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APPENDIX I.
A CASE OF COW-POX.
By J. Macmillan, D.S.O., M.C., M.B., D.P.H.
On the 11th January, 1932, I was asked by a local medical practitioner to see a
patient of his whom he suspected to be suffering from cow-pox. The patient was a
milkman in the employ of one of the local farmers. I saw him in consultation with
Dr. A. F. Cameron and the diagnosis was confirmed. The patient had never been
vaccinated. In view of the rarity of this condition in London I am reporting on it
rather fully.
1—Small ulcer with remains of pellicle 4—Adenitis.
adherent to margin. S—Lymphangitis.
2—Pustule : ? abortive. 6—Severe onychia.
3—Deep-seated vesicles very like smallpox ' Brawny swelling . inflammatory.
lesions on same site. 8—Lesions resembling primary vaccination.
When first seen the lesions were present on the hands, arms and face, as shown
in the diagram. The fully developed lesion was a vesicular ring with a central crust
commencing to form, the whole lesion being about a quarter to three-eighths of an
inch in diameter and distinctly raised on an indurated inflammatory base. It was
obviously a lesion of inoculation. There was severe septic infection of the matrix of
the nail of the left first finger from which a moderately severe lymphangitis extended
to the axilla with adenitis of the epitrochlear and axillary glands. There were three
lesions deep-seated on the right palm and these are indistinguishable from smallpox
vesicles on the same site in smallpox patients. The lesion on the right upper eyelid
was a shallow ulcer with the remains of the pellicle adherent to the margin and an area
of surrounding inflammation.