Armstrong – Table of Contents

Charles Armstrong developed an interest in this potentially serious or life-
threatening complication following vaccination against smallpox. He outlined the
nervous system manifestations that might follow acute infections such as smallpox,
chickenpox, measles, mumps, and vaccination against smallpox. He indicated that the
central nervous manifestations of these illnesses constitute a group strikingly similar in
their epidemiology, symptomatology and pathology.
The apparently increasing incidence and reports of postvaccinal encephalitis (19)
in various European countries, in England, Netherlands, Germany, Portugal, France,
Switzerland, Poland and others focused Armstrong’s attention on this apparent
complication of vaccination. In the 1920s the incidence of “encaphites” of 1:4,000 in the
Netherlands led to the temporary suspension of compulsory vaccination.
Armstrong reviewed the reported symptoms and diagnosis of this complication.
The symptoms usually occurred suddenly and had their onset in 70 per cent of the cases
from the 10th to 13th day following vaccination, that is, when the vaccination, usually
primary, was at its height. The symptoms for different cases varied somewhat but
Armstrong recorded these as occurring most frequently: 1) Fever, (104F or higher in
severe cases). 2) Vomiting. 3) Headache. 4) Stupor or coma. The stupor might develop
within a few hours after the onset of the symptoms and was always present in fatal cases).
Symptoms of meningeal irritation (related to the meninges, the three layers of membranes
covering the brain and the spinal cord: resistance of the neck to movement and the legs to
elevation) were usually present in conscious patients and absent in others. Convulsions
were common in young children; also cramps and spasms. Trismus (severe tonic
contraction of the jaw muscles) had been observed occasionally and was important to