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EPIDEMIOLOGICAL SOCIETY. MONDAY, JULY 2ND, 1855.
Splint, evaporating ether lotions applied, and the patient kept up to the autumn of 1852. It was of this history only that Dr. quiet. Generally this plan suffices to straighten the limb, but Seaton treated in the present communication. The epidemic in some very obstinate instances division of the hamstring commenced in July, 1851, in the northern part of the island, tendons is required; this, however, Mr. Erichsen finds it rarely on the Hyde Estate, in the county of Trelawney, where it apnecessary to employ, only one of the fivefollowing cases re- peared to have been imported by some African emigrants. There had been no epidemic of small-pox in Jamaica since the quiring it. CASE I.-A young woman, aged twenty-two, who had been year 1831. The circumstances attending its importation were
attacked, April, 1855, with acute rheumatism and rheumatic fully detailed. From the Hyde Estate it was communicated contraction of the left knee, the latter bent at nearly a right to other parts of the county of Trelawney, to St. Ann’s adjoinangle and excessively painful, came under Mr. Erichsen’s care, ing Trelawney on the East, and to St. James’s adjoining it on who succeeded in straightening the limb under chloroform. the West. It was traced successively to Portland, Kingston, The subsequent inflammation was easily reduced by leeches Spanish Town, Vere, Clarendon, Hanover, Westmoreland. It and slight mercurials. She appears latterly quite well, and still existed in Westmoreland, and indeed was just commencing She would not allow the limb even at Savanna-la-Mer, when the returns were made to the Central wears the starch bandage. Board. The author then entered into a variety of details, to be touched previous to the use of the chloroform. the remarkable extent to which vaccination had been showing CASE came under care in aged twenty-three, in Jamaica, there being the greatest possible difficulty neglected with contraction of his left which was bent at knee, July, tne people to De t excepting unaer tne gemng right angles, and had been in this condition for eight months, terror of an impending epidemic of small-pox, when they the result of inflammation of the joint. There was no pain or One practitioner, for exuneasiness about it; very limited motion, not more than about anxiously sought the protection. in a residence of sixteen years had not vaccinated two inches when he attempted to move the foot. Mr. Erichsen persons, operated on upwards of 3000 in a short had him placed under the influence of chloroform, and then more time after the outbreak, and the testimony of all the others as stretched the heard limb : loud noises were forcibly crackling the like effect. Under these circumstances, it was to ifsomething were being crunched or torn through. There were wasto be that the epidemic would be wide-spread and fatal ; no inflammatory symptoms subsequently; and he was able to as if the natural mode of diffusion were not sufficient, in leave the hospital in ten days, merely wearing starch bandages. and some of the island the disease was propagated by inocuCASE 3.-A woman, aged thirty: anchylosis nearly complete this practice was made penal by an order of the of left knee for nine months, consequent on rheumatism; scarcely Dr. Seaton then proceeded to notice the principal the epidemic under the various heads of the period any motion in the joint; no pain or tenderness. The limb here also was straightened, or forcibly extended, under the influ- of incubation, duration of the precursory fever, course of the ence of chloroform. The extension was attended with loud period at which death took place in fatal cases, The principal complication snapping or crackling of the old adhesions. Some severe in- complications, treatment, &c. &c. flammatory action followed, which, however, was easily sub- appears to havebeen diarrhoea or dysentery. Measles were dued by evaporating lotions. This woman also had starch seen along with small-pox by Dr. Bowerbank, of Spanish bandages applied; and left the hospital quite improved in Town, and Dr. Chamberlaine, of Kingston; and many cases health. were seen by various practitioners, in which the diseases sucCASE 4.-A woman, aged forty-two, whom we saw operated ceeded each other. With regard to the susceptibility to smallShe complained of anchylosis of the knee, pox manifested by the various races, the immense majority of on early last month. with bent or twisted condition of the fore-arm and hand, all cases occurred in the negro race; but the reasons assigned for the result of rheumatic inflammation contracted twoyears since. this are, that this race is in overwhelming preponderance, and Mr. Erichsen straightened the limbs as usual under chloroform; that the white race almost universally, and the coloured popuvery generally, are protected by vaccination. So far as though at first he believed that he should have had recourse to; lation division of the tendons. Loud crunching sounds were heard, observation of this epidemic, and the opinions of the present reporters go, they would not support the view that the negro This case also has done well. as in the former cases. race is liable to any malignancy of type, except from extraneous CASE 5.-This was an instance of anchylosis of the left knee, circumstances, as their extraordinary filth, crowding, and the in a female, aged thirty-two, of not less than sixteen years’ like. On the value of vaccination, the returns give protective standing, during the whole of which period the limb had not important information. They show that in a large number of been put to the ground. The leg was considerably wasted, cases, reputed to be vaccinated, there was a total absence of though nearly as long as the healthy limb; it was bent nearly evidence that the vaccination had been effective, and that the at a right angle; the hamstring tendons were very tense. Mr. same difficulty is experienced in Jamaica which has been felt Erichsen having placed the patient under chloroform, divided in this country in securing the proper inspection of the vacthese tendons, and then forcibly straightened the limb, tearing cinated, and even to a much greater extent. Dr. Clark, of down, apparently to us, several old adhesions, in and around Armotto Bay, gives an account of the results of his inquiries the joint. No inflammatory action supervened; and this limb 459 persons who had been subjected to the vaccine is now in a straight position, supported by starch and gum respecting and who resided in localities which for months were puncture, bandages. the seat of epidemic small-pox. Eight only of these were reThese cases may not claim any superiority over many others to have had small-pox. In six of them it was satisfacputed of a like kind by their originality, yet they are deserving of torily ascertained that no vesicle had followed the operation; notice for their practical value. the other two had left the neighbourhood before the inquiry was instituted. Instances were given of localities well vaccinated enjoying entire immunity from the disease. Abundant evidence was also furnished, in the returns, of the careless manner in which vaccination was often performed, and of the extent to which improper lymph was used, giving rise frequently to spurious results; yet when small-pox afterwards occurred, it was put down as "after vaccination."" On the EPIDEMIOLOGICAL SOCIETY. subject of the modifying power of vaccination, the most valuable information was given by Dr. Bowerbank. He had MONDAY, JULY 2ND, 1855. a record of 301 cases of small-pox attended by himself. kept PRESIDENT. DR. BABINGTON, Of these, 241 had never been vaccinated, and of them forty-five died, or more than eighteen per cent.; while of fifty-eight who had been vaccinated, only two died; and of two who had been DR. bEATON read a paper, entitled, I inoculated, one died. In one of the two deaths said to be after AN ACCOUNT OF THE EPIDEMIC OF SMALL-POX WHICH OCCURRED vaccination, there was no evidence of the vaccination; in the IN THE ISLAND OF JAMAICA IN 1851-52. other, the small-pox succeeded to measles, and was complicated The author stated that he had drawn up this account from the with dysentery, which was, in fact, the fatal disease. Of the returns which had been made by various medical practitioners fifty-eight vaccinated, in thirty-four there were good cicatrices, in the island to the question circulated by the Central Board of in twelve imperfect cicatrices, and in twelve none at all. Of Health there in 1852. Copies of these returns were forwarded the 241 unvaccinated, the disease was confluent in fifty-one, to the Small-pox and Vaccination Committee of the Society, discrete in 183, modified in seven. Of the thirty-four vacciand were found to contain much interesting matter on the nated, with good cicatrices, it was confluent in two, discrete general subject of vaccination in hot climates, as well as a in fourteen, modified in eighteen. Of the twelve with imperpretty complete history of this particular epidemic of small-pox fect cicatrices, it was confluent in none, discrete in eleven, *
I
2.-A man,
in
who ample,than 200
expected parts lation, till Council. features of eruption, .
,
.
,
’
Medical Societics.
146
from the vaccination of blacks was far greater than that amongst the white races; and if he should have been disposed to infer from analogy, even had he not had the support of facts, that if the constitutional effects of vaccination, usually so mild in whites, were so severe in the negroes, small-pox amongst the latter was likely to be far more fatal the former. It was quite true (continued Dr. M’William) that the negro population of Jamaica was to a considerable extent vaccinated, while the African negroes were not; still he should have expected that the mortality from small-pox amongst negroes in Jamaica would have been greater than had been shown by the author of the paper. Dr. BRTSON said that the fearful mortality from small-pox amongst negroes in Africa was undoubted, whether as occurring in villages, in slave barracones, in slave ships, or even amongst the Kroomen and other negroes employed in men-of-war on the African station. Mr. MARSON, in reply to a question, stated that the incubative period of small-pox may be accurately sat down as fourteen days after exposure to contagion; there were twelve days of freedom from sickness, and as nearly as possible about fortyeight hours of illness before the appearance of the eruption. Dr. FINCH made some observations upon the disposal of the dead amongst the Europeans and coloured races of Calcutta, the former being buried, and the latter as usual being burnt. He adverted to the obstacles to vaccination that had for a long time prevailed at Calcutta, such as the cow being an object The native inoculators and army had Dr. STEWART, Superintendent-general of Vaccination in of Hindoo worship. Calcutta, entirely concurred in the views and opinions enun- Government often to contend with. Lord William Bentinck ciated by the author of the paper, and said that nothing he had had sadly cut down vaccination establishments. After some remarks in reply from Dr. Seaton, and the listened to had given him greater satisfaction. The facts and views of the author were the more satisfactory to him seeing thanks of the meeting being voted to him as the author of the that, during thirty years, he had superintended vaccination in paper, the Society adjourned. Calcutta. He had frequently been obliged to urge them on the notice of Government, in the face of opposition from quarters where he least expected it. Not a little of this opposition came from individuals for whose talent and character he had the highest respect. It had been a source of deep regret, that amongst the Bengal Medical Board there had been a desire to revive the practice of inoculation. Dr. Stewart did MraKe J.):Me&s
modified in one. Of the twelvewithout cicatrices, it was confluent in three, discrete in nine, modified in none. With regard to race, of the 241 unvaccinated, there were five whites, with one death, ninety-eight coloured, with eighteen deaths, and 138 negroes, with twenty-six deaths. The ratio of mortality, therefore, in all the races, would appear to have been the same. The results recorded by Dr. Turner, of Spanish Town, were generally in accordance with those obtained by Dr. Bowerbank. He also saw cases of small-pox in people who had been inoculated, and in others who had had the natural disease. As the general result of their experience, the medical practitioners of Jamaica expressed, without exception, their unabated confidence in the protective value of efficient vaccination, and, with one exception, their opinion, that inoculation is both inexpedient and unjustifiable. Even the exception is only apparent, as the practitioner who thinks the practice sometimes advisable would restrict it to cases in which a large number of persons susceptible of small-pox collected together, without there being a supply of reliable vaccine lymph. These conclusions, he (Dr. Seaton) observed, were entirely at variance with the extraordinary statement promulgated a few years ago by Dr. Copland, that in hot climates and dark varieties of the human species vaccination had been demonstrated to be inefficacious-a statement most mischievous if not true, and for which he had never been able to find any foundation, either in published books or in documents which he had been able to consult.
than amongst
Reviews
and
Notices of Books.
-
147
attacked, April, 1855, with acute rheumatism and rheumatic fully detailed. From the Hyde Estate it was communicated contraction of the left knee, the latter bent at nearly a right to other parts of the county of Trelawney, to St. Ann’s adjoinangle and excessively painful, came under Mr. Erichsen’s care, ing Trelawney on the East, and to St. James’s adjoining it on who succeeded in straightening the limb under chloroform. the West. It was traced successively to Portland, Kingston, The subsequent inflammation was easily reduced by leeches Spanish Town, Vere, Clarendon, Hanover, Westmoreland. It and slight mercurials. She appears latterly quite well, and still existed in Westmoreland, and indeed was just commencing She would not allow the limb even at Savanna-la-Mer, when the returns were made to the Central wears the starch bandage. Board. The author then entered into a variety of details, to be touched previous to the use of the chloroform. the remarkable extent to which vaccination had been showing CASE came under care in aged twenty-three, in Jamaica, there being the greatest possible difficulty neglected with contraction of his left which was bent at knee, July, tne people to De t excepting unaer tne gemng right angles, and had been in this condition for eight months, terror of an impending epidemic of small-pox, when they the result of inflammation of the joint. There was no pain or One practitioner, for exuneasiness about it; very limited motion, not more than about anxiously sought the protection. in a residence of sixteen years had not vaccinated two inches when he attempted to move the foot. Mr. Erichsen persons, operated on upwards of 3000 in a short had him placed under the influence of chloroform, and then more time after the outbreak, and the testimony of all the others as stretched the heard limb : loud noises were forcibly crackling the like effect. Under these circumstances, it was to ifsomething were being crunched or torn through. There were wasto be that the epidemic would be wide-spread and fatal ; no inflammatory symptoms subsequently; and he was able to as if the natural mode of diffusion were not sufficient, in leave the hospital in ten days, merely wearing starch bandages. and some of the island the disease was propagated by inocuCASE 3.-A woman, aged thirty: anchylosis nearly complete this practice was made penal by an order of the of left knee for nine months, consequent on rheumatism; scarcely Dr. Seaton then proceeded to notice the principal the epidemic under the various heads of the period any motion in the joint; no pain or tenderness. The limb here also was straightened, or forcibly extended, under the influ- of incubation, duration of the precursory fever, course of the ence of chloroform. The extension was attended with loud period at which death took place in fatal cases, The principal complication snapping or crackling of the old adhesions. Some severe in- complications, treatment, &c. &c. flammatory action followed, which, however, was easily sub- appears to havebeen diarrhoea or dysentery. Measles were dued by evaporating lotions. This woman also had starch seen along with small-pox by Dr. Bowerbank, of Spanish bandages applied; and left the hospital quite improved in Town, and Dr. Chamberlaine, of Kingston; and many cases health. were seen by various practitioners, in which the diseases sucCASE 4.-A woman, aged forty-two, whom we saw operated ceeded each other. With regard to the susceptibility to smallShe complained of anchylosis of the knee, pox manifested by the various races, the immense majority of on early last month. with bent or twisted condition of the fore-arm and hand, all cases occurred in the negro race; but the reasons assigned for the result of rheumatic inflammation contracted twoyears since. this are, that this race is in overwhelming preponderance, and Mr. Erichsen straightened the limbs as usual under chloroform; that the white race almost universally, and the coloured popuvery generally, are protected by vaccination. So far as though at first he believed that he should have had recourse to; lation division of the tendons. Loud crunching sounds were heard, observation of this epidemic, and the opinions of the present reporters go, they would not support the view that the negro This case also has done well. as in the former cases. race is liable to any malignancy of type, except from extraneous CASE 5.-This was an instance of anchylosis of the left knee, circumstances, as their extraordinary filth, crowding, and the in a female, aged thirty-two, of not less than sixteen years’ like. On the value of vaccination, the returns give protective standing, during the whole of which period the limb had not important information. They show that in a large number of been put to the ground. The leg was considerably wasted, cases, reputed to be vaccinated, there was a total absence of though nearly as long as the healthy limb; it was bent nearly evidence that the vaccination had been effective, and that the at a right angle; the hamstring tendons were very tense. Mr. same difficulty is experienced in Jamaica which has been felt Erichsen having placed the patient under chloroform, divided in this country in securing the proper inspection of the vacthese tendons, and then forcibly straightened the limb, tearing cinated, and even to a much greater extent. Dr. Clark, of down, apparently to us, several old adhesions, in and around Armotto Bay, gives an account of the results of his inquiries the joint. No inflammatory action supervened; and this limb 459 persons who had been subjected to the vaccine is now in a straight position, supported by starch and gum respecting and who resided in localities which for months were puncture, bandages. the seat of epidemic small-pox. Eight only of these were reThese cases may not claim any superiority over many others to have had small-pox. In six of them it was satisfacputed of a like kind by their originality, yet they are deserving of torily ascertained that no vesicle had followed the operation; notice for their practical value. the other two had left the neighbourhood before the inquiry was instituted. Instances were given of localities well vaccinated enjoying entire immunity from the disease. Abundant evidence was also furnished, in the returns, of the careless manner in which vaccination was often performed, and of the extent to which improper lymph was used, giving rise frequently to spurious results; yet when small-pox afterwards occurred, it was put down as "after vaccination."" On the EPIDEMIOLOGICAL SOCIETY. subject of the modifying power of vaccination, the most valuable information was given by Dr. Bowerbank. He had MONDAY, JULY 2ND, 1855. a record of 301 cases of small-pox attended by himself. kept PRESIDENT. DR. BABINGTON, Of these, 241 had never been vaccinated, and of them forty-five died, or more than eighteen per cent.; while of fifty-eight who had been vaccinated, only two died; and of two who had been DR. bEATON read a paper, entitled, I inoculated, one died. In one of the two deaths said to be after AN ACCOUNT OF THE EPIDEMIC OF SMALL-POX WHICH OCCURRED vaccination, there was no evidence of the vaccination; in the IN THE ISLAND OF JAMAICA IN 1851-52. other, the small-pox succeeded to measles, and was complicated The author stated that he had drawn up this account from the with dysentery, which was, in fact, the fatal disease. Of the returns which had been made by various medical practitioners fifty-eight vaccinated, in thirty-four there were good cicatrices, in the island to the question circulated by the Central Board of in twelve imperfect cicatrices, and in twelve none at all. Of Health there in 1852. Copies of these returns were forwarded the 241 unvaccinated, the disease was confluent in fifty-one, to the Small-pox and Vaccination Committee of the Society, discrete in 183, modified in seven. Of the thirty-four vacciand were found to contain much interesting matter on the nated, with good cicatrices, it was confluent in two, discrete general subject of vaccination in hot climates, as well as a in fourteen, modified in eighteen. Of the twelve with imperpretty complete history of this particular epidemic of small-pox fect cicatrices, it was confluent in none, discrete in eleven, *
I
2.-A man,
in
who ample,than 200
expected parts lation, till Council. features of eruption, .
,
.
,
’
Medical Societics.
146
from the vaccination of blacks was far greater than that amongst the white races; and if he should have been disposed to infer from analogy, even had he not had the support of facts, that if the constitutional effects of vaccination, usually so mild in whites, were so severe in the negroes, small-pox amongst the latter was likely to be far more fatal the former. It was quite true (continued Dr. M’William) that the negro population of Jamaica was to a considerable extent vaccinated, while the African negroes were not; still he should have expected that the mortality from small-pox amongst negroes in Jamaica would have been greater than had been shown by the author of the paper. Dr. BRTSON said that the fearful mortality from small-pox amongst negroes in Africa was undoubted, whether as occurring in villages, in slave barracones, in slave ships, or even amongst the Kroomen and other negroes employed in men-of-war on the African station. Mr. MARSON, in reply to a question, stated that the incubative period of small-pox may be accurately sat down as fourteen days after exposure to contagion; there were twelve days of freedom from sickness, and as nearly as possible about fortyeight hours of illness before the appearance of the eruption. Dr. FINCH made some observations upon the disposal of the dead amongst the Europeans and coloured races of Calcutta, the former being buried, and the latter as usual being burnt. He adverted to the obstacles to vaccination that had for a long time prevailed at Calcutta, such as the cow being an object The native inoculators and army had Dr. STEWART, Superintendent-general of Vaccination in of Hindoo worship. Calcutta, entirely concurred in the views and opinions enun- Government often to contend with. Lord William Bentinck ciated by the author of the paper, and said that nothing he had had sadly cut down vaccination establishments. After some remarks in reply from Dr. Seaton, and the listened to had given him greater satisfaction. The facts and views of the author were the more satisfactory to him seeing thanks of the meeting being voted to him as the author of the that, during thirty years, he had superintended vaccination in paper, the Society adjourned. Calcutta. He had frequently been obliged to urge them on the notice of Government, in the face of opposition from quarters where he least expected it. Not a little of this opposition came from individuals for whose talent and character he had the highest respect. It had been a source of deep regret, that amongst the Bengal Medical Board there had been a desire to revive the practice of inoculation. Dr. Stewart did MraKe J.):Me&s
modified in one. Of the twelvewithout cicatrices, it was confluent in three, discrete in nine, modified in none. With regard to race, of the 241 unvaccinated, there were five whites, with one death, ninety-eight coloured, with eighteen deaths, and 138 negroes, with twenty-six deaths. The ratio of mortality, therefore, in all the races, would appear to have been the same. The results recorded by Dr. Turner, of Spanish Town, were generally in accordance with those obtained by Dr. Bowerbank. He also saw cases of small-pox in people who had been inoculated, and in others who had had the natural disease. As the general result of their experience, the medical practitioners of Jamaica expressed, without exception, their unabated confidence in the protective value of efficient vaccination, and, with one exception, their opinion, that inoculation is both inexpedient and unjustifiable. Even the exception is only apparent, as the practitioner who thinks the practice sometimes advisable would restrict it to cases in which a large number of persons susceptible of small-pox collected together, without there being a supply of reliable vaccine lymph. These conclusions, he (Dr. Seaton) observed, were entirely at variance with the extraordinary statement promulgated a few years ago by Dr. Copland, that in hot climates and dark varieties of the human species vaccination had been demonstrated to be inefficacious-a statement most mischievous if not true, and for which he had never been able to find any foundation, either in published books or in documents which he had been able to consult.
than amongst
Reviews
and
Notices of Books.
-
147