BMJ

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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