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38
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
that the taking away of lymph on the eighth day of itself causes
some risk of inflammation of the arm. This, however, has not
been confirmed by any evidence before us, and it is probable that
it is almost wholly an imaginary danger.
We have dwelt upon features presented by the cases of erysipelas
and various forms of septic disease which have followed
vaccination, because they suggest precautions which may be
adopted to lessen, if not to prevent, such evils in the future. If,
for example, vaccination were performed at the patient's home
instead of at a public vaccination place the chance of disease
being contracted at the time of vaccination would be to some
extent diminished, and the same may be said of the inspection of
the vaccinated person which takes place eight days after the
operation.
A study of the cases which have been made the subject of
careful examination and report points to the conclusion that an
exercise of greater care would largely diminish the risk, already
small, of erysipelas-contagion and blood-poisoning.
Although it may be confidently hoped that by additional care
on the part both of vaccinators and parents, the number of
inflamed arms and of cases of erysipelas may be reduced to very
few, yet it is not to be expected that such occurrences will be
wholly prevented. A vaccination wound is like one from any
other cause, so long as it exists, a source of some risk.