Impetigo contagiosa : its individuality and nature / by Henry W. Stelwagon.

  • Henry Weightman Stelwagon
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Impetigo contagiosa : its individuality and nature / by Henry W. Stelwagon. Source: Wellcome Collection.

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    Several have suggested that in some way it was related to vac¬ cination, as has already been intimated. Fox himself stated that some cases followed this operation. Piffard* 1 and Dubring2 have seen such instances; Hyde also saw such relationship in some cases. Others have failed to recognize any connection whatever, and in many writings on the disease the question is not discussed, and the inference is that in these cases such rela¬ tionship was not noticed. As before remarked, in my cases a dependence opon vaccination could not be demonstrated. In addition to clinical observation, Piffard based this view upon the discovery of a fungus in the vaccine crust resembling that found in the crust of contagious impetigo. The fungus was found in a number of vaccine crusts, but only in several impetigo crusts, a fact suspicious in itself. No fungus could be seen in fresh vaccine lymph. It is probable that if impetigo crusts were exposed to the air as long as vaccine crusts usually are, an ex¬ amination would disclose the fungus in a greater proportion. Dr. Piffard himself did not, however, consider this proof of a relationship conclusive. There are several grounds against the supposition that the disease follows vaccination. The disease is commonly observed among the poor, and rarely among the well-to-do. Vaccination, on the other hand, is almost universally practised among the better classes, whereas among the poor it is frequently neglected. This being the case, contagious impetigo should not be so rare among the well-to-do, and so common among the poor; in other words, where vaccination is freely practised, scarcely any cases are observed. Again, the disease should be more prevalent during smallpox epidemics, as then vaccination is more common. A study of the literature of the disease fails to show that this was the case; on the contrary, the reports really prove the reverse. Another point against it is that not infrequently the disease breaks out simultaneously in several children of a family, only one or two of whom had ever been vaccinated. With these grounds, and the additional fact that in the mass of cases reported no connection with vaccination was observed, the conclusion is inevitable that no such relationship exists. In summing up my investigations of the disease, as above detailed, the following resuls are adduced: 1. It is a separate and distinct disease 2. It is not parasitic. 3. It is not related in any way to vaccination. 4. It is an acute, contagious, systemic disease (exanthema) with cutaneous manifestations, having a definite course, and, in all probability, due to a specific poison. The first three deductions are, I think, well founded; the fourth is merely suggestive. 1 Loc. cit. I 2 Duhring: Diseases of the Skin. Third I edition. 1882, p. 298.
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