cination may be properly done by any
intelligent person when the circumstances demand it. Vaccination is
usually performed upon the outside of the arm, a few inches below the
shoulder, in the depression situated in that region. If done on the
leg, the vaccination is apt to be much more troublesome and may
confine the patient to bed. The arm should be thoroughly washed in
soap and warm water, from shoulder to elbow, and then in alcohol
diluted one-third with water. When this has evaporated (without
rubbing), the dry arm is scratched lightly with a cold needle which
has previously been held in a flame and its point heated red hot. The
point must thereafter not be touched with anything until the skin is
scratched with it. The object is not to draw blood, but to remove the
outer layer of skin, over an area about one-fourth of an inch square,
so that it appears red and moist but not bleeding. This is
accomplished by very light scratching in various directions. Another
spot, about an inch or two below, may be similarly treated. Then
vaccine matter, if liquid, is squirted on the raw spots, or, if dried
on points, the ivory point is dipped in water which has been boiled
and cooled, and rubbed thoroughly over the raw places. The arm must
remain bare and the vaccination mark untouched until the surface of
the raw spot is perfectly dry, which may take half an hour. A piece of
sterilized surgical gauze, reaching halfway about the arm and kept in
place with strips of adhesive plaster (or an absolutely clean
handkerchief bound about the arm, and held by sewing or safety pins),
ought to cover the vaccination for three days. After this time the
sore must only come in contact with soft and clean old cotton or
linen, which may be daily pinned in the sleeve of the under garment.
If the scab is knocked off and an open sore results it should be
treated like any wound.

If the vaccination "takes," it passes through several stages. On the
third day following vaccination a red pimple forms at the point of
introduction of the matter, which is surrounded by a circle of
redness. Some little fever may occur. On the fifth day a blister or
pimple containing clear fluid with a depressed center is seen, and a
certain amount of hard swelling, itchiness, and pain is present about
the vaccination. A sore lump (gland) is often felt under the arm. The
full development is reached by the eighth day, when the pimple is full
and rounded and contains "matter,"