&E N R Y A U S T I N M A R T I N ,

V A C C I N E L I BR A R Y .

DISASTERS

FR O M

VA C C I N A T I O N
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I
R E PR N T ED ,
FR O M A P R I ZE . E SSAY ON V A C C IN A T I O N

BY E D WA R D BA L L A R D ,
NL D .
 D I SA ST E R S

V A C C I N A T I O N .

The i ns t ance s O f reputed vaccino syphiliti c inoculation

which have produced the greatest impression upon the public
m ind are those in which vaccination has been followed by
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syphilis in a number o f children vac cinated from the same

sour c e and where the disease has spread to m o th er s nur s es
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brothers sisters & c in the locality after the manner o f an

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epidemic disease S uch instan c es hav e been truly termed

&

di s a s ter s Four s uch di s a s ter s have b een more o r less

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carefully recorded and I propose now to consider them and

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t o enquire how far they afford evidence of the fact o f vaccino

syphilitic ino culation or whether t he occurenc e s are capabl e ,

o f any more probable explanation .

G E N E A L O GI O A L S C & E ME S O F FO U R S E R I E S OF R EPU T ED
V A C C IN O -
S YP & L T CI I I I N O C UL A T IO N S .

1 R i va lta s er i es .

T ube O f lym ph from A cq ui .

G i ov a nn i C h i a b r er a ,
s yph ili t i c & v a c c i m fer : l m p h bl oody
&
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y .

39 ot h er chi l dr en , Lo ui s a M a nz on e ,
& i s m ot h er infect ed by c ont a gion .

i i
v a cc n a t ed , nf ect e d . infec t ed b y,
v a c c in a t ion .

7 ch il dr en , v a cc n a t e i d . & er n ur s e infect ed
in fect ed . by co nt a gi on .

3 ch ild en byr 1 8 m ot h er s a nd n ur s es .

c on t a gi o n .
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2 . L upa ra s er i es .

T ub e of lymph fr om C a mpob a s s o, blo ody , v acci nifer s yphi liti c

22 oth er ch ildr en .

i
v ac c na t e d , i nfect ed . i
v a cc n a t e d , i n fect ed .

N ur s es a nd m ot h er s infect ed by c ont a gion .

& usb a n ds infect ed by

c ont a gi on .

11 chi ldr en v accina t ed ,

infect ed .

11 n urses i nfect ed by c ont a gion .

S ev er a l b or e ch ildr en N ur s e chi ldr en infect ed .

infect e d w it h by c ont a gion .

s yph ili s .

3 . B erga me s er i es .

Pr es er v e d lymph from pr ev i ous s ea s o n .

P ierr e Fer r a ri &h ea lt h y& .

G ir ola m a C a r enini & d oub t fully s yph ili tic& .

p
&o s e h V a ls ecch i , 4 o t h er ch ildr en , i
v a c c na t e d ,
i
v ac c n a t e , n ect e d i f d .

O th er ch ildr en , m ot h er s a n d n urs es, infect ed

b y c on t a gion .

& usb a nds a n d ch ildr en i nfect ed

by cont a gi on .

C h a r l es P er ruchi ni ,
v a cc ina t ed, a n d r em ai n ed h ea lt h y .

3 o t h er ch ildr en , i
v a cc n a t e d , a nd
r em a i n ed h ea lt h&y .
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4 . A ur a y seri es .

D ry lym ph fr om pr efect ur e a t V a nnes ,

l
&

M ah e ,
i
v a cc n a t e d ,
D e N or o y ,
i
v a cc n at e d ,

infect ed infect ed
Ma r ie F R as n ar o, . r em a i n ed h ea lt hy .

I
B oula i r e, v a cc n a t e i d , 40 o t h er chil dr en , A nn a A n dr a n , v a ccm at ed

i nfect ed . v a cc n a t ei d infect ed
, . infect ed .

17 o t h er childr en a t l ea s t ,

v a c c in a t ed in fect e d ,
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1 . T he R i va lta This series w a s n ot i ndeed t h e

s er i es .
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first l n point o f date but it was the firs t t o attract p ublic ,

a ttention by the magnitude o f t h e disaster The p articulars .

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were first furnished by M C eri s s e whose information has .
,

s ince been supplemented by a comm ission of 1 nqu1 ry

instituted by the G o v er nment I will abridge the account .

as it may be gathe red from the v arious s ources at o ur disposal

a s much as is consistent with perspicuity
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O n May 24th 1 86 1 a child residing with his parents at

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R i v alta n amed G io v anni C hi a b r er a w a s vaccinated by a

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surgeon named C a gi ola with lym ph preserv ed in a tube sent t o

him fr om A cqui He was elev en months o ld His previous his
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tory i s that t w o or three months before his v accination he had

been used to draw t h e breast of a w om a n unquestionably afiect ed
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w ith syphilis His father although said to hav e been the Don
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&uan o f h i s village containing a population o f abo ut 2000 souls

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presented n o trace o f any re c ent or former syphilitic infectio n

In deed according t o the account given s yphilis was a disease
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u nknown up t o this time in the place That the child s mother .

was n o t syphilitic is Sho wn by the fact that at a later period she

Wa s infected from her own o r some other child C h i a b rer a then .
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w a s most probably infected with syphilis to start with The .

U nio n Mé dic a l e ov em ber p 2 59, t o Fe br u a r y 2 1 s t 1 862

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33 L N 1 86 1 , .
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vaccination a s might have been antic i pated in s uch a case

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pursued a regular co ur s e O n t h e tenth day from vaccination

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however he began to suffer from diarrh oea which continuing

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led to a marasmus o f which he died in the following O ctober

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It w a s in this month Of O ctober that the commission made

its inquiry and it was found that the mother o f C hi ab r er a
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had then primary syphilitic ulcerations beneath the nipples .

The child was also found to hav e some erythema about th e

anus which the diarrhoea might account for as well as on
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the prepuce and a little excoriated papule o n the free borde r

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o f the latter & the i nguin al glands were swollen and hard ,

an d he suffered from alopecia It i s remarkable t h at the

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father w a s found at that time not to have been infected If .

we say th at the child imparted the contagion to the mothe r ,

the great difficulty about the case i s that nothing w a s foun d ,

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o n examination o f the child s mouth But still even if S h e

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h a d got syphilis by suckling some other chi ld the freedo m ,

Of C h i ab rer a s mouth would Show that he w a s already

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constitutionally affected Put the case h o w we will we

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c annot escape the inference that C hi a b r er a either by ,

her editary transmission & which is not very lik elyb o r fro m
the woman he sucked & w hich is probable & or in some other ,

way had become cons ti tuti ona lly s yp hi li ti c and wa s s o at

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the time when his vac cination was performed .

. 0 n the t en th da y that is o n the 2n d o f &une forty s i x

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other children were vac cin ated from C hi ab r er a & the fir s t vac
c i n ifer o f the series & O f these thirty nine became affected w i th
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syphilis the seven who escaped being am ong the la s t O f the

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batch v accinated from him A ccording t o Dr De & att the

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syphilitic symptoms showed themsel v es at periods v a r ym g

from ten days t o two months the mean time being twenty ,

days after v accination They consisted first o f all in

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u l c erations a t th e seat o f the v esicles with specifi c glandular

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enlargements and then subseque ntly m ucous tubercle s

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ulcerations o f t h e mouth and throat cutaneous eruptions &c , , .

S ome o f the children died .

Among th e thirty nin e infec te d from C hi ab rera wa s L ouisa

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Man zone & the s econd vaccinifer o f the series & S h e was aged .

s i x mo n ths O n t he tenth da y again she was used for t h e

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vac cinatio n o f sev enteen other children o f whom seven ,

became affe cted with syphilis suffering in the same manner ,

as the thirty nine infected from C hi a b r er a Two months

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afterwards s h e was taken to Acqui a n d seen by Dr S i lv en ti , .

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who recognised upon her a syphili tic eruption with mucous ,

tubercles about the anus and v ul v a mucous patches o n the ,

commissures Of the lips an d indolent glandular enlargem ents

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the primary affection at the seat o f the vesicles not e v en being

healed The child died in S eptember The nurse who
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suckled her g o t ulcers o n the b reast and from the v arious ,

other children who were syphilised the disease spread by con

t a gi o n to eighteen mothers o r nurses and to three other children .

Now how are we to account for all this syphilis was n ot

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prev alent i n the v illage at the time and C hi a b r er a does not ,

appear at the time he w a s vaccinated to hav e been a ctually

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s ufler i n under any o f the constitutional ma nifestatio n s of the

g
infection he had undergone & so that I do not see how the
infection o f the thirty nine ch ildren vaccinated from hi m
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could be attributed to anything but th e introduction with the

vaccine v irus taken fr om his arm o f the syphilitic v irus at
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the same time and that both were taken from the same
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source With regard to the second v accinifer Manzone

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what we hav e specially to remark is that if the sev en children

v accinated fro m her and subsequently suffering from s yphilis
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were also as is m ost probable actually i nfecte d in a similar

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manner t o those infected from C h i ab r er a we must admit and ,

explain as best we may the fact that the lymph taken fro m
M an z o n e s arm communicated syphilis at the time when
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Manzone h erself not hav ing yet undergone the primary

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manifestation c ould not h a v e been cons ti tuti ona lly i nf ected

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This appears t o hav e been o n e of M R i co r d s difficulties in

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r egard to the R iv alta series The explanation which I .

suggest is this that the syphilitic v irus from Manzone which

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operated in the se v en v ac cinated from h er was not a virus ,

manufactured in M an z one s sys te m Clearly it was not ’

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ould n ot be that but f the i denti ca l ci r us

was p or tion
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c , a o

o b ta i ned
f r o m C hi a br er a pla c ed originally i n the punctured

spot and undergoing there those lo cal change s and possibly

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that lo ca l r ep r oduc ti on which would ultim ately result in the

ch an cre wh en the v a c c1 ne disease had come to an end .

P ossibly this explanation if ac cepted m a y ac count further , ,

for the fact that only sev en o ut o f se v enteen v accinated from

her were syphilised & Wherea s thirty nine o ut o f forty six -

v ac ci nated from the constitutionally affected c hild C h i a b r er a

were syphilised There must hav e been some cause for this
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great disproportion & it may lie in the fact &partly &that in

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M a nzone S case the v esi cle was not in all parts equally
im pregnated by t h e v irus It 1 s m be r ec ollected that the .

operation o f the virus is n o t d epen dent upon quan tity but ,

upon quality .

2. T h e L up a r a s er i es — This series o f reputed vaccino

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syphilitic i n oculations o ccur e d in 1 8 5 6 but wa s kept secret until ,

t h e R i v alta ser i es had been m ade publi c a nd the subj ect was ,

un dergoing dis c ussion i n medical circ le s M Marone in . .

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whos e practi c e it o ccur ed and who publish ed his a c co un t o f

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it in 1 862 states that he h a d n o t dared to make it known

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before p a rtly be cau se o f his o w n reputati on and partly

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because he feared that he should 1 nj ur e that O f v accination .

general The publi c ation o f the R iv alta cases showed

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him that he sh ould keep silence no longer The following .

i s the sum m ary furnished by M Depaul 1 A t the close

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o f O ct o b er 1 85 6 M Marone obtained some ly m

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. ph in tube s
fr om Campobasso it was tr ansparent but tinged w ith bloo d .

A large number o f infants were vaccinated and twenty three ,

o f them were infected with syphilis He gi v es the names .

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and the ages whi ch last varied from fiv e t o ten months

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All these children as w ell as their parents were heal thy at

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the t ime of the v ac cination The v ac cinal eruption proceeded .

regularly up to the period o f desi c cat ion but then the dry
cr ust began to soften anew and when it fell O f
f an ulcer with
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if
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l
I m pr a z i a le de F or en c e, N o 5 , 1 8 62
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1 p ili
D e la S y h s V a cc na e , &c
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i l
1 08 . p . .
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indurated b ase w a s fo und t o occupy its seat In other cases .

the dr y crust remained adherent fo r an unusual length o f

time and then fell O ff At the expiration o f a few days the
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cicatrix r e opened and a sore was pro duced having all the
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characters o f an indurated chancre and lasted a month or s i x ,

weeks . In all the subj ects indolent non suppurating ,

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enlarge d glands in the axilla were Observed In all o f them .

also towar d s the middle of &anuary the gener al symptom s

of syphilis appeared—roseola p apules
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pemphigus mucous , , ,

patches o n the lips mouth anus and genitals with inguinal

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and cer v ical glands engorged The nurses were infected in .

their turn with indur ated chancres on the breast & and at ,

a later period that i s afte r fiv e o r eight weeks they had

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also gener al symptoms roseola psoriasis impetigo mucous , , , ,

patches & c In their turn also the mothers imparted the

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disease to the father s M &Marone h a s S ince learned that

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the vaccine s ent from Campobasso had been furnished by a

little girl who died some time after v ac cination from an
eruptiv e affection the character o f which however has n ot
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been thoroughly dete rmined .

Fi lom en a L i tt ort i o n e o f the twenty three infected ser v ed

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for new v ac cinations E le v en infants wer e contaminated .

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First they had the characteristic primary affection and then the ,

consecuti v e phenomena Mothers were again contaminated .

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and they infected othe r s The disease having been at last .

recognised a specific treatment was instituted & but never

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t h eles s se v eral o f the children died

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E leven nurses infected .
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by the v accinated children infected in their turn other , , ,

children w h o were n ot v accinated but w h o had been suckled ,

by them S e v eral o f th e contaminated women t oo havi ng

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fallen pregnant were confined either pre m aturely or at full

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term o f ch lldr en dead or liv ing but i n ever y c a s e bea r i ng

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the m f
a r ks o c on eni t a l s
g yp h ili s .

This again is a series where the probabilities are quite

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against the idea o f accidental o r fortuitous infection syphilis ,

prior to 1 85 6 n o t hav ing been Observed by M Marone .

among the peasant s of L upara It i s p r etty nearly the .

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c ounterpart of the R ivalta series It is defectiv e ho w ever , . ,

in so m e points We learn nothing absol ute about the child

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from whom the lymph was taken & but it is tolerably certain
that t h e lymph itself contained s omehow s yph ili tl c virus & ,
it ,

m ight hav e been a c cidentally & and absolutely certain that ,

first vac c inia and then syphilis resulted from i ts use In .

fav our o f the hypothesis that the chi ld w a s syphilitic th ere is , .

the fact that putting syphilis aside t here are v ery few
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eruptiv e diseases o f infancy & ex c ept the exanthemata &which

are o f a fatal character It is to be r egr ett e d i that the
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proportion o f those v accinated in the first a nd se c ond

generations with the Campobas so lymph who be c ame infe cted
is not stated together with the da y o f eruption o n whi ch
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lymph was taken from L i t t or t i S till we meet here with id .

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s i milar o c curren c e to what we s a w in M a n z o n e s c ase namely ’

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the transmission Of syphilis prior to its c onstit utional

de v elopment and as I belie v e simply m edi a t ely
, .

3 .T h e T or r e de B us i or B erga m e ser i es —This series w as

reported to the C onseil de S an té of B ergame in 1 86 3 by , ,

Dr A delasio and is included m a paper read to the Medical

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Congress o f L yons by M V i enn oi s fi The account is a v ery
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long o n e and I shall therefore content myself with giv ing an

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abstra ct of it .

In the autumn O f 1 86 1 M Q ua r engh i a physi cian at Torr e

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de B usi vac cinated Pierre Ferrar i w ith lymph whi ch had

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been pr es ei v ed from the last season six months pre v iously .

T h e pustules were well de v eloped and presented all their ,

n ormal c hara c ters s o good w ere they that they were sele c ted

for the v accinations of the following s eason In none of the .

subj e cts v ac cinated at this time did the v ac cination produce

any morbid c ompli c ations It is to be Obser v ed that Ferrari
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died a year afterwar ds it is said of se v ere cough &

, toux ferine .

The parents when examined in A pril 1 863 were found

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per fe ctly healthy and they had a repute o f being moral

, .

O n May 8th 1 8 6 2 G irolama C a r en i ni b orn of parents

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as c
D e p ilis V a ccin al e
la S y h ,
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&c .
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p . 3 03 .
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yo ung and in p erfe c t health was v a c cinat ed with the ly mph ,

o f Ferrari preser v ed i n t ub es I t does not appear on the

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statement that other children were v accinated With the sam e

lym ph I t 1 s stated by th e m oth er s of the children who were
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v a ccinated from G irola m a that althoug h S h e was plump and ,

of a good c olour the y noti c ed here and t here upon her an

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erupti on whi ch by the des cr i pt l o n giv e n was some thing

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like c hi cken pox 1 h e p ustules from whi ch the lymph was
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taken were fin e and the Op eration itself was performed w i th

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a n eedle without any blood being drawn

, W hen the child .

w as examined subsequ ently fiv e natural cicatri c es were found , ,

a n d there w a s nothing abnormal upon the body o f the c hild .

The parents were also c arefully examined and no tra c e of any ,

syphi litic a ffe ction was found u pon them A ll that they .

would admit was that the chil d h a d got an eruption from

exposure t o the sun W ell from this child G irolama six.
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other c hildren were v accinated on the 1 5 th May &e i ghth

day & and out O f the S i x five were infe c ted w ith syphilis but
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th e v a ccinator could not re c olle c t whether the on e whi ch

escaped infe ction was v ac c inate d fi r st or last &
In the cas e .

of the fiv e infe cted it is stated that the fal l of the crusts was
delayed and that indurated ul c ers replac ed them whi ch were
, ,

followed by se c ondary symptoms which were in no c ase ,

typical but left c opper coloured stains A bout the same

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time mu c ous p atches appeared and the mothers a n d n ur s es ,

were infe cted and imparted the disease t o their husbands

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The disease spread also by contagio n to b rothers Sisters , ,

aun t s a nd cousins A ltogether there i s a re c ord of twenty

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,

three perso n s whom these children infe cted .

A n d now c omes the r emarkable p ai t of the re c ital & re ad in

the light O f o ther simila1 series & O n e of the infe cted childre n .

&oseph V a ls ec ch i aged fiv e m onths who infe c ted altogether

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fiv e other persons w a s sele c ted o n M a y 2 3r d for supplying

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lymph for the v a ccination of fiv e other children I t took .

u pon all I n four of the fiv e the heali n g of the pustules is

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f
T he ed it o r a dd s a n ot e t o th e ef e ct f
t h a t,
&
if M Qua en ghi
. r c onld no t

r e co ll ect t h is ,
h ow ca m e he to r eco ll ect t h a t n o :
bl o o d w a s d a wn r .
 12

s ai d to have been r ather t ardy and there w a s s ome alterati on ,

i n the form o f the cicatrices and in t w o there had occur r ed a

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cutaneous eruption which go t well Of itself and did not

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affect the general he a lth .

O ne o f these fiv e Charles Perr uch i ni ser v ed for the v a cci

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nation O f three more children who remained perfectly healthy , ,

only on e o f them presenting the cicatrix a little elevated in

the middle .

I cannot r eg ar d t hi s a s a satisfactor y rec ital It bears o n

f
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its face s o much evidence o f after recollection on t he part o f

the v accinator N O doubt that the inv estigations made into the
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health Of the fiv e infected fro m G irolama and their relativ es

is accurate enough I think t here is n o do ubt in the world
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that they had syphilis after v accination with G i r ola m a s ’

l

lymph but I a m not at all sa tisfied about G i r ola m a s syphili s

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N o r am I quite satisfied that the children v accinated o n the

23 r d May were v ac cinated from V a ls ecc hi —a t least I belie v e ,

that a man w h o trusted s o much t o memory w a s very likely

t o be mistaken a s to the c hild he took the lymph from It .

i s much m o re probable that the vaccinator was careles s and

Slo v enly and had infected the first series himself in some way
, .

It is true the repo r t goes that he used not a lancet which , ,

might hav e b e en used pre v iously for some other purpose ,

but a n eedle & still e v en here he might have made an i n

,

correct sta tement i n order t o Shield himself A ll that this .

r ecital in fa c t c a n a b s olut elly tell us is th a t the t w o vir use s

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that o f vacci nia and that o f syphilis may be recei v ed at the ,

sam e Spot and may both o n e after the other be developed

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there Besides we are not told a s in the former series that

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syphilis was unknown in the p lac e pre v iously .

M A delasio records an additional instance o f infecti on

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th at happen ed at A lm é in the same p r o v ince as B ergame

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O n S ept 1 4 1 86 3 in the Commune of L

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th e child
C h arles A rr i g oni serv ed as vac cinifer t o a w hole series o f
ch ildren The v ac cine was regular in its course upon all Of
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them Among these children was the daughter o f Dr X

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a physician Of t he country This child in the pre v ious month.

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of April had been s ent to nurse t o a woman A E

, ap ,

pa r ently in good health but presenting a fissure o n the ,

breast said to hav e been ca used by the biting of the teeth

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Of her firs t child but whi ch had raised some S uspi ci o us in,

the mind of the midwife o f the hospital Three months after .

wards Dr X S child had upon the thighs and groins

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r ounded rose spots some O f them flat and other s ele v ated , , .

O n S ept 21 s t &eighth day & Dr X . vaccinated from ,

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h i s daughter t w o children Cornago and Corelli some days , ,

after which the r ose spots became more pronounced and more
c onfluent and a fissure o f the anus super v ened with eu
, ,

g or g em ent Of the cer vical gland s and he diagnosed syphilis , ,

in which he was confirmed by o n e o f his colleague s The .

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child s nurse also had three ulcers on the ge ni tals and
i ndurations in the groins .

The mothers say that the v accin al pustules o f the doctor s ’

d aughter were fine and that no blood flowed during the ,

vac cination The incubation o f the v ac cine was a little

.

prolonged in the case O f Cornago a n d Corelli The crusts .

fell o n the thirty fift h day and gav e place t o ul c erations -

, .

Towards the middle o f November these two children had

m ucous patches o n the buttock s around the a nus a n d o n the , ,
~

thighs and rhagades

,

This case again is altogether defe ctiv e N O doubt Dr

, ,
. .

X ’
S child was syphilitic but there is nothing to Show ,

that the infection of Cornago and Corelli was not fortuitous :

that they receiv ed the syphilitic v irus from the interior o f .

the vesicle and from no other source ,

.

I cannot take these B ergame cases into account in the

dis c ussion .

4
. T h e A ur y S
a er i es — The acco u nt o f this serie s is gi ven
by M Depaul in his official report to the Minister Of A gri
.
&6

c ulture & c in France A gain I giv e it in abstract leav ing

, . ,

out nothing l n any way I belie v e essenti al to the forming of , ,

a s o und j udgment I may say that the first intimation o f the .

B ullet in de l ’
A ca d é m ie I m p . de
.
Med .
’
t . x xx u, N O . 4, p . 20 1 .
 14

occur r ence was recei v ed by M Depaul from D r s C lo s m a . .

deno and D enis o f A uray wh o accompanied M Depaul in

, , .

his v isit t o the place three months afterwards and that ,

some additional facts were obtained by a member of t h e ,

A c ademy M de & ergaradec

, It appears that a midwife
. .
,

named Madame Fran cois L em o uel an experienced vacci nator , ,

w h o had o n t w o occasions been rewarded for the z eal s h e

displayed w as the vac cinator Of the series S h e receiv ed
, .
,

on May 20th 1 8 6 6 some dry lymph from the pr efecture a t

, ,

V annes with which o n the next day s h e v accinated t w o

, , ,

children in ex c ellent healt

“
named Ma h é and De Nor oy .

M a h é when visited by M Depaul in August w a s aged

,
.
,

fi fteen months and had two o r di na ry c i ca tr i ces o n the right

,

arm and thr e e on the le ft A little indolent axillary adenitis .

‘
existed o n both sides A ccording to the a c count given by .
“

the family he had been v ery ill during the five weeks
,

succeeding the vac cination and the pustules had suppurated ,

during seven weeks At the time Of t he v isit however he .

, ,

was v ery w ell in health although he had not undergone any ,

Specific treatment and h i s mother had not suffered in any way

, .

&ean Marie de N or cy aged ten months had like the , , ,

'

preceding child been suckled b y hi s mothe r He was a

, .

large and fat child and appeared in good he alth He had o n

, .

each arm t wo normal scars only still a little red He also , .

had o n both sides a little indolent axillary adenitis cer v i c al

, , ,

adenitis but n o eruption or other affection of the skin The

.
, .

mother had n ot suffered in health but ac cording t o her and , ,

her husband the child had been very ill for at least five week s
,

after the vac cination the pustules suppuratin g during all that
,
’

time . An eruption whi ch they called measles had,

“
,
&

appeared three weeks after vaccination .

De Nor oy was used as vaccinifer o n the eighth day for the

v a c cination Of Marie Fran coise R o s n a r o S h e presented o n .

August 20 th o n each a r m s i x cicatrices perfe ctly normal

, ,
&

both in size and colour & no trace o f adenitis cervic al or ,

axillary and n o eruption upon the skin In a word thi s .

,

child w a s completely healthy and in excellent general ,

 15

c onditi o n Her mother , a t the time o f the visit was in bed

.
,

wi th rheumatismal pains b ut M Depaul co uld find nothing , .

s uspi c ious ab out her and her nip les were free from disease
“

p , .

The father o f the child also was found free from all syphilitic
infection .

This child R o sn a r o was selected as vaccinife r for the next

batch o f v accinations of which more than eighty were made ,

o n the 3r d 4t h and 5 t h o f & A list Of forty two childre

, une , n &
.
-

w h o suffered from syphilis hav ing been v accinated from , .

R o s nar o is given by M Depaul & they suffered as usual fr o m

, .
, ,

primary ulcers at the seat o f the vesicles followed by various ,

secondary affections Two o f these were used as v a c ci ni fer s

.
,

and their history is as follows z— B oula i r e a girl aged seven ,

teen mont h s when seen in A ugust had fallen a way a great

, ,

deal and had all the aspect O f the syphilitic c achexia There
, .

were two vi olet coloured cicatrices o n the left arm o n e upon ,

a very manifestly indurated base and three similar o n the ,

other arm & indolent axillary adenitis o n both sides a little ,

posterior cervical aden i tis and general r oseola The other , .

,

Anna A ndran aged nineteen months was still suckled by her

, ,

mo ther There were three cicatrices o f a v iolet tint and

.
,

reposing upon a somewhat indurated base on the left a rm and ,

three o n the r ight & axillary indolent adenitis o n both sides ,

considerable o n the right b ut less on the left & post erior ,

c ervi cal adenitis a n d general roseola ,

.

From these children Bo ulai r e and A n dra n , a large number ,

:
‘

o f v accinations were done certainly less howe v er than from , , ,

R o sn aro . M Depaul howe v er only S ucceeded in s eeing and

.
, ,

e xamining seventee n o f them and t hree o f these seem to ,

have had nothing amiss with them after the vaccination but ,

t h e rest exhibit ed phen o mena similar to those Observed in

B o ula i r e and A ndr an .

A gain I must s a y th at here is a series which h a s not recei v ed

,

the amount o f investigation which was required to establish the

o rigin o f t h e is h i li in a v accine v esi c le contaminated from
yp s

the s ubj e c t o n which it existed We start with the dry lymph .

from the prefecture but we a re told nothing about the child

,
 16

from whom i t w a s t aken W a s it i mpossible t o have di s

.

covered thi s Then the tw o children Mah e and De Nor oy

, , ,

hav ing been vaccinated were ill probably they we r e infected

,

with syph ilis but even this is not clear to my mind S till
, .
,

it does not follow th at the lymph from the prefecture was in

fault There was an intermediate agent o f Whom we are
.
,

tol d nothing but that s h e was a zealous vaccinator possibly

s h e w a s too zealous and not sufficiently careful
, And more .
,

over she was a midwife and might ha v e had syphilis herself for
, , ,

anythi ng we are told by M Depaul o r hav e become in .

,

some way contamin ated with the v irus o r have g o t h er ,

clothing contaminated and have wiped her lancet upon it ,

o r in some such way infe cte d the children that s h e vaccinated .

Wh o can tell & S h e is just a s likely t o have been in fault

as the vaccine in a ny part of the series
,
.

And then the Odd thing 1 s that R osn a r o in t h e second ,

generation from the dry lymph did not suffer from syphilis ,

at all and yet if we are to believe M Depaul communicated

, ,
.
,

the disease from her vesicles to forty two other chi ldren -
.

& ow was this & If Mah e and De N or oy receiv ed the s yph i

litic virus at all and if R o s n ar o was t h e li nk between them
,
- '

and the forty t w o o f the third generation R o s n a r o probably

-

also r eceiv ed the virus into her arm and if s o why did S h e ,

not suffer from syphilis & Wa s s h e already congenitally

i nfected o r had s h e already had the disease fortuitously &
,

We are told that s h e and her parents were healthy only her ,

m other kept her bed fo r rheumatis mal pains in which M , .

D epa ul s experience could discover nothing syphilitic S till

’
.
,

M Depaul might hav e been wr o ng and these pains might

.
,

have been syphilitic but we do not know that this is e v en

,

probable Here then is a break whi ch we cannot get over

.
, , .

Mah e and De Nor oy doub tfully infected somehow R o sn a r o .

& second generation &n ot infected & there is no real o c casion

why s h e Shoul d hav e been for vac cinal virus does not al ways
,

giv e syphilis when taken from a syphili tic subj e ct nor yet ,

always when taken from a child into whose arm t h e virus o f

v accinia and syphilis have both been deposited and wh o ,
 17

Sub s equently su from both diseases & A n d then forty

ffers
t w o children infected & third generation & and from t wo Of ,
—
these a number mo r e Fo m y c wn part I must de clin e
r , ,

until Other facts may be forthcoming to accept the inference

& ,

that this i s certainly a true series o f v accino s yphilitic i n o cu -

la ti o n s in the sense in which this term i s used

, N O doubt .

vaccine and syphilitic virus were both deposited in the s ame

puncture at the same time where v er the t w o diseases ap
,

e a r e d but there is much do ubt o n my mind whether both

p ,

came out of the same vesicle .

V A C C I N A L S YP & I L I S .

R ep r i nted f r om the M edi ca l T i mes a nd G a z ette ,

SA TUR D A Y, FE B R U A R Y 1 , 1 8 73 .

The impo r tant subj ect o f vaccinal syphilis came again

before the M edico Chirurgical S ociety o n Tuesday ev ening
-

when a paper was read by Mr Hutchi nson detailing two .

new cases He also dr ew some general deductions from the

.

facts as already ascertained which together with others “

, ,

elicited in the course o f the discussi on that followed consti ,

tute the most important practical suggestions yet m ade with

r egar d to this most unsatisfa c to r y subj ect That syphilis .

c o uld be communi cated b y v a cci n a t i o n was though a d'

m i tt ed abroad long d isputed in this country

,
S ince the .

publication o f Mr Hutchinson s paper and a co mm uni ca

.
’
,

tion by Mr Thomas S mith to the Clinical S ociety where the

.
,

patient was exhibited it can no longe r be s o We hav e n o w

,
.

eme r ged from the regi on o f doubt t o o ne Of belief in the “

 18

possibility of such an un t owar d occ urr ence and in accord , ,

ance with the practical turn which most p r ofe s sional discus
s 1 0 n s sooner o r later take i n thi s country we have p r omptly ,

begun to seek a remedy for the possible evil .

The patients whose cases Me ut ch i n son narrated c ame

to him s eeking relief for other maladies O ne a m a n o f .
,

middle age came for iritis and w a s found to be covered

, ,

w ith a tr ue syphilitic rash and to have Open vac cination ,

wounds which had assumed the chara cters of chancres He .

had been vaccinated from a puny child w hich when seen , ,

by Mr Hutchinson had n o other indication o f syphilis

.
,
,

than a somewhat flattened nose A month after vaccination .

the sores formed o n the arm and in due course the secondary,

rash appeared . None o f the others vaccinated from t h e

same child suffered This man soon g ot well under appr o
.

r i a t e treatment
p .

The sec ond case was that of a lady Over 4 0 who cons ulted ,

Mr Hutchinson for a urethral growth It was Seen that sh e

. .

w as covered with the stains Of a syphilitic eruption and o n ,

inquiry i t was found that this had followed o n vaccination , ,

that s h e had suffered from iritis and had gradually recov ered ,

under the use of anti syphilitic remedies The child from

-
.

which sh e w a s vaccinated had condylomata r ound the anu s

when teething a s had a child born O f the same parent s
,

pre v iously though their firs t born was healthy

,
-
.

In such a sketch as this it would be impossible t o go into

the minute details necessary t o brin g o ut clearly the facts
w hich established these cases as instances of vaccinal syp hilis
w e must refer o ur readers to the original paper published ,

elsewhere in o ur columns S uffice it to s ay that Mr Hutch

. .

inson was able s o far as we could understand to bring t h e

, ,

truth Of his facts a s well as o f hi s theorie s home to the minds

.

o f th ose present Difficulties were raised but upon the

. ,

whole fairly answered Thus the question of immunity a s

.
, ,

experienced by some seemed not easy t o get over but it was

,

elicited that where sev eral indiv idual s were vac cinated from
the s ame child those wh o s uffered we re t h e last o r ne arly SO
, , ,
 19

wh o recei v ed lymph from the arm of th e infected child .

Heretofore as we hav e said it h as not be en a dmitted that

, , ,

i f due care be taken s yph ili ti c i nfect i on by vaccina tion I S

‘

p ossible E spe
. c ially has this been urged by the Crown
Officers when asked t o encourage heifer vaccination The .

facts n o w before the public will tend t o rouse them if they ,

hav e not been roused already from the fal s e security into
,

which they hav e been lulled And as was stated at the

.
,

m eeting it i s plain that o ur compulsor y v accination laws

,

c annot be maintained unmodified It is true that the num

.

ber o f instanc es yet before us is small but we also well know ,

t h e manifold inducements t o keep these secret In point O f .

fact nearly all the cases reported hav e crept o ut accidentally

,

and if a full and searching investigation were made— could

we fo r the time being create a medical Palace o f Truth ,
&

we doub t n ot b ut that many mo r e facts might be acquired .

Never theless what we do know suffices to warn us Of the

,

possibility Of the dreadful contamination and warns us t o ,

provide acco r dingly .

In the meantime it is generally agreed that the v accine

lymph e v en Of a syphilitic child if perfectly pure cannot , ,

communicate syphilis fro m on e indiv idual to another Thi s .

may be true o r it may not & a t all e v ents it is the current

g ,
-

,
‘

belief and facts seem to uphold it O n the other hand the

,
.
,

impression is that if bl ood corp uscles red or white or other , ,

formed material enter into the fluid used for v ac cination

, ,

there is a risk of syphilitic contagion It has been said that .

the infected indiv iduals hav e been the last to be vaccinated

from the diseased child & and as it is th e custom with some
either t o scrape or squee z e the vaccine v esicle with the lanc e t ,

s o as t o procure the greatest possible qu antity o f v accinating

fluid it wo ul d seem as if the corpuscles procurable from the

,

walls o f the v esicles were a possible mean s o f contamination .

Whether this be S O or not it is plain that ev ery possible

,

means must be adopted for pre v enting the contamination of

the v ac cine liquid with solid parti cles other than those itself
con t ains .
 20

But another very serious question ari ses In t h e instan ce .

o f the lady seen by Mr Hutchinson there w a s a desire to

.
,

Obtain vaccination direct from the h e ifer but n o fluid co ul d ,

be Obtained The child selected w a s in many respec ts th e

.
,

picture of health at the time O f va c cination though s ub Se ,

quently c q n dylo m a t a were developed round its anus As t h e .

law stands infants must be vaccinated before th ey are thre e

,

months Old but apart fro m s nuffles it is quite possible

, ,

there may be no manifestation o f con stitutional syphilis till

they are six o r eight months Old o r even it may be later It , .

is n o t fair to subj ect he althy infants t o the risk o f v ac cination

from others which though healthy at the ti m e m ay s ub s e
, , ,
“

quently Show Signs of inherited taint It is quite plain from .

past experience that heife r vaccination cannot be kept up ,

sav e in times o f public excitement except G o v ernment i nt er ,

é
'

vene & and it is n o t fair to subj ect pe ople s children to risks ’

such as those which vaccination syphilis implies with n o ,

alternativ e save t o go t o p r i so n The risk admitted t h e .

,

Option must follow or the law will fall to the ground More
,
.

o v er the risk admitted mu ch greater care e ven in ordinary

“

cases is nec e ssit ated and the practi c e Of vaccinating m

, ,

, any ‘

children from o ne m us t b e held at all ev ents O pen to suspicion

'

A n d that the risk does exist all we t h i nk m us t now admit '

In this m
, , , .

atter the thanks not only Of the Profession but o f

, ,

the public are due to Mr Hutchinson for the pains he h a s

,
.

taken in the executi on O f his self imposed and ungrateful

“
-

task Had his cases been less convincing had they been
.
,

brought forward in a less perfect manner he would hav e ,

“

failed t o conv i nce us o f the reality of the danger He himself .

would hav e b een looked upon as a r aiser &if false alarms and ,

the public would hav e again been lulled into a dan gerou s
feeling of security Much yet remains to h e done before t h e
'

matter is finally settled and the mode O f possible infection

,

established & but forewarned we are forearmed and recog , ,

n i s i ng the possi bility o f the danger

. we are in a position t o ,

to provide again s t it & nowledge does not bring panic but

.
,
&
confidence .