REPORT OF THE ROYAL VACCINATION COMMISSION. 685 



seen, has been proved to be a very slight one), but it is possible it would 

 not wholly remove it. 



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. 

 On these points we shall have some remarks and recommendations to 

 make at a later stage of our report. 



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 anv other cause, so long as it exists, a source of 

 some risk. 



The use of calf-lymph, though it may be supposed to be more free 

 from the risk of conveying erysipelas, does not appear to prevent inflamed 

 arms. Some witnesses have indeed supposed that it is attended with 

 more risk of inflammation than the employment of that taken from the 

 human subject. This opinion has not, however, been corroborated by 

 some of those of widest experience. 



Nothing has produced so deep an impression hostile to vaccination as 

 the apprehension that syphilis may be communicated by it. It was at 

 one time doubted whether syphilis could result, and it was even confi- 

 dently asserted that it could not. The fact that this was possible had 

 been fully established, and was generally acknowledged by the medical 

 profession, before we commenced our inquiries. 



The very close resemblance in certain very rare cases of the results 

 of vaccination, whether with calf-lymph or humanised lymph, to those 

 attributed to syphilis (a resemblance so close that it has caused in a few 

 cases a difference of opinion whether the disease was syphilis or vaccinia) 

 has led to the expression by Dr. Creighton of the opinion that there is 

 some essential relationship between the two diseases. This, however, 

 is a point of speculative, almost it might be said of transcendental 

 pathology, upon which for practical purposes it is useless to enter. It 

 must be sufficient to remark that, whatever may be the relationship 

 alluded to, it exists, if it exists at all, equally between small-pox and 

 syphilis as between vaccination and syphilis. For all practical purposes 

 variola and vaccinia are both wholly distinct from syphilis, and their 

 differences are, with the rarest exceptions, easily recognised. They are 

 alike in being attended by affections of the skin and mucous membranes, 

 and exceptionally by disease of the bones, eyes, and other parts ; but in all 



