Armstrong – Table of Contents

considered entirely fortuitous given the widespread distribution of the organism in nature.
In view of this, the investigators at the Hygienic Laboratory, including Armstrong (2, 6),
sought to examine the role of the vaccination dressing in promoting conditions at the
vaccination site conducive to the development of tetanus. They determined that fastening
the dressing firmly to the vaccination by means of straps or tapes prevented the drainage
of lymph and capillary blood when the area swelled from the primary take. The
accumulated fluid softened the vaccinal vesicle producing an exudation of serum and pus.
The resulting tissue damage promoted the development of putrid, anaerobic conditions
suitable for the germination of ingested tetanus spores to the toxin-producing vegetative
bacillary forms. Armstrong also demonstrated that a mixture of intentionally tetanus-
contaminated vaccine virus rubbed vigorously on the abraded skin of rabbits and
monkeys did not result in tetanus unless the lesions were covered subsequently.
Additional experiments involving deep subcutaneous injection of vaccine virus followed
by intravenous injection of tetanus spores also resulted in tetanus among the laboratory
animals.
As a preliminary conclusion Armstrong stated (6) that while physicians might be
unable to prevent such accidental contamination, he felt that the evidence was practically
complete that, by observing a proper vaccination technique, the development of tetanus
as a vaccination complication could be eliminated. Furthermore, he defined a proper
vaccination as one in which the insertion area was not over one-eighth inch in its greatest
diameter, made by some method that did not remove or destroy the epidermis (top layer
of the skin) and which gave a superficial implantation of the virus. The multiple pressure
method as advocated by Dr. James P. Leake, (Surgeon, USPHS), admirably met these