Editors: JOHN P. HUBBARD, M.D..
IN HEALTHY individuals, vaccination with BCG produces a local reaction at the site of inoculation which appears after a period of three to four weeks, or longer, i.e., at about the same time as the first signs of allergy can be detected. Enlarged glands in the corresponding area may also be observed. This "normal BCG-itis" is often scarcely noticeable to the individual. Nevertheless, the reaction to vaccination has not always this benign character. Strong local reactions may occur. These appear in the form of an induration of 10 mm. or more accompanied, in certain cases, by ulceration, pustules, and glandular complications. The intensity of the reaction depends, among other things, on the number of bacilli (killed or living) which have been injected, on the vaccination technique, and on individual factors. Observations made by the Joint Enterprise revealed, among 14,000 persons examined 6 to 10 weeks after vaccination, 3% reactions measuring 10 mm. or more. Ulcers appear relatively earlier, i.e., between the 4th and 8th weeks; in some groups ulcers were observed in 0.23% of the individuals. "Local abscesses" are mentioned in some studies. Cases of glandular complications with suppuration are of the greatest practical importance. As many as 196 cases out of 62,200 individuals (0.03%) have been observed in certain countries; the left axilla was affected in most of the cases.