ARTICLE VII. VACCINATION: ACCIDENTS AND BY JOHN H. McCOLLOM, M.D. OF BOSTON. In this paper no attempt will be made to prove the protective power of vaccination, a self-evident proposition, neither will anything be said regarding the technique of vaccination; these subjects having been ably treated in other papers presented to the Society to-day. It must be taken for granted that vaccination is an operation and that any operation no matter how slight may be followed by injurious effects, if there is carelessness in its performance or in the subsequent care of the wound. When we take into account the immense number of individuals vaccinated each year and the remarkable rarity of any serious results, the wonder is, if vaccination is such an injurious procedure as is claimed by its opponents, that there are not more disastrous effects. Many of the alleged injurious effects after careful investigation have been proved to have no connection with vaccination either directly or indirectly, but have been shown to be due to carelessness on the part of the individual. It has been alleged that syphilis is frequently caused by vaccination. While this may have been possible in certain rare instances when humanized lymph was used, it is impossible when bovine lymph is employed. It has happened to the writer in several instances to investigate alleged occurrences of communication of syphilis, but in each case careful investigation revealed the fact that the individuals were suffering from the primary lesion of syphilis at the time they were vaccinated and that vaccination was used as a cloak to cover this condition. As an illustration of the manner in which vaccination is unjustly accused of conveying syphilis Dr. Cory, in his Theory and Practice of Vaccination describes very aptly the following case of a child whose father contracted syphilis shortly after his marriage. Dr. Cory says: "It was the second child of the marriage; the first died within a very short period of birth. This child, being apparently healthy, was vaccinated at St. Thomas's Hospital in 1878. It was duly inspected, and was brought again with the eruption, which first appeared on the tenth day after vaccination. This is a very good example of the cases of alleged syphilis after vaccination. It is so tempting for parents to lay the results of their own iniquities upon vaccination, especially when they are encouraged so to do by shameless agitators. To enable us to view the truth of these allegations against vaccination, we will suppose a man to have had syphilis and to play a game of football; he receives a kick on the shin, and in due course a syphilitic node may develop from the bruise. The man would be as entitled to say he acquired his syphilis from playing football as a parent of a child who has had syphilis would be to say that the child acquired its syphilis from vaccination." Erysipelas may follow vaccination but there is no proof that the specific organism of this disease is in the vaccine lymph. Erysipelas also frequently follows the scratch of a pin or any slight abrasion, but this is no argument against vaccination but it is an argument for the careful protection of the vaccine vesicle. Urticaria may follow vaccination * Lectures on the Theory and Practice of Vaccination. By Robert Cory, M.A., M.D. Cantab., F. R. C. P. London. Page 65. just the same as that the ingestion of fish and other food may also cause this troublesome eruption. Impetigo contagiosa sometimes appears after vaccination, but as impetigo is an extremely common disease there is no proof that 'the vaccination is the cause of this manifestation, as the disease is fully as frequent among children who have not been recently vaccinated as among those who have been recently vaccinated. Abscesses in the axilla may follow a vaccination but this condition is extremely rare and in my experience it has always been due to some carelessness on the part of the individual. The site of the vaccination may slough, but I have never seen any serious result other than a somewhat tedious healing follow this condition. When this sloughing takes place it is always due either to a diminished vitality of the individual or carelessness in using the arm. It is doubtful if cutaneous tuberculosis is ever communicable by vaccination, but the abraded surface if brought in contact with the sputum of a tuberculous patient may be infected. This is only another argument in favor of carefully protecting the site of the vaccination. As illustrating how the abraded surface may become infected with micro-organisms the history of the following case is of interest. A child four years old was vaccinated with bovine lymph in the usual way. The vaccine vesicle passed through its regular stages and in due process of time the crust separated leaving a slightly abraded surface. Shortly after this a small patch of a membrane having the clinical appearance of a diphtheric membrane appeared on the abraded surface. Cultures taken from this membrane revealed the presence of the bacilli of diphtheria. The child was not seriously ill and after a short time the membrane disappeared. Investigation proved that a sister of this child was suffering from a mild attack of nasal diphtheria, as proved by a bacteriological examination, and no doubt infected the vaccinated patient with the micro-organism of diphtheria. Certainly vaccination of itself could not have caused diphtheria. If diphtheria can be communicated in this way certainly tuberculosis may be. Within the past year there have been several instances in the country of tetanus alleged to have been communicated by vaccination. It is a matter of very great doubt if the vaccine lymph, unless prepared with a total lack of care such as is incomprehensible, ever contains the bacillus of tetanus. Dr. Joseph McFarland has investigated this subject very carefully and throughout the whole extent of the country he was unable to collect more than 95 cases. Considering the immense number of people vaccinated during the past year, if the lymph was at fault, it is hard to understand why there were not more cases of tetanus. An equal number of injuries with a toy pistol or a rusty nail would be followed by a vastly greater number of cases of tetanus. The conclusion which Dr. McFarland reached in his exhaustive paper are as follows:* "1. Tetanus is not a frequent complication of vaccination, a total of ninety-five cases having been collected. 2. The number of cases recently observed is out of all proportion to what has been observed heretofore. 3. The cases are chiefly American and occur scattered throughout the eastern United States and Canada. 4. They have nothing to do with atmospheric, telluric, or seasonal conditions. 5. They occur in small numbers after the use of various viruses. 6. An overwhelming proportion has occurred after the use of a particular virus. 7. The tetanus organism may be present in the virus in small numbers, being derived from the manure and hay. 492. The Journal of Medical Research. Vol. VII., No. 4. May, 1902. Page |