Printed recto-only, approx. 8.25 x 7 inches. Heavy soil and wear at the folds, with small losses at the edges. Penciling to verso, including clarification of the patient's name, "Lillian Friesel," rather than "Lillie Anfesel."

An uncommon vaccination certificate that used the term "perfect vaccination" to indicate the cowpox vaccination "took" successfully, based on the physiological response of the patient. By 1892, the idea that "perfect vaccination" actually meant lifelong protection was already being challenged, as laid out in Crookshank's 1889 History and Pathology of Vaccination. As cases rose of vaccinated individuals getting smallpox, the term played a role in the debate about the efficacy of vaccines and ultimately needing to distinguish between "perfect" and "successful" vaccination--which might not prevent the disease altogether, but led to less severe presentations when it occurred.