Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West.

  • West, Charles, 1816-1898.
Date:
1845
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Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West. Source: Wellcome Collection.

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    age of 14 indeed, all the vaccinated children who were attacked, had a very mild varioloid ; while persons between the ages of 20 and 40, although vacci¬ nated in their infancy, had confluent varioloid closely resembling smallpox From these facts, Dr. Wagner infers that the varioloid is smallpox mitigated by vaccination. This conclusion, however, is opposed to observations made apparently with equal care by Dr. Fischer* of Tambach, in the Duchy of Gotha, who observed an epidemic of varioloid quite independent of smallpox, but alternating with epidemic scarlatina. He founds his opinion as to the non-affinity of the two diseases, on 1st, the shorter duration of the eruption, the fact that it appeared first on the extremities, and that it was always suc¬ ceeded by desquamation of the skin. 2d. The absence in its course of any affection of the conjunctiva. 3d The invariable occurrence of erythema be¬ fore the eruption, and the fact that the red spots of the early eruption, had not the central hardness of variola. 4th. The absence of smallpox odour, or of the suppurative fever, and the desiccation of the pustules on the 6th, not on the 8th or 9th day after their appearance. 5th. The circumstance that the course of the attack was in no degree modified by previous vaccination. 6th. The very mild character of the epidemic. M. Legendref has investigated the very difficult subject of the simultaneous existence of variola and vaccinia, of which he has observed 10 instances. His conclusions, which are founded on a com¬ parison of 56 observations derived from different sources, are to the effect that vaccination almost always modifies the characters of variola, but that the per¬ formance of vaccination in a child previously exposed to the contagion of smallpox, seems to favour the appearance of that disease, though in children above 4 years of age it usually appears in a favorable and greatly modified form. That while vaccination performed during the incubation of smallpox, modifies the characters of that disease, the vaccine vesicle itself is usually modified in a degree directly proportionate to the shortness of the interval between the performance of vaccination, and the appearance of smallpox. When vaccina¬ tion is performed after the appearance of variola, the vaccine vesicle sometimes runs its course, but does not modify the variola. The practical inference which he deduces, is that in young and weakly children who have been ex¬ posed to the contagion of variola, the performance of vaccination only in¬ creases their danger, and is therefore to be avoided. Mr. WyldeJ brings evi¬ dence of the good results of vaccination in Ireland, from the tables drawn up during the census of that kingdom in 1841. He shows that, notwithstanding the vast increase of the population of Dublin, the deaths from smallpox during the past 10 years have scarcely amounted to half of the number who died from the same cause in an equal space of time during the middle of the last century. He states further that the superiority of vaccination over inocu¬ lation is shown by the fact that smallpox mortality is highest in those pro¬ vinces in which inoculation is most practised, and vaccination least. The pro¬ portion borne by smallpox to all other epidemic diseases is— Leinster .. 1: 8*9 Munster . . 1: 6*6 Ulster . . 1: 5-96 Connaught . . 1: 5-35 Dublin .. 1:1379 [This, however, is not of itself proof of the rarity of smallpox in Leinster or Dublin. It may result, and in Dublin it doubtless does, in part from the greater frequency of typhus and other epidemic diseases.] The comparatively small success of vaccination in India, has given rise to an inquiry, the results of which are contained in the valuable Report of Dr. Duncan Stewart.§ The chief causes of this want of success may be referred to the heads of—1st. Native prejudice. 2d. The propagation of a spurious dis¬ ease owing to the carelessness of native vaccinators. 3d. The influence of * Casper’s Woehenschr. Dec. 28, 1844. f Arch. Gen. de Med. Sept. 1844. $ Edinb. Med. and Surg. Journal, April 1845. § Report on Smallpox in Calcutta and Vaccination in Bengal, 8vo ; Calcutta 1844. A fuller notice of this interesting document will be fpund in the present Number of this Journal.