Inoculation

“ It is a matter of small consequence, whether a disease be entirely extirpated, or rendered so mild as neither to destroy life nor hurt the constitution; but that this may be done by inoculation, does not now admit of a doubt. The numbers who die under inoculation hardly deserve to be named. In the natural way, one in four or five generally dies; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient. ”

“ Although it is impossible to determine geometrically the degree of health requisite for inoculation, you may safely trust to that indeterminate judgment we commonly pass, when we say, such a one is well: we mean that nothing amiss is observable, nothing at least that attacks the vital functions, nor any tendency to sickness, as in children during dentition, or women during pregnancy, &c. ”

“ The prophylactic effects of inoculation are explained on the theory that by means of this operation the wandering cells are prepared, as it were, for subsequent accidental irruptions of similar pathogenic bacteria, are habituated or compelled thereby to at once devour such organisms when they enter the body spontaneously, and thus to render them harmless. Inoculation would thus be a sort of training or education of the phagocytes. ”

“ The choice of the patient's age, of the temperature of the air, season of the year, states of the blood, and general habit of the body, "free from gouty, rheumatic, scorbutic, inflammatory, or feverish dispositions of every kind," as well as of every acute or critical disease with their effects, which render those who labour under them more unfit subjects of inoculation, are none of the most inconsiderable benefits which may be derived from the taking the disease in this way. ”

“ The great, and especially their leaders, the ladies, he imagined, would be allured by being put to no fright and no pain, unrestrained in their diet, undisturbed in their joys; the people would be drawn in by an operation either chargeable nor confining; all would be glad to enjoy the benefits of inoculation without its risks, and to spread it new fashioned all over the continent:
That eloquence of heart, which never fails to please, and seldom to convince, gave our professor great advantages over his rivals. ”

“ MANY books have been published within half a century, about inoculation; the authors of which, being mostly intent upon proving the benefits of the method, and paying no attention to the improvement of it, have neglected to determine and direct the best way of giving and treating the disorder communicated in this manner.
The rules laid down by the first introducers of the operation in Europe, have been exactly repeated; the way of inoculating taught in books remains what it was fifty years ago ”

“ Ever since inoculation has been received in Europe, the practitioners have been of opinion that the essential advantages of the artificial over the natural small-pox were, 1. the preparation; 2. the discharge of the variolous matter by means of the wounds; and 3. the assistance of art in a disorder which is known as soon as it appears.
In opposition to these principles, I shall attempt to prove, that these three pretended advantages have hitherto been so many bars to the perfection of the method, and the source of almost all the miscarriages which have retarded its establishment. ”

“ Raising the Virulence of an Organism.—If it is desired to raise or "exalt" the virulence of a feebly pathogenic organism, special methods of inoculation are necessary, carefully adjusted to the exigencies of each individual case. ”

“ Whence a strong reason against our hazarding inoculation before that age is passed, especially in crowded towns; except where the vicinity of the natural contagion renders it necessary, or the convenience of inoculating a whole family at a time; as it then becomes better to venture the less favourable circumstances of the age of the patient, or the chance of the pain from toothing, than to risk the infection in the natural way. ”

“ By immunity is meant non-susceptibility to a given disease, or to experimental inoculation with a given bacterium or toxin. The term must be used in a relative sense, and account must always be taken of the conditions present. Immunity.An animal may be readily susceptible to a disease on experimental inoculation, and yet rarely or never suffer from it naturally, because the necessary conditions of infection are not supplied in nature. That an animal possesses natural immunity can only be shown on exposing it to such conditions, this being usually most satisfactorily done in direct experiment. ”

“ From the inattention of those who have written upon the subject, might it not be concluded, that there really is but one method of inoculating; or if more, that they are equally good? that, provided the variolous matter be inserted, and the small-pox conveyed, all the rest is of no consequence; and if the operation should be more or less successful, or even if fatal accidents should happen after it, that these effects are to be imputed to nature, to chance, to inoculation itself, but by no means to the particular method which has been followed? ”

“ That this new method of inoculation hath been amazingly successful, is beyond all contradiction; but that this success is not confined to the Prisoner at the bar, is equally indisputable. None of our patients die. The success is universal. Whether we prepare our patients or not; whether we give them mercury, or no mercury; whether we inoculate with crude lymph, or with matter ultimately variolated; [Pg 71] whether we sweat them in the eruptive fever, or send them into the cold air; in short, let us proceed as we will, to kill a patient by inoculation, seems to be out of our power. ”

“ In those countries, where inoculation has been most successful, where it is attended with little or no danger, where thousands are inoculated, and are hardly sick at all, in a word, throughout the East, the operators only enquire, whether the person is in full health.
The history of inoculation in Europe must convince any man, who does not wilfully shut his eyes against light, both of the inutility and danger of preparations ”

“ In the study of animals it is comparatively easy to reproduce a disease by inoculation. But experiments upon man are commonly impossible, and in the case of human diseases it is frequently very difficult or impossible to obtain the final test of the matter. After finding a specific bacterium associated with a disease, it is usually possible to experiment with it further upon animals only. ”

“ It has been found possible to cultivate the microbes contained in the blood, tissues, and secretions in certain of the infectious diseases, and after a series of cultivations, so that these organisms are far removed from the animal substance which contained them, and with which they were so intimately associated in the individual, they have been employed for inoculation—with this important result, that the primary disease was reproduced. ”

“ A very ingenious and eminent physician, who has long practised inoculation largely with great success, and has published a valuable treatise upon this subject, directs both antimonial and mercurial medicines, during the preparation. ”

“ And such persons, when no ways prepared, have from inoculation alone, and a care to avoid all errors in the non-naturals, had the small-pox in the slightest degree, and most favorable manner possible. ”

“ But notwithstanding the obviousness of this truth, many people, accustomed to judge more from their own argumentations than from facts, will hardly be brought to believe that one pustule has the same effect as ten thousand. Though approves of inoculation in general, the bulk of mankind will be afraid of a copious eruption, and uneasy after a sparing one. ”

“ In the various expedients that have been devised to mitigate the severity of morbid affections, and to render those which are dangerous, mild and innocent, no invention, surely, (if it may be called an invention, and not rather the inspiration of Heaven itself in pity to man) no attempt to disarm a fatal disease of its violence, was ever so successful, or ever equal in its importance, to that of inoculation properly managed. ”

“ Such cultures are called “deep cultures.” To obtain growth of an anaerobic organism on the surface of a medium, in using the plate method, and also for cultures in fluids, the air is displaced by an indifferent gas, usually hydrogen.
In testing the effects of bacteria by inoculation the smaller rodents, rabbits, guinea-pigs, and mice, are usually employed. One great drawback in certain cases is that such animals are not susceptible to a given Inoculation.bacterium, or that the disease is different in character from that in the human subject. ”

“ The inoculated nutrient medium is then maintained for three days at a temperature of 37° centigrade, and may then be used for the inoculation of a larger quantity of nutrient medium.
Theoretically, a single cell of a bacterium is sufficient to inoculate any quantity of any suitable fluid; but in practice it is found necessary or expedient to employ 5 or 10 per cent. of inoculating matter to the volume of the liquid to be inoculated. ”

“ The usual seat of inoculation is the extremity of the tail, the virus being introduced beneath the skin by means of a syringe or a worsted thread impregnated with the lymph. Protection against infection can also be secured by subcutaneous or intravenous injection of a culture of Arloing's pneumo-bacillus on Martin's bouillon, and by intravenous injection of the lymph from a diseased lung, or from a subcutaneous lesion produced in a calf by previous inoculation. ”

“ Immune body or amboceptor is the name given to a substance present in the serum of an infected animal that has successfully resisted inoculation with some particular micro-organism, and which possesses the power of linking the complement normally present in the serum to bacteria of the species used as antigen in such a manner that the micro-organisms are rendered innocuous, and ultimately destroyed. ”

“ If the above testimony of persons of character and veracity, together with the concurrent persuasion of farmers in general, be allowed of, it must be determined, that there is no instance of a second infection. Supposing now it should appear, that this distemper [535] is regularly, as in the natural way, tho’ in a milder manner, produced by inoculation, and that inoculation secures a beast also from a second infection; then undoubtedly inoculation will be recommendable. ”

“ Many diseases that now yield to no curative treatment are being met by inoculation. By this method the body is reinforced by serum injections, that disease germs and infections may be warded off, or in case of attack, be so fortified against the disease germs as to destroy them or render them inactive. ”

“ There are but few now conversant in the practice, who will allow that those who die from inoculation exceed one in a thousand of those who take the small pox that way; and we hear of some who have inoculated several thousands, successfully, without a single miscarriage. ”

“ But in absolutely demonstrating, starting from the germ theory of disease as a basis, that disease could be guarded against, at least in certain cases, by inoculation with attenuated virus, he has opened the way probably for results the greatness of which we do not yet appreciate. ”

“ The patient to be infected being in the same house, and, if no objection is made to it, in the same room, with one who has the disease, a little of the variolous matter is taken from the place of insertion, if the subject is under inoculation ”

“ It is not once in a thousand times that a dog or a cat is used for inoculation. The act of inoculation is not in itself painful. A small area of the skin is carefully shaved and cleansed, that it may be aseptic, the hypodermic needle is sterilized and the method of hypodermic injection or of vaccination is the same as it is in medical practice. ”

“ Experience has shewn, that this disposition is always attended with a kind small-pox, provided other causes, or some error in the insertion or treatment of it do not increase the disorder, and disturb nature in her operations. Health therefore is all we want in subject intended for inoculation.
Granting this, it is evident that there is no need of preparation for a person in full health; and that for one who is not well, the only preparation must be to make him so. ”

“ These, I imagine, Dimsdale's treatise will have an happy tendency to prevent, by rend'ring the practice of inoculation more familiar and better understood. To those who have not had much opportunity of seeing in what manner any physical operation is best managed, or how a particular disease is treated with the greatest success, it will always be of infinite advantage to avail themselves of the assistance of a skilful pilot. ”

“ VI. Dosage of the Virus.—For the first inoculation, one immunizing unit, 1 I. E. [= 1 Immun Einheit] is used for each calf; for the second inoculation, which is not to be undertaken until at least twelve weeks after the first, five units (5 I. E.) are used for each calf. As a rule the dose of 1 I. E. is 0.004 gramme dry Tb., that of 5 I. E. for the second inoculation is therefore 0.02 dry Tb. ”

“ You take your chance of the germ being in the scrapings, and, lest you should kill it, you take no precautions against other germs being in it as well. Anything may happen as the result of such an inoculation. ”

“ Of the chief methods used in producing active immunity the first is by inoculation with bacteria whose virulence has been diminished, i.e. with an “attenuated virus.” Many of the earlier methods of attenuation were devised in the case of the anthrax bacillus, an organism which is, however, somewhat exceptional as regards the relative stability of its virulence. Many such methods consist, to speak generally, in growing the organism outside the body under somewhat unsuitable conditions, e.g. at higher temperatures than the optimum, in the presence of weak antiseptics, &c. ”