Report to the Commission of Dr. Sidney Coupland, on the outbreak of small-pox in the city of Gloucester in 1895-96.

  • Great Britain. Royal Commission on Vaccination.
Date:
1897
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Licence: Public Domain Mark

Credit: Report to the Commission of Dr. Sidney Coupland, on the outbreak of small-pox in the city of Gloucester in 1895-96. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    from the time of vaccination. If however, the mother is correct, she noticed rather more redness about the 3rd day after the arm was inspected and the vesicles opened. Though the progress was slow, this gradually increased. On the 20th day the case was considered as one of severe vaccination which might have been irritated, and the child was feverish. Four days later there was unmistakeable erysipelas. From these facts it would appear that erysipelas supervened during the development of the areola, and that the child's death was primarily due to the exhaustion con- sequent upon it. There is no record of any probable extraneous cause for the erysipelas. TT D A ] Case XXIX., reported to the Local Government BOARD BY THE LOCAL EeGISTRAR. {Report dated 23rd July 1889.) M. J. L., female, aged four months. May 13th, 1889, by Mr. E., Public Vaccinator. June 25th, 1889. Vaccination six weeks, erysipelas five weeks; asthenia. Mr. E., vaccinator. Direct from arm of child W. (No. 195) on 8th day. Said to be healthy before vaccination. Vaccination quite normal till after 8th day. Later, child suffered from spots like little gatherings, which became covered with yellow crusts and left superficial red blotches. Arm six or eight weeks in healing. Two other children vaccinated with same lymph at same time as vaccinifer did well. Three vaccinations, normal. Vaccinations of two other children at same time from another source, also normal. None. Child not taken to be inspected. 8th day. A little redness round pocks. 10th day. Arm inflamed; the vesicles broke and discharged. Uth (? 18th) day. Erysipelatous inflammation, and sloughing of vaccination vesicles. Axillary glands enlarged. These subsequently subsided. 12th day. Inflammation spread across the chest and next day reached the opposite arm, axillary glands becoming temporarily enlarged. Inflammation subsequently spread all over body, legs, and hands. An axillary ulcer formed, but there was no deep suppuration. The child eventually sank from exhaustion. Note.—Mr. E. says he was not called to see the child until May 30th (18th clay), a week later than mother states. Not rubbed or irritated. Fresh cream and bread poultices applied. Vaccination was performed with an instrument difficult to keep clean; dried blood and hairs were found in holes of the cap. Certificate of successful vaccination was given before the result was known. Stated by mother to have been previously stout and healthy, and to have had no illness; but was suffering badly at time of vaccination from thrush of mouth and anus. Mother did not think it worth while to mention this to Dr. E. Mother delicate. Three One dead of bronchitis. elder children healthy. nary of rter's 'usiun. Home dirty and generally unhealthy. During course of vaccination the child was moved from this cottage, which had a defective drain close to door and an open ditch containing black and stagnant sewage about 10 feet from house. It was brought back again before death. The child died of erysipelas. The inflammation appeared at a late date. Infection probably took place (the reporter surmises) subsequent to and not at the time of vaccination. There is no definite evidence as to its origin, but Dr. E. attributed it to the unwhole- oome state of the child's surroundings, and the poulticing of vaccination wounds. |~T. D. A.] Case XXX., reported to the Local Government Board by the Local Eegistrar. (Report dated 30th October 1889.) J. M.j female, aged three months. July 6th, 1889, by Public Vaccinator. July 28th, 1889. Not given. Direct from vaccinifer, E. A., female, at two months, whose vaccination normal. Two in number ; they were not used as vaccinifers, and could not be traced; one of them had died a few weeks before report was made from convulsions. None. Not brought for inspection. According to grand- mother who took the child to be vaccinated this was done in four places on left arm, the lancet being cleansed in water before using. She did not bring child for inspection on 8th day because it was not well. On 9th day the grandmother states that redness and inflammation of the arm set in, but no doctor was called till July 22nd (17th day) when there was erysipelas involving half the body and the vaccination vesicles were inflamed. No cases of erysipelas in neighbourhood, bub scar- latina prevalent. When child brought to be vaccinated, it was wearing a red-coloured frock, which, on advice of public vaccinator, was left off. Sanitary state of dwelling (in a yard) not good as to privy accommodation and drainage. Family cleanly and respectable. The Public Vaccinator is a careful operator, keeping instruments in proper condition. The case did well until the 8th day, when child sickened, and next day the arm was noticed to be inflamed; but no medical attendant called until the 17th day, when the erysipelas was widely diffused. The cause of the erysipelas is undetermined. [8. C] Ac ~0~ a). Case of. Vaccina- tion. Death. Certified cans. Source of lymph Co-va- cineei. Sub-vac- cinees Course of vaccination. Course of illness. General conditions. (2.) Summary of reporter's conclusion. Case XXXI., reported to the Local Government Board by tee Medical Officer. (Report dated 19th August 1889.) M. A. B., female, aged three months. July 15th, 1889, by Dr. P., Public Vaccinator of H. Union, as a private case. July 29th, 1889. Not given. Stated to be from tube sent by the partner of Dr. T., Public Vaccinator of C. C. district, on Thursday, July 4th. No record of lymph had been kept. JSfote a.—Dr. T. had at this time a similar case of abnormal vaccination, in which erysipelas super- vened, and which ran an identical course, although the child ultimately recovered. From the arm of this child (M.) some tubes were filled on 8th day, July 1st. Dr. T. did not thhik this lymph had been used but did not know what had become of it. Note h.—Two tubes of this batch of lymph were sub- mitted to Dr. Klein for examination : (1) one unopened ; (2) one partially used for vaccinating another infant, C, No. LXV. Both these on cultivation yielded micro- organisms. (1.) The colonies were staphylococcus pyogenes albus liquescens. Were all streptococcus of erysipelas and very numerous (see Case LXV.). One other child (S. C, Case LXV.) vaccinated from same batch of lymph. First operation, July 13th, un- successful. Eepeated July 20th with lymph from same stock. Fatal erysipelas supervened. None. 3rd day. Arm inflamed at shoulder. 8th day. No vesicles, or redness of vaccination places. Small thin scabs only. On outer side of elbow large blister. Arm from elbow to wrist red, hard, and swollen. Subsequently inflammation spread from elbow up the arm, across chest- down the other arm. Inflam- B 3 Ac Case of. Vaccina- tion. Death. Certified cause. Source of lymph. Co-vac- cinees. Sub-vac- cinees. Course of vaccination and illness.