In certain cases of vaccination a double infection may sometimes take place. When the vaccine virus has produced a vesicle, the microbes of contagious impetigo may be accidentally implanted. The vaccine lesion now becomes unusually inflamed and itchy. Through scratching a number of other crusted lesions are developed upon the arm and elsewhere, and doubtless some of the cases of generalized vaccinia which have been reported may be justly considered to have been cases of contagious impetigo beginning at the point of vaccination.
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Fig. 12.—Umbilicated lesion on forehead.
Upon the scalp the lesions of contagious impetigo are frequently found, and usually appear as small, isolated, circular crusts. These frequently occasion temporary areas of partial baldness, and when the disease is of long standing and there is very much suppuration a permanent loss of some hair may result. The affection is often associated with pediculosis capitis, and in such a case the frequent scratching of the head is very apt to multiply the lesions, and often the diagnosis is obscured by the development of eczema upon the scalp and back of the
