Occasional Sequelce of erysipelas has been set up by vaccination, and even pymmia has been known to follow, and cause the death of the child. These unfortunate consequences are not to be attributed necessarily to any carelessness or awkwardness on the part of the operator, nor to any impurity in the lymph employed. They are due to the constitutional state of the child at the time of the operation—a state in which the puncture of the lancet is followed by these untoward accidents just as any other trifling operation might be followed by them. A roseolous and papular rash has been already referred to as sometimes following the maturation of the pustule ; but other rashes, such as eczema and the various skin eruptions to which children are liable, may be seen after vaccination. These rashes are always attributed by parents to the insertion of the vaccine lymph. In some cases vaccination may have been indirectly a cause of the skin affection by lowering the child's general health—a result which in childhood is apt to follow any feverish attack ; but often the occurrence of the eruption at a short interval after the vaccination is a mere coincidence, and is owing to an entirely different cause. In out patients' rooms of hospitals it is not uncommon to find even scabies attrib uted to a recent vaccination.
Syphilis and scrofula are said to have been conveyed from child to child by the vaccine lymph. With regard to the first of these diseases, it was long denied that such transmission was possible. Experiments were made,
and in France children were deliberately vaccinated with lymph taken from other children suffering from inherited syphilis ; but in no case was syphilis found to be communicated by the operation. Many cases, how ever, have been since published which leave no doubt that communication of the syphilitic virus may take place by this means. The old notion that the fact of a vaccine vesicle undergoing its normal development and pre senting its normal appearance is distinct proof that the lymph within it is uncontaminated by foreign virus, appears to be a correct one. In syphilitic children vesicles may assume this appearance, and are then incapable of transmitting any disease other than the cow-pox. If, however, in taking lymph from these vesicles, the puncture be made carelessly, and, with the lymph, some of the blood be taken up by the point of the lancet and inocu lated into a healthy child, syphilis may follow. No doubt many of the cases in which a syphilitic rash has followed vaccination have occurred in children the subjects of inherited syphilis, in whom the febrile movement induced by the process of vaccination has determined the outbreak of an already existing disorder. So also in scrofulous children, a little derange ment of the health will often rouse up the latent cachexia, which but for this might have remained dormant a little longer.