Vaccinia in man : a clinical study / by Theodore D. Acland.

  • Acland, Theodore D. (Theodore Dyke), 1851-1931.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Vaccinia in man : a clinical study / by Theodore D. Acland. Source: Wellcome Collection.

    51/94 (page 43)
    I have seen several cases in which ulceration of the pocks, glandular abscesses, erysipelas, and even septic intoxications followed the vaccination (7) of infants whose conditions of life were unfavourable. Amongst these are included illegitimate children born in destitution, and, it may be, vaccinated when a few days old, in a workhouse infirmary : from the comparative comfort of which they are removed before the vaccinated arm is well, to surroundings which could not fail to be harmful even to a healthy child. It is not to be wondered at that such infants, ill clothed and worse fed, a burden to their mothers, and sometimes with their lives insured, should succumb to an operation even so trivial as vaccination. No mention would be made of such cases here were it not that they have frequently been made the sub¬ ject of legal inquiry, and the child’s death attributed to vaccination. In the majority of cases in which inflammatory complications follow vaccination there are numerous factors which tend to bring about the catastrophe; and it is illogical to draw any definite conclusions as to the origin of the lesion without giving full weight to the extraneous influences which, apart from vaccination, may have been brought to bear upon the individual case. Under the heading Syphilis, p. 62, will be found tables giving the points of difference between vaccinal ulceration and syphilitic chancre ; but it may briefly be said here that, as a rule, vaccinal ulceration is well marked at a time when syphilitic chancre would not yet have developed ; and that vaccinal eruptions, if present, differ widely from those which occur as secondary phenomena in acquired syphilis (cf. p. 63). Their development is irregular, their distribution unsymmetrical, they are often intensely irritating, and they tend to conform to the various forms of erythema and urticaria rather than to the papular, squamous, and macular eruptions of secondary syphilis. Gangrene at the point of vaccination.—In isolated cases gangrene occurs at the point of vaccination, and it sometimes follows vaccination in syphilitic subjects. One such case is reported by Balzer ; one by Wheaton. I have myself investigated two cases (8), in one of which the syphilitic parentage is certain and in the other probable. It is not unreason¬ able to suppose, if the individual vaccinated be the subject of in¬ herited disease, and the operation be performed when the child is very young, that the result is largely due to the condition of the tissues, and not necessarily to any abnormal quality of the lymph. Three cases have been recorded and summarised by Mr. Hutchinson (20) in which there was no known exciting cause for the local lesion except the fact that the child had been vaccinated : it is probable that none of these children was syphilitic, and it is possible the phenomena may have been the result of idiosyncrasy in reference to the vaccine virus. Mr. Hutchison instances, in support of this view, the occurrence of noma and cancrum oris, forms of spreading gangrene which have nothing to do with syphilis, but which may occur as sequels of the acute specific fevers, such as measles or scarlet fever.