Kinnear, J. (1948) Epidemic of bullous erythema on legs due to bed-bugs The Lancet, Volume 252, Issue 6515, Page 55 doi:10.1016/S0140-6736(48)90447-4
This story is kind of fantastical on first reading:
In June, 1947, a woman presented herself complaining of recurring blisters on her legs. The lesions had appeared at intervals for some months. A band of erythema was found across the back of both calves just above their maximal circumference. This erythematous zone was studded with bullae varying in size up to that of a pigeon’s egg. The lesions were considered to be most likely due to insect bites, but no history of duties at home or at work likely to expose the calves to attack in this manner was obtained.
Then a second patient appeared, but she knew her blisters appeared after traveling in a tram.
Incredibly:
Within a fortnight some half-dozen further cases were seen, all exactly similar and all with a history of using the same tram route. All were women. A local practitioner telephoned to ask if I knew about the epidemic of blisters on ladies’ calves, since he had had several cases. I told him to find out if his patients used this tram route, and he informed later that they all did. News of further cases was also obtained from medical and non-medical sources, but the total number of women affected is not ascertainable.
Dr. Kinnear, a dermatologist, inspected not the trams on the route but a similar car:
and found that the seats on the lower deck (which was the one used by all the patients) consisted of two parallel leather-covered cushions running the length of the interior of the car. Each seat was kept in place by a vertical slat of wood running in front of the cushion. The lower edge of this slat of wood appeared to be the same height from the floor as the lesions, and, on sitting down and putting their feet as far back as possible, passengers would bring the calves of their legs into contact with the lower edge of the wood.
Sanitary inspectors then did inspect all trams on the route and found them all to be free of bed bugs save one where:
the lower edges of the slats of wood were grooved, and these grooves were the habitat of numerous bed-bugs which evidently reversed their normal mode of life, lying hidden by night when the tram was in the garage and by day sitting in a row along the edge of the wood extracting nourishment from the legs of unsuspecting lady passengers.
I find it interesting that so many women came down with blister-like bites. Bullous reactions are supposed to be rare. Was it this particular strain of bed bugs? It’s so hard to figure out much about bites, but I’ve found some texts that I hope to share with you. (This, by the way, is not the “extraordinary history” I mentioned which will be a bit of excavation of the stigma and therefore not as fun as Scotland trams and blisters.)
If you are curious about the Dundee trams of this era, take a look at these photographs.
the possibility that these specific bedbugs had physically been exposed to some contagion or irritant which they deposited as they fed. if these bites resulted from bedbugs which had crawled through, say, fecal matter, this could explain the reactions. bullous eruptions have also been associated with scabies. as more of the population is exposed to bedbugs, the popularly held rule that bedbugs do not transmit disease will be tested.
Hi johnycakes, I’m sorry your comment got waylaid. Thanks.
Hmm, I guess we’ll find out — as you say, more and more people have bed bugs, but I think it’s also a question mark whether any effects could be detected. Who’s looking? Doctors still don’t even know to think “bed bugs” when patients present with bites.
I should say, of course, because often these discussions are misconstrued, that I’m relieved that bed bugs are not known to spread disease. We’d be totally ****** if they did.
unfortunately, it’s only a matter of time. as you state, docs don’t even recognize bedbug bites, let alone the repercussions. so far only allergic reactions to the bite have been diagnosed. but to my knowledge no study has been done to determine if bedbugs can pass on disease. why don’t they pass on disease. do bedbugs have a natural germ killing ingredient which cleans their mouth parts ? is the time between feedings to long for transmission ? or have the right circumstances ( the perfect storm so to speak ) not occurred yet ? theoretically, any process which involves blood can be transmissible. i would imagine researchers and public health officials have given this some thought. at this point i don’t think anyone brings up the possibility for fear of panic.
Actually, there have been many studies. Many are very old, some are more recent, conducted around the time investigators where worried that HIV might be transmitted by insect bites (no). Recently a review of all this literature was published in the Journal of the American Medical Association. Thanks to the largesse of the army’s pest mgmt library, you can read it, use accession number 185767.
This review is problematic for me for different reasons. I have no qualifications to evaluate the disease transmission studies, or any studies, but I believe that this review misrepresents one study about bed bug bites. I have an interest in bite reactions and I know their review of one particular article is incomplete and misleading. Also, I really strongly dislike Goddard for his public statements about bed bugs. His “spin” when this review article came out was stomach churning. But he’s an eminent medical entomologist. Anyway, sorry, I get carried away when I think of him, as you will see, there are plenty of studies. With the consensus that they don’t spread disease, however, perhaps it’s unlikely that there will be much additional research, but we’ll see. The remaining scenario is the dirty needle scenario. Which would be very hard to detect. I don’t understand this too well, to be frank.
Some think there may be evolutionary reasons for bed bugs not spreading disease. Happy reading.
the” dirty needle scenario ” is exactly what i was alluding to. thank you for the link to the army studies. a 1963 study concluded:
A review of 93 studies concerned with the
possible role of bedbugs in transmission of
human diseases revealed that several successful
laboratory experiments led certain investigators
to the conclusion that bedbugs transmit leprosy,
oriental sore, kala-azar, 0 fever, relapsing
fever, and brucellosis in nature. Actual trans-
mission, however, has not been scientifically
proved.
scary stuff
This may be wordy and might not be of interest to you, but…ya never know…it may help someone.
I just came across this site, when I saw your listing of this bite article.
I’m a recent “victim” of bedbugs, but I’m (hopefully) one of the lucky ones.
It’s been about 3 weeks since I found a bug crawling on my bed. My apt. has been treated (twice) by the exterminator and I’ve not seen another one.
A few weeks before I found the bug, I was getting bitten. I thought…mosquito. After the first few bites, every bite turned into a huge blister. I went to doctors for infection and blister treatment. Happily I can add that as soon as I started my cleanup (wash floors, bed, furniture etc with Murphy’s) I’ve had no new bites. I had about 20 total. The dermatologist didn’t seem impressed by their size. They also didn’t know what the insect was that caused them…but they took a biopsy that told them…INSECT BITE (duh!). I looked all over the internet and couldn’t find ones that matched mine. I posted photos to bedbugger.com where someone said they’d only seen similar cases 3 times in 7 years.
All that being said, it’s still not positive that my bites, and my allergic reaction, are from bb bites, or from something associated with pidgins that land on my airconditioner (and live above the window in the roof facing), or carpet beetle larve (I found 3 on my boxspring and 2 behind a wire on the wall). So, I continue to look for any info on bb bites.
I saw a date on the article that said it was published in 1948. I was hoping for something more current. And I was hoping to see images of their bites.
Photos of my bites are kinda “ugly”, but if anyone wants to see them, let me know.
Thanks for your post Renee! I’ll be checking this site for bb updates. Keep up the good work.
Hi Faith,
For a 2006 article about bullous reactions to bed bug bites, with photographs, see this.
For a photograph of a blister-like (contact) reaction to carpet beetles, see this page of a pediatric dermatology atlas. You can consult your doctor about contact dermatitis and carpet beetles. But I’m sure next time you see a bug you will trap it and have it identified if you are not sure what it is. Your doctor should also be able to show you photographs of bullae. I would ask your doctor to be more helpful.
In any case, I hope the source of the reactions is now clear.
And thanks… (feel free to link to your photos if you like)
Thanks you so much for your helpful and quick response.
I’d already seen the journal document, and it definitely described my bites. I brought it, along with my photos to my doctors, who just shook their heads yes. I have a return scheduled to the dermatologist to remove stitches. I don’t think he will be any more helpful. if I get any more bites I would use a different doctor.
Looking at the images in the Atlas, I’d say my bites looked like the carpet beetle ones, once they start to deflate. I had almost all single bites…and then a cluster, which, along with the new knowledge of the neighbor below me having bb, convinced me they were bedbug bites. That night I found the bug on my bed…and saved it for the exterminator.
Having found a bed bug, may be coincidental to my “bites”, which did seem to stop once I’d cleaned the bed and floors etc….killing any carpet beetle larve that was there. I may never really know, unless I find someone who can unequivocally tell from my photos what the bites are from.
In the meanwhile, I have to debug my apt. and all my belonging, incase there are leftover bb or their eggs.
I’m wondering if the unique lesions might have had something to do with the wooden slat and how it might have been treated, either in manufacture of for insect control.
Renee. You are a national treasure and we’ll miss you. Best of luck.
Aww, thank you Ci Lecto, that is so very kind. I hope I can cram everything I’m reading into these last few days to leave on a high note. Also, I was thinking today that I hope my obsession with bed bugs continues to be unrequited, for it would suck for them to start thinking of me when I’m ready to stop thinking about them every day.
Interesting about the slat. Blood-sucking insects are capable of some weird stuff, though. My bet is on them. (I had to look up pigeon eggs to picture the size of some of these blisters.)