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153
attack, but only to suggest that caution is necessary, and that it
would be an error to refer all cases of Erysipelas, or allied
diseases, occurring after vaccination to that operation as their
cause.
There can be no doubt that even very slight wounds may
lead to Erysipelas. It has been induced by scratches from pins,
abrasions from the dress and other injuries, in themselves most
trivial.
We propose to call attention to some of the features which
have been observed in the cases we have investigated where
Erysipelas has ensued upon, and in all probability been connected
with, the act of vaccination. We have already said that in some
of these cases, erysipelas was prevailing in the neighbourhood,
and sometimes even in the immediate vicinity of the vaccinated
child. In a considerable number it was reported that the condition
of the premises in which the child was living was extremely
insanitary. In some it was manifest that there had been a lack
of care and attention on the part' of the mother or other person in
charge of the child. Not unfrequently the wound was in contact
with and rubbed by articles of dress very likely to cause inflammation,
and cream and other substances were applied to the wounds
under circumstances which made the process a source of danger.
There were instances in which persons in the habit of nursing a
vaccinated child were suffering themselves at the time from
running sores, which were very likely the source of contagion.
In some cases, too, where the vaccinated vesicles had been opened
on the eighth day, Erysipelas manifested itself at a time which
suggested that it had been acquired at a date subsequent to this
opening of the vesicles. A priori, this would appear to be a
source of danger by rendering an attack of erysipelas more
probable if the child came within the reach of contagion. The
evidence, however, is not conclusive that Erysipelas has, owing to
this cause, appeared more often than it would have done if the
vesicles had remained unopened. There is an opinion abroad