These experiments were conducted in the Cooper Hospital, so that constant and careful observations could be made. White rats were selected because they are extremely susceptible to tetanus and because in these animals tetanus develops within twenty-four hours after infection. A large number of white rats were moculated with all the samples of vaccine and kept under observation for five days. Not a single one of the animals has, at any time since their inoculation, manifested the slightest symptoms of tetanus. The results of our experiments enable us to state positively that the vaccine virus was pure and free from tetanus germs, thus proving that the cases of tetanus which occurred in Camden were not caused by the vaccine employed. This investigation should remove all fear from the public mind and should encourage people toward vaccination as a preventive to a disease which is imminent as an epidemic. ALEXANDER SCANLIN ROSS, M.D. PHILADELPHIA, PA., Nov. 27, 1901. HENRY H. DAVIS, M.D., President Board of Health, City Hall, Camden, N. J.: DEAR DOCTOR-In answer to your inquiry of even date, I desire to state that our vaccine physicians have vaccinated nearly one hundred thousand persons in the past three months, and during the same period it is safe to state that at least 700,000 persons in Philadelphia have been vaccinated, without a single case of tetanus having been reported to this office. Yours truly, J. LEWIS GOOD, President Philadelphia Board of Health. VACCINATION IN PORTO RICO. WAR DEPARTMENT, SURGEON GENERAL'S OFFICE, WASHINGTON, D. C., Nov. 23, 1901. HENRY H. DAVIS, M. D., President Board of Health, Camden, N. J.: SIR-Replying to yours of November 20, 1901, relative to statistics concerning tetanus after vaccination, and the efficiency of vaccination in preventing smallpox, I am directed by the Surgeon General to refer you to the report of the Superior Board of Health cf Porto Rico, Major J. Van R. Hoff, Surgeon, United States Army, chairman, period '98-'00, page 117, in which the following statement is made: "The average annual number of deaths from smallpox for the past ten years was 621; the greatest number, 2,362, occurring in 1890, and the least, 11, in 1893. In 1899 there were about 50 per cent. less deaths than in any of the three years preceding. This decrease was due to the general vaccination of the island, which was concluded June 30 of that year; 860,000 vaccinations were performed under the direction of the chief surgeon of the department during the four months preceding this date. All the deaths reported in 1899 from smallpox, except one, occurred prior to the day on which the work was concluded. At the rate of 242 for the first six months the annual deaths would have been practically the same as in the preceding three years. During the seven months covered by these statistics but one death has occurred from this cause." It is stated by Major Hoff that subsequent to the completion. of the general vaccination of the Porto Rican population on June 30, 1899, there have occurred, down to the present time, but three deaths from smallpox in Porto Rico-the average annual death rate from this disease being reduced from 621 to less than 1.5, with an apparent saving of 1,239 lives since the date mentioned.. No epidemics of variola have occurred since that time in Porto Rico. A slight outbreak of varioloid occurred in the city of Ponce, but it was attended with no deaths and quickly subsided. Although there were over 860,000 vaccinations performed on a susceptible and generally unvaccinated Porto Rican population, only one death occurred which could be attributed to vaccination. This was due to tetanus, and occurred in a child. Tetanus is, however, an extremely common and fatal disease in Porto Rico, causing no less than 818 deaths on the island during the seven months, October 1st to May 1st, 1899-1900, or 3.41 per cent. of the mortality. The occurrence of the case of tetanus following vaccination was undoubtedly due to a secondary infection from an outside source with the widely distributed tetanus germ. A second instance illustrating the efficiency of vaccination is given in the report of the Surgeon General of the Army for 1899, page 245, where a brief description is given of the stamping out of an epidemic of smallpox in the district of Holguin, Cuba. In this epidemic, 1,185 cases of smallpox were collected into isolation hospitals by the army surgeons in charge. General vaccination of the Cuban population was practiced and the epidemic was promptly brought under control. It is of interest to note that not a single case of smallpox occurred in the carefully vaccinated regiment of United States troops which furnished the guards for the lazarettos, performed the work of disinfection of infected buildings and in other ways were constantly exposed to the danger of contracting smallpox. Respectfully, EDWARD L. MUNSON, Captain, Assistant Surgeon, U. S. A. THE DIPHTHERIA ANTITOXIN AND TETANUS OUTBREAK IN ST. LOUIS. DRS. B. MEADE BOLTON, C. FISCH and E. C. WALDEN, the commission appointed to investigate the cases of tetanus following the administration of diphtheria antitoxin in St. Louis, have reported (St. Louis Medical Review of November 23, 1901) as follows: "As a result of our investigations we draw the following conclusions: "The diphtheria antitoxin prepared by the Health Department of the City of St. Louis, and dated September 30, and some of the serum dated August 24, was the cause of the recent deaths from tetanus in the cases where this antitoxin was used. This antitoxin was sterile, but contained the toxin of the tetanus bacilius in considerable amount. "There were two different sera issued under the date of August 24; one portion not containing the tetanus toxin and characterized by other properties, while the other contained the tetanus and was identified with the serum bearing the date of September 30. "The most important result we have arrived at is the positive demonstration that the toxic serum dated August 24 and that dated September 30 are identical. From this we conclude that the serum of September 30 was issued without having been tested by the proper methods, and that a part of it was filled into bottles bearing the date of August 24, and furnished with labels having previously been stamped with this date. We are justified in drawing this conclusion from two observations. First, that the serum of September 30 was issued before there was time to have performed the simple tests necessary to determine the antitoxic potency of the serum. Second, in the same way, serum dated October 23 came into our possession on November 1. This serum had been issued to physicians by the Health Department, and by them returned to the coroner. It is obvious from this that no animal experiments could have been made with this antitoxin. As this was the case with the serum of October 23, it is the natural inference that the serum of September 30 was issued in the same way. "We must deny any possibility of latent tetanus having existed in the horse 'Jim' from August 24 to September 30, as no wellauthenticated cases have been reported in which the incubation period extended over seven days, in experiments directed to test this point. The period of incubation cannot be determined from clinical observation, from the nature of the case. It therefore follows from this that the serum drawn on August 24 was free from tetanus, but that the serum of September 30 was drawn during the period of incubation, and had it been tested upon animals it must necessarily have revealed its toxic properties. "From the foregoing facts we are forced to conclude that the diphtheria antitoxin prepared by the City Health Department has been issued before it was possible to have obtained results from the absolutely necessary tests. Had these tests been performed, the results upon animals would have been such that the serum would not have been dispensed, and the cases of tetanus forming the basis of this report could not have resulted." THE EFFICACY OF VACCINATION. DR. WILLIAM M. WELCH, Physician in Charge of the Municipal Hospital, Philadelphia, read a paper at a recent meeting of the County Medical Society, on the "Efficacy of Vaccination," in which he said, in part: "Not one thus far who has been vaccinated previous to exposure has contracted smallpox. About fifty individuals, including physicians, nurses and attendants, have been continuously and freely. exposed to the disease. "In addition to the individuals referred to as being exposed, there were some sixty or more workmen, engaged in the construction of a new pavilion, who were in close proximity to the smallpox patients. These were vaccinated with glycerinated lymph, some for the first time, and none up to the present date has contracted the disease. One workman, who, by the way, was the only one to refuse vaccination, has within the past week been brought into the hospital with smallpox. He bears upon his arm a good scar from infancy. An unvaccinated garbage wagon driver and several other unprotected individuals, who were merely exposed upon the grounds, contracted the disease. "We have, from time to time, received in the hospital persons with well-marked and even fatal smallpox in whom vaccination performed some weeks before had failed. "Many physicians hesitate about vaccinating individuals who are suffering from some other disease. At the Municipal Hospital recently scores of patients suffering from diphtheria and scarlet fever were vaccinated as a precautionary measure. The vaccina tion did not unfavorably influence the original disease, and, on the other hand, the course of the vaccinia was in no case unusual. Only One in Three Hundred. "Since the beginning of the present year about 300 cases of smallpox have been treated at the hospital. Of this number not a single patient had been recently successfully vaccinated. The shortest period elapsing between a successful vaccination and the contraction of the disease was five years. In this case, which occurred in a boy 11 years old, the eruption consisted of only a score or so of papules, which scarcely developed into vesicles, but dried up in a few days. It was not found necessary to confine the lad to bed. While the majority of the patients admitted they were unvaccinated, a very large number had been vaccinated in infancy. To our knowledge, none, save the boy mentioned, had been successfully vaccinated within the past ten years. "The writer believes that it may be laid down as a rule that if a child is successfully vaccinated in infancy, and again at the age of puberty, the protection will be permanent. The exceptions to this rule, however, may be sufficiently frequent to warrant repetition of the vaccination whenever there is exposure to smallpox." VIRCHOW AS A POLITICIAN.-The London "Spectator" says: "Berlin has been honoring itself by celebrating the eightieth birthday of Professor Virchow, the great pathologist, whose demonstration that the human anatomy was based on cells laid the foundation of modern medicine. He is the son of a little farmer in Pomerania, and his rise from that position to the headship of science in Germany has been marked by a singular peculiarity. Professor Virchow, though devoted to scientific research, has been a weighty politician. He was practically for twenty-five years the leader of the Liberal party, had once the honor of a challenge from Bismarck, and incurred the fiercest anger of the Court, which secured his expulsion from his scientific appointments. He was also a hard worker in the field of local government, having been for forty years a member of the Municipal Council of Berlin, which he induced to undertake and carry through great sanitary reforms. He is now honored by Court and people alike, the Emperor forwarding to him the Grand Gold Medal for Science in a letter which, though without warmth, acknowledges to the full his scientific rank, and the people complaining that the decoration is insufficient. Here rarely or never do our scientific men or even physicians enter politics." |