Armstrong – Table of Contents

requirements and was recommended. Dressings fixed to the vaccination site were to be
avoided. Armstrong indicated that should a dressing be deemed necessary for any reason,
a large square of gauze pinned to the inside of a loose-fitting sleeve might be employed.
In this 1929 study Armstrong concluded formally as follows: 1) tetanus as a
complication of smallpox vaccination was confined, as far as he was aware, to primary
“takes” in which some type of dressing was strapped to the vaccination site. 2) He
produced evidence which indicated that in post-vaccinal tetanus the specific organism
gained entrance to the vaccination through an accidental infection from extraneous
sources. 3) Laboratory evidence showed that a deep implantation of C. tetani in the
devitalized components of a “take” is necessary before post-vaccinal tetanus will
develop. 4) A dressing strapped to a cutaneous (skin) vaccination permitted this deep
implantation of organisms by producing severe “takes” and by retaining exudate there
from at the vaccination site. 5) Injection methods of vaccination such as the intra- or
subcutaneous techniques were suitable methods for the experimental production of post-
vaccinal tetanus and would seem to be, from the standpoint of this complication,
potentially dangerous methods for human use. 6) He explained the freedom of openly
treated cutaneous vaccination from the complication by the continual wiping and
ventilating action occasioned when the arm was moved within the sleeve or under the
bedclothes. The light friction kept the vaccine vesicle dry and firm, and, thus, either
prevented or promptly wiped away any exudate that might appear. 7) A small, superficial
implantation of the virus, as recommended in the multiple pressure technique advocated
by Dr. James P. Leake, and the abandonment of dressings fixed to the vaccination site
would eliminate tetanus as a complication of vaccination. If a dressing was deemed