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

  • Theodore Dyke Acland
Date:
1897
Catalogue details

Licence: Public Domain Mark

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

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    reported to the Commission as one of vaccinal injury, may be mentioned, exemplifying the lack of attention to cleanliness which is often the main factor in bringing about these kinds of skin eruption, in which I found a child wearing a hat the lining of which was soaked with pus from an impetigo which had occurred a year previously. It is unnecessary to discuss this question at length : it cannot be doubted that impetigo may follow any wound, vaccinal or other, in which pus is formed ; and that the liability to the affection is enormously increased by want of cleanliness and bad hygienic surroundings. It is a more serious question whether these disorders are ever actually com¬ municated by vaccination. If impetigo is due, as is probable, to the presence of pyogenic cocci in the discharges, it is possible that some lack of care in the selection of the vaccinifer might lead to the inocula¬ tion of one child from another. I have only investigated one case in which there was any evidence that such communication might have occurred; and in this instance the vaccinifer did not begin to suffer from impetigo until some days after the lymph had been taken from his arm, so that there was no proof that the child was capable of communicating the disease at the time that he was used as a vaccinifer. It is also possible that both vaccinifer and sub-vaccinee may have suffered from the subsequent eruption in consequence of accidental contamination of the vaccination wounds by the lancet used for the operation.1 In foreign countries groups of cases of impetigo have followed vaccination in such a manner as to leave little or no doubt that the affection was communicated by the operation.2 The lesson to be learned from these cases is obvious; namely, that there is risk in using any individual suffering from a communicable disease as a source of lymph. Herpes tonsurans.—The accidental inoculation of the tricophyton ton¬ surans in the process of vaccination has been observed abroad (Hagar (25), Eichstadt (21)), but I am not aware that any case has occurred in England. Like many other communicable skin diseases, it is common in poor and ill-cared-for children; and it is not surprising that in rare instances vaccination should be the means by which it is transmitted from one child to another. In the case of an affection of the skin so readily communicable from one child to another as tinea tonsurans, it may be fallacious to conclude that the disease was transferred in the act rather than at the time of vaccination; since to undress a number of children in a hot, crowded waiting-room, such as that in which vaccination is sometimes performed, must facilitate the distribution of the spores, and render infection more than usually easy. Pemphigus ; Psoriasis. — The occurrence of these affections after vaccination has been recorded (Dauchez (17), Rioblanc (50)); but if any connection exist between the operation and the eruption it is as yet 1 See Case 180, App. ix. R.C.V. p. 366. 2 See Fiirst, loc. cit. p. 72, and Third Report R.C.V. 1890, p. 135, and Peiper, loc. cit. p. 64.
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