the arm. I then vaccinated again higher up on the deltoid. Eight days subsequent to this date I examined both cases again. In the junior I found two vesicles where the first and second vaccinations had been made, and both passed through their stages synchrononsly. In the case of the senior no repetition was called for; but the symptoms and sequelæ were alike in both cases. On the twenty-fourth day from the first vaccinations, an annoying and obstinate papular affection, a severe attack of lichen agrius, recognized by pin-head or minute, dry, hard and red elevations over the entire body, made its appearance. The papules developed such an inflamed appearance as to simulate erysipelas, especially over the left arms, in which the vaccine virus had been introduced. An exudation of sero-purulent fluid made its appearance through large chaps or abraded surfaces. and gave rise to painful pruritis. A pyretic condition of the system prevailed for a period of two weeks, with occasional gastric disturbance. The furfuraceous desquamation of the cutaneous surface was ten days over the vaccinated arms, which were badly swollen from the shoulder to the finger tips. I am satisfied that no relation of acne, which often so closely resembles the panular and pustular syphilodermata, existed, and that the acneiform eruption resulting from the ingestion of the bromides could be discriminated." Dr. W. O. SKINNER: "I had a student from Keokuk who had been vaccinated repeatedly by his physician without effect, and also by me without good results, until I vaccinated him upon the leg, when it took to perfection, demonstrating that it is likely to take upon other parts of the body when it fails upon the arm. We have had cases here that have been vaccinated eight or ten times without good results, The people have been much opposed to the use of humanized virus, fearing that disease might be transmitted to them; so very little humanized virus has been used in this community. I did some arm-to-arm vaccinating and without a failure, that I know of, demonstrating that as the surest way of getting good results."

Dr. W. H. SPARLING: "We vaccinated many hundreds, using almost altogether bovine virus. The results in children previously unvaccinated were generally satisfactory, though much slower than humanized in its operation. There were a great many failures, however, and some required to be revaccinated three or four times. In adults who had formerly been vaccinated, the bovine virus was remarkably unsuccessful in cases which subsequently yielded readily to humanized virus. We had some pretty sore arms, it is true, as results of vaccination, but no such terrible cases as are reported from other quarters, none requiring amputation, or anything approximating that in severity. Nothing, indeed, which could not be attributed to a strumous diathesis, or ill-health at the time of vaccination. In my experience, the most severe in its operation is humanized virus which is a direct result of vaccination with bovine virus; in other words, humanized matter which is one remove from the heifer. I can sincerely say, that, comparing my late experience with bovine virus, with all my former experience with humanized virus. I have failed to detect in the former any deleterious effects, such as blood-poisoning and the like, and must consider it safer in every respect than the latter; the only objection to its general use being that it is so much slower in its operation, and so much more uncertain to produce any effect. In a case of emergency, I think humanized virus should be relied upon, if obtainable. Now, with respect to all the cases of vaccination with bovine virus coming under my observation, one thing was remarkable, that in no instance, no matter how scrofulous the individual might naturally be, was there the sign of any local or general poisoning from the virus, unless there was proved to be a susceptibility to its action by a more or less typical result of vaccination. If the vaccination failed to 'take,' the scratches or abrasions would real up completely, in a few days; and that, too, in persons in whom slight wounds were none too apt to heal kindly. I think the experience of very many physicians will bear me out in this; and it was a very common remark during the epidemic, that if the bovine virus would do no good, it certainly would do no harm. Such having been my own experience, I cannot but feel incredulous when we are told of the terribly poisonous nature of the matter that we have been using in vaccinating our patients."

Dr. GEO. SUMRALL: "There were some points sold here on which the matter was brown enough to be called mahogany. There were some severe complications in the city. My twenty-sixth primary failed, but his brother, vaccinated at the same time from opposite side of quill, had a typical sore; the second vaccination gave a typical result. In primaries, had to vaccinate 4 twice, 2 three times, 1 five times, but by these vaccinations my results were made perfect, even to affecting the axillary glands. I am 47 years old; was successfully vaccinated at 8, at 38, and again last winter, to very positively affecting the axillary glands on both sides. In one vaccination, the fourth day showed positive mark of success. In very many (my own for one,) positive mark of success did not appear before the fourteenth day; in two cases on the sixteenth, and in one on the eighteenth; all of which ripened into typical fever and soreness of axillary glands, leaving typical marks. Vaccinated one after varioloid, two after variola; all failures."

Dr. J. P. WALKER: "Have met with more than the usual number of herpetic and erythematous eruptions, and in two cases vaccine pustules over various parts of the body."

Vaccinal and Post-vaccinal Erysipelas:

It is a noteworthy fact that in the reports of over one hundred and eighty thousand vaccinations-in thirty-nine thousand of which humanized virus was employed-only four cases of erysipelas following vaccination are reported. That very many more cases oceurred may, possibly, be true; but, if so, the failure to note them, when such minor complications and sequele as lichen, herpes, urticaria, eczema, erythema, roseola, maculæ, bullæ and other eruptions;

inflamed and suppurating glands; otitis, abscesses, indolent ulcers, etc., are all reported, suggests a doubt concerning the reputed frequency of vaccinal and post-vaccinal erysipelas.

One of these erysipelas cases, which caused considerable excitement and, for a time, arrested vaccination in the locality, was thus reported to the BOARD:

JOHN H. RAUCH, M. D., Secretary State Board of Health:

LITCHFIELD, ILL., Feb. 23, 1882.

DEAR SIR: In the Globe-Democrat of the 16th, under the alliterative caption, “Virulent Vaccine, appears a dispatch from this city, wherein is related that Miss C. G. died from the joint effects of overheat while dancing, exposure and vaccination. I am informed that the parties sending dispatches do not furnish the head-lines. These are made up in the newspaper office to suit; but, in my judgment, the dispatch in this instance did not justify the startling head-lines.

Miss G., I am informed, applied for vaccination to Dr. Strafford, at the time of her menstrual period. He advised her to wait, but she determined to get through with the vaccine disease in time to attend the ball and refused to wait. He vaccinated her and the arm was very sore when she went to the ball. She became very much heated, and soon after the arm inflamed and became exceedingly painful, and, in short, manifested all the symptoms of erysipelas. The symptoms were detailed to me by the sister of charity who nursed her. This sister had also been vaccinated, and the disease was well developed when she was nursing Miss G. At this time her arm is very much inflamed, swelled and painful. I have not examined it, but her physician, Dr. Colt, assures me that she has not erysipelas. Immediately after nursing Miss G. this sister had charge of an old lady in the hospital, who has a tumor with a large ulcerative surface. It was her duty to wash and dress this tumor once or twice a day. And now the old lady has erysipelas, extending from this tumor over the scalp and face.

In view of these facts, I think it is a fair presumption that Miss G. died of erysipelas, following vaccination and, in a measure, the result of vaccination. Perhaps a better presentation of all the facts in the case might lead to a different conclusion.

In this connection I wish to speak of what seems a well authenticated case of ampu tation following vaccination.

A young man of this county, named A. P., returned home from Jacksonville, where he was attending school. His uncle, R. N. P., informed me that his nephew had a terrible arm from vaccination, and that two of his classmates, who were vaccinated at the time he was, had each lost an arm in consequence.

A sister of charity, a nurse in the hospital here, and recently from Springfield, relates a similar case as occurring in that city.

These stories are probably the result of misinformation, but they have a bad influence here. To-night I visited a family of four children of ages from 11⁄2 years to 11 years; none of them vaccinated. The parents were advised, in view of Miss G.'s death, not to vaccinate. Yours respectfully,

H. H. HOOD, M. D.

Correspondence with the other physicians mentioned in the above has failed to elicit any further facts. Dr. Stratton discredits the amputated arm story in toto; and it has been found impossible to learn the names or residences of the Jacksonville students, the names of the surgeons who performed the operations, or anything else to corroborate the story. It is positively certain that there was not the shadow of a foundation in fact for the statement concerning “a similar case" in Springfield--whether the "case" refers to erysipelas or amputation.

Amputations, Death, and other alleged Vaccinal Disasters:

As to the other alleged cases in which amputation was rendered necessary; in which tetanus supervened; or death, in some other way, followed vaccination, the contradicting evidence is of both kinds, negative and positive. There is an utter absence of any original reports sustaining these alleged cases. It is true that the BOARD frequently, during the progress of the epidemic, received communications, both from medical men and the laity, depicting a terrible condition of affairs, re vaccination; but it is also true that such communications either referred to some other place, never the one whence they were written, or to some other person, never to the

writer or to any one under his immediate observation." Scores of this kind of report were received, and were, in every instance, investigated, and in every instance disproved. If any case of amputation or death was occasioned by vaccination during the late epidemic, the facts have been successfully withheld from the knowledge of the BOARD, notwithstanding its vigilance and earnest efforts to become familiar with every phase and isolated fact of the subject.

Probably the best sustained and most widely credited "vaccination horror," as it was called in the public press, which occurred during this period, was that located in Wayne county, the details of which are here given as fairly illustrative of several features, and as the solitary exception in which correspondence elicited a reply from one who claimed to have personal cognizance of the fatal effects of vaccination. Merely premising that reports from several sources had been received to the effect that two prominent citizens of Wayne county had died, and several other persons were dangerously ill, from the effects of vaccination, the following correspondence tells the story more graphically and instructively than is possible in a condensation. The first letter was sent in duplicate to the physicians in the immediate vicinity of the reported "horror :"

ILLINOIS STATE BOARD OF HEALTH.

OFFICE OF THE SECRETARY, SPRINGFIELD, ILL., July 26, 1882. DEAR DOCTOR:-Will you kindly furnish this office with a brief report of your recent vaccination experience, for which I enclose you a blank form on postal-card.

A statement has been received to the effect that a man named A. B. Porter, aged 48, recently died in Lamard township, Wayne county, from the effects of vaccination; that another by the name of Cisne is supposed to have died from the same cause; and that several others were made very sick-one girl, aged 19, still remaining under treatment. It is very important that such cases be reported fully--in addition to the report on the postal-card--and you are relied on as a leading practitioner to furnish the facts so far as they have come to your knowledge. Very respectfully,

DEAR DOCTOR:

[Response No. 1.1

JOHN H. RAUCH, M. D., Secretary.

PLEASANT GROVE, Wayne county, Ill.. August 1, 1882.

4 On the 15th of February, 1882, I was called to visit one of John W-'s girls, aged about 17 years, very sick. I saw her. She was sitting in an arm-chair by the fire. I inquired why she was not in bed. They said she could not lay down; that she would smother to death; that they had to carry her out-doors to get her breath. She could whisper. I examined the throat. It was very sore, tonsils swollen. I immediately applied a large mustard-plaster to the neck: made it very red; then removed the mustard and put on a large blister-plaster. Then I had time to talk. They said she had been vaccinated some two or three weeks previously; that she took a chill, then fever: had been up and about part of the time, but had some fever nearly every day since; had been very bad one or two days. This girl was not healthy at best; rather scrofulous. They said she could not be cured with this mustard and blister. Her throat improved rapidly; in one hour she could lay down on the bed and sleep. I gave her no opiates. It was the inflammation of the lungs and throat. I gave her a little stimulants, plenty of quinine, etc. She improved well and got well. I treated the case but three days. On the 15th of the same month, I was called to the same house to see another one of the girls, aged about 19, healthy, intelligent and nice girl, the pride of her parents. She was in bed, very cold and sweating: had been suffering all night; had but little pulse, and was sinking very fast. There was terrible congestion of all the internal viscera. She could talk feebly, part of the time frenzy; said she was dying, and it looked like it. They told me she had been vaccinated when the balance of the family were; that she took a chill, then fever, and fever every day since, but could be up part of the day until the 4th; she got terribly bad. But now to the remedy; first, a large dose of alcohol, then mustard to the arms, legs and stomach, large doses of quinine, with ginger. She improved, got stronger in 40 minutes, and continued better. In about 8 hours got the body warm, the blood to circulate. After remaining with the girl about 8 hours I had to leave to see another sick girl. Dr. Johnson had been sent for before I left and got there very soon after. I returned In 3 hours. Johnson was there; the girl was warm. I gave the case to him and left, and saw the girl no more until about 3 months. Johnson treated the case several weeks. I heard from the girl to-day; she can sit up a little, but has lost her mind, demented and

*With the exception below given.

gone to a skeleton; will likely soon find her way to an asylum or the grave. What was the matter? Blood poisoning--of what kind no one knows. But to the case. No. 3. RP, healthy, about 17 years of age; was vaccinated; took chill and fever, as usual; some days nearly well, then down with fever, and thus continued, all irregular. I was called. The girl had high fever, next day nearly well, next day worse. I gave her medicine about 7 days and left her as I found her; could sit up part of every day; she got well soon; that is, the disease became exhausted. I had just as well poured all the medicine on top of her at once. Case No. 4--Rush Porter, aged 48, stout; had been vaccinated; took chill, then fever; had fever for a few days, then got better; could work a little: took down again very bad; chill all day, then fever, puking terribly. I saw him; he was wild with fever; no pain, but felt sick all over: he said "sick enough to die, sick from head to foot." This sickness continued with him till death; he breathed very rapid, like one had been running; his pulse run to 120. I gave him medicine every two hours for about 7 days and nights; could not tell that it either did him good or harm. The fever was as irregular as the wind, and like the wind took down its tree. He spit up a great deal of thick coppercolored mucus, pale or dingy red, not pus, not blood, but the like of which I never saw before. The disease attacked the general system, fell heavy on the stomach, then the lungs, then the brain. I have seen a great deal of cholera, small-pox, milk-sickness, nearly all types of fevers, but what was the matter with Porter? Blood poisoning-what kind-no one can tell. The first case fell heavy on the throat and lungs, but got well. The second fell heavy on all the internal viscera, then closed in on the brain and ruined the mind. The third it tormented for weeks, then became exhausted. The fourth set heavy on the general system, then the stomach, lungs and brains are killed. I went to see others, but they were unimportant. I lost but one. I saw arms till I got tired of looking at them, but never saw but two pustules that looked like small-pox. It is supposed that James Cisne died from being vaccinated. but I did not see him, and can't tell. We can starve out the small-pox, but please leave vaccination alone in back counties. It hardly ever reaches here. People in cities should be vaccinated, I think. Did this virus come from small-pox, gonorrhoea, syphilis, scrofula and flstilou, or dead sheep?

[Response No. 2.1

DR. J. B. MANAHAN.

PIN OAK, Ill., July 31, 1882.

MY DEAR SIR: I was the consulting physician in the cases of Rush Porter and J. M. Cisne, both of Arrington township and not of Lamard.

Rush Porter died of typhoid pneumonia. Examined his arm three weeks after vaccination and found a good healthy scab, just ready to drop off. Also saw the scar just previous to his death; it was round, well pitted and healthy, and don't consider that it had anything to do with his disease or death.

J. M. Cisne died with double pneumonia. Had been vaccinated some two or three weeks previous to his death, but was in nowise troubled with his vaccination. Dr. A. 8. Robertson, his attending physician, will confirm this statement. Never having seen the 19-year old girl referred to, I cannot give any reliable statement as of my own knowledge. I had a talk, however, with her physician, Dr. Kelso, who said she had tubercular meningitis, being of -- parentage, and that vaccination had nothing whatever to do with her present condition. Very respectfully, W. S. THARP, M. D.

The other replies are simply corroborative of Dr. Tharp's statements.

VACCINATION IN PUPLIC INSTITUTIONS, ETC.

SUPPLEMENTING the order of the BOARD, dated January 10, 1882, and requiring that all persons in attendance at State universities, colleges and schools; and all inmates of asylums, alms-houses, jails, and kindred institutions, be forthwith vaccinated or revaccinated, as the case may be, with as little delay as possible, the following form was prepared and distributed:

aged (as stated): (3) ........years, .....
......months;and pronounce (4)

properly protected from SMALL-POX by reason of (5).

(A) Successful recent primary vaccination.

(B) Successful recent re-vaccination.

(C)..unsuccessful recent attempts at vaccination which demonstrate insusceptibility (D) Previous attacks of small-pox or varioloid.

1-Name of city, town or village. 2-Date. 3-Age in years and months. 4-Strike out superfluous pronoun. 5-Check the initial. "A," "B." "C" or "D." which indicates the "reason." If it be "C." insert number of attempts. At the present time (winter of 1831-2) no person over the age of puberty should be considered "properly protected" who does not come within one of these four definitions,-using the word "recent" to imply that the operation has been performed since January 1, 1881.64 6-Signature of certifying physician, who should in all cases be a legally-qualified practitioner.

This Certificate was intended to be furnished to the individual whenever he or she left the institution, while the stub or counterfoil (see below) was retained by the vaccinating physician, from which to make up his report to the STATE BOARD OF HEALTH.