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Efficacy of VaccinationAuthor(s): Henry KnightSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 5, No. 128(Mar. 11, 1843), pp. 471-472Published by: BMJStable URL: http://www.jstor.org/stable/25491898 .
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EFFICACY OF VACCINATION. 471
pain were often renewed with more violence than ever, the lesion wlhich the parts had suffered only adding to the previous enervation and debility. We have no correct idea how mercury or arsenic, taken internally, acts upon the affected or other nerves; but we can fairly observe and appreciate their effects upon the blood-vessels, by their increasing capillary action, and giving more contractile vigor to congested and dilated vessels. This energetic effect relieves the associated nerves from pressure, wherever situated; but it will be more palpably displayed where the vessels are closely bound up or imprisoned with the nerves. The benefits resulting from moxas, or perpe tual blisters, seem also to be owing to their continued diversion of the fluids from the subjacent or neigh bouring vessels that are injuriously pressing upon the affected nerve, and not from any direct curative action which they have upon the nerve itself. It is also to be remarked, that in the great majority of cases of
neuralgia the pain is very much increased, if additional pressure be made by the finger at the several points affected, where the nerve is emerging from a bony or other unyielding aperture, thereby corroborating the doctrine that a less pressure is the cause of a
lower degree of pain. A severer pressure by the finger will also, in some cases, produce numbness and insensibility.
These, then, are shortly the views which I beg to offer concerning the topical nature of our well characterised neuralgie, especially those of the intermittent type. Irrespective of constitutional or other derangements, I conceive that they primarily consist in a hypernmic and an atonic dilatation of the blood-vessels, which either surround or accompany the nerves affected through unyielding canals or apertures in bone, carti lage, or else through fibrous sheaths or fascie of
more or less density or resistance-that the pain is
occasioned by pressure or counterpressure, varying according to the phlogosis or fulness of the dilated vessel-that the intermittence depends on the diurnal or periodical nervous exhaustion or accumulation of excitability in the system-and lastly, that the above
pathological view is confirmed by the effects of such tonics as bark, steel, arsenic, and mercury, taken in
ternally, the action of all which is principally confined to the vascular system.
EFFICACY OF VACCINATION.
[The following letter, from the superintendent re gistrar of the parish of Birmingham, has been for warded to us by Dr. Edward Johnstone. It contains some important facts relative to the effect of proper vaccination in preventing the occurrence of small pox, and is, moreover, very creditable to the zeal of its author.-EDS.]
DEAR SIR,-You are aware that in the month of
July, 1840, the royal assent was given to an act,
3rd and 4th Vic., c. 29, " to extend the practice of
vaccination." By that act, guardians of the poor in
every parish are directed to contract with legally qua
lified medical practitioners for the vaccination of all persons resident in their respective parishes; and to remunerate such medical officers according to the number of persons who, not having been previously succesfully vaccinated, shall be successfully vacci
nated by them. By the same act, any person con
victed of producing, or attempting to produce, by
inoculation or any other means whatsoever, the dis
ease of small-pox, is subjected to imprisonment in the
common gaol or house of correctioii for any period
not exceeding one month. The guardians of the poor of the parislh of Birming.
ham were- not slow to obey the injunctions of the
Vaccination Act; they made arrangements for com
mencing operations with the year 1841 in a most effi
cient manner. Of the importance of the Vaccination
Act to the welfare of the country at large, I presume
there can scarcely be a difference of opinion; of its
importance in the parish of Birmingham, and the ne
cessity for its being promptly acted upon by the guar
dians of the poor in this parish, my position, as super
intendent registrar, afforded me an opportunity of
judging, which was not so open to other persons. At
the time I am alluding to I deemed it prudent to coil
fine my observations on the subject to a few profes
sional gentlemen, lest an unnecessary alarm might be
excited; it may now, however, be useful to record
them. During the quarter ending December 31, 1840,
small-pox prevailed here to what appeared to me a
frightful extent; it amounted to full 11 per cent. of
the entire number of deaths in the parish; and in the
most central district in the parish, out of ninety deaths
in the same quarter, twQnty-one deaths, or 23i per
cent., were registered as caused by small-pox. From
the 1st of January to the 7th of February, in 1841,
nine deaths from small-pox were registered in the
same district, being equal to 20 per cent. of the whole
number of deaths in that district during the same pe
riod; by March, however, this plague seemed to have
been stayed. I now proceed to my chief and pleasing
object in making this communication, which is to
notice the apparently very successful result of carry
ing out with vigor the provisions of the Vaccination
Act in this extensive parish.
During the first three months of 1841 more than
700 cases were successfully vaccinated by our medical
officers, and the number so vaccinated in the whole
year 1841 was 1481; in the year ending December
31, 1842, the number so vaccinated was 850.
Now, Sir, you will learn with pleasure that in
the whole year, ending 31st December last (1842),
only 10 deaths were registered in the entire parish of
Birmingham as caused by small-pox, being about 1
in every 358 deaths instead of 1 in every 9 deaths, as
was the case in the quarter ending December 31,
1840, to which I have before alluded. And I desire
further to notice that not one of the ten deaths from
small-pox, registered in the year 1842, has occurred
since the month of April last, so that for many months
it would appear that no death has been caused by
small-pox in this parish. I will not, as a non-profes
sional man, indulge in conclusions, or attempt deduc
tions from these facts; I remember the adage, "Do
not shout till you are out of the wood ;" but surely
there is very great encouragement to guardians of the
poor, to the medical profession, to parents, and the
public in general, to persevere in a course promising
such important results, and to keep ulp a kind, althouglh
by no means a disinterested, watchfulness over the fa.
milies of their poorer neiglhbours.
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472 TREATMENT OF ACUTE MANIA.-MALFORMATION OF FCTUS.
I will only add that I feel assured that although you may have been previously acquainted with the facts I have stated, you will, nevertheless, excuse my having addressed you on the present occasion.
I am, Sir,
Very respectfuilly, HENRY KNIGHT.
To Edw. Johnstone, Esq., M.D. Birmingham, Feb. 21,1843.
TREATMENT OF ACUTE MANIA. TO THE EDITORS OF THE PROVINCIAL MEDICAL
JOURNAL.
GENTLEMEN,-In common with your readers at large, I feel deeply indebted to Mr. George Miller, in whom I fancy I recognise an old fellow student at
Winchester, for the highly initeresting case which he read before the Chichester Medical Society, and
which he has so elegantly and ably reported in your
Journal of the 4th instant. The case appears to have
been one of acute mania, with the phenomenon of
catalepsy suiperadded, and in this light the writer has
evidently viewed and treated it, although he has
designated it by the term of catalepsy alone.
Having had of late the opportunity of observing
much of mania in its various forms and degrees, and
having had also the practical management of some
cases very similar to that most important and affect
ing one related by Mr. Miller, I feel in some measure
justified in venturing to offer one or two suggestions on the case, chiefly with reference to the treatment
to be pursued in the like melancholy instances of
cerebral disease, both "so formidable and pitiable," as Mr. M. justly characterises them.
It may not again fall to the lot of Mr. Miller to
witness a scene so sad. Mania in this truly acute
form does not often come under the notice of the
practitioner in medicine. This case, however, strongly supports an opinion which I entertain myself, but by
no means peculiar to myself, for I heard it verified in
the summer of last year by Dr. Davy, one of the assist
ant physicians of the Hanwell County Asylum, that
veritable acute mania is frequently, nay, if the -exciting
cause be taken into consideration, almost generally
a disease attended by low typhoid symptoms-in other
words, by an asthenic state of the vital powers rapidly
succeeded by collapse. The case in question fully illustrates this; a strictly conscientious clergyman
works hiimself up into a condition of highly nervous
irritation and excitement, " deprived of sleep at night
as well as considerably emaciated for want of proper
nutriment ;" he then becomes maniacal, in a state of
corporeal exhaustion; this irritation passes on to
vascular congestion of the brain, and even to menin.
geal inflammation. The early history of the case
warrants this conclusion as to the then pathogno
monic state, and the appearances within the cranium
revealed on dissection, are those of the two latter
serious affections. It were almost superfluous to say that both these conditions are often concurrent with,
and produced by, an exhausted, or anoemial, state of
the body; and, from the whole of the symptoms so
well described by Mr. Miller, I submit that tlhis was
the true pathology of the present case.
I do not pretend to criticise or find fault with the
treatment adopted by Mr. M. and the able physician
whom he met in consultation; the entire medical ma
nagement was most judicious and scientific. Nor do
I assume that recovery could have taken place under
any circumstances; but my experience authorises me in recommending the earlier administration of nou
rishment and support, if not of stimulants. As early
as on the 21st of August I should have given some
thing more than "tea, coffee, or arrow root;" the
latter I should have combined with wine, and this
too, very possibly, even if he would have taken ani
mal food in the solid or fluid form; or I should have
allowed porter or mild malt liquor in any other shape
that he might have preferred. The bitter beer, as it
is called, I have known to be greatly enjoyed and to
prove anl excellent tonic at such time. On the 25th
and 26th, when he asked for wine, I question whether
it would have been improper. The pulse on these
days did not prohibit the trial.
Had the patient's system been thus supported, he
could have borne rather more extensive topical de
pletion than was actually practised. From four to six
ounces of blood abstracted by cupping-glasses, on the
26th, applied to the occiput or behind the ears milght,
perhaps, have proved servicable in relieving the con
gestion then plainly established. It is to be regretted that mercury, known to be the
most powerful remedy we have in isubduing conges
tions of the blood, particularly in the encephalon,
and when approximating to phlogosis or effusion, did
not produce its specific influence. The difficulties in getting the remedy down by the mouth were, doubt
lessly, very great, but friction with linim. or ung.
hydrargyri, on various parts of the body, would have
been practicable. The blistered surfaces, moreover, might have been dressed with pure calomel.
In the history of the case I cannot find when calo
mel " in small and repeated doses" was conimenced;
but I conclude that Mr. Miller has committed an
error of the pen, in writing " calomel and opium to
affect themouth," as having entered into the treatment. I remain, Gentlemen,
Your obedient servant, G. Bunt.
Loughton, Essex, March 7, 1843,
MALFORMATION OP F(STUS.
TO THE EDITORS OF THE PROVINCIAL MEDICAL JOURNAL.
GENTLEMEN,-If you thiiik the following curious case of congenital deformity worthy of insertion in your valuable Journal, it is quite at your service.
I remain, Gentlemen, Yours sincerely,
JOHN MILTEORP. Topcliffe, near Thirsk, Yorkshire.
Mrs. P. was taken in labor of her first child on the
23rd of September, 1842. The breast presented. To my great surprise, after one leg was brought down, no other could be found, although I examined very carefully. The fcetus, which was a seven months' one, lived about an hour (when born), and presented
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