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.
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.