This is compulsory by law in Great Britain within the first six mouths of infant life. The purpose and value of vaccination have been fully discussed on pp. 526-530. It may be advisable to re-state here that a child should be vaccinated between the second and fourth month after birth, before teething begins, but that if small-pox be prevalent at the time, and if there be any danger of infection, it cannot be vaccinated too soon. There is no risk at all to be compared to that of catching small-pox, in vac cinating even the day after birth. If the vaccine matter is taken from a healthy child on the eighth day after its inoculation, and if only lymph and no blood be taken, there can be no risks whatever of transferring any disease. All risk is got rid of by the use of calf lymph, now easily obtained everywhere. Fur ther, the extremely painful, red, and swollen arms that one occasionally sees are in most cases due to the carelessness of the mother or nurse in not properly guarding the arms from injury by rubbing or in other ways, and specially to badly-adapted clothes which compress the parts at the arm-pit and lead to inflammatory swell ing of the whole arm. The full measure of safety is secured when four good vaccination marks are produced. The mother, therefore, should allow the child to be vaccinated on four "places" if she wishes the utmost benefit of the operation. Many doctors vaccinate only on two "places", and if the district where the children live and are likely to remain is commonly free from the disease, so that the risk of infection is slight, two marks may be satisfactory enough. Vac cination on only one place, however, is too little to be satisfied with. If, however, there is any risk of infection in the neighbourhood where the child lives, or if there is any likelihood of the persons removing to any district where there is risk, vaccination should be performed on four "places" to secure the greatest amount of protection. If children are well managed
they should give comparatively little trouble during the period when the vaccine is operat ing on the body. Careful dieting, the usual attention to bathing and cleanliness, attention to the bowels, and care to prevent injury and irritation to the arm ought to ensure little disturbance. If the child suffers at all it will be between the seventh and tenth days, when it may be hot and restless, and the bowels slightly disordered. A tea-spoonful of castor oil, or three or four tea-spoonfuls of fluid mag nesia is all the necessary treatment. The heat of the vaccinated part may be soothed by plac ing lightly over it, if it seems needed, a piece of lint soaked in cold water, and keeping it soaked. If the lint is allowed to dry, it will adhere to the part, and attempts to detach it will cause still more pain than before.
Sonic children, comparatively few, however, fail to take the vaccination. By the Vaccina tion Acts the operation must have been per formed three times and failed each time, before the child is declared insusceptible. If this has been done, the doctor will give a certificate to that effect. But it would be well, if the opera tion had failed twice with lymph obtained in the ordinary way, that it should be tried the third time with calf lymph.' Should a child not be in good health, a medi cal man may, if he deems it advisable, postpone the operation to a period beyond the legal six months by signing a certificate to that effect.
Revaccination is considered on p. 530.