Bakewell. — On Vaccination. 637 



large destruction of the red corpuscles during the febrile stage 

 of va^ccinia, followed by an anaemic condition. How long this 

 anaemic condition lasts we have no trustworthy observations 

 to tell us ; and how far it extends — that is, what is the actual 

 loss of red corpuscles — is, as far as I know, in the same state of 

 uncertainty. Of course, we often find parents complaining 

 that children who were perfectly healthy before vaccination 

 have lost colour, strength, and flesli after it, and have never 

 recovered their previous good health. But these complaints, 

 tinctured as they evidently are by a strong prejudice against 

 compulsory vaccination, must be received with caution. Still, 

 there is such a mass of evidence of this kind that it ought to 

 be allowed some weight. 



So much for the inevitable results of vaccination. The 

 accidents of vaccination may be roughly classified under the 

 following heads : — 



1. Inflammatory: including erysipelas and other septicae- 

 mic diseases ; glandular swellings ; phagedaena, sloughing, or 

 mortification at the points vaccinated. 



2. Eruptive diseases, mostly of a pustular charactei', occur- 

 ring with or immediately after the vaccine eruption ; eczema, 

 herpetic eruptions, ecthyma, and impetigo. 



3. The inoculation of constitutional diseases — syphilis, 

 leprosy, tubercle. 



Now, as regards the inflammatory diseases, there are some 

 vaccinators of large experience who assert that they have 

 never seen any ill-results of this kind arising from vaccination. 

 Well, some people are very lucky, but they have no right 

 to argue from their limited experience that such accidents 

 never occur. I have been very fortunate in my midwifery 

 cases ; I have never lost a case in my own practice for 

 thirty-five years ; but for all that I do not deny that women 

 die in childbirth. I have seen erysipelas more than once or 

 twice, or a dozen times. In the West Indies it used to be 

 common. The inflammation that followed the vaccination of 

 coloured children was very intense, and the number of insects 

 attacking the unfortunate children no doubt contributed to 

 carry the germs of erysipelas to them. Glandular swelhngs, 

 particularly in scrofulous children, are not rare. I had my- 

 self a case in which each vaccine vesicle was followed by 

 mortification of the skin beneath it, and a j)hagedsenic 

 ulceration which required very vigorous measures to stop it. 

 This was in a young woman during the epidemic period in 

 Trinidad. I am not sure whether it was a primary vaccina- 

 tion or a revaccination. The latter, as is well known, causes 

 very severe inflammation, pain, glandular irritation, and 

 erysij)elas in the majority of adults, besides severe and uiost 



