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VACCINATION
AND ITS
PROTECTIVE  POWER,
IN THE
STATE OF WEST VIRGINIA:
A REPORT TO THE GOVERNOR, NOVEMBER 8,1870,
By JOHN C. HUPP, M.D.,
        F
   State Vaccine Agent.
  -  ' T l]V ■*• T»,T


  WHEELING:
JOHN FREW, PUBLIC PRINTER.
     1871. 
H<j52v
 1371 
VACCINE  AGENT'S  REPORT.
                    THE  STATE OF  WEST VIRGINIA,
                             Vaccine Agent's  Office,
                                    Wheeling, November 8, 1870.
 To His Excellency William E. Stevenson,
                        Governor of West Virginia:
   Sir:  Among the provisions of an act of the Legislature, to provide for
 the  public health and  define the duties of the Vaccine Agent, is the
 following :
   " 11.  The Governor shall annually appoint and  entrust  with some fit
 agent, who shall furnish by mail or otherwise, every citizen of this State,
 and soldier in the armies of the United  States, and in the service of the
 State, who may apply therefor, with genuine vaccine matter, and direc-
 tions how to use it, free  of charge."
   In accordance with your expressed opinion, that a 'report of the quan-
 tity of virus distributed, and who gets it, and on the general importance
 of the subject, &c,  *   *   would be generally useful,' the following
 report has been prepared.
   It  may be premised in the outset, that my first commission as Agent
 bears date of January 1, 1863, which was under the reorganized  govern-
 ment of Virginia.
   From that date to the present I have been successively entrusted with
 the very important and  responsible duties of sending to  all who would
 accept it, the " simple, easily  applied, harmless, and perfectly sure  pre-
 ventive " to " one of the greatest scourges of the human race."
   The present seems  to  be a time,  eminently fit and proper,  for  such
 report as your Excellency has indicated.
   To set forth, in as concise a manner as possible, what means have been
 taken during the last eight  years towards staying the pestilence, which
 has made its appearance annually or oftener in the State, is the first ob-
ject in tile preparation of this report.

          MEANS EMPLOYED TO PREVENT THE SMALL-POX.
   'Immediately on his appointment,  or  re-appointment, the Agent gave
notice by advertisement in two newspapers, printed  in the city of Wheel-
ing, that he was ready to furnish genuine vaccine matter, without charge,
to any person  or persons mentioned in the eleventh  section of the  act
providing for the public health.' 
4
   The specimens of virus distributed were accompanied  with printed
 instructions, as follows:
                            instructions.
   " To renler the law ' Providing for the public health' as efficient as
 possible in extending the protection afforded  by vaccine virus to ' Every
 citizen of this State, and  soldier in the armies of the United States, and
 iu the service  of the State,' the Agent respectfully offers the following
 suggestions to  those who obtain matter from this office:
   " The time when vaccination ought to be attended to is, when the small
 pox is not in your neighborhood.
   "As to the proper age for performing vaccination, if  left to your own
 choice, you might properly select the  fourth month as the most  conven-
 ient, as at this age the arm is plump and the person free from such con-
 tending influences as  teething; but the operation may  be performed at
 any time when an urgent necessity exists.
   " The Agent requests reciprocal  action on the part of those receiving
 matter, and hopes that all recipients of virus will regard  it as a duty they
 owe the State, to collect the scabs resulting from the use of the enclosed virus,
 and send immediately to the Agent, selecting only such as come from the
 arms of healthy persons, and such scabs as have not been interfered with
 in their regular course by accidental violence, or other cause.
   "By the fulfillment of this duty, on the part of the  recipient, many
 difficulties  connected with the satisfactory  administration of the office,
 and many misapprehensions which otherwise  might spring up between
 the Agent and the applicant, will be obviated, and a constant supply of
 genuine, fresh and reliable virus secured.
   " The success of vaccination cannot  be guaranteed ; for vaccine virus,
 under circumstances the  most favorable, is subject to rapid decomposi-
 tion, and during transmission it must be exposed to uncontrollable sources
 of injury.
   " Trial is the only test of worth the Agent can offer you.  When, upon
fair trial, virus proves unsuccessful, the Agent desires  to be notified of
 the fact, when  more will be immediately furnished.
   "How to prepare  the Patient.—With the point of a sewing needle,  or
 lancet, make five or six  parallel scratches at  the point selected for the
 introduction of the matter, cross them  at right angles, with similar incis-
 ions.  The surface should present a slight  blush, with a very few specks
 of blood. Do not apply the matter till the bleeding has  ceased, nor until
 all blood is  carefully wiped from the scarified surface, otherwise the virus
 would be washed away by the blood, rendering the  operation  nugatory.
   "How to prepare the Virus.—On  glass or china, reduce by means of a
 clean blade and pure cool water, a small portion of the scab, into a very
 thin paste.
   "Hoiv to apply the Virus.—Gently stretch the skin, at  the point where
 you have made the parallel scratches, thus opening them.  With  the
 point of a small and thoroughly clean blade, smear and  rub over  the
 scarified surface, with one drop of the virus, prepared as above, and allow
 it to dry, which completes the operation, with every chance of success."

  The following table gives an abstract of the quantity of vaccine matter
distributed in the respective counties of the State during the  last eight
years. 
5
TABLE—Showing where virus has been sent; total number of distributions
         each gear, and the aggregate during the last eight years.
COUXTY.	1803 2 5	1S64	1865	1866	1867	1868	1869	1870	No. of distri-butioos to each county during 8 yrs.
									2 6 1
					1	1			
								1	
	2 4								2 14 1
		9	2				4	2	
Cabell.......................................						1			
								1 1	1 1
Clay...............................................									
	3	3							6
							1	1 2 1 1 1	1
									1
									2
									1
	2 2	i	2 ;......		2		2		15
									2
									1
	22 1 1 4 6	10	2 1	1		6	11		52
									3
									1
		2 7	3	1		1	2 2	2 1 1 1 3 1 1 1	15
									15
									1
							2 1 6 5		3
	17	S	2	3	9 1	1 9 3			29
	15 | 17 1 1 ......i......								57
			1	1					16 1
									1
	13 1 1	4		1			3		21
									2
		a							4
								1	1
		1 25							1
	134 1 1		2 j 5		22	34	25	83	330 1
			2	3					6
								1	1
	21 2	9 1	2	2	2	16 2			52
									5
								1 1 1 1	1
	I 1		1 1						2
									g
									1
	10 1 3 9 1	3	3	2	....	2	2		23
									1
Tvlpr ............		2	1	1				3	8
							1		12
									1
		1 3							1
	10		1 2 1	1 2	1	2 1 4	2 6	1 1 2 1	20
									6
	1	1							16
									1
Hospitals and regiments of soldiers	19 317	29 136							48
			29	23	38	82			
							75	119	819
 
6
  Thus we find exhibited in the foregoing table :
Aggregate No. of distributions in eight years,   ....    819
No. of persons vaccinated by the Agent in eight years,   .    .    1,302
Grand total of vaccinations and distributions of virus in 8 years,    2,121
  The foregoing table gives a faithful exhibit as to the distributions of
matter, but affords an imperfect idea as to the labor actually performed
by the Agent, in the execution of the duties to him, by law, entrusted.
  Orders  calling for enough matter to vaccinate  the  inhabitants of a,
town or neighborhood have  been of frequent occurrence.   But the dis-
tribution of matter is the least laborious and responsible portion of the
Agent's labors.   To have on hand fresh, genuine  and reliable vaccine
matter when, " by mail  or otherwise," urgent calls are  made upon him
for matter, is the great desideratum.
  All demands  for vaccine matter  are  urgent.   Most persons  think
nothing about vaccination until the small-pox  has made its appearance
in their own families or immediate neighborhood.   Then, panic stricken,
they frantically seek for protection.
  Small-pox is liable to be imported into our midst any day, by railroad
or steamboat.  Hence, the  Agent must, at all times and under all  cir-
cumstances, have on hand a supply of " genuine matter."
  No mention will be made to your Excellency of the  many difficulties
and perplexities, necessarily encountered in  keeping on hand a constant
supply of " matter;" but the Agent would here state, that the  thirteen
hundred and two vaccinations (nearly all gratuitously) performed, were
with this intention.
                  PROBABLE NUMBER VACCINATED.
  There is no accurate data from which  an  estimate can be made as to
the number of persons  vaccinated  with  " matter" sent out from  this
office.  Twenty persons vaccinated from each specimen or parcel of mat-
ter sent, would  make over sixteen thousand,  and to this number add the
thirteen hundred and two vaccinated by the agent, would give more than
seventeen thousand persons vaccinated within the State in eight years,
and more than two thousand each year during the same period.

             THE DEMAND FOR " MATTER" PERPETUAL.

  According to the Auditor's report for the year  eighteen hundred and
sixty-nine, about ten thousand children are born in this State every year,
which, in  eight years, would give an increase in our population from this
source alone of eighty thousand persons.
  From eighty thousand, the  number born  during the last eight years,'
subtract say, in round  numbers, seventeen  thousand, the  number  vac-
cinated during  the same period, and this leaves sixty-three thousand of 
7
 the number of persons born during this period who are  unprotected from
 small-pox.
   Thus, it is painfully apparent, that the demand for "  matter" will not
 only  continue but will constantly increase, in any given time, in the pro-
 portion to the number of children born in the State during the same time.
   Great benefits have been secured to the people of every county, from
 the matter already distributed ;  but the State has been badly protected,
 many of the inhabitants never having been vaccinated, there is thus
 always a soil adapted for the growth of small-pox.
   Every child born  in the State, so long as it remains unvaccinated,
 furnishes an additional  subject to be protected  from this loathsome dis-
 ease.  For " susceptibility to variola is a condition common to the whole
 human family."
                    IMPORTANCE OF VACCINATION.
   Suppose the State deprived, for five years, of the  " boon conferred on
 humanity by the immortal  discovery of Jenner," and  that during this
 period the small-pox should be  imported among us—what, then, would
 become of the sixty-three thousand unprotected persons now in  the State
 together with those ten thousand children born every year? Thus, within
 five years, the number of unprotected persons in the  State would become
 one hundred and thirteen thousand ; a number nearly equal to one-fourth
 of the State's present population.  Small-pox spares  neither sex nor age.
   Withhold vaccination and where is the hope of escape, except by flight
 from  the fell destroyer, for these 113,000 unprotected children?
   Sum up " the natural history of small-pox in undisturbed  and in un-
 protected communities,"  and there read their dreadful destiny!
   "Of every one hundred persons attacked thirty-three die" and " among
 those whom it permits to recover," may  be found those disfigured with
 scars,  those with general health profoundly shattered, and last, though
 not least, those partially or totally BLIND and  DEAF.
   Should such a calamity befall  the State, as that of withholding from
 the people, for even a brief period,  " the inestimable advantages of that
 protection from  small-pox which vaccination  affords," then, indeed,
 would the mortality from that disease become  "  Something awful,  some-
 thing almost incredible."
   Our Legislature, awake to the always  impending dangers to the people
 from small-pox, has enacted wise and wholesome laws encouraging  the
 application of the vaccine prophylactic, with the beneficent purpose of
 averting so dire a calamity.   And why should it be otherwise ?  Vacci-
 nation is preventive of small-pox, and in all cases perfectly harmless.
  These  facts, gained  by experience and observation, and overwhelm-
ingly  substantiated by the highest hygienic authorities, have been patent
to the civilized world during nearly three-quarters of a century. 
8
  Where, within the whole range of human experience,  was ever an
epidemic of variola, however severe, that vaccination did not promptly
and effectually arrest, when it was universally and efficiently applied to
the class or community exposed to the contagion ?
  It is  deemed unnecessary to mention examples  confirmatory of the
promptness and efficiency with which vaccination arrests the spread of
small-pox, when the fact is so overwhelmingly substantiated by universal
observation and experience.  Hence, is deduced  undeniably, the conclu-
sion, that " Small-pox only exists among us in consequence of the neg-
lect to apply the preventive."
  Some school boards require " Children to  produce evidence of their
having been successfully vaccinated before they are permitted to attend
the public schools."  Exemption from severe variolous epidemics in the
/Vrnerican and in  all European armies, is the result, directly,  of compul-
sory vaccination.   It is  said that Prussia and Austria  have not been
scourged with an  epidemic of small-pox, of any severity, for the last fifty
years.
  Why ? Because these governments  require the efficient application of
the vaccine prophylactic to every person within their respective terri-
tories.
  West Virginia  can do the same.
  Shall we speak of the cost of such an enterprise when  the  health and
lives of the whole unprotected population in the State, are at hazard ?
  An intelligent  public sentiment in this State, it is believed, approv-
ingly awaits the inauguration of so beneficent a legislative provision.
  If " a numerous population is of the highest importance to the strength
and welfare" of a State, why should her  legislators falter to  enact such
laws as will protect the health and lives of her people ?
  " Legislators enact laws for the protection of sheep, the prevention of
hydrophobia and  cattle disease, for the  impounding of  the poor man's
pig and cow," and why not provide laws  and make liberal provisions for
the execution of those laws, enacted "for the prevention and amelioration
of disease, a preventible disease of human beings," which " kills one in ev-
ery three that it attacks, and blasts the beauty of the rest?"
  Many  remarkable and interesting incidents occurring under the imme-
diate observation  of the Agent might be  given, illustrative of the

                PROTECTIVE POWER OF VACCINATION
  Only two or three instances, however, will  be mentioned, in  which
vaccination, without doubt, was the means'of saving life.
  The  City of Wheeling was scourged with small pox, in the spring of
1864—so much so, that the Board of Health deemed " it eminently fit
and necessary to  order and direct the vaccination of all persons within 
9
 the city, who may not have been vaccinated."  There were several cases
 of variola and varioloid  in the fourth ward.   In executing the order of
 the Board, I found a family in the immediate neighborhood of the infected
 locality, in which were five unprotected persons, one of whom had occa-
 sionally carried articles of diet to the house, in which the sick were con-
 fined, passed them to the attendant  at the  window, and  consequently,
 had been exposed to the variolous contagion.
    The unprotected members of this family, were brought out from under
 the bed and other places of concealment, and three or four insertions of
 vaccine virus were made in an arm of each.
    At the points of insertion of virus in each  of these five children, thus
 vaccinated compulsorily, characteristic vaccine vesicles  arose.  But the
 member of this family that had been exposed to the variolous contagion,
 had a mild, but very distinct eruption of varioloid also, which run its
 course regularly  with the vaccine disease.   I saw this  child  on the
 eighth day after vaccination, with both diseases in full bloom, playing
 about the room with the other four children.   The question arises:  could
 such a happy and satisfactory a state of this child's condition have been
 met with, without vaccination ?   Who can  doubt that this child had
 already contracted small-pox before I inserted the vaccine prophylactic ?
   Hence it is deduced, that even after small-pox had possession (in some
 degree) of this child, vaccination at so late  a period, rendered, in this
 instance, the variola entirely harmless.  And how much more so would
 it have secured complete exemption from even varioloid, if a  timely appli-
 cation of the vaccine prophylactic had been made.
   The impunity with which the other four members of this family played
 in the same  room, and  slept in the same bed with this child, diseased
 with varioloid, (which will communicate variola to  the unprotected, as
 certainly as variola itself will,) is also undoubted evidence, as to the pro-
 tective power of vaccination.
  And further, I have, in repeated instances, seen the mother with her
 face and person thickly dotted with incipient confluent small-pox, and her
 unprotected child closely nestled by her side.  In every such instance, I
 promptly vaccinated the child, and  always had the pleasure of witness-
 ing the regular development of the true Jennerian vaccine vesicle—the
 undoubted proof of the child's protection and safety !  And subsequent
 to vaccination in those instances, each child continued for weeks, in the
 midst of the most virulent variolous contagion with absolute impunity!
  Such are some of the triumphs over variola, achieved by  vaccination.
 Can there be any better protoelfon against small-pox than this ?
  We deem it unnecessary to  multiply instances, illustrative of the effi-
cacy of vaccination, as a preventive of variola.
  We have somewhat to say of
      2—Vaccine Agent's Rep. 
10
                           vaccine virus,
 the instrument we have  employed in the accomplishment of results  so
 uniformly satisfactory.
   An experience of twenty-two years in  applying the vaccine prophy-
 lactic, has brought no facts to my notice that would lead me to conclude
 that " vaccine virus  loses its protective  power in passing through the
 human race."
   The vaccine virus distributed from this office to all the physicians  in
 Wheeling, and to every county in the State, has been the matured crust
 removed from the arm, about the fourteenth day after vaccination.
   For distribution and for constant use in vaccinating, I prefer vaccine
 virus in this form :
   1st. Because of its greater convenience, and
   2d.  On account of its certain and  effectual, in my experience, prophy-
 lactic  powers.
   The matured scab  or  crust, is generally preferred and used by the
 most experienced vaccinators in our country, who may be regarded as of
 standard authority.
   Edwin M. Snow, M. D., Superintendent of Health in  the City of Pro-
 vidence, in  his published Report on  small-pox in that  city, 1859, says:
 "The  vaccine virus used  in this city during the past  winter, has been
 almost invariably, a solution in water, of the dried scab, taken from the
 arm, from the fourteenth to the twentieth  day after vaccination."
   As to its protective power, Dr. Snow adds :   " It has  given during the
 present season, absolute,  unqualified protection  against repeated and
 continued exposure for weeks, to severe cases of small-pox, and it has done
 this in scores of cases, and without a single failure."
   Drs. J. F.  Meigs and William Pepper, of Philadelphia, in their Prac-
 tical Treatise on Diseases of children, 1870, say :  " In  this city, however,
 the  crust is usually employed, and  has been found entirely  efficacious
 and satisfactory."
   Prof. George B. Wood,  of same city, in  his Treatise on the Practice of
 Medicine, states that " The scab is certainly efficacious, and in this country
 is almost exclusively used." * * * " I have used it from the commence-
 ment of my practice, and I remember only two instances in unprotected
 persons, in which I did not sooner or later succeed  with  it."
   Prof. Austin Flint, of Bellevue Hospital Medical College, in his Treatise
 on Practice of Medicine, says:  " The vaccine crust has the advantage of
 being more easily preserved, and of retaining the virus for a longer time
 than the lymph."
  Prof. J. Lewis Smith, of Children's Hospital, New York, says:   " The
 scab is more easily preserved than the lymph, and, therefore, if the scab
and lymph  are old, the scab is to be preferred." 
11
   In Dr. D. Francis Condie's  Practical Treatise on the Diseases of Chil-
 dren, we read as follows :   " The experience, however, of the great body
 of American practitioners, has  confirmed them  in giving to the dry crust
 or scab, the preference over the recent lymph, as a means of propagating
 the vaccine disease.  While equally efficacious with the latter, the scab is
 much more manageable, and more readily preserved."  * * *
   Such is the evidence of men  who have obtained eminence in their pro-
 fession, are skilled in sanitary science, and are, on this subject, regarded
 as of standard authority.
   As to the                                         v
                     QUALITY OF VACCINE VIRUS
 distributed from  the office, the  following letter may furnish sufficient
 evidence.
                            "  Surgeon General's Office,
                                     Washington City, D. C,
                                               February 11, 1864."
   " Sir :—I am instructed by the Acting Surgeon General, to inform you
 that the Vaccine Virus lately forwarded by you to this office, has proved
 so much better than that usually received, that he will be glad to take as
 much as you can spare of a similar quality.
                   I am sir, very Respectfully,
                                 Your Ob't Servant,
                            By  order of the Acting Surgeon General,
                                           Chas. C  Lee,
                                              Asst. Surg. U. S. A."
 " John C  Hupp, Esq.,
            Vaccine Agent's Office,
                   Wheeling, West Virginia."
   To any person about to be exposed to the contagion of small-pox, we
 would recommend and urge the propriety and necessity of
                           re-vaccination.
   For this is " the only reliable evidence we can have, that complete vac-
 cine protection has been obtained."
   To obtain this evidence, re-vaccination is necessary.  Re-vaccination
 solves the query—removes the doubts in any given case, and decides the
 question, whether the vaccination is complete, incomplete or there is non-
 protection.
   No person doubts the existence of varioloid.   The fact that varioloid
 does exist, is positive proof of the protective power of vaccination.   Par-
 tial protection yields varioloid, total unprotection yields variola in per-
 sons exposed to the variolous contagion.
  If we possessed no means of protection, varioloid could not exist; but
variola would exist with undisturbed dominion  over the health and lives 
12
of the people, and would constantly multiply.  As it would increase, our
population would decrease.
  The fact that vaccination, may, in certain instances, protect only par-
tially, or for a limited time, or forsooth, may " wear out," is no evidence
against  its  protective power.   As clothing covers nakedness, and more
clothing compensates for insufficient covering of the body, so is the pro-
tective power of vaccination  and re-vaccination to the  unprotected and
partially protected from small-pox.
  All things of the  earth  are  perishable.  Some things, from the wear
and  tear of time,  require  repair or renewal sooner than others.  But
because all  earthly entities do wear out, we cannot, from this, conclude
that they did not previously  exist, nor that they should not be repaired
nor renewed.
  Likewise, if vaccination is suspected to be incomplete  or worn out, the
remedy  is re-vaccination.
  Therefore, when a vaccinator is called upon to decide whether a family
is, or is  not protected, instead of  trusting  in abstruse theories, or specu-
lative conjectures, let him rather be  practical  and re-vaccinate; and then
he can feel " as confident of their safety from an attack  of variola, as he
can of anything in the future."
  We might quote  statistics, showing the great good  vaccination has
secured  to  the human race,  and lay before  your Excellency the con-
clusions elucidated from such data;  but this  report is already more ex-
tended than was originally designed, and is herewith,
                        Respectfully Submitted,
                                   John C. Hupp, M. D.,
                                              State Vaccine Agent.
  Wheeling, November 8,1870, 
VACCINATION
AND ITS
PROTECTIVE POWER,
in the
  STATE OF WEST VIRGINIA:




A REPORT TO THE GOVERNOR, NOVEMBER 8,1870,


              /
    By JOHN C. HUPP, M.D.,


       State Vaccine Agent.
•J 2.
  WHEELING:

JOHN FREW, PUBLIC PRINTER.


     1871.
 
 
 
 
 
 
 
 
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