Armstrong – Table of Contents

advisable for any reason, the objectionable feature of the fixed covering could be avoided
by pinning a few layers of gauze to the inside of a loose fitting sleeve.
During the period of this report (6) Armstrong presented these views vigorously
to a wide medical audience (3, 4, 5). Armstrong (4) addressed a strongly worded critique
rebutting several investigators who, in a totally uncontrolled study, advocated
“intradermal vaccination” as the sole method of vaccine administration to the exclusion
of all other well-established safe methods of vaccination. The gentle, multiple pressure
method advocated by Armstrong and Leake gained wide acceptance; the only
modification was the later introduction of the bifurcated (two-pronged) needle that
continued in use until the United States discontinued routine vaccination in 1972.
Armstrong’s investigations and recommendations helped remove one of the
possible hazards associated with smallpox vaccination. The incidence of post-vaccinal
tetanus gradually diminished and disappeared. The widespread practice of vaccination
resulted in the elimination of smallpox from the United States and from those countries
where standard medical practice included vaccination. The last case of smallpox in the
United States occurred by importation into New York City in 1949. Despite the success
of vaccination in eliminating smallpox, there was general recognition, since the time of
its original use, that a variable number of mild and life-threatening reactions
accompanied vaccinations. Most people experienced minor reactions including sore arm,
fever and body aches representing an actual attack of cowpox. In the past about one out
of every thousand persons vaccinated for the first time experienced serious but not life-
threatening illnesses. These included toxic or allergic reactions at the vaccination site
(erythema multiforme), spread in persons with atopic (allergic) dermatitis (eczema