaccination by non-professional persons, under peculiar circumstances, for in many cases it has proved and must prove, of the most essential benefit, but still they cannot be expected to distinguish accurately an irregular development from one which is the reverse. attack of small-pox, is not in every case a security that the disease may not be contracted a second time; for, although, in the eruptive fevers generally, as well as in small-pox, the general rule is, one attack in a lifetime, it by no means invariably holds good, and it is unreasonable to look for more from cow-pox than we find in the analogous cases already alluded to. Admitting, then, that certain exceptional instances may fairly be expected in which the most perfectly developed cow-pox will not protect against small-pox even in its most fatal The most interesting recent fact conform, it becomes a question how far its nected with the history of vaccination, and protection really extends, and whether, one which throws light upon its constitufrom some cause or other, its influence has tional influence, has been elicited by the not become diminished since the early days experiments of Mr. Ceely of Aylesbury, of its introduction. Many are inclined to which prove the identity of the two diseases, this opinion, on account of the recent epi- cow-pox and small-pox, and that their demics of small-pox which have prevailed apparent difference depends upon their in various districts; but it will require modification by the animal constitution; in much stronger evidence of the fact than has other words, that by taking the matter from ever yet been produced, to justify, as some a patient labouring under small-pox, and would have it, the abandonment of vacci- therewith inoculating a cow, the genuine nation, and the recurrence to inoculation cow-pox was produced, and thus, that by for small-pox. One thing is certain, that its passage through the constitution of the Dr. Jenner, strongly alive to the circum- cow, the former virulent disease is deprived stance that milkers inoculated with the of its virulent and fatal character, and congenuine cow-pox were not protected by it if verted into a mild and perfectly safe disthe disease had passed a certain stage, both order, and equally important, deprived of practised, and insisted upon the practice, as its contagious property, otherwise than as it a condition necessary for success, that the can be communicated from one person to same law should be had regard to in the another by direct introduction of its tangible transference of the matter from one human virus into the blood. Connected with this subject to another.* It must be asked, has fact, is the occurrence of the grease on the this precaution been observed in the cases heels of horses, which was at one time conof those who have proved to be insufficiently sidered identical with cow-pox, but must protected. It may, or may not, have been now be considered as the same virus, but the case; but there is some reason to expect, modified by the equine constitution. that among the thousands and millions who have undergone vaccination, a certain proportion have thus been lulled by the semblance of protection which was no protection at all. Again, it is an ascertained fact, that the presence of other disorders materially interferes with the regular progress and perfect development of cow-pox; and thus there is introduced another element of fallacy and of failure, and, lastly, are there not those who have been vaccinated, but in whom the disease, owing to constitutional peculiarity, or insufficient performance of the vaccinating process, has either been irregularly developed or not at all, but who nevertheless rank among the vaccinated? With all these sources of failure, it cannot be matter of surprise, that a proceeding to which is confided the protection of millions against so active an enemy as small-pox, should in a certain proportion of instances fail, still less so, when it is reflected, that amid the various hands to which its per The next point is one intimately connected with the prejudices of the public, and especially of the poor-the possibility of other diseases, or a tendency to them, being introduced along with the cow-pox virus, taken from persons who either had the dreaded disease, or a tendency thereto. The idea is not without apparent foundation, but the state of the case is one which most parents are unwilling to admit. Any medical man who has had much to do with vaccination, and who has watched its effects, must have known cases, in which children previously apparently healthy, have, after passing through cow-pox, become liable to cutaneous eruptions, discharges from the ears or eyes, and even abscess; some of these are of course adventitious circumstances, but they occur too often, and too closely following vaccination, to be entirely so; moreover, they are precisely analogous to what is witnessed every day of the effect of eruptive febrile diseases, such as measles *The every day experience of medical men testifies to the necessity of special attention being paid to this point. and scarlatina, upon children of weakly and scrofulous constitution. That the virus itself introduces other than its own specific disease is not to be believed, but that the peculiar disturbance it occasions in the constitution, stirs up as it were, the latent tendencies to disease above-named, cannot be doubted. It is proper that the public should be rightly informed upon this point, for it is one on which much misconception prevails, and it is the chief ground of prejudice and even of resistance to vaccination, especially among the poor. The medical man is constantly met with objections, on the score of the liability to the introduction of other diseases along with the cow-pox, and when a reluctant consent is yielded, it is always guarded with strict injunctions as to the selection of the matter from a "healthy child," each person considering their own offspring as unexceptionable. It certainly is not a pleasant admission for parents, either to themselves or to others, that their children have bad or scrofulous constitutions; but the fact still stands, that vaccination, as well as the other eruptive fevers, may in them give the first impetus to latent disease. A parent may decide not to subject a child to the chance, but in doing so, it is exposed to the much greater hazard of an attack of small-pox, in the first place as a disease, and in the second as an excitement of other diseases, still more powerful than vaccination. Further, however, as a proper concession to the opinions of the public, a medical man ought to take the vaccine virus from perfectly healthy children only; and it may be said, if we find such a powerful modification of the constitutional effects of the disease by its passage through the body of the cow, there may be some influence, to us unappreciable, exerted in the passage through the varied constitutions of mankind; at all events, the simple supposition is sufficient to dictate care in the selection of those from whom the vaccination lymph is taken. The best period of life for the performance of vaccination, is infancy, between the third and fifth months, before the constitution becomes disturbed by the process of teething; it may, however, be performed at any time, from immediately after birth, should circumstances, such as exposure to the contagion of small-pox, render it advisable, and of course at any period of after life. A child ought to be free from illness or disorder at the time of vaccination; any tendency to fever, to diarrhoea, &c., &c., or any eruption, should be removed before the process is undergone.† It is always preferable to vaccinate from the fresh arm, if possible; when this cannot be done, vaccine virus or lymph is used, which has been preserved for the purpose, either dried on ivory points, or between two small squares of glass, or liquid, in small glass tubes. In these cases it ought to be as fresh as possible, otherwise it is liable to fail, but if well preserved from the air by means of oiled silk, or metallic leaf wrapping, and kept in as cool a place as possible, it will keep its efficiency far longer, and is thus sent or taken to warm climates. The hermetically sealed tubes are said to be peculiarly well adapted for the above purposes, and sugar has also been used as a medium for preserving the lymph for a lengthened period. The scabs, too, dried, and kept from the air, are said to be capable of producing the disease after keeping they require to be rubbed down with a little water when used. The part of the body on which vaccination is usually performed, is the arm, about half-way between the shoulder and elbow; a point not of very great importance in males, but to be attended to in females, who may wear low dresses, or short sleeves, and who will not thank the doctor for a scar upon a visible part. Some vaccinate upon both arms, others consider three, or even two, well developed vesicles upon one arm sufficient. In choosing the arm in a child, it should be done with reference to the arm on which the nurse or mother habitually nurses it; attention to this simple point, may save the child some uneasiness, or even from failure of the entire process, by the vesicles being rubbed or broken. All that is requisite for the process of vaccination, is the contact of the virus with the surface of the true skin, which of course is done by piercing through the upper or scarf skin; this may be effected without pain sufficient to make an infant cry, by a series of scratches crossing one another, continued till the slightest exudation of coloured serum takes place. A small quantity of the vaccine is now to be placed upon the abraded spot, and the thing is done. If the lymph has been dried, it is advisable to rub it into the exuded serum with the point of the instrument used. The points of insertion should be placed about three quarters of an inch asunder. anything which will abrade the skin in the manner described alone, and apply the virus, may be used as a vaccinating instrument; a large needle will do if nothing better is at hand, but a lancet, not over sharp, is perfectly convenient for the purpose, or the vaccinator of Dr. Graham Of course • Vaccination is now very properly compulsory, and convictions have already been obtained under the Act, for the neglect of what all sensible people mus: admit to be one of the best sanitary measures ever introduced. The legal time, (three month.s) is probably too limited for the above reasons. This is doubtful, and ought not to be relied upon, when any other means are available. Weir-fig. A.-which is furnished with a, istic form-fig. C--that of a circular vesicle C 1 series of metallic points-1-at one end of the instrument, for the abrasion of the cuticle, and a small knife-2-at the other, for the collection and application of the virus. When ivory "points"-fig. B. B are used to vaccinate from, the charged extremity-1-may either be well rubbed on the scratched surface of the skin, or the virus may be scraped off and applied with the lancet, or a deeper incision*being made with the lancet, in place of the scratches, the extremity of the point is to be pressed into it for twelve or fifteen seconds. These directions are material, for vaccine virus is always sent out from the "National Vaccine Establishment" upon ivory points. with depression in the centre. At this period it contains a transparent "lymph," and it is surrounded by a perceptible blush, or "areola," the vesicle itself looking pearly has become changed into matter, and the or yellowish. By the tenth day, the lympli vesicle looks more opaque and darker; the areola of inflammation has much extended, the affected skin feels hot and hard, and is sometimes covered with minute blisters. After the eleventh day, the areola begins to fade, the vesicle darkens still more in colour, becomes drier and shrivelled, and finally assumes the form of a dark chocolatebrown scab, which separates somewhere about the twenty-first day, leaving the skin healed, but permanently marked with the impression of the vesicle, and with a number of little pits. Occasionally the process does not go on quite so regularly; four, five, or six days may elapse before the points of insertion inflame; and it may be the tenth or eleventh before the vesicle is fully formed. On the other hand, it may advance so quickly as to be well formed by the seventh day. These differences are chiefly due to constitution. In a weakly child the process is apt to be delayed, and vice versa. The constitutional symptoms also vary, but generally are palpable about the eighth day; the child is fretful and feverish, and continues so, more or less, for three or four days. Without the evidence of constitutional disturbance, the protection cannot be calculated on as complete. The course of the vaccine disease is generally a regular one. About the third day after the insertion of the lymph, the spots appear slightly elevated and inflamed, like small pimples; on the fifth, each has a perceptible vesicle upon it, which continues The management during the progress of enlarging, until, about the eighth day, it the vaccine disease is very simple, the prinussumes its perfectly developed character-cipal being the protection of the vesicles * Care must be taken to avoid making the incision so deep as to produce much bleeding. |