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PRACTICAL OBSERVATION;
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           OR        f
INOCULATION
COW-POCK.
 BY JOHN REDMAN COXE, M. D.
Member or the American philosophical society, and onb
  OF THE PHYSICIANS TO THE PENNSYLVANIA H0STITAI..
          Embellished with
      A COLOURED ENGRAVING,
Representing a comparative View of the various Stages of the'
        Vaccine and Small-Pox.
PHILADELPHIA:  ^3 \ • / &
PRINTED AND SOLD BY JAMES HUMPHREYS,
  At the Corner of Walnut and Dock-streets.
        1802.
[Copy-Right fecurcd according to Law.] 
 
TO
 EDWARD  JENNER,  M. D.  &>c.

      SIR,
                THAT Philanthropy, which
has already so deservedly exalted you in the opi-
nion of the world, will I trust plead my excuse,
in thus obtruding on your important avocations,
the result of my observations respecting the in-
valuable blessing, you  have so widely extended.
   The subject is comparatively  new amongst
us;  but  its utility, is  I hope, firmly establish-
ed.   That you may long enjoy  the pleasing re-
flections  of an approving conscience, and the
gratitude of the human race, is  the sincere wish
of,
       Sir,
           Your Friend,
              and Humble Servant,
                 JOHN REDMAN COXE.
Philadelphia,
  June ift, i8oz. 
 
INTRODUCTION.
                      THE important advantages
of Vaccination, or Inoculation for the Cow-Pock,
appear to be so thoroughly established, and so ma-
ny  valuable  treatises  have been written  on  it, that
any further attempt may be  deemed a work  of su-
pererogation: But when it is  considered, that this di-
sease  is comparatively new in the extensive regions
of America;  and  that those treatises have hitherto
been chiefly confined  to Europe; when it is consi^
dered likewise, that numbers are yet unsatisfied, or
unacquainted with, t^ facts  upon which the intro-
duction of this invaluable disease is founded;  it may
not perhaps be improper to add,  the additional testi-
mony in its  favor  which has accrued  here,  to the
immense mass which is now contained throughout 3
great  part of the civilized globe. 
                         vi

   A work on this subject will not I trust, be deemed
cither uninteresting or useless to the Practitioners of
America, many of whom from  their diftant situati-
ons, cannot  so  readily acquire  information on  this
new and valuable  audition to  Medical  Science.*
When we reflect that the lives of thousands, are per-
haps dependent on  the  speedy extension of this in-
valuable blessing,  1 hope I shall be exempted from
any charge, but that of a desire to awaken the minds
of parents and physicians, to the superiority of  this
disease over the small-pox.
   Having fortunately been instrumental, in introdu-
cing this disease into Philadelphia and the adjoining
country,  I candidly confess, I feel a pleasure in the
reflection which nothing should  tempt me to forego:
Nor are my  feelings less agreeable, in considering
myself as the  very first person in this  city, who actu-
ally had it by  inoculation  here.   I  have proved in
my own person  the mildness of the Vaccine, and the
perfect confidence I  placed in the accounts of its im-
mortal discoverer.
   It is proper here to observe,  that the  prophylactic
power of the Vaccine had been long known.  This is
not the discovery to whitk  Dr. Jenner lays claim.


  * One of the principal reasons which influenced the publication of
the present treatise, arose from the numerous applications for informa-
tion oh the subject,  which it was impossible to comply with in every
instance.   I request those gentlemen, whom  I have thus apparently
neglected, to pardon me, as my silence was altogether accidental. 
vii
He  first experimentally proved,  that the virus did
not lose its specific  property, by being transferred
from one human subject to another by  inoculation;
and to him therefore is mankind indebted for the happy
prospect it unfolds, of completely annihilating a dis-
ease, whose name  alone must ever be  remembered
with horror.
   It is  not among the least remarkable circumstances
of this discovery, that the  fact of its preservative ef-
fect  against the  small-pox  should have  been so long
known, without any  practical use being made of it!
Like Columbus'  egg,  the  induction  now appears
so simple,  that we are lost in astonishment, it was
not sooner verified !   It was reserved for the illustri-
ous Jenner ;  an:^ evinces  the truly philosophic mind
that  readily combines important truths, which others
overlook.—This truly  important experiment,  was
made on the  14th day of May  1796:  a day ever
memorable in the  records of humanity, by opening
to view a perfect security  against the most ferocious
and  destructive  disease, which was suffered to escape
from the box of Pandora !
 „ When the  important advantages of Vaccination
over Inoculation,*  are generally  known and proper-
ly estimated, we may safely conclude the celebrated

  * I use the term Vaccination, in opposition to Inoculation, which
certainly should now be appropriated solely to the Small-pox.  Inde-
pendently of the propriety of the measure, it prevents the unnecessa-
ry addition of the name of the disease employed. 
                         viii

 author of the  discovery  will  receive that universal
 homage he  so richly deserves.  The  philanthropy
 he has evinced, in communicating it immediately to
 the public, in  place of converting it to his own pri-
 vate emolument,*  is worthy of the liberal profession,
 to which he  is  so bright an ornament;  and, whilst it
 raises  him in the eftimation of a grateful world, must
 certainly prove the ftrongeft reproach to thofe,  who
 by an  opposite conduct, hope to serve  themselves at
 the expence of suffering humanity*
   Although I  have met with  a large  proportion of
 the facts laid down by writers on this disease, and
 have never neglected for a  single day to note every
 occurrence to which I had previously been a ftranger;
 yet I am very far from viewing the prefent perform-
 ance,  as giving that complete  view of every variety
 in the  disease, which is only to be known by time and
 longer experience.  Enough is said however,  I trust,
to point out the necessity of strict attention, in order
to prevent our being imposed upon by the spurious for
the genuine disease; an error, which by the false con-
fidence impressed, has unfortunately been productive
of consequences fatal to the patient,  and of injury to
the extension of this most valuable blessing.   That
this is  not  a false dread,  must be very evident to the
inhabitants of  such places,  into which  the spurious

   * This truly deserving character, has,  I have good grounds to
 assert, spent upwards of £.6000 sterling, or full 15,000 dollars, i«
 his various researches and experiments, relative to this disease. 
ix
disease has been unfortunately communicated;  even
here, where the knowledge of the disease  has  been
more extended, and more easily acquired, it has been
insufficient to prevent the occasional  appearance of
this insidious enemy,  which has not failed  to check
the favourable impression of the disease, which many
had previously entertained.  To guard in some mea-
sure against this evil, I have added an engraving .re-
presenting the various stages  of this disease, which
will give Practitioners a pretty good idea of its  true
character, until experience shall have more fully made
them acquainted with it;  It is  taken  from  one of
Dr. Jenner's, which is excelled only by Nature her-
self.  To  this I have  taken  the liberty to add the
profile of the pustule on the respective days, as given
by Messrs. Ballhorn and  Stromeyer,  and which  I
consider an interesting  and useful addition, by exhi-
biting more clearly a striking difference in the Vaccine
and Small-pox.   To those who  are in possession of
Dr. Jenner's invaluable engraving, it will appear,
that I have in the view of the disease on the twelfth
day,  given that beautiful variety of the recession of
the Areola, which is represented in the third plate of
his treatise on the  " Variolas Vaccinae," and also in
the  treatise of Messrs. Ballhorn and  Stromeyer; in
place of the more usual appearance,  which is repre-
sented in the plate from which this is copied.
t  -' ] 
^ 
PRACTICAL  OBSERVATIONS,  &c.
             J3EFORE  we enter upon the consideration
of this highly important disease,  it may not be improper
to take a view of its origin;  which I shall be pardoned for
presenting to the reader, in the words  of Dr. Jenner him-
self.  (See his Enquiry, &c. p. 2 to 6.)
   " There is a disease,  to which the horse, from his state
of domestication, is frequently subject.  The farriers have
termed it the Grease.   It is an inflammation and swelling
in the heel, accompanied at its commencement with small
cracks or fissures, from  which issues a  limpid  fluid, pos-
sessing properties of a very peculiar kind.  This fluid seems
capable of generating a disease in the human body  (after it
has undergone the modification I shall presently speak of)
which bears so strong a resemblance to the small-pox, that
I think it highly probable it may be  the source of that
disease.*
   k< In this dairy-country a great number of cows are kept,
and the office of milking is performed indiscriminately  by
men and maid-servants.  One of the former having been
appointed to apply dressings to the heels of a horse affect-
ed with the malady I have  mentioned,  and not paying due
attention to cleanliness,  incautiously bears his part in milk-
ing the cows, with some particles of the infectious matter

  * This Treatise it must be remembered, was written in 1798. 
12
adhering to his fingers.  When this is the case, it frequent-
ly happens, that a disease is communicated to the cows,
and from the cows to the dairy-maids, which spreads through
the farm until most of the cattle and domestics feel its un-
pleasant consequences.  This disease has obtained the name
of  C<"0-pox.   It appears on the nipples of the cows in the
form of irregular pustules.  At  their first appearance  they
are commonly of a palish blue, or rather of a colour some-
what approaching to livid, and  are surrounded by  an in-
flammation.  These pustules, unless a timely remedy be ap-
plied,  frequently degenerate into phagedenic ulcers,  which
prove extremely  troublesome.  The animals become indis-
posed, and  the  secretion of milk is  much  lessened.   In-
flamed spots now begin to appear on  different parts  of the
hands of the domestics employed in milking, and sometimes
on  the wrists, which run on to suppuration,  first assuming
the appearance of the small vesications produced by a burn.
Most commonly they appear about the joints of the fingers,
and at  their extremities; but whatever parts are  affected,
if the situation will admit, these superficial suppurations put
on  a circular form, with their edges  more elevated  than
their centre, and of a colour distinctly approaching to blue.
Absorption  takes place, and tumours  appear in each axilla.
The system becomes affected, the pulse is quickened; shi-
verings, succeeded by heat, general lassitude, and pains a-
bout the loins and limbs, with vomiting, come on.   The
head is painful, and the patient is now and then even affect-
ed with delirium.*  These symptoms,  varying in their de-
grees of violence, generally continue from one day to three
or four, leaving ulcerated sores  about the  hands, which,
from the sensibility of the parts, are very troublesome, and
commonly heal slowly,  frequently becoming  phagedenic,
Jjkke those from whence they sprung.   During the progress

  *  " It will appear in the sequel that these  symptoms arise princU
pally from the irritation  of the sores, and not from the prima'ry aftion,
of the Vaccine virus upon the constitution."   Note of Dr. J. 
13
 of the  disease, the lips, nostrils,  eye-lids, and other parts
 of the  body, are sometimes affected with sores;  but these
 evidently arise from their being heedlessly rubbed or scratch-
 ed with the patients' infected fingers.  No eruptions on the
 skin have followed the  decline of the feverish symptoms in
 any instance that has come under my inspection,  one only
 excepted,  and  in this case a very few appeared on the arms;
 they were very minute, of a vivid red colour, and soon died
 away without advancing  to  maturation; so  that  I  cannot
 determine whether they had any connection with the prece-
 ding symptoms.
   " Thus the disease  makes  its  progress from  the horse
 (as I conceive) to  the nipple of the cow, and from the cow
 to the human  subject."
   It was for a considerable time supposed,  that this  idea of
 the origin of the extraordinary disease in question was ill
 founded,  because  several attempts  had  ineffectually  been
 made to excite the disease in the cow,  by immediate ino-
 culation with the matter of grease ;*  but it would seem from
 more fortunate experiments, that its real origin is here deve-
 loped.  In Ring's Treatise, p. 14, &c. a veterinary surgeon
 is said to have actually succeeded in  " producing the disease
 artificially in a cow, by removing a scab from the teat, and
 applying the recent blackish  matter of grease to the absorb-
 ing surface of the sore."


   * This idea is opposed by the justly celebrated Dr.  Woodville,
 whose experiments to elucidate this interesting point, entitle him to
 the greatest praise.—A knowledge  however  of the success of the
 experiment  in other hands, which so often proved abortive with Dr.
 W. may be of service in  guarding aga'nst the mode of  drawing
general conclusions, from negative experiments.  We here see, all
 reasoning drawn from them, however plausible, at once falls to the
 ground by this single positive fact.  In the same hasty manner, con-
 clusions have been drawn, that persons who have previously  had the
 Small-pox,  are exempt from the Vaccine $  which although it may be 
14
  Mr. Ring at page 15, has given a very interesting letter
from a Mr. Rankin, relating a case of disease accidentally
produced on the face and hands of a farmer, by  the fluid
oozing  from  the heels of a horse  labouring under the
scratches, which  spirted upon him when  dressing  him.
The pustules  induced,  bore the strongest resemblance  to
the casual Cow-pox,   and  were  attended with considera-
ble fever, full quick pulse,  violent head-ach,  foul tongue,
thirst, &c.
  At page 693, Mr. Ring says,  " I am informed hy Dr.
Jenner, that in the case where the Cow-pox could be tra-
ced by  Mr. H. J. Jenner from the grease,  a boy, having
drawn a string: backwards and forwards over the heels of the
horse, drew it repeatedly across his fingers,  till he had caused
-an abrasion of the cuticle.  Thus the subjacent parts were
inoculated with the virus of the horse; and the disease re-
sembled the Cow-pox;  the  lymphatics exhibiting beauti-
ful tints of red, in consequence of that affection."
   Dr. Jenner has favored us with a remarkable case  which
came under his notice,  of the system remaining unsuscep-
tible of the variolous contagion, after having been affected
by the  matter issuing from the heels of horses.   The ia-
disposition produced had been pretty severe.   Six years af-
terwards, the Doctor inoculated the person repeatedly, and
exposed him also to the contagion of the  small-pox, but
without producing any effect.  To this case  is annexed a
note, stating as a remarkable  fact well known to many, the
frequent failure of attempts to communicate  the  small-pox
by inoculation to blacksmiths, who in the country are far-


 generally the case, is not so in every instance, as I shall hereafter  no-
 tice; hence patience is a great desideratum in experimenting.—Cows
 undoubtedly,  as well as men, are not  always in a state to receive the
 impression of this disease :—Hence the frequent failure by inoculation
 in one person with the very same  matter,  and with similar precauti-
 ons, which produces it in  others. 
>                is
riers; and asking if it may not now be accounted  for, oa
rational principles.*
  Another instance is adduced by  Dr. Jenner to  prove the
obscure appearance of small-pox, after the disease produced
by the grease,  at least occasionally.  In the next  case how-
ever he attempts to shew, that this cannot be entirely re-
lied on, " until a disease has been generated  by the morbid
matter from the horse on the nipple  of the cow, and passed
through that medium to  the human subject;"—for the per-
son who is the subject of this case, took the  small-pox up-
wards of twenty years  afterwards.   (See cases 13, 14, 15.)
  Though these cases do not completely prove the Vaccine
to originate from the Grease; yet the two first must be al-
lowed to render the idea extremely probable.
  Three men were affected from the heels of a mare with
sores in their hands, followed by inflamed lymphatic glands
in the arms and axillae, shivering succeeded by  heat, lassitude,
and  general pains in the limbs.   Two of them had passed
through the small-pox, and described their feelings as very si-
milar in both diseases.  One of these was daily employed as
a milker at the farm; and in about  ten days  after washing
the mares'  heels, the disease began to appear among the
cows.  This fact certainly goes far in demonstrating the ori-
gin of the disease; and  the probability is increased by the
subsequent information,  that "a child of five years old was
inoculated with matter taken from a pustule  on the hand of
one of these men :  He became ill  on the sixth day with
symptoms  similar to those excited  by Cow-pox matter."
Dr. Jenner was prevented ascertaining,  whether  the matter
thus passing from the horse through the human constitu-
tion,  will produce a similar effect, as after passing through
the cow, in consequence of this child dying before any trial
was made with variolous matter. §

  * It would be  satisfactory to have this fact further established by
those medical gentlemen, whose situation  in the country gives them
greater opportunities of attending to it.
  § This child's  arm is the subject of Dr. Jenner's second plete. 
i6
   It appears to me, the foregoing facts are sufficient in thtf
mind of an unbiassed person, to establish the truth  of Dr.
Jenner's important opinion of the origin of this disease.   If
more are deemed necessary,  they may be found in Dr. Jen-
ner's invaluable treatise, to which I must refer, particularly
to his interesting observations at p. 90 & scq.*
   Before  I conclude this part of the subject it may not be
amiss to mention Dr. Jenner's opinion,  of the probabi-
lity that  other parts of the horse as well  as the heels,  are
capable of generating the virus which produces the Cow-
pox.
   " An extensive inflammation of the erysipelatous  kind
appeared without any apparent cause upon  the upper part of
the thigh of a sucking colt,  the property  of Mr. Millet, a
farmer at  Rockhampton, a village near Berkeley.  The in-
flammation continued several weeks, and at length termina-
ted in the formation  of three or four small abcesses.  The
inflamed parts were fomented, and dressings were applied by
soyne of the same persons who were employed in milking
the cows.  The number of  cows milked was twenty-four,
and the  whole of them had the Cow-pox.  The milkers,
consisting of the farmer's wife, a man and a maid-servant,
were infected by the cows.   The man-servant had previous-
ly gone through the Small-pox, and  felt  but little of the
Cow-pox.  The servant maid had some  years before been
infected with  the  Cow-pox, and she  also felt  it now  in  a
slight degree.  But the farmer's wife,  who never had gone
through either of these diseases, felt its effects very severe-
ly."   Seep. 62. ,,
   As it is of  great importance to determine with precision,
the origin of this disease, I have been more full, than other-
wise to  many might  seem necessary; but as this question
involves in it the possibility of producing the disease amongst
us,  whenever we unfortunately may lose the  infection,  I

   * I shall in a future part give some interesting communications re-
 specting the domestic origin of the disease among our own cows. 
*7
have stated what will 1 think suffice to call the attention of
those persons to it,  whose time and opportunities may ena-
ble them to do justice to  the subject.*
   As I entertain but little doubt from what is above stated,
that the origin of this disease has been satisfactorily traced
by the illustrious Jenner, I may be permitted to add, that
amidst our veneration for the  cow,  we  should  not forget
our grateful tribute  to the horse, for doubly proving, thus,
a source of health  and pleasure.   Experiments  must de-
termine, whether the teat and udder of the cow by inocu-
lation  with the grease, are alone capable of elaborating this
infection;  or whether other  animals may not be employ-
ed  so to modify it,  that  it may serve the same good pur-
pose.   It is an important fact deserving of notice, by those
who may  be disposed to pursue experiments on  the sub-
ject of this disease, that when it broke  out among the
cows of Grey's inn  lane,  (Woodville, p. 10.) of two hun-
dred cows, four-fifths were eventually infected;  the  rest,
which were not in milk,, escaped the disease.  This proves
its  non-contagious nature;  but the object I  have  in view
in  mentioning it,  is  to- ascertain if the cow in this state, is
less liable to receive  the infection by inoculation; for having
vaccinated a cow in this situation twice, ineffectually, by
five punctures  in all, and with fresh matter, I am rather
suspicious it may be the case.
   Having never seen the casual Cow-pox  as it has  been
termed, that is, the disease communicated immediately from
the cow to  the human subject,  I shall refer to Dr. Jenner's
account, observing only,  that it is t© be viewed in the light

  * Great accuracy is requisite  in conducting such experiments, that
we may know every circumstance tending to render them successful,
when it is necessary to  recur to them for a supply of infection. They
must chiefly be made in the country, from the greater facility of pro-
curing the matter of grease, &c. than in town.
                 C  3 ] 
i8
of an  inoculated disease,  although not effected with  the
point of a lancet, nor even perhaps through the medium of
an abraded cuticle, though probably this is the case in most
instances.   It is  said to be generajly a more violent disease,
which may partly arise from the greater number and mag-
nitude of the pustules,  than when communicated by art, in
consequence of the greater extent of surface exposed to the
infection in milking the cow.
  In order that it may be understood what day precisely of
the disease is spoken of in the following pages,  I must re-
mark,  that the first day commences from the moment of
the insertion of the virus, and  is compleated at the same
hour of the succeeding day; so that, when mention is made
of any particular day, as the sixth,  it is to be understood of
the whole  twenty-four hours,  immediately following  the
completion of the fifth  day.   It may be thought unnecessa-
ry to mention this;  but some persons I believe,  are not in
the habit  of counting  the day of inoculation as the first,
which becomes a source of error and confusion, from a want
of uniformity in a circumstance apparently trifling.
  This disease as communicated by inoculation,  in its com-
mencement much resembles the small-pox:  Towards  the
middle or close of the second day when the operation takes
effect,  (that is thirtv-six to forty-eight hours from the period
of inserting the virus), a light speck of inflammation may ge-
nerally be perceived: This becomes much more conspicuous
in the course of the third  day, and in most instances by the
commencement of the fourth, a minute pimple may be  felt
rising above the  skin, and surrounded by a circular inflam-
mation at its base.   It now gradually increases  in size,  and
by the close of the fifth day begins to assume, (especially if
viewed with a magnifying glass),  that appearance which so
much .distinguishes it from the small-pox.  This consists in
the perfect regularity,  and beautifully circumscribed form
of the pock, which has a surface flattened, with a depressed 
l9
centre, of a darker colour,*  so as to give an appearance of
elevated edges.   In the small-pox on the contrary, by the
sixth day, the inoculated part begins to assume an irregular,
or angulated  appearance, and its  surface is not so flattened
in proportion to its diameter.   This  circumscribed appear-
ance is retained by the Vaccine during its whole progress,
even during the process of scabbing,  whilst the small-pox
becomes daily more irregular, in consequence of the conflu-
ence of the adjoining pustules.   (See the plate.)f
   About the fifth day,  the pock begins to change from the
red pimple to a vesicle containing a fluid, which through the
cuticle somewhat resembles the colour of whey.  This fluid
is at its first formation in its most  active state,  and probably
will be less liable to fail, if taken at  this early period, than if
delayed to a later day.  From the sixth day to the tenth is
mentioned as the proper period for collecting it; I shall how-
ever notice some exceptions to this  hereafter.   During this
interval the pock augments considerably; the flattened appear-
ance becoming more conspicuous in proportion to its size; so
that sometimes  in a pock of nearly half an inch diameter, its
elevation above the surrounding skin will scarcely, if at all,
exceed the one tenth, or the one twelfth of an inch, evinc-
ing at the same time,  the total absence of the plump rotun-
dity  of  the variolous pustule.   About the eighth or ninth
day,  the pock having arrived to maturity,  the constitution-
al symptoms begin to shew themselves;  the general  indis-

  * This dark  coloured speck  in tire  centre, Mr. Addington says,
" represents the cuticle still adhering in that spot  to the skin under-
neath." p. 16.
  -f- It is this peculiar appearance of the Vaccine disease,  which is to
be particularly attended to,  in forming our opinion of its genuine cha-
racter. The more it recedes from this standard, the greater is the pro-
bability of its being a spurious disease  which is excited.   It may be
proper to observe,  when the Vaccination is performed with an  infected
thread, the subsequent pustule is sometimes of an oblong or oval fU
gure,  though still  retaining its regular circumscribed form. 
20
position being preceded by swelling and pain of the pustule
shooting up towards the axilla, (and shoulder occasionally),
the glands of which now become  swelled and painful,  es-
pecially on moving the arm, whilst the system sympathises,
as evinced by languor, drowsiness,  paleness, chilliness, and
flushes of heat, head-ach, pain and fulness of the eyes, pain
of the,limbs and of the back,  loss of appetite, nausea, and
sometimes vomiting, an increased frequency of pulse, thirst,
and white tongue,   it  is not to be supposed that these all
occur in every  patient;  on the contrary, it is difficult in
many instances to  detect the presence  of any one of them;
some or other of  them however for the  most part occur,
and continue with greater or less  violence,  (seldom  so as
to confine  the patient) from  one  hour,  to two,  three or
more days,  when  they  subside spontaneously, without any
disagreeable consequence.   The slight marginal inflamma-
tion which has accompanied  it from  its first appearance,
about the eighth or ninth day begins to augment very mo-
derately, increasing more rapidly  about  the tenth or ele-
venth days, so as  to  extend to one, two, three,  or  more
inches in diameter, forming a most  beautiful efflorescence
or areola, which has been regarded as  a proof that the ge-
neral affection of the system had taken  place:  As however
the areola does not always exist, and  yet the prophylactic
property of the disease is perfect; we must not lay too great
a stress upon it, nor be alarmed at its non-appearance, un-
der an idea of the disease being merely local.*
   The centre of the  pustule which always  is depressed,
how begins to assume a'darker appearance;  this gradually


  * That the areola, even  though it does occur, is not to be consi-
dered as an absolute proof of the existence of the constitutional af-
fection, may be inferred from its presence in a spurious disease,  (see
case i) in which not  the slightest indisposition existed :  Whereas  in
most instances the constitutional effects are more violent in the spu-
rious disease. 
                            21

extends  to the circumference, and  in  three, four, or  five
days, the  scab is generally complete,  so that by the four-
teenth day  it  is of a brown  colour, darkest in the centre,
and assuming a polished hue.   This dark brown, or maho-
gany appearance,*  daily grows more intense as the fluid be-
neath is  absorbed;  at length it begins to detach  itself at the
circumference  from the edge of the surrounding skin,   still
adhering at the centre beneath,  till  eventually,  it falls off
at different periods of time,   generally  from three to four
weeks from Vaccination,  leaving the skin sound, but most-
ly with a slight depression or pit.
   About the eleventh day, the areola is mostly at its height,
when it  exhibits the appearance of a pink, or damask rose,
accompanied with  tumefaction and hardness of the limb, to
the extent which it occupies. ||   Its appearance is sometimes
alarming to those,  who  from not  having  before  seen the
varieties of the disease are not prepared for such a sudden
alteration.  It however subsides in a few days, and frequent-
ly retires from the centre first; leaving as it were, an inter-
val of uninflamed  surface, surrounded  by  a ring  of efflo-
rescence.   A  light blush however mostly  regains till  the
completion of the  scab ; §  the tumefaction generally  de-
clines with the efflorescence.
   This may be considered as a tolerably accurate account of
the progress of the disease, as  it has  occurred to me. Some


  * This colour has been more properly  compared I think by  Mr.
Addington to the colour of  a dried  tamarind stone.  I may notice
here that in the African, it rather seems to be influenced by the co-
lour of the rete mucosum, as it generally I  think approaches  to a
black.  Since writing  the above note, I am happy to add the opinion
of Dr. Spense of Dumfries (Virginia), who  says it precisely resem-
bles " a piece of rough black sealing wax."
  ]\ There is considerable variety in the actual grade of the colour
ef the areola, from a light pink, to a deep crimson.
  § It may be rather  said to exhibit a dusky  hue, attended with a
desquamation of the cuticle to the extent of the tumour produced. 
varieties remain, to be  considered, most of which  J have
likewise seen,  and which I shall treat of in the same order.
    The success of the operation must depend in a great
degree, upon the  disposition  of the  system to receive the
impression of the disease, when we are perfectly assured of
the goodness of the infection.    I say in a great degree,
because even with such a disposition existing, the best mat-
ter may fail by an injudicious mode  of Vaccination, so as
to produce great local irritation,  which effectually prevents
absorption.   This  we  also  find is often  the  case in  the
variolous inoculation.   In perhaps a majority of cases,  the
first attempt succeeds.    As far as my  experiments go,  I
have  excited the disease  in about three-fifths  by the  first
attempt, or rather more than one-half. §   Whether the ca-
ses of failure would have equally opposed the variolous con-
tagion is perhaps impossible to  say;  I rather  apprehend  it
would have proved to be the case.*   Mr.  Ring, p. 508, re-
lates the case of the brother  of Dr. E. Bancroft, who "  was
inoculated  for the  small-pox eleven times, and once taken
to a patient labouring under the disease, and inoculated in
both arms w"«;h a large quantity of recent matter,  but to no
purpose; yet he afterwards caught the small-pox in the na-
tural way."   Mr.  Ring mentions three instances of five at-
tempts, and  one of six, before infection took place, in his
practice, and ascribes it to the constitution of  the  patient,
since  it was chiefly in children of a weak habit,  that  this
difficulty occurred.t   It is not however probable,  that  this

  § By a reference to the tables I have drawn out of  the first  fifty
cases which came in order under my care, it will be seen, that many
attempts were made with old infection, in order to afcertain how  long
it might be preserved.  I have therefore I  believe, failed  more  fre-
quently than others who have invariably employed recent matter.  See
the last note of the tables.
  * Dr. Rollo mentions a child having been vaccinated ineffectually,
who ten days before had also been inoculated for the Small-pox with-
out success.   Ring, p. 124.
  f See cases  9 and 30 of  the tables, far exceeding those mentioned
by Mr. Ring. 
*3
 Weakly constitution should alone be the cause f  as indepen-
 dently of my having succeeded frequently in the first attempt
 on weakly children, many of my patients in whom it failed,
 were by no means to be classed in this description. Although
 we cannot account for it, the fact remains certain," that one
 person more readily receives this disease (as well as other
 diseases), than another; and that this disposition varies in
 the same person at different times.
   The appearance of  the  speck of inflammation indicating
 the success of the operation is also very various.  In gene-
 ral we may very accurately perceive it about the  commence-
 ment of the third  day.  In several cases 1 have however ob- ,
 served it  evidently early on the  second day,  or  between
 twenty-four and thirty hours from Vaccination.   1 speak
 here only of such cases  which  actually succeed, for some-
 times a considerable inflammation takes place in a few hours,
 with great itching, and even an elevation  of the cuticle as
 if a pustule was commencing.   Where this occurs, we may
 almost invariably, perhaps always, predict  the failure of the
 attempt.  This  is likewise generally the case in the small-
 pox, when the system is disposed to reject it.  This species
 of local irritation  I have experienced repeatedly, in the at-
 tempts I have made to produce  the-Vaccine a second time
 in myself; but which have hitherto failed; the  inflammati-
 on disappearing  about the fourth day.*
   It sometimes  happens  that the disease instead of becoming
 perceptible at this early period, does not shew itself till a ve-
 ry late date.   In the Medical Review for April  1800,   Mr.
 Taynton gives  the case of  an infant, in which no appear-
 ance of success took place till the twelfth day;  from which
 time it ran its course very  rapidly.   In the Medical Journal
 for May 1800, the Rev'd. Mr.  Finch gives an  instance of
 the pustule not appearing till the eighth day; and in another-.
 not till the fifteenth.

  * Since writing the above, I have succeeded in exciting a spurious
pustule. See the tables, case i. 
24
   Doctor Cappe says, cases have occurred, in which there
has been no appearance of a vesicle till the ninth day;  and
Mr. Ring has known two instances in which  it did not ap-
pear till the fifteenth day; an 1 on?,  not till the sixteenth.
" It is however certain  (says Mr. Ring, p, 339) that in
many cases the disorder makes a greater progress by the se-
venth day, than it does in others by the twentieth."*
  The Medical Committee of Rheims  mention the delay
of the appearance of  success- in Vaccination as far as  the
twenty-second day.   See Husson's Jiecherches, p.  29.
  By referring to case 6, in the tab;es, an  instance will
there be seen of this dormant state of the Vaccine virus for
eighteen days.  The Rev'd. Mr. Holt in the Medical Jour-
nal for 1799,  mentions a curious fact somewhat analogous.
" 1 inoculated, says he,  near  thirty, twice or thrice,  appa-
rently without effect, allowing an interval of five or six days;
but though they sickened from the last incision,  a pustule
regularly appeared wherever I had formerly inoculated them,
as if the dormant matter had been roused by the activity of
that last inserted."
  I may add  to this,  that I have since met with three or
four cases in which the previous Vaccination came on, after
a weeks interval, upon the successful progress of a second
attempt.
  The same variety exists in  the Small-pox as in the Vac-
cine before success is apparent. Dr. Odier  of Geneva men-
tions seventeen days;  and Mr. Ring (p. 3,83) -.'.sserts that
cases have occurred,  where  the symptoms of inflammation
have not appeared till twenty-rune  or  thirty days after the
operation.
  As the appearance of inflammation, indicating the infec-
tion having succeeded, varies  so considerably, .,o also does
the advance of the pustuie,  now commencing us progress.
In most cases a fluid cannot be distinctly perceived till about

  * Where the pustule does not appear as early as usv d,  its progress
is generally more rapid. 
H
the fifth day.  I have however had one instance in which I
not  only perceived,  but actually  obtained  matter  on  the
ninety-third hour from  the  period of Vaccination.   As  I
obtained if, without any  difficulty, I concluded I might have
discovered its existence  six  or eight hours previously,  or
three days and a half from inserting the infection.*
   From what has been previously stated of the great variety
in the progress of this disease, it may be readily concluded,
that no absolute number of days from Vaccination can be
fixed on, for taking the matter for future practice.  I have
taken it in one case from  the eighth  to the fifteenth day
inclusive;  from another, a patient of Dr. Hewson's,  I pro-
cured matter on the eighteenth day, with which I produced
a most perfect disease.   I must however  mention, that the
progress of the Vaccine in the case of  Dr.  Hewson's  above
alluded to, had  been suspended by the  measles. As this
ease is considerably interesting, I have Dr. Hewson's per-
mission to make the letter public which contains the detail.

   "  Dear Sir,
          "  On  Friday the  17th of December last,  I ob*
tained on the point of a lancet, some  of the Vaccine virus
from  Mr.  M 's child,  and  having previously  moistened
the  same  with  a  small  particle of  water,  I  inoculated
Sarah Wattles aged ten months,  and Maria Wattles aged
twelve years. ^This was the order of the inoculation, which
I have thought  worth noticing, as in Sarah Wattles it did
not succeed, but in Maria Wattles, where I was obliged still
further to dilute the matter, the  inoculation took effect.
   "  On Thursday  the  23d,  (the seventh day)  examining
Maria Wattles'  arm, I discovered a  small limpid  vesicle
at the place of inoculation ;  the skin immediately surround-

  * In this case the pustule did not advance  more rapidly than usual
to its termination.  On the contrary I  obtained matter till the tenth
-lay inclusive, when the areola began its career.  Case 43* 
26
 ing this vesicle was of a fine vermillion colour, and hard to
 the touch.   The mother informed -me,  that she had ob-
 served some signs of  inflammation the day before, when  I
 had omitted to visit the child.  The  vesicle gradually in-
 creased till Wednesday the 29th, (thirteenth day)  when I
 perceived a small scab in the centre.   I immediately inocu-
 lated  with the matter taken from this child, the children of
 Mrs.  Levis, Maria, Sophia, and  David,  occupying the up-
 per story  of the same house   These children were brought
 down stairs for the purpose.
   "  Upon repeated inquiries I never could learn,  that the
 child  suffered any general indisposition until the evening of
 Tuesday  the 23th, (the twelfth  day)  when she was seized
 with  sickness at her stomach and frequent vomiting.  These
 symptoms continued the next day, when 1 found  the  skin
 hot and dry,  and pulse frequent;  I could not ascertain the
 number of strokes in a minute, the child  being very restless.
 I ordered  some antimonial wine as an emetic to be given in
 the evening,  and requested the mother to give her the infu-
 sion of senna the following morning as a cathartic.
 .  " Tuesday the 30th,  (fourteenth day) the medicines have
 operated freely; the child still continues fretful, and has con-
 siderable fever.  The scab is nearly formed.  I directed ten
 drops of antimonial wine to be given four times a day, mild
 diluting liquids ro be drank freely, and the child to be  kept
 moderately warm.   On  Sunday the  19th of December,
 (third day of Maria W's.  inoculation) Alexander Wattles
 about eight years old, had brought the measles to the house.
 Delia Wattles  had taken them on Saturday the 25th;  and
 S. Wattles lay at this  time in the  cradle with all the symp-
 toms  of the measles.   These  circumstances led me to sup-
 pose Maria's indisposition to be the  same disease;  and  this
 opinion was strengthened by the appearance of an efflores-
cence on Friday the 31st,  (hfu-endi day).  It was not till
 Sunday the 2d of January, that any pustules appeared. They
were  confluent  and left no doubt  of the  disease' being  the
small-pox.  The pustules  began to dry on Tuesday the 
27
4th of January, (nineteenth  day of Vaccination) and the
child went regularly through the disease.
   " 1 have already mentioned that I attempted to inoculate
Sarah Wattles with the Vaccine virus.   On the third  day
from inoculation 1 observed a small purulent pustule which
disappeared on the fifth.   She took the measles as  related
above.   She had but just recovered of this disease, when,
to wit,  on Thursday the 6th of January, she was covered
with a scarlet eruption, which I apprehended to be the small-
pox.   This though of the distinct kind, never filled proper-
ly, and at last proved fatal,  carrying her off on the seventh
day.
   Two of Mrs. Levis's  children, Sophia and David,  took
the Vaccine infection from the first inoculation.  On Tues-
day the 4th of January, (seventh day) I found them setting
with Mrs. Wattles'  children, the mother wishing them to
take the  measles.   My  anxiety was  very  great lest they
might take the  small-pox.  On Tuesday the 1 lth of Janua-
ry being the fourteenth day after inoculation,  Sophia Levis
had a slight eruption on  the face and  breast,  a dry husky
coupfh, and a considerable flow  of tears; the disease  was
very light.   In this child the areola which usually accom-
panies  the Vaccine  disease  did not appear till the nine^
teenth day after inoculation.   It was on the eighteenth day
that you took some matter from the pustule, and you  will
recollect that there was  then no appearance  of an  areola.
Upon inquiry I learnt, that you succeeded with this matter
in giving the Vaccine disease.
                "  With  great respect and esteem,
                          " Yours,
   April 30th,  1802.        "  Thos. T. Hewson."

   I believe the testimony of most Practitioners, is in favor
of obtaining the matter as early as possible to insure success,
as it is then supposed to  be  in its most active state.   At
what point we must  stop, seems as yet to be undetermined.
Dr. Odier, of Geneva,  has considered it as most proper to. 
28
 be taken when the efflorescence is complete ;  whilst the il-
 lustrious author  of  this  important discovery,   considers
 this efflorescence as a  " sacred boundary beyond  which the
 lancet  should not pass."   Again, Dr. Cappe, and others,
 consider the matter as proper for Vaccination  as  long  as  it
 continues limpid;  and by others we are recommended to
 take the matter on the eighth day, or eight times twenty-.
 four hours from the period of Vaccination : 1 have as above-
 mentioned,, taken matter,  in a case of the most perfect ap-
 pearance and regularity, on the fifteenth day,*  when the
 areola had nearly declined; this I have done  in several in-
 stances-, from one I took it on the twelfth day,  when  the
 areola extended perhaps full three inches from the pustule,
 which was beginning to decline.  (Case 22.)   These  may
 suffice to shew its safety, where the matter continues  lim-
 pid, and the scab has  not  too  far advanced.   Dr. Cappe
 says, Dr. Woodwille informed him  " he had twice inocu-
 lated on the thirteenth day  from patients,  in whom the di-
 sease was so far advanced,  that he could only obtain a little
 moisture from the margin of the scab; yet he  was success-
 ful/'
   Were we to consider the presence of the areola, as the
 point beyond which we should never infringe,  we should in
 frequent instances  be  unable to  decide:  How are we to
judge when  this  " sacred  boundary" does not  exist,  or
 how can we properly  estimate its appearance  in  the  dark
 skin of an African ?  As a general rule I think it may proper-
 ly be retained; but we shall all,  probably,  in  our practice,
 find exceptions to it.   I should rather be disposed to adopt
 as a rule in taking the matter, that idea which  restricts it to
 the eighth day.   I speak  of those cases  which advance
 with due regularity; because this day embraces usually the
most tardy, and most rapid  cases.   It will also  for the most
part be in unison with  the former; but to this we shall like-
wise find exceptions,  as the areola sometimes commences
f See p. 25. 
29
on the fifth, sixth, and seventh days.*   Although I would
prefer taking matter at an early period  of the disease;  yet
my opinion, formed from the few experiments I have made
on this point, leads me to conjecture, that when  the pustule
has exhibited the character of the real Vaccine, no danger
is to be apprehended from using the matter, even  although
the areola be formed,  provided  the fluid  continues  limpid,
and the scab has not too  far advanced:  I  should never hesi-
tate  to  employ such matter,  especiallv if none  other offer-
ed.§


   * If the pustule runs its regular course, though quick,  it is a per-
fect preservative.   And why should not this, be the case  as well as
when its progress is preternaturally slow ?  Husson, p.  29,  mentions
the areola on the eighth day.   If the areola always existed,  and  if its
actual presence could  be  always detected, I think that it would be
the most accurate  criterion ; but as this is not the case„so neither fliall
we find the disease on  the eighth day in many successful cases, suffi-
ciently advanced to procure infection, see p. 23, 24. of cases not ad-
vancing even  as late as the twenty-second day:  Hence  the  difficulty
of  fixing on any point of time, which shall be exempt  from any ir-
regularity.
   § In the Medical Repository, Vol. V. p. 348, in answer to an in-
quiry on the necessity  of establishing a point of time  for  taking the
Vaccine infection, Dr. Waterhouse considers the limpid state of the
matter as a fallacious criterion ; giving as a reason that " in the rising
cf a vesicle from almost any  cause, the scarf-skin separates  from the
true, and a portion of the superfluous ivater of  the blood,  and some-
times of the coagulable lymph, is found under it."  He adds, " I have
known this limpid fluid exude in considerable quantity from the Vac-
cine pustule that has been too much irritated by pricking, and exhaust-
ed of its virus.  It gives a fhining, glazy appearance to the thread."
1 cannot however  acquiesce in this reason, because  I  cannot suppose
any other vesicle is likely to  be taken for the Vaccine ; at  least when
it is more generally known.  I do not think it probable that any per-
son acquainted with the Vaccine would be liable to err on  this point.
And I must confess I  do not feel satisfied with  the idea that the lim-
pid fluid exuding  from the Vaccine pustule, which has been  too much 
3°
   In the quantity of matter to be obtained from a patient
in this disease, great variety exists.   In a disease consisting
for the most part of a solitary pustule, it may be concluded,
that in general, it does not amount to  any large  propor-
tion §.   In several instances, where from the beautiful  ap-
pearance of the pustule I  had  anticipated  the procuring  a
considerable quantity of matter ; I  have scarcely obtained
Sufficient to moisten the point of my lancet.  This was the
case with one of the most perfect pustules 1  have seen,  al-
though previously to its scabbing,  I think it was upwards of
one third of an inch diameter   (See Case 38).  In  other
cases however, a pock of less diameter than a small pea||  has
yielded much more matter than it appeared to me to be  car-

irritated by pricking, has been exhausted of its virus.  How  are we
to determine the point at which we should cease to irritate the pustule
by pricking it ?  I have not hitherto found the effetl alluded to,  nor
do I apprehend much danger from it.   If the matter is taken away
incautiously,  and unnecessary irritation  is employed, I can suppose a
change in the properties of the secreted fluid.   I have  mentioned a
case in, which I obtained matter daily from the seventh to the fifteenth
day, or above a week ; in  which the areola had nearly subsided be-
fore my last attempt j yet,  with perhaps forty or fifty punctures, the
lijatter continued good to the last, as I proved by its efficacy, thirteen
days after having been taken,  in producing a disease which effectually
guarded against the smali-pox.
  A thread when fully impregnated with  the Vaccine infection, has
always to me had a shining glazy appearance. ' A moderate solution
of gum arabic will give an accurate idea of the Vaccine infection, on
glass,  on a lancet, and on  thread.   (See its Analysis, p. 32.)
   Although I thus differ on this point from  Dr. Waterhouse,  I am
satisfied of the propriety of establishing eii,ht times twenty-four hours
as the point of time for taking infection.
   § Although in most cases only a single pock appears, yet now and
then one or more besides,  occur.   See  case n. 34, 42.
   || Dr. Husson says he has seen a Vaccine pock not larcer than a pin's
head ;  but which produced in another a pock of the usual size.  The
(fuantity of infection is by no means dependant on the size of the pock. 
3'
pable of containing at one time ; which satisfies me of the
propriety of the  opinion of Dr. Cappe, that it  is  partly
supplied by secretion.  It will often continue to  exude for
a considerable time from the small punctures made in the
vesicle.   One case I met with, in which the pustule, with-
out being of uncommon magnitude, yielded sufficient mat-
ter to coat over a piece of glass, equal  to  about a square
inch, three or four times amply, and to imbue completely a
thread of more than a foot in length.   Upon a  moderate
computation I should  suppose it yielded enough to have vac-
cinated two hundred  persons (See case 25).* In some few
cases 1 have obtained matter five or six  days successively ;
and in the one above  mentioned, eight days ;  whilst  others
have yielded it only one, or at most two days.  It is there-
fore of the highest importance to pay great attention to se-
cure the matter at the proper time,  and never to  suffer an
opportunity of taking it to pass.   From inattention to this
point, I have heard Physicians asking for Vaccine infection,
who but a week before, had  said they had  under  their  care
several cases in the finest state for taking it.   Their mode
was simply  to depend on the quantity they obtained on the
point of a lancet,  for a succeeding Vaccination.   This is
not the method to secure so perishable an article.    Phy-
sicians will  without great attention, have to lament its loss
when they most desire to employ it.   I  shall in a  future
part endeavour to  point out the best mode  of preservation.
   I cannot perhaps in anv part more properly than  here,
introduce a  chemical  analysis of  the  Vaccine matter  made
by citizens Husson and Deputren, and given to  us in Dr.
Moreau's " Historical  and  Practical  Treatise on Vaccine
Inoculation."  (See Ring p. 790.)  This Analysis although
ingenious, does not seem  likely to  be of any practical ad-
vantage.

  * I supplied upwards  of twenty Physicians with matter from this
case alone.—-I might  have procured much more from it, if ieisure had
permitted- 
3^
  " When  exposed to the air,  it  readily dries, without
losing its transparency.    It acquires the hardness of glass ;
and forming a scale, adheres like a  varnish to  the  surface
upon which it is applied.   It oxydates iron.   If left to dry
in the Vaccine vesicle, it forms  itself into small and  hard
globules.   When liquid, it readily dissolves in water;  and
when solid it enjoys the same property.
  " When  exposed to heat, it  presently becomes  turbid ;
exhales a slight  odour  of carbonate of ammonia ; and is
soon converted into a light cellular charcoal.    It produces
no alteration in the colour of syrup of violets ; nor  in  that
of tincture of turnsol.
   " When tried with alkohol,  nitrate of mercury, nitrate
of silver, or nitric acid, it affords a white precipitate; which
will neither dissolve in potash, nor in the  muriate  of Am-
monia.   The concentrated sulphuric acid,  oxalic acid,  the
vapour  of oxvgenated  muriatic acid,  potash,  barytes, and
muriate of  ammonia, neither produce the least action  upon
it; nor  alter in any manner, its external qualities.  It seems
t©' consist of water and albumen; of which the proportions
are not known."
   To this I may add, that it does not appear to me to pos-
 sess any taste; though it seems to have the  glutinous sen-
 sation of a gummy solution, leaving a slight degree of that
 asperity on the tongue, which is produced by unripe fruit.
   With respect  to the constitutional effects in this disease,
 there is considerable difference in time and degree.   In in-
 fants as far as I have seen they have been  almost invariably
 light.   Indeed in  several instances  I  have been unable  to
 ascertain the slightest indisposition.   Even in  a variety  of
 instances where they were  teething,  or  had  slight  com-
 plaints of the bowels,  the symptoms did not appear to me
 to be greater, than might reasonably be ascribed to the ac-
 companying irritation.
    Dr.  Jenner has recorded (p.  137) that  the Vaccine virus
 was inserted  into the arm of a child about twenty hours old,
 who went through die disease without apparent illness, ysit 
33
was found effectually to resist the action of variolous mat*.
ter with which it was subsequently inoculated." I vaccina-
ted my youngest child when only three weeks old, in whom,
although the areola extended nearly  from the  shoulder to
the elbow,  I discovered  no marks of  indisposition  during
its progress ; yet he has withstood the  variolous action in
three  successive inoculations by six punctures, as well as by
exposure to a man labouring under the  Natural Small-pox.
1 cannot however, though so fully acquiescing in the truth
of the benignity of this disease, accord  with those gentle-
men who consider the constitutional disease by no means
essential to the permanent efficacy of the Vaccine.    It ap-
pears  to me an absolute truth, that a constitutional affection
must  occur, however slight it be, to produce the  astonish-
ing change we find effected in the system.     It seems ut-
terly  impossible a  mere local disease  could suffice to produce
this general effect.  I shall however extend this argument by
stating, that the Revd. Mr. Holt, in  the Medical Journal for
December 17.99, has mentioned the cases of William Neil of
ten years, and  Hannah Beal of six years of age,  who had
each  above one hundred pustules in  different parts  of their
bodies, which assumed precisely the appearance  of that given
by inoculation, except that they were  smaller: no com-
plaint of more than ordinary indisposition was made in ei-
ther case."    Eight children vaccinated from the matter of
these pustules had the disease in the mildest form.   These
cases, whilst they evince the mildness of the Vaccine, shew
the existence of a constitutional  affection,  without which
such  a general  eruption could not have occurred.   I have
met with one  case in which ahout the eleventh or twelfth
day,  a true Vaccine pustule formed upon the inside of the
right knee: now  there  can scarcely exist a doubt in this
case of a constitutional affection; yet  it was so very slight,
that,  except the pain of the  axilla,  it was not to be percei-
ved  (case 42.)    On these cases then I would ground my
                 [ 5  ] 
34
opinion, that a constitutional effect must  take place, to  se-
cure the system from future danger of Variolous infection.*
   This fortunate exemption from, or rather moderation of
febrile action, is however,  not  universal.   In  various  in-
stances, even in children,  the  symptoms  are  considerable,
tho' rarely sufficient to produce alarm.   The pain  arising
from the inflamed  and  tumid state of  the axillary glands,
■in many instances is considerable for a day or two, or even
longer;  tho' where it  exceeds a moderate degree, it  ap-
pears generally to depend on  the  too  free use  of the arm
whilst the glands are  in the above state;  and  hence it usu-
ally is greater in adults than in children,  because they
are unwilling to suspend their daily occupations.    This is
not however always the case, for we often see examples of
continued labour, without the slightest  increase of the con-
stitutional affection,  even when this is apparent.
   When the pain of the axilla exists, I have generally  ob-
served a pain of the part vaccinated,  extending  upwards to
the axilla, as if in the course  of the lymphatics.   This pain
is sometimes very considerable,  being accompanied'with a
burning or stinging sensation,  and with  more  than usual
tumefaction  and hardness of the surrounding cellular mem-
brane.
   The absorption of  the virus differing  as we have seen
very materially in  different people,  it  may reasonably  be
supposed,  (as really is the case) that considerable variety ex-
ists in the commencement of the axillary inflammation and
subsequent indisposition.   It is in the actual state of inflam-
mation of the axillary glands, that animpiudent use of the

   * No one I  believe will doubt the necessity cf a general affection of
the system in the small pox, to secure it against a future attack : most
Practitioners must have either seen, or read of cases of a perfeft local
variolous pustule, whicfo by  no means proved a preventive to the fu*
ture attack of this complaint.  I shall in a subsequent part give some
very strong instances of a second  attack  of small pox, neither of
which were merely local; but attended by every requisite which ca»
prove a constitutional affection. 
3$
arm may tend to prolong the disease;  and hence 1 have seen
the pain continued for full three weeks;  accompanied with
considerable tumefaction of the arm, and a blush of inflam-
mation, extending to the wrist and above the elbow.
   The febrile symptoms vary very considerably.    I  have
already mentioned that in some persons, especially children,
they are not evident; whilst  in others, the disease hasbeea
accompanied with all the intermediate grades of drowsiness
and head ach, up to chills,  pain  of  back and limbs, and
even nausea and vomiting.  This  is  seldom the case ; so
seldom  indeed, that I must confess, I believe with  Dr. Jen-
ner, these violent symptoms arise not necessarily from the
disease, but  from the accidental  irritation and consequent
inflammation of the vaccinated part.   In  confirmation of
which I can safely  affirm, the only  considerable cases of
fever I have met with in this disease,  have  arisen  after the
tenth and twelfth days; when an ugly sore has been induced  *
by rubbing off the scab in its forming  state, or great in-
flammation  has  taken  place by  the  irritation  of  rough
clothes, &c.   Previous to this, a moderate  degree of febrile
indisposition  and axillary  inflammation  was all  that  was
complained of;  whereas at this period,  great fever, head
ach, pain of back, nausea and vomiting, took place. I shall
have occasion shortly to say more on this point; I shall on-
ly add at present, that this occurrence  is not uniform,  even
when continued irritation would lead us to  anticipate the
most disagreeable effects.   In one case of  a  black child of
about a twelvemonth old,  about  the  fourth day, the  apex
of the small pustule  which was forming was rubbed off,
and this was successively the  case every day or two, nearly
seven or eight times, owing to her tight and rough clothes.
She had a slight indisposition on the eighth day with pain
in the axilla, the former of which I ascribed to her teeth,
three of which came through at this period, and  though  I
fully expected a  disagreeable sore,  yet by the sixteenth or
eighteenth day it was nearly dried away, without producing
any inconvenience.   About a month after this, I inoculated. 
36
the child for the small  pox, under  a firm persuasion  that
she would take  the infection ; the three  punctures 1 made
inflamed slightly,  and advanced  to the  state of pustules,
which never  completely  maturated, but  dried away about
the eleventh or twelfth day, without producing any erupti-
on, or any febrile indisposition (case 18).
   From the earliest appearance of the pustule, a slight de-
gree of inflammation surrounds its base.   This scarcely ap-
pears to enlarge, except  from accidental  irritation, till to-
wards the close of that period  when  the  constitutional
effects seem subsiding,  and which  in most of the  cases  I
have seen was on the tenth day.    At this period it begins
to augment pretty rapidly ; in some  instances,  it has  not
diverged from the tumour more than half an inch,  whilst
in others it has extended from two  to four, five, and nearly
six inches.   This inflammation, known by the name of the
efflorescence and areola, is mostly of the same circumscribed
circular appearance of the pustule,  but at  times it diverges
unequally.  Its  existence does not seem to be  essential to
the perfection of the disease, although its presence is  desi-
rable, from its being most frequently present.  It was for a
considerable time regarded  as  a  proof of the certainty of
the constitutional influence of the  disease on the system;
which, without its  presence was viewed as a  mere  local
affection.  Mr.  Ring however expressly mentions, that he
has  known  " several cases where there was  a total ab-
sence of  areola," yet in none had  he known  the  patient
capable of receiving the infection of the small pox.   I  have
seen two cases of this kind, both  of which have since  been
ineffectually inoculated for the small pox ;  so  that I feel
perfectly assured of the efficacy of the Vaccine, even when
 unconnected with this peculiar appearance.
   1 have stated  that the areola does not always occur : I
have also remarked, that a  moderate degree of inflamma-
tion, surrounds the base of the tumour from  its  commence-
ment, even when no areola follows.  As these  two grades
therefore seem  totally unconnected, although  the areola 
37
when it takes place, appears only to be an extension of the
former, I have occasionally noted it down under the name
of the secondary inflammation,  to  distinguish it from the
primary  or  permanent one.  The  induration of the sur-
rounding skin is more or less considerable as the areola ad-
vances, and generally declines as the efflorescence recedes.
I have already mentioned the difficulty of ascertaining the
presence of the areola  in the black  skin of the African •
In the mulatto it  is in most cases  sufficiently evident.   I
have  always considered  the above  mentioned  tumefaction
and induration of the surrounding  skin as the sole criterion
of its existence in the  negro.  As I have met with seve-
ral instances of the absence of this state of the skin in the
negro, I have considered it as evincing the non-existence  of
an areola.   The two cases  above  mentioned were  white,
in whom I could make no mistake on this point: I leave
it to  be verified therefore, by those whose greater sources
of observation on the negro, may qualify  them to deter-
mine it.
   As I have seen cases  in which   no areola  existed, so I
have also met with several instances, both of its early and
tardy- appearance.   The early advance, as mav be supposed,
is in  those cases which have been  followed rapidly by the
subsequent  changes.   This was remarkably the case in my
own  person.  By the commencement of the fifth day, two
very  fine pustules were progressing, with an efflorescence of
nearly one fourth of an inch, at which period, I experienced
considerable head ach and  drowsiness ; on  the  sixth  day,
these symptoms had augmented, and shooting pains, ex-
tending from the pustules to the axilla, were  plainly per-
ceived.   The axillary glands were  slightly enlarged.   The
efflorescence had advanced considerably, with slight tension
and tumefaction of the parts.    By  the eighth d;.y the areo-
la was between two and three  inches  in  extent from the
 pustule, or about five inches in diameter ; by the 10th day,
 or the usual time  of the areola forming,  the pustules were
 nearly scabbed over, of a dark mahogany colour;  the efflo- 
38
rescence had gone entirely by the twelfth day, and  one of
the scabs fell off on the fifteenth, and the other on the  six-
teenth day, both  leaving a second scab beneath, which fell
off on the twenty-third and twenty-eighth days.
   Another instance came under my notice, of a child whom
I vaccinated nine times before infection took place (case 9).
From this child on the seventh day I obtained matter.   On
the 8th a scab was forming widi a slight areola, which  was
perceptible the preceding day.   About  the  sixteenth  day
the scab fell off, leaving another beneath.  On the twenty-
first day I inoculated her in two places with variolous mat-
ter, taken the preceding day from a patient labouring under
the natural small  pox.   The punctures slightly inflamed for
three or four days and then gradually dried away.  It is re-
markable in this case, that the matter I employed for Vacci-
nation  which took effect, was taken on the eighth  day
from a child, in whom  the areola did not  occur till  the
eleventh ; which  last  case  was vaccinated  with  infection
taken on the  eighteenth  day of the disease,  one  day only
antecedent to the areola.*  In one other case the areola be-
gan on  the seventh day, and by the ninth was nearly gone,
the scab being partly formed (case 42).   It may not be un-
interesting to add, that this case I vaccinated with  infection
taken  from  a secondary pock on the  arm of her sister,
about two inches  above the original one,  on the twelfth day
from vaccination, and the third or fourth of its appearance.
About the tenth  or eleventh day, a Vaccine pock  appeared
on the inside of the right knee.   This  case I have  before;
adverted to, and these are the  only two  cases  I have  met
with, of any other pustule than on the  vaccinated part;  I
except the appearance  of pimples which are not uncom-
  * I notice this to prove, that the  early or tardy appearance of the
disease, does not influence such as are produced from its infection* 
39
mort,  and  which  probably  may depend on  the  Vaccine.
Variolous inoculation failed in this instance.f
   1 cannot tell the latest period of the  appearance of the
areola.   I have mentioned a case above from  which I took
matter on the eighteenth day, at which time the areola ap-
peared just commencing  (Dr. Hewson's letter, p. 27).  I
have seen it several times as late as the twelfth day.
   It might be supposed the efflorescence would occur quick-
ly, in proportion to the rapid progress  of the pustule,—but
this does  not seem to be  the case.   In the instance formerly
noticed as yielding matter on the latter end of the third day,
the areola did not commence till the tenth day; nor did the
scab complete itself before the usual  period.   Case 43.
   The heat of the vaccinated part appears to be considerably
augmented ; how much  the thermometer would indicate, I
have  never tried.  A more  troublesome attendant on the
areola than the heat, is a violent  sensation of itching.  It
is of a burning stinging  kind,  resembling I think  the  sting
of nettles; and requires the utmost exertion to avoid scratch-
ing.   This itching sometimes extends several inches.   It is
generally bounded by the circumference of the areola,* and
is one of  the most unpleasant symptoms,  though not always
equally violent;  in children it has to me appeared a chief
  f In one case which came under my care, aft inflamed circle com-
menced about the beginning of the fifth day, extending by the evening
to nearly an inch from the pock ; but by the evening of the  sixth, it
bad totally disappeared, and the true areola did not commence till the
close of the eighth day.  I could not ascribe this appearance to any
particular cause, and it is the only instance of the kind I have seen.
  * Though it is generally towards the close bounded  by  the extent
of the areola,  yet we find it occasionally appearing at an earlier peri-
od, as the fifth, sixth, seventh, &c. days, before the areola had com-
menced, and extending then to two or more inches from the  pustule.
Perhaps the extent cf the itching may generally denote the future ex-
tent of the areola, as I have noticed in several instances. I have see*
it decline before the areola commenced. 
40
caus-^of their fretfulness and anxiety, even when the febrile
indisposition appeared but very trifling, f
  In addition to the varieties existing in the appearance and
magnitude of the areola, its continuance may also be men-
tioned, as differing  in different persons.  It mostly however
begins to recede about the twelfth or thirteenth days; com-
mencing frequently from the centre, and  gradually, advan-
cing to the circumference, so as to leave a ring of inflamma-
tion at some distance round the pustule.   The declension of
the areola is nearly as rapid as  its progress, leaving the  skin
for a short time of a dingy hue;  at least I  have repeatedly
seen it. J  A desquamation  of  the cuticle  to the extent  of
the areola generally follows.
  The change of colour which takes place in the centre  of
the pustule  about the close of the tenth day, in consequence
of the contained fluid beginning to dry away, indicates the
commencement of  the process of scabbing, which  is mostly
complete in two  or three days; that is to say, a darkish hue
has by this  time extended over its surface.   The pock  gra-
dually hardens,  becoming of a dark brown,  mahogany,  or
chesnut colour, exhibiting a fine polish and of the same cir^
Cular, or oval, appearance with the pustule.  In about ten
days or two weeks,  if it is not previously rubbed off, the  fluid
below having been  totally absorbed, the scab begins to sepa-
rate at its circumference from  the surrounding skin; it  then
soon falls off, leaving the skin below perfectly sound, though
mostly with a depression or pit.  In some cases the scab falls
off before the fluid  is perfectly absorbed, leaving consequent-
ly,  a surface not completely healed, on which a second and


  f  This  itching frequently continues troublesome although lead
water or other cooling applications be employed.  I have lately recei-
ved a letter from England, in which I am informed, bathing the  in-
flamed part with rectified spirit  of tvine, or  ardent spirits, has suc-
ceeded immediately in removing it.  I have not yet tried its efficacy.
  % Sometimes the areola declines in such a manner as to leave an
external ring of inflammation, and an internal one adjoining the pus-
ule.  (See the plate, twelfth day.) 
4i
 sometimes even a third and fourth scab successively  form,
 without any inconvenience or uneasiness.
   It sometimes  happens,  as I have  before stated to have
 been the case with myself,  that the scab forms  at a  much
 earlier period, even so soon as  the seventh and eighth days:
 it faMs off" proportionably early.   In  other cases  no disposi-
 tion to form a scab exists as late as the fifteenth, sixteenth,
 and seventeenth days; even though the areola had commen-
 ced at the usual period, and continued not  longer than is
 common.   In the case I several times have adverted to (case
 26) from  which I obtained matter on the fifteenth day,  the
 areola appeared on the thirteenth, but  less regular  than usual,
 on the fourteenth day the patient exerted himself very con-
 siderably at a fire  in handing buckets, after which  a  red
 streak of the size of his finger was very conspicuous, run-
 ning from the pustule to the axilla (doubtless exhibiting the
^course of a lymphatic), but not accompanied with any pain:
 on the fifteenth the areola was nearly  gone, but there was no
 appearance of a scab.  The pustule all this time was increas-
 ing,  being at this period very nearly  half an inch in diame-
 ter.  On  the sixteenth a scab  commenced,  which did  not
 come off till the fifth week from vaccination, and then left a
 second scab below:  I  might have procured matter two or
 three days I believe longer than I  did, but I was fearful of
 inducing a spurious disease.*   In another  case  the  areola
 commenced about the eleventh day, continuing the twelfth,
 thirteenth,  and fourteenth,  during all which time the pus-

  * With this matter I vaccinated 3t the same time two  children, in
one of whom the scab did not form till the fifteenth or sixteenth day,
when the pock was nearly half an inch in diameter.   In the other the
scab progressed at the usual time (see case  33, 34.)  All these facts
convince me that perfectly limpid matter from a perfect pustule may
at any time be taken before the scabbing commences.  I do not how-
ever mean to recommend it.  One thing is  remarkable in the  above
cases ; that the matter failed in both, in the  first attempt,  when it was
eight days old, but succeeded in the  second  attempt five days later.
                 [6 ] 
42
tule increased considerably,  alid continued  so  to  do till the
seventeenth day, when it was more than one-third of an inch
in diameter; it now began  to  scab, and rapidly increased.
In this case I tried to obtain matter from the pustule previ-
ous to the commencement of the areola, but it was scarcely
enough to moisten the point of my lancet,  though  the pus-
tule was as beautiful as I have seen.   1 did not try after the
areola commenced; but I apprehend I might  have secured
some on the fifteenth and sixteenth days.
  These appear to be the varieties of the  regular  disease;
I must not however omit to mention  that I have met with
several cases, in which from five or six, to twenty or thir-
ty  small  pimples  arose in  the vicinity of the vaccinated
part,  continuing for about three days, and then gradually
declining without  filling with any fluid.  I considered them
as arising from  local  irritation.  It is mentioned  by Ring
and others as occasionally occurring. J   Whether they ever
fill, and assume a  Vaccine appearance I know not, but ra-
ther imagine this  to be the  case;  in case 34, on the ninth
day several little pimples  broke out  about the  vaccinated
part and above  it.   By the twelfth day they all had disap-
peared but three,  of which  one assumed the  true  Vaccine
character; from it I transferred the disease to another per-
son.  It is to be noticed that these secondary pustules  ad-
vance rapidly to their acme, and  as rapidly decline.  The
above-mentioned pustule had a scab nearly complete by the
termination  of  the fifth day.  Although the Vaccine erup-
tion,  independently of the local pock,  is a  very rare occur-
rence, yet sufficient proof exists that such an eruption occa-
sionally takes place. The above case is in point.   The child
vaccinated from it, had also a true Vaccine pock on the right
thigh. These are  the only cases I have seen;  but President
Jefferson in  his  letter to Mr. John Vaughan mentions two
or three of about two hundred cases,  who had from two to

  X These are the same kind I apprehend which are mentioned by Dr.
Jenner (seep. 13), and  which  are represented in the  plate on the
tenth day. 
43
half a dozen pustules  on the inoculated arm  only.*   The
Rev'd.  Mr. Holt I have mentioned above as giving two ex-
traordinary cases of above one hundred pustules each, (see
p. 33.)  As for the pustules which appeared in London at
the first introduction of the disease, little doubt is now en-
tertained of their having been variolous.  Dr. Woodville is
I believe entirely of this opinion at present.   It  does not
appear, that the infection of the true Vaccine pustulous cases
is more disposed to produce a violent disease than  if taken
from the local pustule.
   In two or three instances in infants,  about  the  sixteenth
day,  I  have noticed a  few minute pimples or specks on the
face and neck,  resembling flea-bites which gradually  disap-
peared ; whether they were any way connected with the Vac-
cine I cannot say.   I  have seen also about the same period
a nearly similar eruption, but more numerous upon the head
of an infant of two months old, which appeared to be attend-
ed with considerable itching: it declined however  in a few
days.   I do not think  these were any more than accidental
concomitants of the disease.   I have seen a similar  eruption
on the  twenty-first day, and on the fifteenth,  in two chil-
dren vaccinated on the same day  and with the same matter.
An eruption on different parts of the body, as a scarlet efflo-
rescence, has also been mentioned by some authors.  I have
never seen it.
   Having  thus given as concise a view  of the origin, as also
of the general appearance, the progress and the varieties of
this extraordinary disease, which have come under my own
notice,  as was in my power.  I shall say a few words  on
the medical treatment.
   " Much of the hazard incurred in the small-pox is owing
to a larger eruption upon the skin than the constitution can
support," as Mr. Aikin has justly remarked.  This howe-
ver is not the only source of danger.  The febrile symptoms,

  * Probably these might  be only pimples of the nature abovemen-
tioned ; I have not learnt if any came to maturity. 
44
even when scarcely followed by a dozen pustules, are often
accompanied by convulsions of the most  alarming nature.
Neither has the small-pox been rendered  so  perfectly safe
by inoculation as some pretend to assert, as to enable us  to
insure its successful termination.  Those Physicians there-
fore, who oppose the Vaccine under the  plea of the absolute
safety of inoculation, must either be totally ignorant of the
disease they profess to understand,  or wilfully blind  to the
hazard incurred, from the narrow principle of self-interest.
I shall however attempt to prove to the satisfaction of even
these narrow-minded Practitioners, that it is as much their
interest as their duty, to employ this, the mildest of diseases,
in preference to one of the most destructive maladies of the
human race.   It has been estimated that one person  in two
hundred dies of the inoculated small-pox, and this is perhaps
not  much out  of  the wrav on a large scale.  Now  if we
cbnsider the total inhabitants of this globe as amounting  to
a thousand million, we may calculate that the  one-fiftieth
part die annually,  and a like number receive existence.  Of
this fiftieth part or twenty millions  (supposing  the whole
number were to be inoculated  for the small-pox)  the above
calculation of  one-two-hundredth  part falling  a sacrifice
to its fury, will yield a total annual mortality of one hun-
dred thousand persons.  When however we view the rava-
ges of the Natural Small-pox, especially in the vast regions
of Africa  where medical advice is scarcely known, it would
be found that not less than one in ten (many calculate one
in six to die with the natural small-pox) or two  million an-
nually,  fall victims to this dreadful disease.   As this calcu-
lation is only made on a supposition of  a  perfect regularity
in the premises laid down,  I  shall take  surer ground,  by
stating from the authority of  Dr. Lettsom, that two hun-
dred and ten thousand persons annually die of the Small-pox
in Europe alone.  And Dr. Herman Mc. Donald asserts that
it proves fatal to forty millions in every century.  In France
it is calculated  that one in fourteen dies  of the small-pox.
The total number of deaths in a year is  estimated at nine 
45
hundred thousand on an average, of which upwards of six-
ty-four thousand are of the small-pox.
   Dr. Moreau informs us sixteen thousand persons  died  of
the small-pox at Naples in one year, and twenty thousand
at Paris in another.   In England thirty thousand perhaps are
(were) carried off annually by the small-pox.  How grateful
to the feelings of the illustrious discoverer of the  efficacy
of Vaccination  must the reflection prove, that to him will
mankind owe the preservation  of so many lives !
   These strong and demonstrable truths must I think carry
conviction to every mind, that great indeed is  the moral
obligation of Parents and Physicians,  to save this immense
population to the  world, by the general introduction of the
Vaccine ; a  disease, which  most assuredly,  has never  of
itself proved fatal to a single person.   What must be the
feelings of a parent wdio with these facts before him, (not
founded on the assertion of an individual, but confirmed by
the  testimony of thousands of witnesses, the most respecta-
ble for their talents and situation), what  I ask must be his
feelings, when he sees a beloved infant writhing under the
tortures of this foe to mankind, without  having  even given
him a chance to escape by shielding him with this " asgis
of Jenner ?"  If  a parent's  feelings can thus be wounded
by self conviction; how much more intensely should that
Physician surfer,  who, duly impressed with the certainty
of the  preserving influence of the  Vaccine,  should lose  a
patient by inoculation !   For my own part,  I freely own,
that with my present views on this subject,  I should feel
myself accessary to the death of the patient; and nothing
but inability to  procure the Vaccine infection,  would ever
now induce  me to recur to variolous infection,  antecedent
to Vaccination, in which case I should regard it as the less
of two evils.*

   * I may perhaps add another exception to this general determination.
I mean the inabili'y by repeater attempts  to produce the Vaccine. See
case 30, whom I vaccinated fourteen times ineffectually, previously to
any attempt to inoculate.   He has resisted one attempt to excite the
Small-pox. 
46
  It appears  to me  most extraordinary,  that every parent
does not anxiously seize  the opportunity of giving  their
helpless offspring a  chance to escape the  ravages  of the
Smallpox.   The simple act of substituting the minutest
speck of Vaccine or Variolous infection, may  prove the
means of future happiness, or a source  of bitter reflection,
and too late repentance.    If  beauty in a female is  desira-
ble in the eyes of a parent, how much reflection is necessary
before those pleasing prospects are blighted by die Small-pox !
Even were it proved the  Vaccine was not the preservative
it is,  what ill is to be apprehended from a disease, so slight
as to exceed the range of possibility, to suppose, that death
could be induced by it ?
  How eccentric is the conduct of mankind ! With testimo-
ny  in favor  of the Vaccine  ten  thousand  times stronger
than would be required by the most  prejudiced person, to
convict an individual in a court of justice, is it not surpri-
sing the slightest objection  can  be  advanced  against it ?
Can we be  surprised at the disbelief evinced by many in
the Holy Scriptures, though so strongly attested; when we
see this propensity to scepticism so prevalent on  a subject,
the truth  of which  every  one  has  it  in  his  immediate
power to verify,  and which appears  to stand on a founda-
tion as strong as Christianity itself?
  What shall we say of the  conduct of those  Physicians,
who, without any endeavour to investigate the truth of the
doctrines advanced  respecting the Vaccine,  arrogantly as-
sume to themselves the privilege of denying  its merits alto-
gether, or else assume as a fact that its  prophelactic pro-
perties do not exceed the limits of a few years ? Such Phy-
sicians there  are,  (if they deserve the title) and not many
miles from this metropolis, who thus strive to  check the
progress of this invaluable blessing.   If they wilfully  re-
ject the firm basis on which  it stands,  they certainly de-    *
serve  the detestation of mankind: if it arises from igno-
rance,  we  must  pity  the  fate  of  such,  as   trust their
lives  in  the hands of those,  who  \ull  not  take  the 
47
trouble'to render themselves acquainted with the facts they
thus presume to oppose.
  That it is the interest  of Physicians to  employ  this in
preference  to  the small-pox,  will I hope be rendered evi-
dent when  I come  to consider the difficulty of procuring
and  preserving the infection.   On those two points I rest
the argument; because I am well satisfied none but Physi-
cians will take the necessary trouble to effect  these  ends,
or with but  few exceptions.    Those who are objects of
charity must still continue  such,  wdiether the  Vaccine or
the Small-pox are employed ;  and those who can afford  to
recompense a Physician for his labour,  will scarcely take
the disease into their own  hands,  merely  to  save a  trifling
cxpence.*
  But to return from  this  digression.    It may readily be
imagined,  that a disease so mild as the Vaccine, very rarely
requires the aid of medicine,  indeed I might say, never,  as
far as It respects the mere disease.    Perhaps  nineteen of
twenty scarcely exhibit a  perceptible  indisposition: during
the  period  of dentition,  or in  slight  complaints of the
bowels,  I  have in several instances  had reason  to suppose
the febrile symptoms were  not increased by the accession
of the Vaccine.  In adults, they are occasionally more con-
siderable ;  but even they, suffer but little uneasiness which
a dose of cooling physic is not capable of removing.
   Dr. Jenner says (p. 98)  " from  the very slight indispo-
sition which ensues in cases of inoculation, where the  pus-
tule, after affecting  the  constitution, quickly  runs into  a
scab spontaneously, or is artificially suppressed by some pro-
per  application,  I am induced to believe, that  the violence
of the symptoms may be ascribed to the  inflammation and
irritation of  the ulcers (when ulceration takes place to any

  f The danger of producing a spurious disease in place of the ge-
nuine pustule, should also have its due weight with those who are
disposed to  take the disease into their own hands. 
48
 extent, as in the Casual Cow-pox),  and that  the  constitu-
 tional symptoms which appear during  the presence of the
 sore, while it assumes the character of a pustule only, arc
 felt but in a very trifling degree."   At (p.  103) he adds
 " that the most material indisposition, or at least that which
 is felt most  sensib y, does not arise primarily from the
first action of the  firu; on the constitution,  but it often
 comes on, if the pustule is It ft to chance, as  a secondary
 disease."  He further adds (p. 109) "  As the cases of ino-
 culation multiply, I am more  and more convinced  of the
 extreme mildness  of  the  symptoms arising merely  from
 the  primary action of the virus on the constitution, and
 that those symptoms  which (as in the accidental Cow-pox)
 affect the patient with severity, are entirely secondary, ex-
 cited by the  irritating processes of inflammation and  ulce-
 ration."  I am happy to have the authority  of this  cele-
 brated character on this important point;  and  as far as my
 experience goes, I most unequivocally coincide in the above
 remarks.  All the cases  which have proved  any way dis-
 agreeable, have been  those, where from  inattention the
 scabs have been rubbed off and ulceration produced.    And
 this leads me to say a few words on this head, as it regards
 the symptoms and medical treatment.
   It has been observed that in a majority of cases, the pro-
 cess of scabbing follows vesication with the most  perfect
 regularity.   In these cases little indisposition is perceptible ;
 but when from inattention  or  from any other source, the
 scab is either rubbed  off, or the pock is much irritated ; vio-
 lent  inflammation sometimes  follows,  accompanied with
 considerable tumefaction, extending to a greater or less dis-
 tance,  sometimes even up to the  shoulder and down to the
 wrist;  great  pain of the part vaccinated,  shooting  up to
 the axilla; to which succeed  inflammation  and swelling of
 the axillary glands, chills, fever,  restlessness,  anxiety, nau-
 sea,  vomiting, head-ach and  pair,  of the  back.    These
 symptoms in part, or successively,   increasing, usually sub-
 side in a few days of themselves, though now and  then a 
4$
case of greater violence will protract itself one,  two, and
even three weeks.   It is  however  uncommon  to  find it
so violent as not speedily to yield to  a gentle antiphlogistic
treatment, in  which may be  included due  attention  to  the
local complaint, which by this  time has probably put on
the state of a  disagreable phagedenic  ulcer;  sometimes
with a luxuriant growth of flesh, shooting up  nearly one-
third of an inch above the surrounding skin, and very ten-
der to the touch.   The axillary glands I have seen swelled
nearly as large as a pigeon's egg, and accompanied with an
erysipelatous  inflammation over the whole limb ; the ulcer
at the same time pouring out a considerable quantity of a
limpid  fluid for the most  part,  but  occasionally of a puru-
lent nature :  When the disease has got to such a  height,
 (which it seems incapable of doing without  a  successive
 series  of negligence and  topical  injury), it requires some
 active application to arrest its progress.   In three  or  four
 cases which have come under my notice, I have found no-
 thing equal to the unguentum  citrinum.   The mercurial
 and the red precipitate ointments are much recommended.
 In milder cases lead water, or  Goulard's  extract, will ge-
 nerally prove effectual.  When the inflammation and  pain
 are very great, it  is  necessary sometimes  to  poultice the
 sore;  in one  instance a poultice of the marsh mallow, ap-
 plied without my advice,  seemed to give more  relief  than
 the usual bread and milk poultice.   It is seldom I  believe,
 that  the  above mentioned  ointments applied  night and
 morning to the surface of the  sore only,*  will not cause
 it to assume a healthy state  in  a few days ; lead water or
 merely cold water to  the  inflamed limb may be applied at
 the same time with advantage.   Some smart purgative eve-
 ry day or two, and abstaining from animal food and liquors,

   * I saw one  case in which the unguentum citrinum, applied incau-
 tiously over the surrounding inflamed skin, seemed to destroy it, and
 thereby augmented the sore.   When applied solely to the ulcer its ef-
 fects were very advantageous.
                 [ T  ] 
5°
will generally produce a cure in a  short time, or so dispose
it to heal, that any common dressing will suffice.
  I  have been  much surprised to see  the small  cicatrix
which has remained  after such a disagreeable ulceration ;
indeed it would seem as if it  was  incapable of exerting  so
much violence on the skin and cellular  membrane as  the
Small-pox; although its appearance in such violent cases is
1 think nearly as alarming as that arising from  the Small-
pox.  1 form this opinion from the case of a mulatto wo-
man who came under my care,  and whom I  vaccinated in
two places of the fore-arm (case 25) ; the infection took
effect, and by the fifth day, the punctures were raised into
two purulent looking pustules, not of the regular Vaccine
form.  As I had not a doubt of the spurious nature of the
disease,  I repeated the Vaccination on  the same arm at
about two inches distance from the former.   This attempt
produced one of the most beautiful pustules  I  have seen,
and little indisposition attended.    About  the  cessation of
the attending symptoms,  notwithstanding my strictest cau-
tion, 1 found her nursing  a child,  and  otherwise using  her
arm,  by which the true  Vaccine pustule was  rubbed  off,
and the  crustaceous scabs of the spurious  ones also.   From
this moment the symptoms increased;  and ran to the extent
I have above enumerated.   The  arm  was swelled most
enormously, and the pain and enlargement of  the axillary
glands was very alarming.   The steady application of  the
citrine ointment, and  one or two strong mercurial purges,
soon relieved the most urgent  symptoms; and  though  the
sores had extended themselves to above three-fourths of an
inch, yet in  less than a week they were  reduced nearly  one
half,  and the whole was  perfectly well in about six weeks
from the  first Vaccination.  In another instance, a child of
two years of age,  the pock which progressed in  the most
favorable manner, was unfortunately rubbed considerably
on the seventh  day,  and  this  was repeatedly the  case  till
the tenth and eleventh days,  when  the indisposition,  till
now  trifling,  became  very serious : the  inflammation  and 
5*
swelling increased rapidly, and  the  pain was very severe.
In this case it was that the axillary glands became nearly as
large as a pigeon's  egg.   The sore looked very ugly, and
required constantly to be  poulticed for several days, during
which it was with difficulty  I  could persuade the mother
to force  down a dose of  physic.   It soon began to assume
a better appearance, and by the end of the fourth week
was  nearly covered with a  hard dark  coloured  scab.   J
must observe that this child was  of a very gross  habit of
body, and much troubled  with worms.   Being anxious to
see the regular progress of the disease,  I did not  restrict
the child in his diet during this period.   The  weather was
at  the same time very variable,  cold  and  wet,* and  the
child always out  in the street.   These  circumstances  will
tend  in some degree  to  account for the violence of  the
symptoms.
  Where proper precautions are adhered to,  I believe but
few instances  of  such violence would take place : indeed if
the sore is  taken immediately in hand, lead water would in
nine cases of ten prove sufficient  to check the further pro-
gress.  If the inflammation  after the  twelfth  day should
continue, lead water seems all  that is  required,  and not
even  then, unless it should seem to increase; for till that
period, it is only progressing as it ought.
  It  has been proposed by some, after this period, to check
arty further disposition in the pock to spread, by applyingsome
active corrosive substance for a few seconds,  by which cica-
trization is forwarded and danger of ulceration is prevented.
The sulphuric acid on the head of a  probe is recommended
to be held a few seconds to the pock and then washed off.
Of  its efficacy I cannot speak,  as I have not tried it; being
more desirous of seeing the natural progress  of the  disease


  *  Upon referring to the other cases which have proved troublesome,
I  find they all took place in the same state of the weather.  And it has
been observed in England that a cold N. E. wind produced an aggra-
vation of the inflammation. 
52
than to check it.   Mr. Aiken has given a judicious caution
against  its premature  use,  lest it  should  entirely  extin-
guish the disease, before the constitution is rendered secure
against the Variolous infection.
  In  the above mentioned cases  the cicatrices were very
small compared with the  apparent ulceration,   I must add,
that nothing like convulsions appeared in any instance,  al-
though  the symptoms ran so  high.   How  different from
the Small-pox !  I may indeed ask in what do  they agree ?
I think I may say in nothing ! Whatever proves bad in  the
Vaccine, is not essential  to,  but an accidental cojicfftnitant
of the disease;  whilst what is good is exclusively  its own.
On the  contrary, the Small-pox is  bad from  beginning to
end, without a single admixture of  good to recommend
it;  and  not unfrequently leaving a remembrance of its,elf to
the termination of  life.
  I cannot refrain from adding the character of the  Vaccine,
as drawn by the enthusiastic but masterly hand of Mr. Ring.
" As to the genuine disease,  if disease it can  be called,  on
the third day it resembles a flea-bite; on the sixth a crystal;
on the tenth a pearl; on the twelfth a rose;—a rose without
a thorn!
   " The vesicle which it displays,  may be considered as a,
gem of inestimable value ; and the fluid which it  contains,
a precious balm.  How enviable is the lot  of that man,
who has put the world in possession of such a treasure ! It
is to himself an inexhaustible source  of happiness  ;  and to
the land which  gave him  birth an  eternal  monument of
glory."   See p. 748.
   As the preservation of this matter is of the highest  im-
portance to mankind, it is incumbent  on every Physician to
pay the  strictest attention to this  point, more especially
those who live in the country, where  a failure might be
with difficulty supplied.   Disappointments will often occur,
even when every  precaution is taken to insure  success.
Matter  will frequently fail, though employed immediately
after being taken  from a pustule,  at the earliest period: 
                          S3

this I apprehend must depend in a great measure on  zn in-
disposition to receive  the  impression  of the disease;  we
see the same in the Small-pox ; and the same diversity ex-
ists in different persons, and in the same person at different
times, with respect to the application of medicines.
   This torpor, or whatever it may be, is unaccountable per-
haps, though the fact is certain.   I have  in a former part
mentioned a few remarkable instances of this kind.
   Though  the Vaccine infection fails  perhaps more  fre-
quently in a first attempt than the Variolous,  I do  not so
clearly perceive that it is more perishable.  What would be
the greatest period of time at which Small-pox matter would
succeed,  I do not exactly know.  The Vaccine has proved
effectual at the end of three months according to  Dr. Jen-
ner ; and Dr, Marshall succeeded with it after as long a pe-
riod.  1 received a portion from England which proved  suc-
cessful,  though it must have been nearly three months old.
These  circumstances  appear favourable,  but  I suspect  it
would not often be the case without  the greatest  precauti-
on.*  Four portions of matter which  I received from Eng-
land, failed  in taking  effect though put up with the minu-
test care.   Matter which has been taken but  a very short
time, (not above a day or two) has  failed in the  hands  of
Practitioners to whom it was sent at but a few miles distance
from town.   Other portions have proved successful which
have been sent off under similar circumstances.   When it
is to be immediately employed, perhaps the lancet is  the best
mode of conveyance; though 1 am not so satisfied  on this
head as I was, because  the matter is very insoluble, and I
apprehend is seldom so thoroughly dissolved, as when uni-
 ted  with water by  a lancet point on a piece of glass.   If it
 is taken on a lancet, it is improper to allow it to remain more
 than a very few days, because it very soon rusts the iron.

   *  By referring to case 47 in the tables, it will be seen  that I had
some reason to believe I succeeded in exciting the Vaccine with infec-
tion almost four months old, which I had paid no particular attention
to preserve from the air. 
54
   i ne method 1 have employed to preserve the infection
has chiefly been on thread  and glass.   1 have taken it on
thread mostly for the purpose of sending to Practitioners at
a distance from the city.  1 have generally inclosed the thread
in a piece of paper, and surrounded it with gold-beater's skin,
so as to transmit it readily in a letter by the post; or I have
thrust the paper into a quill, and after stopping it  with a
cork, have surrounded this with gold-beater's skin.  In a
few instances I have sent the  matter on a piece of glass,
which I have fitted with a piece of talc or  isinglass, and
coated with gold-beater's skin; and again I have put  the
impregnated  thread between  two  plates  of isinglass and
coated it as before.   All these several  ways have I believe
succeeded.
  For my own use, I  preserve it  between two plates of
glass which 1  coat as above; and I have always taken the
precaution to note down on a piece of paper with which I
surround them, the name of the patient, together with the
day of the disease, and  that of the month,  by which means
I am able  to trace up the disease to its primary source: I
have never omitted when it was in my power, to  procure
the first portion of matter,  and thus secure it for my future
use; after which,  I have procured  it for others.
  An ingenious mode, which is pursued by a Practitioner of
this city, is by applying to the punctured pustule, a capillary
tube; by exhausting the air with his lips, the fluid which ex-
udes is forced up into the tube.  This is then stopt with wax,
or some other substance.  To vaccinate with this, after ma-
king one or more punctures on the arm, the end of the tube
is applied, and a fine wire pushed down, which carries the
limpid infection before  it and deposits  it on the punctured
part.  By this mode of preservation, evaporation is entirely
prevented, and the infection  continues fluid.  How  long
this may be the case 1 know  not.  I  apprehend however
some danger is incurred  of the putrefactive process com-
mencing in  the tube,  in consequence of the atmospheric
air contained.   This, though small in quantity, is  large in 
ss
comparison to the  portion  of infection which has  been
drawn up, I know of no mode by which  a vacuum  is to
be  maintained there.   Messrs. Ballhorn and Stromeyer*
have proposed the vacuum of a barometer to secure the in-
fection on thread.   Time will shew if the above objections
are well founded.  I have not yet pursued the plan, but think
it deserves attention.
  The most certain method of transmitting the infection to
a distance is doubtless by a patient having the disease  upon
him;  the sources of failure however are so numerous, that
it behoves every Practitioner to attend most closely  to its
preservation whenever he has  obtained it.   I  think  it of
sufficient  importance  to specify the various  sources of fai-
lure of infection in this disease, which at present occur to
me.
  First.   It arises from the inattention of Physicians them-
selves, in not securing the matter when once it is in their pos-
session, but depending for a future supply from their  more
attentive neighbours; this is an evil which I hope will cure
itself;  as I think Physicians will soon discover their error in
depending upon others for a supply.
  Second.  It fails from the mode of preserving it,  as on
the point  of a lancet,  if not employed in a few days.
  Third.   With every disposition to secure it,  it  fails be-
cause a Physician  cannot always insure a succession of pa-
tients; in consequence of which the matter  loses its effica-
cy before it is again employed.
  Fourth,  It fails from the premature  destruction of the
pustule, by being rubbed off.
  Fifth.   Sometimes with the most favourable appearance,
the pock will yield little, if any infection.
  Sixth.   From the mildness of the disease, we cart never
insure  finding the patient in the way at the proper period for
taking it.


    *  Traite de Y inoculation de la Vaccine, p. 79. 
5«
  Seventh.   It happens that from an indisposition to receive
the disease;  really active matter will produce no  effect in
one person,  though in another it will succeed. §
  Eighth.   It may be taken at too late a period of the di-
sease.
  Ninth.  Drying with too considerable a degree  of heat,
as by the fire, which destroys its activity.
  Tenth.  The true Vaccine will sometimes produce a spu-
rious disease  in one person, though it would not in  another,
(Case 1. Note).
  Eleventh.   A  rough and unskilful mode  of performing
this  apparently trifling operation, by exciting considerable
inflammation, may destroy the disposition to receive the im-
pression of the disease, and hence prove a source of failure.
  Twelfth.   The last and  most extraordinary source of
failure  is,  that which arises from  parents not permitting
the  matter  to be taken from their  children.  That such
an  occurrence should take  place  is wonderful,  when it
is considered  that only one  pock in general is produced!
This it must be allowed is a most impolitic plan.  How can
a parent expect to be supplied with  infection, when  he re-
fuses it to others  !  it is not in this disease as  in the  Small-
pox, which  preserves itself by its contagious nature, or
which often  produces such abundant crops as are  sufficient
to inoculate a whole  town.   I do not think a person  who
thus refuses  to extend the benefits  of this  disease,  ought
ever to partake of them; but should be doomed  to suffer
under the severity of the Small-pox.  Nor  could  he com-
plain ;  because he is aiding this insidious disease, by not op-
posing  It;  or at least by shutting up the means of oppositi-
on in his power.

  § We even see this in the same person, when of two or three punc-
tures, made precisely in the same way and with the same care, only
one will take effect. The same matter also, will  with similar pre-
cautions fail in the same persons, in one attempt, which will succeed
at a later period.   See cases 33, 34. 
57
   Many persons suppose that taking the matter is productive
of a sore arm.  This is not the case as hundreds can  testi-
fy.  Nay more, it appears when done cautiously to be use-
ful,  by taking away that matter sooner, which must other-
wise be absorbed in a more tedious  way.   The few  cases
of sore arms I have met  with, have been where I  have
taken the matter but once  or twice; and I have I believe
in nearly a dozen  cases, obtained it from four to  eight days
successively  without detriment.   I  hope these observations
may prevent the frequent occurrence of an evil of such  mag-
nitude to  the community.    It  may easily be supposed, that
what happens to one person, might to  another;  and  it is
only extending the refusal to every Practitioner, and how
soon should  we have to lament the loss of this invaluable
blessing !
   It is from the above  considerations, that I have anxiously
endeavoured to establish an institution for the Vaccine ino-
culation.   Hitherto  I  have failed.  Many have  supposed
it may be preserved  by the charitable  institutions already
existing.   Little difficulty it is true has yet occurred: by
considerable pains I  was  enabled to preserve the infection
till the period of inoculation was approaching ;  by which
time it had extended its influence among my  fellow  Prac-
titioners:  many were anxious to participate in the  blessing,
and  the disease consequently kept its ground.   But now
the season for inoculation  declines,  the infection  may  not
so readily be procured,  from its being out of the power of
Physicians to insure a constant succession of patients;*  and
if even one  or two could do so, it can scarcely be supposed
they will  occupy their  time in securing matter for those,
who by inattention and neglect have lost it to themselves.

  * Although Vaccination may suffer a temporary decline during the
warm weather, yet  every  season is nearly equally proper; and no
doubt the period will soon  arrive, when such  will be the confidence
placed in the mildness and  efficacy of  the  disease,  that no particular
time of the  year will  be considered as preferable to another.
                 [ » ] 
5»
I must lament the want of such  an  institution,  which is
established in almost every city of note in Europe; and which
example New-York and  Baltimore have wisely followed.
I anticipate the establishment of one  here, when  the diffi-
culty of preserving - the  infection, pure  and  permanent',
shall evince its propriety.
  The great difficulty of procuring and preserving the in-
fection, is the  argument I proposed to advance, as proof of
its being the interest of Physicians to  employ the Vaccine ;
for it is incredible that it can ever be long  in any hands
but those of the  medical profession, as none  but Physici-
ans, and but few of them  I  fear, will  take  the neccessary
trouble to preserve it*.   Hence I think those persons  are
in a great error, who consider the  introduction of  the Vac-
cine  in opposition to the Small-pox as inimical to  their in-
terests.    Were this even the case it is of small weight in
the balance of humanity.
  With respect to the best method of Vaccinating I  shall
say but little.   The mode I have  almost invariably pursued
has been by puncture;  which mode,  from the less  degree
of injury,  I apprehend, is more likely to induce the genuine
disease in all its native elegance, than when an extraneous
body, such as  thread, is suffered   to be retained,  and con-
sequently to produce occasionally, local irritation  not  con-
nected with the Vaccine ;  of this however I  am  not posi-
tive, for some  of  the most beautiful pock I have seen have
been excited by means of thread.
  When I have not employed the fluid infection, I have
generally moistened the dry matter on glass.   This requires
much care,  owing to its difficult  solubility.   With a lan-
cet thus  armed, I gently  raise the cuticle  from  the skin
beneath,  forming a small triangular  pouch, into which I
introduce the  infection, which thus lays as  it were com-

  * How can it be properly ascertained also, by any but those who
are conversant with the disease, whether they produce a spurious or
genuine pustule ? 
59
pletely enveloped.   It is by no means requisite to draw any
blood in the operation.  On the contrary,  where the sys-
tem  is disposed to receive the  impression, the less the inju-
ry to the tender extremities of the  absorbents,   the better.
In a few instances  it  has progressed most delightfully,
though at the time of Vaccination I was altogether unable
to distinguish the puncture I had made; hence I have,  oc-
casionally, from a desire to introduce more of the infection,
produced, by unintentionally wounding the cuticle in ano-
ther part, two pustules.   This shews the facility of  indu-
cing the disease in some  instances,  in  contradistinction to
those difficult cases I have before noticed.
   To dilute the infection  I have constantly employed cold
water ; not that I consider it more proper than  warm wa-
ter, as some do, who view the matter in so volatile a light;
but the idea of using warm  water appears to   me,, absurd,
when we consider the quantity taken upon the point of the
lancet is so small, that it must have  acquired the tempera-
ture of the atmosphere almost before it is brought into con-
tact  with the infection it is intended to  dilute; and certain-
ly long before it is inserted into  the arm.   Whether warm
water was originally employed to give a greater air of mys-
tery to this simple operation,  I know  not;  I am however
perfectly satisfied  it  is altogether unnecessary.
   I  have said above, that it is unnecessary to draw blood:
I may however add, that a small quantity will not  prevent
the action of the infection.
   As this disease is comparatively new in this extensive por-
tion of the globe, it will  certainly not be deemed improper
in this place to take a short view of some  of the most  im-
portant  facts,  which substantiate its  prophylactic powers
against the Small-pox,  in order to combat  the opposition  it
may experience from ignorance  or intentional misrepresent-
ation ;  as well as  to remove the fears, which have unfortu-
nately been excited against it, by the introduction of a spu- 
6o
rious disease in several parts of America ;  which fears have
as yet by no means subsided.*
   To accomplish this end, I shall notice  in the first place
the testimonial in its favor which was brought forward in
London, and signed by more than fifty Physicians, and dou-
ble that number of Surgeons,  gentlemen of the highest re-
putation in the profession.  'Phis example was followed in
various  parts of England  with the greatest advantage; and
such a testimonial should also be signed by the Physicians of
America, who know the value of the Vaccine, in order more
speedily to diffuse it.  The  following  is the testimonial.
   " Many unfounded reports having been  circulated, which
have a tendency to prejudice the public against the inocula-
tion of the Cow-pox; we, the undersigned Physicians and
Surgeons, think it our duty to declare our opinion, that those
persons who have  had the Cow-pox, are perfectly secure
from the future infection of the Small-pox.
   " We  also  declare, that the inoculated Cow-pox  is  a
much milder and safer disease, than the inoculated Small-
pox."
   To render this testimony more strong it may be observed,
that several of the gentlemen who have thus given it their
decided  support, were in the first instance strongly opposed
to the disease:  As  it may  be reasonably presumed they  did
not change their sentiments without the most perfect con-
viction,  this testimony is certainly of the  strongest kind.
   The Rev'd.  Mr. Jenner related to Mr. Ring (p. 606),
that he had vaccinated about three thousand persons.  " At
Burbagein Wiltshire, where he had inoculated (vaccinated)
about half  the inhabitants  of the parish, the small-pox since
raged, and swept away a number of persons; but all those who
had been inoculated by Mr. Jenner escaped, as if sacred from
the ravages of that destructive pestilence."  To this " se-

  * This part of the  subject is earnestly recommended to the atten-
tive consideration of those whose minds are yet undetermined respect-
ing the merits of th- Vaccine,  whether they be Parents or Physicians. 
6i
vere test" of the efficacy of the disease,  as Mr. Ring calls
it, I shall add the following letter from Dr. Farquhar to me,
in answer to an enquiry 1 made upon the subject, and which
with his permission,  1  made public at the time,  in hopes of
exciting the confidence of the public in the Vaccine.

                    " Philadelphia, Dec. 16th, 1801.
      " SIR,
               " WHOEVER makes the investigation of
medical science the object of his pursuit,  and its application
for the benefit of mankind the end  of his wishes, is cer-
tainly entitled to the gratitude of his fellow-citizens.   The
advantages of Cow-pox over the Variolous disease  having
been so fully proved, your exertions for its  introduction here,
are highly laudable.  In reply to your  enquiries respecting
Vaccination in Jamaica,  I beg  to  inform you,  that matter
having been about eight months ago procured  from Eng-
land, inoculation immediately rook place; since which pe-
riod many thousand persons have undergone the disease. Of
this number about twelve hundred were  inoculated in the
parish of Trelawny, who (excepting about thirty, in whom
after repeated, inoculation no symptoms of disease occurred)
had the complaint so mild,  that during  its continuance they
were enabled to  follow their usual avocations.  Of the thir-
ty before alluded to, upon being inoculated with Variolous
matter,  fifteen had the Small-pox; but although, in order
to ascertain the truth of the Vaccine proving a certain ex-
emption from  the Variolous disease, every person, who had
been previously  inoculated for  Cow-pox, afterwards un-
derwent the same operation with Variolous matter, in na
one instance did the disease follow, when the presence of
Cow-pox had been previously correctly ascertained^ Among
the advantages of the Vaccine disease over Small-pox, are,
its never  having in any one case terminated fatally; its
requiring no previous preparation of either regimen or me-
dicine;  its being attended with so  slight  mdispositioa at 
62
 scarcely to constitute a disease; its being produced by ino-
 culation only,  and consequently never contagious.   It dif-
 fers from Small-pox also in this,  that  a person  may have
 the complaint more than once; it however sympathizes with
 Small-pox so far,  that when a Variolous  atmosphere pre-
 vails,  its 'symptoms are considerably more severe; and  its
 proving a certain  exemption to that  disease is now so fully
 proved, that it has ceased in Europe to be doubted.   Inno-
 vations in medicine have ever met with opposition;  it is not
 then to be wondered, that  there are those who have  with-
 held their sanction from the introduction of Cow-pox:   Its
 advantages are now, however,  so well established, that we
 may reasonably hope Small-pox in a few years will be known
 only by name.  Indeed, when we reflect that under all the
 advantages of art the Variolous disease  sometimes termi-
 nates fatally, and that of  many hundred thousand cases of
 Cow-pox in Europe, no one person has ever been known to
 die, we cannot but consider Vaccination as one of the most
 beneficial discoveries in the annals of medicine:  And that
 your well meant endeavours to extend its  advantages may
 be crowned with success,  is the wish of,
                 " Sir,
                   " Your very obedient servant,
                       " GEO.  FARQUHAR, M. D.
                             " Of Clarendon,  Jamaica."
    " Dr.  J. R. Coxe."

    An interesting experiment was  published here also, trans-r
 lated from the French papers, fully substantiating the fact,
 this I  also shall introduce as of the highest importance.

/ From  the " Journal du Commerce," a  Paris Paper of
               the 24th November, 1801.
                   '■' General Committee  of Vaccine.
    " A long and important experience having entirely con-
 vinced the committee of the very little  danger attending the
 inoculation of the Vaccine (or Kine-pock,) there remained 
63
to ascertain more particularly its preservative effects,  and to
find out whether its duration, respecting which some doubts
had been entertained,  would  extend  beyond the revolution
of a year.   In order to make this experiment with all the
care and the authenticity  which  it  deserves, the committee
assembled together as great a number as they could possibly
find, of the ablest and most eminent doctors of physic.  It
now publishes the result  of the counter-experiments  made
in their presence, upon one hundred  and two children who
had formerly been vaccinated.
      "  Verbal-process  of the counter-experiment.
   " We the subscribers, being invited by the central conj-
mlttee of  Vaccine to attend the process of a counter-expe-
riment which it had in contemplation to make, by inocu-
lating  with the Small-pox a great  number of  individuals
who  had previously  been inoculated with  the Vaccine,
met accordingly at the house of citizen Thouret,  Director
of the Medical School, on the 23d and 30th Vendemaire,-
7th, 19th and 30th Brumaire, year 10, to witness the ex-
periment and to examine into its results.  In each of the four
first sittings, the committee presented  us  a person having
the Small-pox well characterised. The matter which served
for the inoculation was at each time  takerr out  of the pus-
tules, and introduced in our presence, by three incisions at
least, to every individual  who had been formerly vaccinated.
   " Thirty-seven who  submitted,  the 23d Vendemaire,
to the Variolous inoculation,  have been attended by several
amongst us, until the 30th of the same month,  and  visited
the same  day by  every  one of us.   The punctures were
dried  up on twenty-four:  The other thirteen had some
local effect,  characterised by a hard  tumid  redness, with a
small suppuration at the puncture.   The dessication was
complete on the 6th Brumaire, the thirteenth day after the
insertion.   It has been satisfactorily proved that during the
whole time no febrile affection has been experienced, and
there was not  on any of  these individuals the least sign of
general disease,  or the smallest appearance of eruption.  It 
64
is necessary to add, that most of the children had  on very
coarse linen and thick harsh clothes, the friction of which
seemed to us to have  considerably increased  the degree  of
inflammation which manifested itself at the incisions.
  " Twenty more have been inoculated on the 30th Vende-
maire, with the same  precautions  as the first thirty-seven ;
that is to say, with matter taken from a Variolous  patient
then present; on  the 7th Brumaire the punctures were ex-
tinct on nineteen ; one only presented, like the preceding
thirteen, a local effect, which had  completely  disappeared
the 12th Brumaire, being the twelfth day from the inser-
tion.
  " Twenty-five  more underwent, on the 7th Brumaire, the
same  Variolous inoculation.  The 15th (the eighth day of
the insertion,) no  marks could be traced of the punctures on
twenty-three ; the two others presented yet some symptoms
of local inflammation, resembling  that above  mentioned,
and which did not continue longer.
   " Lastly, on the 19th Brumaire  the experiment was ended
by inoculating in  the like manner  twenty individuals.   On
the 30th of the same month the punctures  were dried  up
on eighteen.  Of the two  others, one presented on each
arm a hard dry brown scab.   The  second showed on the
right  arm two rounded regular  pustules,  the borders of
which were still  lightly inflamed, full of a  purulent  mat-
ter and having a  Variolous  aspect.   These two patients,
attended every day by two  of us, have had no symptoms
of fever, nor any appearance of a general eruption.   It is
necessary  to observe that at the moment of the  inoculation
of these two, they were undergoing an anti-venereal treat-
ment.
   " It follows from this experiment,
   " 1. That out  of one hundred and two individuals, for-
merly inoculated  with the Vaccine,  (several of whom had
been  so for a year,  and  some others even for near eighteen
months) the Variolous inoculation has produced  no effect
on eighty-eight  of them.  2d, That the  temporary inflam- 
65
mation  noticed at the punctures of the other fourteen, has
not been followed with the Small-pox, as no symptoms of
fever, uneasiness, or eruption were perceived on either of
them.   3d. That in the last case, the pustules of a Vario-
lous appearance were  the effect of a local  action, similar to
that which can be excited by inoculating the  Small-pox on
individuals  having formerly had that malady,  and which
will also be often contracted, even after having  had it, by
Physicians and nurses attending  upon  Variolous patients.
4th. Finally, that it is natural to conclude the Vaccine has
preserved from the Small-pox the one hundred and two in-
dividuals who had been inoculated with it in  our presence.
   " Signed, in Paris, the 30th Brumaire, year 10, (21st No-
vember, 1801).   Maloet, Descemet, I. Roi, Andry, Mon-
taigu, Barrie, Delaporte, Roussille-Chamseru, Rousset-Van-
zeme, Doctors of the ci-devant faculty of medicine at Paris:
—Portal, Halls, Jussieu,  Fourcroy, counsellors  of state :—
Parmentier, Huzard,  Tessier, members of the national insti-
tute :—Sue, Dubois, Chaussier, Petit-Radel,  professors  of
the medical school:—Heurteloup, Biron, Vergez, La Croix,
of the  council of health of the armies :—Bichat,  Anvity,
Dupuytren, Alibert, of the society of the school  of medi-
cine :—Tourdes, professor of  the  school of medicine  of
Strasbourg:—Sedillot, jun. of the society of medicine of the
Louvre :—Ruffin,  Bertin, Le - Blanc,  Leveille, Bourdette,
Moreau (de la Sarthe.)
   " The committee wishes, if there remain  any objections
to  set forth against the Vaccine, that they may  be founded
upon facts as well authenticated.
   " Signed, by  all the members of the committee, Paris,
30thBrumaire, year 10.  Thouret, President;  Guillotin, 1.1.
Leroux, Pinel, Doussin, Dubreuil,  Salmade,  Desches, Ja-
delot, Marin, Parfait, Mongenot, Husson, secretary.
        " A true copy,
                 " (Signed)     HUSSON, Sec'ry."
[9] 
66
   Mr. Ring  who is very sanguine in the cause, had at the
time of his writing vaccinated about  800, and speaks  of
its proving efficacious in every instance wherein he tried  it«
   To  these  I  shall only add,  that I  have  now  tried  its
efficacy in above thirty of my patients  who had been pre-
viously secured by the Vaccine.   In most instances I made
two or three punctures,  with Variolous  matter  recently
taken from persons labouring under the natural disease; and
in several instances I repeated  this two, three,  or four
times  added to which, I  have  exposed  several  persons
to the  chance of taking the Small-pox, by causing them  to
visit patients  labouring under heavy burdens of that disease.
The result was an uniform opposition to the variolous con-
tagion.  In  two or three instances alone a local pock took
place on the inoculated part, unaccompanied by eruptions
or any febrile indisposition.   This  it is  well  known will
frequently occur by inoculation after the Small-pox itself.
By far the greatest number however died away,  so as  in
four, five, or six days,  to  leave  no trace of the attempt:
Among these I am happy to add, was an infant  of my own,
who was ineffectually inoculated three times, after  passing
through the Vaccine at  three weeks old;  since which  he
has  been held for above  one-fourth  of an  hour in the
arms of a man, then full of the Variolous eruption.  Con-
vinced as I was before, this was only an additional cause of
gratitude to the illustrious discoverer of so great a blessing ;
whose name  I have endeavoured to render familiar to my
family, by prefixing it to the surname  of the infant above
mentioned.*
  I might go on to transcribe beyond  all bounds, the nu-
merous facts  which testify the absolute efficacy of Vacci-
nation  in preventing the Small-pox.  This is however quite
unnecessary  ; for whoever will not yield implicit belief  to

  » The number of persons  Vaccinated in London, amounted in Au-
gust 1800, to fifteen thousand, of which five thousand  had been ino-
culated without effect. 
67
 the testimony already adduced, would not  be convinced,
 though one should rise from the dead.
   As many have imagined the Vaccine is only a temporary
 security from the  Small-pox;  I  shall  endeavour  to point
 out the error of  this impression,  by  merely noting down
 the names  of various persons who have, at an early period
 of life taken the Casual Cow-pox,  by milking an infected
 cow,  and who have  been repeatedly exposed to the hazard
 of the Small-pox both natural and inoculated.
                      Years.                       Years.
 John  Phillips         53     Joseph Merret        25
 * Mr. Williams      50     Richard Haydon      25
 t Mr.  Crocker       40     X Mrs. Hutchins      20
 Eliz.  Wynne         33     § Mr. Deacon        16
 Mary Barge         31     Mrs. Thurkle        14
 Sarah Port lock       27     Wm. Struchcomb     10
 Hester Walk ley      26     Mr. Collinbridge      10
   Mr. Fermor in his " Reflections on the Cow-pox" is full
 of similar facts from three to 36 years.
   These are surely sufficient to establish  the fact: But as
 time advances, facts increase to prove its efficacy, whether
 produced by inoculation or in the casual way.  Ring men-
 tions one of five  years standing by inoculation,  and hun-
 dreds may now be enumerated.  As therefore it has, when


  * This person has.thirteen children who have all had the Small-
 pox, and he himself, besides attending them during their illness, has
 been four times ineffectually  inoculated.
  f  This man has been  frequently exposed to the Small-pox ineffec-
 tually :  he is a plumber, and has soldered up coffins  containing those
 who died of  it.
  X About five years after,  she was inoculated, with one  hundred
others :  All took  the disease but herself, during which she attended
 to them.  Since this  she has nursed eight or nine persons in the
 Small-pox, three of whom died, and were laid out by her.
  § Ten years afterwards he and his family were inoculated.  One
of tha children died, the rest had it badly : He escaped. 
63
taken casually, preserved the system nearly sixty  years ;
and as the early cases of Vaccination still  continue  to  op-
pose the Small-pox,  we must regard all opposition on  this
head as  mere cavil, and treat it with  the contempt it merits.
I will however go so far as to say, that if it was  proved to
be a preventive for  only ten  years,  it would be an  object
of the  highest  importance ; for what comparison can be
drawn between the ferocious Small-pox and  this mild  dis-
ease.  I would rather suffer Vaccination every  year,  than
run the  hazard of inoculation once in my  life.*
   To estimate more fully the superiority  of the Vaccine,
it is  only necessary to observe, that  neither  heat nor cold
are objections to its use; damp cold  weather is to be avoid-
ed, though it is not  very material.f   Teething in children
need not cause any apprehensions as  to its issue ; nor  do I
indeed,  from what I  have seen or read, know any situation
which would prevent my employing it.  Women within
a few days of parturition, have  been safely subjected  to it,
and Dr.  Jenner mentions an infant  of only  twenty hours
old,  who had undergone its influence.   I  need not  enlarge
here on the feelings  of a parent  when witness to the suffer-
ings of  an innocent  victim to the Small-pox.   Fever, fre-
quent convulsions, the numerous pustules  at times, the dis-
agreeable object,  the chance  of pitting,  anxiety,  and  fa-
tigue of body and mind ; all form a striking  contrast with
the  benignant  Vaccine  ;  which  causes  no  emotions  but
those of gratitude  to our  SUPREME CREATOR,  for
thus kindly counteracting one of  the greatest scourges  of"
the human race.
  I have not as yet said much on one of the most essential
points of difference between the two diseases, viz. the non-
contagious nature of the Vaccine.  It is this which renders it


  * If the Vaccine was not invariably a preservative  against  the
Small-pox, it would only then be on  a par with this last disease, of
which I shall hereafter give some strong cases of a second attack.
  f See  note, p. 51. 
69
so great a benefit to mankind.   The fact is  confirmed by
numerous examples in the practice of almost every Physi-
cian who has seen the disease.   Dr. Jenner  in a  letter  to
Mr. Ring says,  " by no means that I could divise, have  I
been able to infect a  person by  the  effluvia  of the simple
Cow-pock pustule, although I have tried several.  Among
others,  I have suffered children  two or  three times a day
to inhale by the mouth and nostrils the effluvia of pustules
on the arms of  others, when the  matter  has been in  its
most active state, and the pustules punctured in several places
to give the matter its fullest effect." (p. 84).
   It is unnecessary to enlarge on this point.    Every Phy-
sician must have witnessed the  fact; I  have had repeated
instances.  I shall only add, that independently of the value
arising from its  non-contagious  nature, so  mild a disease  is
it considered, that in the Army and Navy of Great Britain,
the persons Vaccinated, are not  considered proper subjects
for the sick list.
   It is a surprising fact in the history of this  extraordinary
disease,  (for such it is in  whatever point we  view it), that
although it is a most perfect preservative against the  Small-
pox,  it  is not  so  with respect to  a second attack of  it-
self; neither is it prevented universally,  by  having previous-
ly undergone the Small-pox.  It has already been observed,
that like the Small-pox, it is communicated with much more
ease in one instance than in another.  The  cause of this sin-
gularity will perhaps never be developed.  In all probabili-
ty, they, whose systems  are opposed to one disease, will
likewise oppose the other.
   Although I have had the disease in my own person in the
most favorable manner,  yet as some have  supposed it  to be
merely local, I shall not depend  on this alone to  prove the
fact, but shall  briefly enumerate  several instances from Jen-
ner, Ring, and  others.
   Dr. Jenner at  p. 20 of his  Inquiry, relates the  case  of
Wm. Smith, who had the disease in 1780,  1791, and 1794,
which was  equally severe in each attack;  and at p. 47, 
7o
he  gives a yet stronger instance  of Eliz. Wynne " whs
had the Cow-pox in the year 1759, was inoculated with
Variolous matter without effect in 1797; and again caught
the Cow-pox in 1798."
  Dr. Jenner supposes  " the susceptibility of the virus  of
the Cow-pox is,  for the most part, lost in those who have
had the Small-pox, yet in some constitutions it is only par-
tially destroyed, and in others it does  not appear  to  be  in
the least diminished."   To this remark  he adds that  some
" have had the disease  in the most perfect manner," and
gives a very strong case of this kind which had been pre-
sented to him by Mr. Fewster,  p. 165:  &c.
  In addition to these facts, Mr.  Ring asserts p. 135, that
many years after having undergone the Small-pox, he suc-
ceeded in exciting a perfect Vaccine pustule on each arm  of
his  nephew Mr. John Ring:  At p. 121, he gives us another
example, where a lady was inoculated, in jest,  by her hus-
band, with Vaccine matter taken  on the point of a needle
from one of her children, .and had the disease in the most
perfect manner, and accompanied  with head-ach and fever,
  I shall not take up time in referring  to more cases.   I
will only add, that I have seen no pustules more perfect than
those which appeared on my own  arm,  and on  that of a
student of medicine who having had the Small-pox previous-
ly,  vaccinated himself  successfully with infection  from the
arm of his fellow-student  (see case 10,) who had the  di-
sease excited in him by matter from one of my pustules.
  Although several persons have  thus successfully excited
the Vaccine disease after Small-pox, I must not omit to add
that such experiments more frequently fail.  The following
extract from a letter of Dr. Waterhouse  on this point, is of
sufficient importance to authorise my introducing it  here.
It is dated  Cambridge,  March  28th, 1802.

  " From all that I have hitherto found  in the  English
publications, and from  my correspondents, I am induced to
say, that the greatest weight  of  evidence is on the side of
that opinion which maintains,  that he  who has actually 
7i
gone through the Small-pox can never have the Kine-pox*
and all the experiments I had hitherto made, added to this
weight.   I nevertheless determined to make a few more
trials, as experiment alone must decide it.
   " I accordingly inoculated seven persons with Kine-pock
matter who had gone through the Small-pox, myself being
of the number, four others were in my own family; the o-
ther two in the neighbourhood.  By the fourth day I was
able to pronounce, that six of them would not have the ge-
nuine Vaccine pustule.  They inflamed too quick; the ino-
culated part resembled the  sting of a bee, and wanted the
requisite hardness, as well as that deep-seated, well-defined,
and slowly-progressing affection, which characterises the ge-
nuine incipient pustule.  Add to this, on the  eighth day the
inflammation surrounding the puncture was rather an erysi-
pelatous blush than the beautiful efflorescence depicted in the
engraving I sent you.*  In thirteen or fourteen days the af-
fection on the arm vanished, leaving scarcely any mark be-
hind.  I  forgot to mention that although they had pain un-
der the arm,  they had not the least febrile symptoms.  Six
or eight months ago, I inoculated six children in one fami-
ly, one of whom had had the Small-pox.  The difference
in the pustules was striking through every stage,  but near
enough to deceive the unexperienced.  Limpid  matter was
in all of  them, and  I presume I could have communicated
the genuine distemper with equal ease from either.
   " But, what shall I say of my own case?  Mine was al-
most totally different; I had inoculated myself in the hollow
space between the finger and the thumb  of  my left  hand,
(between the abductor indicis and adductor pollicis),  and I
thrust into the same part  of my right hand a  splinter, or
small fragment of wood, in order to see the  difference be-
tween the operation of a  poison and a  simple extraneous
substance.


  * This  is the engraving from which the plate is  copied, which is
introduced into this treatise. 
7*
  " On the fourth day it had every mark of the perfect in-
cipient Vaccine pustule.  On the fifth day it had still strong-
er characteristic signs of the true pustule, in so much, that I
should not have hesitated in pronouncing it as such,  in an
ordinary case.   On the sixth I had pain and swelling under
my arm, and a perfectly pellucid fluid was found in the ve-
sicle. On the evening of the seventh day I had, or conceited
I had, a dizziness and nausea; so that had 1 written to you
on  the subject at that period, I should not have hesitated in
saying that I was under the true disease, notwithstanding I
felt confident, that 1 received the true Small-pox by inocula-
tion from  the skilful hands  of the venerable Dr. Redman in
1774: but had  I written twenty-four hours  later,  I should
have retracted  the  opinion, because at that period,  when
the pustule ought to have  increased in turgescence, and to
have blazed forth in the form  of a bright  efflorescence, it
became flaccid, faded,  gradually subsided, and  vanished a-
way, pretty much as the Variolous  inoculation does  after
the Vaccine. Had the local affection increased on the eighth
and ninth days, and the constitutional symptoms been aug-
mented,  I should have joined in opinion with  you, that  a
person could go through both diseases perfectly; but at pre-
sent my experience is against it, and you will understand  I
mean only to speak of my own experience.
   " A little girl in this town,  who had been inoculated for
the Small-pox in her infancy, too"k some of the Vaccine vi-
rus on the point of a needle from the arm of a servant-maid
in  the family, on the ninth day from Vaccination, and with
it pricked her own arm,  merely out of sport.   The infecti-
on was perfect, and the distemper went on regularly through
the three requisite stages  of vesication, efflorescence, and
scabbing,  and the  coincidence of symptoms was exact.  I
never saw a more perfect case of the Kine-pock.  With
matter from her arm I communicated the genuine disease to
 a third person.  This, to  me extraordinary occurrence, de-
 termined me to make a critical inquiry into the circumstan-
 ces of her inoculation, both of her family and of her ino- 
73
culator,  and am entirely disposed to believe that she never
had the genuine but spurious Small-pox.
   " From my own case, may we not infer that the Kine-
pock virus is capable of vaccinating the skin and of raising
a genuine pustule,  and of affecting the lymphatics as every
other acrid matter  will, with redness, swelling and pain;
but  that the susceptibility of the constitution  to its action
was destroyed twenty-eight years ago by the  Small-pox,
which seizing on its appropriate pabulum consumed it  so
entirely,  as not to leave enough  behind to  rekindle on
the  application  of  the Variolous  or Vaccine flame?   or
should this savor too much  of  the old humoral  patholo-
gy,  let us say if you please, it was by destroying the Vari-
olous, or peculiar excitability, or susceptibility to a second
impression: How else can we account for the apparently
perfect,  yet short lived and abortive pustule that was raised
on  my  hand?   We  see  it  was incapable  of going  out
its full time,  being  void of certain requisites  essential to its
perfection;  otherwise the lymphatic, sanguiferous, and ner-
vous systems, would not have refused their action, and forbad
that febrile commotion which seems to constitute  the very
essence of exanthematous disorders.  Dr. Jeyxner is of opi-
nion that persons who have had the Small-pox are  suscepn-
ble of the Cow-pox only in a small degree.  So  they are
of the Small-pox itself in a small degree :  If it be found
on deliberate experiment,  that those who  have really  had
the Small-pox are not  in general liable  to the Kine-pock,
excepting in a slight degree, I think it of some importance
to have it known.  If there occur cases  that appear to be
exceptions, they should be carefully watched and as careful-
ly recorded.   Such cases I rank with those where  a person
has had the Small-pox twice,  which although very rare in-
deed, I have no doubt have occurred."

  Of this letter  I can only say, that as I certainly experien-
ced the full effect of the Vaccine in my  own person, I am
less disposed than Dr. Waterhouse, to consider the  previous
                [  10 ] 
                             74
                                                     i
disease of the little girl,  as a case  of spurious Small-pOtf.
Nor can I altogether concede, that the Doctor's own case was
not a perfect one, though uncommonly rapid and  unaccom-
panied by an areola.   Indeed I have a very confident hope,
that Dr. Waterhouse is on the point  of embracing the op-
posite doctrine from that which he here maintains ;  at least
I judge so from the following extract of a letter with which
he has lately favored me,  of the date of May 26th.   "  I
have lately received a well attested  case of  the Kine-pock
after the Small-pox from  Vermont.  The subject was a me-
dical gentleman.  The question still remains sub judice."*

  * As the great rapidity of the disease  in the Doctor's own  case,
appears  to influence his belief on this point  ; I  am induced to add
the  following case, in addition to others which  may be seen in the
tables, as  a convincing proof, that the  disease  may be very quick
in its progress, and yet be a certain preservative against the Small pox.
  Elizabeth Gallagher, aged 28, a servant at the Philadelphia Dis-
pensary, was vaccinated at n A. M. of Thursday, May 13th, with
recent infection from a child on the 10th day of the disease, at which
time the areola was at its height.  One puncture was made on each
arm, and one on the right fore-arm.  On the 14th, a pimple appear-
ed at each puncture attended  with considerable itching.   On Sunday
the sixteenth she experienced  drowsiness, with  pain of head and back ;
On  Monday seventeenth (fifth day), nausea and vomiting, and  a
perceptible areola ; on Tuesday, pain and swelling of the axilla, the
areola extended full four inches downwards  to the wrist, (on the right
fore-arm), and united above with that which formed around the pock
on the arm. The inflammation was considerable, and Satu;nine appli-
cations were employed.   On Thursday evening (eighth day), a scab
commenced on the pustules, and was nearly complete by Friday after-
noon.  A  part of  the pock on the right fore-arm at its circumference
still contained a limpid fluid, which I employed in vaccinating, but
it failed to infect.  On  Monday, twenty-fourth (twelfth  day), the
scab of the left arm came off; that on the right was separating round
its circumference.   On Tuesday, twenty,fifth  (thirteenth day), I in-
oculated her with recent Variolous matter in three places of the left
fore-arm.  They swelled and inflamed for a few days, and then  died 
75
  After what has been said of the mildness of this disease,
and the absence of the areola in many instances, it may per-
haps be difficult to fix upon any absolute criterion of the ex-
istence of a constitutional  affection.  The fact is however
so; and it appears to demonstrate the improbability of the sup-
position  of the Vaccine and Small-pox being originally the
same;  or rather that the Vaccine is the  parent  stock, from
which the  Small-pox has  deteriorated,  its  difference  only
depending on the length of time in which the latter disorder
has passed through various constitutions in the human race.
That this is not the case, is rendered certain in my opinion,
not only from the existence of the Vaccine after the Small-
pox, bur also from  our knowledge of the  inveteracy,  and
contagious nature of the Small-pox, ever since our first ac-
quaintance with it; These appendages have been constantly
uniform and  not progressive,  in a long  series of years: we
cannot therefore suppose it to have originated from the Vac-
cine, and gradually to have acquired its present malignancy;
as we must at the same time suppose it to be  worse at pre-
sent than at any preceding  period.  Could we even get over
the idea  of its gradual deterioration, how Is it possible to
account for the contagious property of the  Small-pox,  and
at what distance of time from its supposed source, the Vac-
cine, did this extraordinary property commence? This pro-
perty we ought on the same principles  to find increasing:
but no one will contend the Small-pox is a more violent di-
sease at present, than it was a century ago.
   The reverse  of what happens, we  should rather expect;
for we might readily imagine,  a priori,  the  more  violent
Small-pox  would be capable of amelioration, and that be-
sides preventing a recurrence of itself, it might also prevent
the Vaccine:  But we could not so readily expect this  mild

away and disappeared.  On the thirty-first  they were  gone; when it
was again repeated with a sinvlar result.  It may be proper to remark,
that from Thursday the thirteenth to Tuesday following, she had an
unusual  flow of  the menses;  what  influence it had on the disease
\ know not, 
76
disease to be a perfect security against the Small-pox,  and
yet neither to be an absolute guard against  its own recur-
rence, nor yet to be invariably prevented by the more violent
Small-pox.  As fact however proves  the truth  of this ;  it
serves to shew how little dependence  is to be placed upon
Theory, when it departs from the broad and  firm  basis of
experience, to revel in the fertile fields of fancy.
  A very important  caution remains yet to be pointed out,
viz.  that the Vaccine is by  no means to be considered as
an absolute preservative against the Small-pox, unless the
system has been completely guarded by it, previously to
inoculation, or exposure  to the  natural contagion.  This
cannot perhaps be the case before  the ninth or tenth days.*
If a person be inoculated in one arm for the Small-pox, and
in the other for the Vaccine at the same time, he has sure-
ly no right to  expect the  extinction or even  suspension of
the one by the action of the other. Both at this period ex-
ert an equal sway on the system, for  neither have  a prior
claim: and hence, in all probability,  both diseases  will run
their course together; though from the accounts of authors,
and from several cases which have come under  my care,  I
am induced to believe the Vaccine prevents  the  Small-pox
at this early period; and that when it is not  prevented, its
symptoms are for the most part moderated.   I shall here be
pardoned for introducing a case,  in which I was satisfied the
Small-pox was suspended  by the progress  of the Vaccine,
but resumed its course after the termination of that disease.
(See case 14.)
  On the evening of the 28 th of November, I  was desired
to see a woman labouring under a violent  attack  of fever
which had continued three or four days.  The next morn-

  * If a person  at this period be exposed  to the Small-pox, as the
system is not perhaps completely guarded;  certainly it should be no
objection to the Vaccine,  if we should find the Small-pox shewing it-
self in the course of two weeks, that is, twenty-four days from vac-
cination. 
                          77

ing, she was covered with an eruption of Variolous pustules.
She then told me, that precisely two weeks before (Novem-
ber 14th),  she  had visited  a friend in  the  same chamber
in which a person lay ill with the Small-pox. Her husband
accompanied her but went no farther than  the  door;  near
enough however to see the person abovementioned.  As he
had never had the  Small-pox, I resolved to give  the effica-
cy  of the Vaccine, a fair trial,  and immediately vaccinated
him,  by two slight incisions of the left arm, in which I de-
posited a portion of infected thread, ten days old.  By the
commencement of the third day, it had evidently taken effect.
As he was constantly in the room with his wife, I put him
on a low diet,  and gave him occasional  doses of medicine:
he  did not however abstain from his daily  labour.  On the
evening of the  seventh day he complained of pain and swel-
ling of the axilla, which increased till the ninth day and then
gradually subsided.  On the eighth day the Vaccine  pustule
afforded me matter in considerable quantity; and there was
much pain in the part shooting up to the axilla.   This night
he  had a considerable degree of fever which continued  all
the next day, and towards evening was accompanied  by pain
of the head and back,  and also with nausea and vomiting.
On the tenth day several Small-pox pustules made their ap-
pearance on the face, arms, and breast,  from which period
the fever declined,  both  diseases  progressed distinctly,  and
by the fifteenth werc drying away.   By  the  seventeenth
he  was quite well.  Indeed he suspended his daily labour
(of sawing)  for only about three days.  The day of the
Variolous eruption was the tenth  of the  Vaccine, and twen-
ty-five days from his exposure to the source which produ-
ced the  disease in his wife.   That he could not have  ta-
ken it from  his wife,  is evident  from the eruption  appear-
ino- in ten days from  its first  coming  out  on her; which
is too short a period  in the Natural  Small-pox.   Two
weeks is  I  believe the shortest period of the Variolous
eruption taking place  in the  natural  way; this was ex-
actly  the case in a  child of about three months old, whom 
78
I  vaccinated at the same time with this man, and  who
was constantly in the same room with  him and  his wife.
The vaccination  succeeded in the  most perfect manner,
yielding a plentiful  supply of matter on the seventh, eighth
and ninth days, at which time he seemed slightly  indispo-
sed,  and apparently experienced pain in the axilla.   This
subsided  by  the  eleventh or twelfth  day, when  a scab
was forming.   A new set of  symptoms took place  on the
thirteenth,  viz. a considerable degree of fever,  &c. which
continued till  near  the  beginning  of the sixteenth  day 5
when three or four very perfect Variolous pustules appear-
ed on the face, which maturated rapidly, and  were nearly
dried up by the twentieth day.
   It may perhaps be said that the man might have escaped
the first  exposure to the  Variolous contagion,  and have
taken  it from  another  source.   This  however is  unlike-
ly :  I  took considerable pains to find out if  he had been
exposed to any other source, but had  every reason to be-
lieve he had not;  I therefore felt perfectly assured that the
first impression of the Vaccine  upon  the  system, was  to
suspend  the Variolous action  then existing; but that  it
\was incapable of  destroying it,  from  its having got  so
greatly the start; hence its progress  was resumed as soon
as the constitutional symptoms of  the Vaccine began  to
decline.   I doubt not the  Variolous contagion was mode-
rated  also  in both the above cases, certain it  is the matu-
 ration of the pustules was much more rapid than usual.*
   It may not be uninteresting to remark of the  last  men-
 tioned case, that  about three weeks   from  the  time the
 scabs were completely formed, I  was  told the  child was


   * How far the Vaccine has the power to suspend and  prevent  the
 Small-pox after the contagion has been received  into the system, I
 cannot say.   Certain it is that many persons do not  take the Small-
 pox though exposed to its  influence, and such accidental coincidences,
 may be thus ascribed  to the Vaccine in many instances, when in  fact
 the Vaccine had nothing to do with it. 
79
broken out with  a second attack of  Small-pox.   It was
however only the Chicken-pox which he caught from  a
boy in the same house who had broken out about ten days
before.    He  was slightly  indisposed for a  day  or two
preceding the eruption, which continued to come out three
days, and then rapidly dried away.  The fluid in these pus-
tules continued limpid till the last,  which is  not  the case
in the Small-pox.
   I have seen five cases of the union of the Small-pox and
Vaccine, in three of which  the  febrile symptoms  of the
Small-pox occurred (and not  very lightly)  about the period
of the constitutional symptoms of the Vaccine;  and  hence,
I would wish again to enforce the caution I above  menti-
oned, viz.  not  to consider the Vaccine as  a preservative
against the Small-pox before  it has completed its action on
the system; which probably is seldom before  the  ninth or
tenth days.   Before this period then, it is highly improper to
run unnecessary risk by exposure to the Small-pox, or by in-
oculation ;  although I have no doubt that  it will frequently
prevent the disease, even after having been several days ex-
posed to the contagion ; of this Dr. Jenner gives some stri-
king instances at p. 168, 169, of his invaluable Treatise, on
the authority of Mr. Lyford,  and his  nephew  the  Rev'd.
G. C. Jenner.   In one instance two children escaped who
had, previously to Vaccination, been exposed  five days to
the Variolous contagion from their father.   In the other,
a family  of a man, woman, and five children,  were vacci-
nated four days after being exposed  to  the constant  action
of the  Variolous poison.   It took  effect on all but  the
mother,  who consequentlv  had  the  Small-pox.   These
cases are sufficient to prove my position; but will not war-
rant unnecessaiy exposure.
   Several circumstances which have been  mentioned seem
to lead  me to say a few  words  on  the possibility of two
diseases existing  in the system together.  As this involves
one of the most favorite doctrines of the present day, I shall
certainly be excused for collecting together several  import- 
8o
ant facts on this head,  from various sources.    Theory can
have but little ground in a dispute, where fact at last must
determine the question.
   I have already stated the cases which  have  come  under
my observation of the combination of Small-pox and Vac-
cine ; not in succession, but at  the same time,  and  with-
out the least suspension of  action.  To this I may add that
almost all the cases  of Dr. Woodville,  tend  to prove the
same.   No reasonable  doubt can I  believe be  entertained,
that one disease  at times will overpower, or suspend ano-
ther, as in the instance related by the  celebrated Mr. John
Hunter, of the Measles and Small-pox,  and  on which he
has founded this favorite hypothesis.   It is  very  unfortu-
nate that this fact, with others  of the  same nature, have
been considered as so thoroughly establishing the  position
above mentioned, that  a contrary opinion, though backed
by facts from different  sources, has been  considered unwor-
thy of investigation, and has  even been  treated with ridi-
cule, as I have seen.   This is more to be wondered at,  be-
cause as merely  a matter of fact, its truth might have rea-
dily been ascertained ;  and  the arrival  at that truth,  I  am
satisfied is the great object of the researches, of the  advo-
cates of both opinions.
   I shall not take up time at present by detailing the cases
of combined  Vaccine  and Small-pox which  have  come
under my notice.   I shall present to  the public,  cases  in
point, from various authors, sufficient  I  apprehend to esta-
blish  the position.   As it would occupy  unnecessarily  a
large portion of time to detail each case,  I shall refer to the
works where they are  to be found.
   Dr. Jenner, p. 137, gives  an interesting case of  coex-
istence of Measles and Cow-pox, where both  diseases ap-
pear to have run their course without  any sensible interrup-
tion, except a slight  temporary suspension  of the  efflores-
cence, which had not appeared  on  the twelfth day, but
advanced in the  usual manner  before  the pustule  scabbed.
As there exists, however, so great a variety in the appearance 
8i
of the efflorescence, I am not disposed to consider this late
period of its appearance  as  any way  depending on the
Measles;  the constitutional symptoms of which must have
subsided long before.
  At p. 170. Dr. Jenner relates a very striking case of coex-
isting Vaccine and Scarlatina Anginosa,  in a  young  lady.
On the evening of the eighth day from Vaccination she
was seized with symptoms denoting the accession of vio-
lent  fever accompanied with sore throat.   The  next day
the redness of  the  skin  took place ; it pursued  its  usual
progress, as did also the Vaccine pustule without any de-
viation, except  that,  as in the last case the areola did not
appear until the Scarlatina retired.    The same reason may
be urged against the opinion that the existence of the Scar-
latina prevented the areola.
  I cannot omit mentioning  the case immediately follow-
ing the one above, which is  extremely interesting, as it
proves the entire occasional suspension  of one disease by
another.  The sister of the last mentioned case,  who was
exposed to the contagion of the  Scarlatina at the  same
time, sickened almost at the same hour.  The symptoms
were severe about twelve hours, when the rash faintly ap-
peared on the face and neck ; in two or three hours it sud-
denly disappeared, leaving her free from complaint.  The
inoculated pustule had in this case  the efflorescence sur-
rounding  it, which began on the fourth day to die away,
and the pustule to dry up; when the Scarlatina again ap-
peared, and spread all  over her, accompanied with the sore
throat and common symptoms of the disease.
  Ring abounds in instances of the  combination of diseases,
either from his own authority or that of others.
  At p. 107, on the  authority of Mr.  Leigh ton  he men-
tions  three cases of a  co-existence  of Small-pox, Measles
and Hooping-cough.   The same is stated as not unfrequent
in the Marybone  infirmary by Dr. Rowley,   p.  267.  At
p. 108, he says he had within six  months  met with three
cases  of the co-existence of Cow-pox and Measles. Mr. G.
                [ H  ] 
82
 Jenner he adds, had lately met with a  similar case;  and in
 all these cases the periods of the  respective  eruptions vari-
 ed ; in one the Measles appeared on the second day, in the
 second on the eighth, in the third on the fourth,  and in the
 fourth on the eighth ; but  in neither  instance interrupting
 the progress of the Vaccine.  In these also  the Areola  was
 perfect.   A case of Cow-pox and Chicken-pox, occurred
 to Mr. Little of Plymouth,  (see Ring p. 109), the latter ap-
 pearing on .the tenth  day of Vaccination, when the pustule
 had arrived at its height of  Inflammation.
   At p.  207, he  mentions  a patient of Mr.  Sandy's in
 whom the Measles and Small-pox appeared  on  the same
 day,  and both eruptions went on together.
    At p. 268 he mentions  several cases of the  co-existence
 of Cow-pox and  Small-pox ;  the latter  disease  appearing
 the third, sixth, seventh and eleventh  days.   Various other
 cases  are enumerated.
   »A gentleman in this city gave  me an  account  of the
 Vaccine  and Itch combined.
    The following account  of co-existence of  Small-pox
 and Measles,  by Dr. Patrick Russel, is  taken from the Medi-
 cal and Physical  Journal  of July 1800.   The facts are
v powerful stumbling blocks  to the opposite opinion.
    These cases occurred at Aleppo in  1765.  The follow-
 ing is the history  in the Doctor's words.
   ..." In the month of March, an instance  occurred where
 both  diseases were  conjoined in  the  same  patient.   The
 subject was a female child two  years old,  of a pale deli-
 cate complexion.   The redness of the eyes, the coryza, and
 the cough which accompanied the fever, led me  to expect
 the Measles.   On the fourth day, the  eruptions of the Mea-
 sles were visible on the face, the  neck, and  the  back ; but
 at the same time a few eruptions of  a different  kind  were
 interspersed on the face and neck, which if they had  been
 the sole eruption,  I should without hesitation have de-
 clared to be the Small-pox.  The progress of the pustules
 on the fifth proved them to be Variolous.   Both eruptions 
83
were of a favorable kind, and distinctly pursued their re-
gular course.  On the eighth day, the Measles were fading
fast, while the Variolous pustules  on the  face were  near
their height.  The pustules were not numerous, were very
distinct,  and ripened perfectly.    The cough continued to
be a troublesome symptom, especially in the second week.
A diarrhoea supervened about the fourteenth day, and con-
tributed  to render the child's recovery very slow.
   " In the  month of April I met with a similar case.   A
healthy boy, three years old, was  attacked with  the usual
symptoms of the eruptive fevers, at that  time epidemical.
The cough rather seemed to indicate the Measles.   On the
third day, the eruptions of the Small-pox and Measles made
their appearance together.   The  Variolous  pustules were
of the small round kind, and came to perfect maturity, but
 were more  numerous than in the former case.   The Mea-
sles were of a  fainter  colour,  and left behind  them still
less of the  branny scurf, agreeing in  both circumstances
with the disease then  prevalent."  See Med.  and Phys.
Jour. p. 71.
   In p.  29, 30, of the Medical and Physical Journal is also
 a case of the co-existence of Measles and Small-pox, though
 by no means so strong as  the  above.   On the  ninth day
 several pustules around the inoculated part were advancing
 to suppuration,  on the eleventh  some appeared on the body,
 accompanied with fever; on the thirteenth day, whilst the
 pock were  still  advancing, an  eruption exactly resembling
: the Measles, accompanied  with the symptoms of discharge
 from the eyes,  &c. made its appearance.    The two dis-
 eases progressed together till  the fifteenth, when the Mea-
 sles began  to disappear, and were nearly gone by the seven-
 teenth,  at which time the Variolous pustules were also dry-
 ing; away.
   A combination of the same diseases is mentioned in two
 instances, in the third  volume  of  the  New-York  Medical
 Repository, by Dr. Tracv, and ought not to be overlooked:
 1 must  refer the reader to the work adverted to, for a full
 detail of these interesting cases. 
84
   The following letter from Dr. B. F. Young, of Northum-
berland, to me,  among other interesting  information men-
tions a case of co-existing Vaccine and Measles, besides se-
veral cases of what I consider as a co-existence of the Vac-
cine and Small-pox.              >

                " Northumberland, February 27, 1802.
    " Dear Sir,
                  " I have delayed thanking you for your
letter and  the two portions  of virus you were so  good as to
send me some time since,  in order to communicate more
fully the result of many trials  I made  with it.  The  first
portion on glass arrived the same evening with an  armed  lan-
cet from Dr. James;  this lancet was dipped in luke  warm
water and applied to  the glass in such a way as to mix them
perfectly.*  I then  vaccinated five  children, all perfectly
well and free from every kind  of complaint.   Four of  the
five succeeded ;.my own son had the complaint agreeable to
Aiken in every particular, and the different changes all took
place within an hour or two of the time mentioned by him;
consequently  he had  it very favourably.  The second took
sick on the ninth day,  which excited my particular attenti-
on ; the fever increased for three days, and terminated on the
fourth, in a most plentiful eruption, so exactly resembling
the Small-pox,  that I was apprehensive it laboured under a
pre-disposition to that disease at the time I  put the virus in
its arm; their pustules all filled, and are not yet entirely
dried away; the third child sickened  on the eleventh day;
pulse in  the  morning of the twelfth  day 184,  at eleven
o'clock this morning it had a fit, in  which the parents de-
clare it lay half an hour;  the thirteenth, fourteenth, and fif-
teenth days, fever as high as possible, attended with convul-
sions every two or three hours; in the evening  of the  fif-

  * The matter sent by me was taken from case z\ on the ninth day,
and was then forty-one days old.  It had been secured between glass
and coated with golu-beaUr's skin. 
85
tecnth day completely eruptive all over the body, these pus-
tules as they filled became confluent, so as to cover the bo-
dy in one incrustation, not yet entirely dried away.  The
fourth child sickened on the fourteenth day, had one severe
convulsion the night of the fifteenth,  and a moderate erup-
tion the  seventeenth day,  which filled regularly, and has
dried away.
   " From the above account  it will  appear, that I have
been more unfortunate than perhaps most persons who have
been in the practice of vaccinating;  nor can I assign any
reasonable cause for three out of four proving pustular: had
I been less particular in the choice of my patients, or in ma-
king the puncture or rather scratch in the arm, or the lan-
cet made use of,  I should have felt unpleasant upon the oc-
casion ; but as it is, I am satisfied that it is an unusual vari-
ety of the disease, and  that they must occur much oftener
than is generally supposed.   Each of  the arms wanted the
inflamed margin until after the fever,  and  the edges were
never well defined.  With matter  taken from all four of
the children on the seventh, eighth, and ninth days, I vacci-
nated thirty-one, three out of which number proved mode-
rately pustular, not much fever attended either, and no con-
vulsions ; arms generally inflamed on the eleventh day.  In-
deed I now confidently predict an eruptive Vaccine if the ef-
florescence does  not appear on or before the twelfth day. In
one case it was completely formed on  the seventh day,  ow-
ing to the child's sickening with the  measles on the third
day, and the eruption taking place  on the  seventh; on the
eleventh and twelfth day it disappeared entirely.
   " I shall continue the practice in preference to the Small-
pox,  being perfectly satisfied, notwithstanding my having
been so unfortunate in the onset, that it is a much safer and
milder disease than the other; and  that the  number of" un-
pleasant cases will continue to decrease with mc."

   To this I returned the following answer. 
86
                      " Philadelphia,  March 3,  1S02.
     " Dear Sir,
             " Your interesting letter of the twenty-seventh
came safe to  hand this morning, and has greatly surprised
me: Of this  you  will be convinced when I assure you, that
of fifty cases of Vaccine which have come under my care,
I have met with only two,  in which any other pustule  but
that on the vaccinated part took place.  In these, besides the
local pock, one other  appeared in each, the particulars of
which I shall give in a publication I am slowly preparing
for the press.
   " I am however clearly of opinion that the Variolous infec-
tion has in some way crept in among the cases you mention.
My opinion is formed on the following reasons.  Your son
having the disease so favourably,  whilst the  remaining four
suffered so considerably,  though vaccinated with the same
infection,  seems a strong argument  for supposing their pre-
vious exposure to the Small-pox.   The exact resemblance
of the-eruption to the Small-pox, and its confluence in one
instance accompanied  also with alarming convulsions,  are
•other difficulties to be removed before I can  believe it was
■the Vaccine.   The fourth child sickening on the fourteenth
•day, or about the period for the Natural Small-pox; the ab-
sence of the well defined edges of the Vaccine pock; which
I-suspect was not the case  in your  own child, and the al-
most total absence of  pustules  in the  second set  of cases
you  enumerate.
   " I could have wished you had noticed the peculiar appear-
ance of the local  pock,  as compared with the general erup-
tion, and also the appearance of the  contents  of the pustules
themselves.   Did they become  purulent, or did they  con-
tain  a limpid fluid to the last?  An accurate account of each
case with any observations which may have  since occurred
to you will be highly  acceptable.   Did you inoculate the
second set with matter taken from the  local  pock,  or from
the general eruption ? Has not the Small-pox been any where
in your neighbourhood, which might reasonably account 
87
for its occurrence in four of your patients;  whilst your son
from his youth might not be exposed to the danger ?
   " The matter which both Dr. James and I sent you, was
taken from patients who had the Vaccine in the most favor-
able manner.   I can therefore in no way account for the e-
ruption but by supposing the co-existence of  the  Vaccine
and Small-pox, of which I have met with several instances;
and of which Dr. Woodville has a still  more considerable
example,  in the first cases of the Vaccine which came un-
der his notice in the Smail-pox hospital.
   " Your case of Vaccine and Measles combined is very in-
teresting ; 1 will thank you for the detail.  I am collecting the
various facts of this description which I shall bring forward
in the publication above alluded to.  They appear to be so
numerous, that the advocates for the celebrated ]. Hunter's
opinion of the impossibility of  two  diseases co-existing,
will I imagine  find it difficult to explain them away.  I have
no doubt that  one disease is more frequently suspended by
another, as was the case, in the instance adduced by Hun-
ter;  but these certainly are not conclusive,  &c. &c.
               " In the mean time, I am
                   " My dear  Sir,
                      " Your  obedient  Servant,
                         " JOHN REDMAN COXE."

The following is  extracted from a  letter in  answer  to
                  mine, dated  May 5th.
                        "  Since my last communication,  I
have vaccinated upwards of a  hundred, and have had but
one  eruptive case,  and  that very slight.  The matter with
which 1 inoculated the second set of patients (thirty-five in
number, two of which proved pustular), was taken from the
pustule at the  puncture on the  ninth day. I began with my
child,  and added to the general stock upon the point of the
same lancet from each of the others as I visited  them; the
black  boy I  mentioned as being concerned  in  nursing
■----'s child, (the case of violent convulsions), sickened on 
88
 the twenty-first day after I wrote to you; this proved to be
 the true Small-pox, although he had it very favourably ;  a
 little girl in a neighbouring house also had it.
   kv This last circumstance has served  to satisfy my mind,
 that the first cases must have been Variolous, although I can-
 not account for the manner in which it was communicated.
   " The Small-pox was not within twenty-five or thirty
 miles of this  town at the time of my inoculating them; and
 the parents of each, upon being questioned as to the  pro-
 bability of an infected  person  visiting the family, declare
 they do not think it possible; the professions of the family,
 being very different, it  can scarcely be supposed that the
 same person could have  had business with all of them.
   " I have not attempted to inoculate  with Variolous mat-
 ter,  but shall soon make trial of it.
   " I never ventured to try the effects of matter taken from
 a pustule upon any part of the body, but the inoculated  part.
                   " With much respect,
                          " I am dear Sir,
                               " Your's sincerely,
                                  " B.  F. YOUNG."
   " P. S.  / have had upwards of thirty cases of Measles
 and Vaccine  at the same  time,  and  in two instances the
 hooping-cough."

   If now we allow that credit to  the above cases to which
 they appear entitled, we must I think  coincide  in opinion
 that two diseases may exist together in the system.*  Why

  * Mr. Ring says, p. no,  " He (Dr.  Jenner) also limits the axiom
of Mr. Hunter to the  incompatibility of two diseased actions in one
and the same part.  Mr. Hunter's axiom however was more general,
in whatever manner it may have been expressed on any particular occa-
sion.  The prevailing hypothesis, that two-cutaneous diseases cannot
make their appearance at the same time, but that one will always sus-
pend the other, is continually quoted in :he Medical  Schools and So- 
89
at one time this should be the case,  and at another, one di-
sease should suspend the other, is a curious subject of inves-
tigation.*  I shall now take leave of this part of my  en-
quiry, and proceed to say something of the Spurious Disease.
  I have already observed that genuine matter will sometimes
produce a spurious disease from some peculiarity of consti-
tution.    I have in the tables mentioned a  case  of this kind,
in which five  successive' attempts either failed  or produced
the spurious disease. (See case 35). +   The sixth attempt
was apparently more successful,  for although  it got consi-
derably rubbed, it still retained the circumscribed appearance
of the true disease.   I have not  yet tried  the Variolous in-
fection ;  A troublesome itching constantly accompanied the
spurious disease, and the constitutional symptoms occasional-
ly ran  high.   Dr. Jenner supposes, and I think with  much


cieties,  as maintained by Mr. Hunter; and Mr. Home himself lately
informed me,  that Mr. Hunter  was of opinion, two cutaneous  di-
seases could not take place at the same time in the same person.
   "  B\' a reference  to the cases of co-existence before enumerated,
(Dr. Woodville's cases) it will be found, that in some of them, not
only the patients  laboured under  two eruptive diseases at the same
tims ; but that the eruption was  even synchronous.
   "  But what proof have we, that even the  limited  action  of Mr.
Hunter  is founded on the basis cf truth ?  Why are two morbid ac-
tions more incompatible than two healthy actions ?  That two, or more,
healthy  actions in the stomach may co-exist, will not, I apprehend, be
denied.   When the peristaltic motion takes  place, by muscular action,
surely no one will maintain, that the action of the nervous or arterial
system must necessarily be suspended."
   * I shall mention concisely the diseases which appear to have been
combined,  ist.  Measles and Small-pox. -id. Measles and Vaccine.
3d. Vaccine and  Small-pox.   4th. Vaccine and Scarlatina.   5th.
Vaccine  and Ciiicken-pox.  6th. Vaccine and Itch.  7th. Small-pox,
Measles and Hooping-cough.
   f  By a reference to my own case, (No. 1) it  will be perceived that,
with recer.t virus taken from a perfect pustule on  the  seventh day, I
                   [  12 ] 
9o
reason* that these anomalous appearances,  sometimes owe
their origin to the friction of the clothes on the newly inflamed
part of the arm, and he has at p. 17"> given a case, in which
the punctured part was on the sixth  day encrusted with a
rugged amber coloured scab, instead of shewing a beginning
vesicle.  The  scab spread and  increased  in thickness for
some days,  when a vesicated ring  appeared at the edges.
From the fluid matter five persons were inoculated.   In one
of which it produced a perfect pustule; whilst in three of the
others a  creeping scab of a loose texture was produced, fo\-
lowed by the formation of a limpid fluid at its edges as in the
case from which the  matter was taken.   In these instances
the Vaccine  disposition apparently lay dormant, though the
vesicated ring proves that it was at length excited to action,
! presume, matter taken from those cases before the forma-
tion of the vesicated ring, would have  inevitably induced a
spurious disease.
  The spurious Cow-pox may be  induced by inoculating
with matter taken from a cow, who has not the true disease.
Attention to the characteristic marks of the true disease as
laid  down by Dr. Jenner § will prevent this source of error.
time had nearly prevented the introduction of this valuable

produced  a perfect disease in a child of one year  old ; whereas with
matter taken the next (or eighth)  day of the disease, when its ap-
pearance was still more beautiful and its size augmented,  I induced  a
spurious pustule on my own hand, which  was from the beginning at-
tended with an intolerable itching ; a light areola of nearly  three-
fourths of an inch diameter occurred on the fourth day, accompanied
wiih  a hard base.   On the fifth a fluid of  a purulent natare gave the
pustule more of a Variolous appearance and by the seventh day a scab
was forming ;  the whole was nearly gone by the twelfth.  Here was
a pustule differing from  those I had formerly experienced in my own
person, as light from darkness ; it wanted the flat surface and depres-
sed 6entre and was unaccompanied with any  febrile indisposition or
axillary affection which existed in  the perfect disease.
  § Treatise on the Variola? Vaccinae, p.  78. 
91
   Matter possessing the specific virus,  originally,  may  by
suffering a decomposition, from too great heat, from putre-
faction, or from any other cause, prove a source of the spu-
rious disease.*  Matter may be taken at too late a period from
the true pustule when it has totally lost its specific property.
On  all these heads, I must  refer to Dr.  Jenner p. 72 et
seq.  and shall here content myself, with giving  a  valuable
and  concise view of the genuine and  spurious pustule, in
Dr.  Jenner's " Instructions for Vaccine Inoculation," which
1 lately received from England, and which have already been
published in the news-papersi


                  " INSTRUCTIONS FOR

           "VACCINE INOCULATION.

   " LET the  Vaccine fluid be taken,  for  the  purpose of
inoculation, from  a  pustule that is making its progress regu-
larly,  and which possesses the true Vaccine character,  on
any  day from the  fifth to the eighth, or even a day or two
later,  provided the efflorescence  be not then  formed around
it.   When the  efflorescence  is formed,  it is always  most
prudent to desist from taking any more  of the virus  from
that  pustule.
   "  To obtain  the  virus, let the  edges of the  pustule be
gently punctured with a lancet in  several  points.   It will
gradually ooze out,  and should be inserted upon  the arm a-
bout midway between the shoulder and the elbow, either by
means of a very slight scratch,  not exceeding the eighth
part  of an inch, or a very  small oblique puncture.

  * See the letters  in the Appendix, relative to the spurious disease in
New  York, Norfolk, Sec.  From  what  cause the matter  employed
in these places, lost its characteristic property, is impossible to say.
I hope the introduction of these letter* will serve as beacons to prevent
similar  misfortunes elsewhere, by inducing Practitioners  to acquaint
themselves minutely with the character of the genuine Vaccine pock. 
92
   " A little red spot will appear on the punctured part on
the third day, if the operation succeed, which on the fourth
or fifth becomes perceptibly vesicated.   It  goes on increas-
ing till the tenth day,  when it is generally surrounded by a
rose-coloured  efflorescence, which remains  neariy stationary
for a day or two.  The efflorescence then  fades away,  and
the pustule is gradually converted into a  hard glossy scab,
of a dark mahogany colour.  These progressive stages of
the pustule are commonly completed in sixteen or seventeen
days.
   " A single pustule is sufficient to secure the  constitution
from the Small-pox; but as we are not always certain the-
puncture may take effect, it will be prudent to inoculate in
both arms, or to make two punctures in the  same arm, a-
bout an inch and a half asunder, except in  very early infan-
cy, when there is a great susceptibility of local irritation.
   " If the efflorescence surrounding the pustule should be
extensive, and occasion much local heat upon the arm,  it
may be cooled by the repeated application  of pieces of fold-
ed linen dipped in cold water; or still more expeditiously by
a strong solution of the aqua 'lythargyriacetati* in water;
an ounce, for example, of the former in five or six of the
latter.
   " If the  scab should at any time be  prematurely rubbed
off, the part may be  occasionally touched with the1 undiluted
aqua lythargyri acciati.
'   " Vaccine  virus,  taken from a pustule,  and inserted im-
mediately in its fluidstate,  is preferable to that which has
been previously dried; but as it is not always  practicable  to
obtain it in  this state,  we are compelled to seek for  some
mode  of preserving  it.   Various means have been sucro-est-
ed, but from the test of long experience it may be asserted,
that preserving it between two plates of glass  is the  most
eligible.  Let a piece of common window-glass be cut into
squares of about an inch each, so that they shall lie smooth

  *  Goulard's extract of  Saturn. 
93
when placed upon each other.   Let the collected Vaccine
fluid be confined to a small spot (about the size of a split
peaj, upon the centre of one of these glasses;  which should
be suffered to dry in the common  heat of the atmosphere,
without exposure to the heat  of  fire  or  the  sun.  When
dry, it should be immediately secured by placing over it the
other piece  of glass.   Xothing more is  necessary for its
preservation than wrapping it in clean writing paper.
   " The virus, thus preserved, when wanted for the par-
pose of inoculation,  may easily be restored to its fluid state
by dissolving it in  a small portion of cold water, taken up
on the  point of a lancet.  It may then be used in the same
manner as when just taken  from a pustule.
   "  The Vaccine  fluid is liable, from causes apparently tri-
fling, to undergo a decomposition.   In this state it some-
times produces what has been denominated the spurious pus-
tule ; that is,  a pustule, or an appearance on the arm not
possessing the characteristic marks of the genuine  pustule.
Anomalies,  assuming different forms, may be  excited, aC-
cordino- to the qualities of the virus applied,  or the state  of
the person inoculated;  but  by  far  the most frequent variety,
or deviation from the perfect pustule, is that which arrives
at  maturity, and finishes its progress  much within the time
limited by the true.  Its  commencement is marked by a
troublesome itching; and it throws out a premature efflores-
cence,  sometimes  extensive, but  seldom circumscribed,  or
 of so vivid a tint as that which surrounds the pustule com-
 pletely organized;  and  (which is more characteristic of  its
 degeneracy than the other symptoms) it appears more like a
 common festering  produced by a  thorn, or any other small
 extraneous body sticking in the skin,  than a pustule excited
 by the Vaccine virus.   It  is  generally of a  straw colour;
 and when punctured, instead  of that  colourless, transparent
 fluid of the perfect pustule, its contents are found to be  o-
 paque.  That deviation from  the common character of the
 pustule,  arising from Vaccine virus which has been  previ-
 ously exposed to a degree of heat  capable of decomposing 
94
   it, is very different.  In this Instance, it begins with a creep-;
   ing  scab, of a pale brown or amber colour; making a long
   and  slow progress,  and sometimes going through its course
   without any perceptible efflorescence..  Its edges are com-
   monly elevated, and afford, on being  punctured,  a limpid
   fluid.
     " A little practice in Vaccine inoculation^ attentively con-
   ducted, impresses on the mind the perfect character of the
   Vaccine pustule; therefore, when a  deviation arises, of
   whatever kind it may be, common prudence  points out the
   necessity of re-inoculation,  first, with  Vaccine virus of the
   most active kind, and secondly,  should this be  ineffectual,
   with Variolous virus.  But  if the constitution shews an in-
   susceptibility of one, it commonly does of the other.
     " When any constitutional symptoms occur in  inocula-
   ted Cow-pox, they are commonly first  perceptible  (especi-
   ally  In children) on the fourth or  fifth day.   They appear
   again, and sometimes in  adults,  not unlike a  mild attack
   from inoculated Small-pox,  on  the eighth,  ninth,  or tenth
   day.   The former arise from  the general  effects of the
   virus on the habit, the  latter  from the irritation  of the
   pustule.
     " If the  effluvia of the Small-pox have been received into
   the habit previously to the inoculation of the  Vaccine virus,
\  the  Vaccine inoculation  will not always be found  to stop
   its progress, although the pustule may make its advances
   without  interruption.
     " The lancet used for inoculation should always be perfect-
   ly clean.  After each puncture, it is proper to  dip  it into
   water, and wipe it dry.
     " The preservation of Vaccine virus upon a lancet, beyond
   the period  of a  few days, should never be attempted ; as it
   is so apt to produce rust, which will decompose it.
                             "  EDWARD JENNER."

     Inattention to the distinction between the true and  spu-
   rious Cow-pox has produced much confusion, and  for a 
95
disease.   Time has however unfolded more accurately this
difference ; and I feel persuaded, no doubt can  arise in  the
mind of  one who has seen  the  regular progress of this
beautiful pustule : Wherever this regularity is deficient, pru-
dence I think would induce another trial.  The Small-pox
is doubtless  capable in like manner of producing a spurious
disease :  it  is in this manner I would  account  for persons
who have taken the disease in a natural way, after sup-
posing themselves secured,  in consequence of a violent de-
gree of  fever  accompanying the  sore  arm produced  by
inoculation.   An eschar may be produced  by  any sore
which can destroy the cutis ; this therefore though supposed
so by many is not a criterion of the genuine nature of the
previous  Small-pox.
   But after all I have said, I have no  doubt that occasi-
onally, instances do occur of a  second attack of Small-pox,
not merely local, or even accompanied by general  irrita-
tion of the system as the effect  of the local affection ; but of
an absolute second attack.  Why a person should (generally)
escape a second attack of this and other contagious diseases,
even though he should arrive to the great age of one hundred
years,  is a circumstance, of which we are likely always to re-
main in ignorance.  In that long period we might reasonably
imagine a total renovation  of every part of  the  body,  by
absorption, &c. yet the  disposition impressed by a first  at-
tack, still exists; which  whilst it manifests the Power, ex-
hibits  also  strongly,  the Benevolence of the great au-
 thor of our existence.
   In proof of the certainty of a  second attack of  Small-
pox, I beg  leave to offer the following cases.
   At p. 58, Mr. Ring says,  "  One case  where the  Small-
pox occurred a second time, I lately shewed to Dr. Jenner
and Mr. Simpson.   It was brought to  me by my friend
Mr. Leighton.   To those who know that gentleman,  his
own opinion is  sufficient;  but  if any other can be deemed
necessary, it was the opinion of all who  saw  the case,  that
 it was undoubtedly the Small-pox, 
96
  " The number of pustules amounted to some hundreds.
Yet the patient had been inoculated by Mr. Leighton three
years before; and  had a proper inflammation and  pustule
on the arm, together with a small eruption."
  Dr.  Jenner at p.  118, on the authority  of Mr. Fewstcr,
gives a pretty remarkable case, of a child of fourteen months
being inoculated for the Small-pox, which took effect very
favorably.   The nurse twenty-four years of age,  many
years  before had the  natural Small-pox,  and was much
pitted.  She had accustomed the child to sleep  on her  left
arm, with her left cheek in contact with his face, in which
manner he mostly slept during inoculation.  About a week
after the child  was well, a plentiful  eruption  broke out on
the left Cheek of the nurse, but not on any other  part of
the both/,  and went on to maturation.   Three days pre-
ceding the eruption she  had  slight chilly fits, head-ach,
pain of limbs,  and some fever.  The pains wTent off, on the
eruption taking place,  atid  on the fifth day, Mr. Fe wster
inoculated two children  from these pustules, producing a
plentiful eruption*.
  The circumstance of the fever preceding the  eruption
seems  to indicate something more than a mere local disease.
I shall however in the concise manner of Dr. Jenner, tran-
scribe  the case of Mr. Richard Langford, recorded  by Mr.
Edward Withers in the fourth volume of the  Memoirs of
the  Medical  Society  of London,  to  which I  must refer
whoever  wishes more extensive information of the  case.
   " Mr.  Richard Langford, a farmer of West Shefford, in
this county, (Berks), about fifty years of age,  when about
a month old, had the Small-pox at a time when three others
of the family  had die  same disease, one of whom, a servant
man, died of it.  Mr. Langford's countenance  was strongly

  * This fever, &c. it is evident, was not owing to the irritation arii
sin? from the pustules, as they hr.d not then appeared.  It was there-
fore certainly the constitutional effect arising from the primary action
$f the Variolous po;son. 
97
indicative of the malignity of the distemper, his face beino*
so remarkably pitted and seamed, as to attract the notice of
all who saw him, so that no one could  entertain a doubt
of his having had that disease in a most inveterate manner."
Mr. Withers proceeds to state " that Mr.  Langford  was
seized a second time, had a  bad confluent  Small-pox, and
died on the twenty-first day from the seizure ; and that four
of the family, as also a sister of the patient's, to whom the
disease vyas  conveyed by  her son's visiting his uncle, falling
down with  the Small-pox, fully satisfied the country with
regard to  the nature of the disease.  The sister died.   The
case was  thought so extraordinary as to induce the Rector
to have it recorded  in the parish register."

   At p. 178, Dr. Jenner gives us a letter  from Mr.  Tho-
mas Miles,  relating his own case,  as exemplifying the opi-
nion  of the frequent susceptibility of the  system to  the
Variolous contagion,  although it has previously  felt its in-
fluence.   This gentleman  being solicitous  to  shew, the
mode  of  communicating the disease  by  inoculation  to a
mother whose child was about to undergo  the operation*
introduced his lancet in  the usual  way on his  own  hand*,
and thought no more of it  till a sensation in  the part on
the'third day, rem;tided him of it.   It  proceeded  regularly,
and  the pock graduady  filled with a fluid, without  giv-
ing him  any uneasiness, supposing a  mere local affection
would be  the whole he  should experience.   In this how-
ever he was mistaken, ." for on  the eighth day," he adds,
" I was seized with all the symptoms of the eruptive fever,
but in a much more violent degree than when I was before
inoculated,  which  was  eighteen  years previous to  this,
when I had a  considerable number  of pustules.   I must
confess I  was  now greatly alarmed,  although i had been
much engaged in the Small-pox, having at different times
inoculated  not less than two thousand persons.   1  was
convinced mv present indisposition proceeded from the in*
             *   [ 13 ] 
98
sertion of the Variolous matter,  and therefore anxiously
looked for an eruption.   On the tenth day I felt  a very
unpleasant sensation  of stiffness and heat on each  side of
my face near my ears, and the fever began to decline.  The
affection in my face soon terminated  in  three or four pus-
tules, attended with inflammation, but which did not matu-
rate, and I was presently well."

  To these very strong cases  I shall make no  apology for
adding an interesting extract of a letter,  dated  June 15th,
1799,  from  Dr. Henry Arnott, of Hopewell Township,
York County,  Pennsylvania, to Dr.  Rush, and which  he
has politely furnished nie-with.
  " In your Treatise on Inoculation for the Small-pox you
alledge, that  there are  certainly cases where  there  are the
most irrefragable proofs of the infection implanted by ino-
culation being of a Variolous nature,  where  the  disorder
has been afterwards  taken in the natural  way; in these
cases, you suppose the Variolous matter produced  only a
topical or cuticular disorder, and that a fever and eruption
seem necessary for producing some impression on the whole
system, in order to render itever after incapable of receiving
an impression of a similar nature.   Of the truth of this I
was fully persuaded till las: summer in die  month of ]uly,
when (unhappily for  me)  some  cases occurred,  which I
confess stagger me a good  deal, and have exposed me to a
very great deal of country clamour.  Permit me Sir, to lay
the cases before you.   About four years  ago,  I inoculated
a young woman for the Small-pox ;  on  the third  dav the
orifice seemed a little inflamed,  the inflammation howe\ er
went off, till about the ninth day, when it  began to rise up
in form of a pustule, at which time the girl sickened, and
the fever continued four days, attended  with the ordinary
symptoms: about the evening of the fourth day, some pirn-
pie- made their appearance  here and there in different parts
of  the body, which remained until the seventh day ; some 
99
of them  filled with Variolous matter and did not disappear
till the nnuh or tenth day;  they left marks  behind them
which are still visible.   From these circumstances, I was
assured she had the Smali-pox, and confidently, told her so.
Since, about the 20th of March  1793,  the Small-pox has
been  epidemical in this  part of the  country, and  in July
following,  she was called to nurse a family who had them
of the confluent kind in the  natural way: she had scratched
a bit  of skin off the little finger of her left  hand, and being
constantly  employed in  opening the  pustules, moving the
patients from one part  to another,  washing  dirty  clothes,
&c.  &c. It grew up in the form of a large  pustule,  and in
the course  of nine days, she was attacked with the eruptive
fever, which continued with considerable violence for four
days, at which time, the Small-pox  made their appearance
to the amount of five hundred,  the most  of which  filled
with good matter, and continued so  till the  ninth day, when
they  formed into scabs,  and  then disappeared.
   " Another girl was attacked with the fever, which con-
tinued the  usual length  of time, attended with the common
symptoms, after which,  three pimples  made their  appear-
ance, and then disappeared about the ninth  day.
   " Another girl in the  same house  seemed to have been in-
fected by her;  she was seized with a fever,  which produced
several pustules : the first of these girls being satisfied she
had had the Small-pox, exposed herself to the contagion, was
infected  a  second  time,  and attacked  with  the confluent
Small-pox, of which she recovered with  great difficulty :
upon the back of which, the other  girl was  attacked with
the same disorder,  which carried her off  about the four-
teenth day.  A gentleman in this neighbourhood employed
rne to inoculate his  children, seven  in number; previous to
which, he had got a servant girl from Baltimore, who had
been inoculated before she came to the country; the mark
of the orifice in her arm was perfectly visible,  and she af-
firmed she had gone through all the different stages of the 
IOO
disorder: however about the time that the children were in
a blackening state, she  took the Small-pox, but got over
pretty easily
  " Such cases are certainly distressing both to families and
Practitioners:  from these cases however, which I know to
be incontestible facts,  I am really inclined to think, that a
person is liable to be attacked with the Small-pox more than
once in his life."

  To these cases many Practitioners will doubtless be able
to add others.   They certainly are very extraordinary, and
may serve to moderate the clamour of some, who consider
the Vaccine,  as either only acting as a temporary preven-
tive, or as by  no means universally infallible.   The first of
theSe opinions seems sufficiently confuted, (see p. 67); and
should  the  last  be  found true,  (which  of many hundred
thousands has  not yet been the case),  it will still be in this
respect,  on an equality with the Small-pox.
  The great advantage  of this extraordinary disease, is evi-
dently its prophylactic  power against the Small-pox.  But
its benefits to  mankind  do not  cease  here.  Its efficacy in
the removal of sundry diseases of a chronic nature, and
which had baffled a variety  of medical applications,  seems
established  by numerous testimonies.   Although  experi-
ence  has proved it to  have worked a cure in  several in-
stances,  it is  not to be supposed it always will  be equally'
effectual: but assuredly it deserves a  trial in similar instan-
ces which do  not readily yield to the power of medicine.
Its mildness will always be a pledge  of its security; and no
harm can possibly arise, even though no positive good should
ensue.
   Many Practitioners have assured us of its beneficial influ-
ence on weakly constitutions, in repeated  instances.   It is
however notuncommon to see a weakly constitution,amend-
ed  by any disease which affects the system  generally; hence
even the Small-pox will occasionally prove beneficial.   I 
101
can add with much propriety on this point, the observation
of a parent to me after his child had passed through the di-
sease;  that it was not a disease for poor people; in allusion
to the appetite which seemed to have rapidly increased.
   It appears from the observations of Dr. Jenner and others,
that the Vaccine besides frequently  benefitting weakly con-
stitutions, has actually  corrected a  scrofulous diathesis ex-
isting in the constitution.  Dr. Cappe says he has seen "one
of his patients recover from  sore eyes,  and eruptions on the
skin; and three others from eruptions on the  skin,  while
under inoculation of that disease."   Ring, p. 370.
   Mr. Simpson's letter to Mr. Ring contains a most valua-
ble testimony in its favor;  " Mr. G----'s child had a very
obstinate eruption of the crusta-lactea kind;  but more vio-
lent than it  is commonly met with.   It covered  the head
and face, and the greater part of the body.   It withstood
the effects of the usual remedies ; and the little creature was
really disgusting to look at.   The time arrived, at  which
the parents usually had their children inoculated.   I advised
the Cow-pock; to which they at first objected, from a  fear
of aggravating the disease;  but they afterwards consented,
when I assured  them that such an event was not  probable,
and that it was not impossible it might remove it.
   " The child was inoculated with Cow-pox matter ;  and
it was extremely gratifying to me to observe, that as soon
as the constitution was evidently affected, the disease of the
skin began to disappear ;  so that by the time  when  the
Vaccine action  subsided, the whole  of  the eruption  had
peeled off, in the form of very fine scales ; or  was brushed
off, like powder.   Not a particle  of medicine was given;
nor any external application used.    I have the pleasure to
say, there has been no return of the  complaint,  although
ten months have elapsed.
   " Several  instances  have occurred  to me, in which the
general health of  weakly children has been very much im-
proved." Ring, p. 736. 
102
  Doctor Husson in his valuable treatise,  entitled  " Re-
cherches  historiqucs  et  medicales  sur la  Vaccine,"  has
collected together a number of striking instances  of  its ef-
ficacy in regard to health,  as mentioned by different  per-
sons, and two strong cases  which came under his own ob-
servation.   One was a case of vident head-ach  of three
years  standing, attacking the patient  every three or  four
days, and which had  baffled  every effort.   The  Vaccine
pustule  was accompanied with a very  extensive erysipelas,
&c. The child at the expiration of five months had had no
return of the head ach.    The other was a case of scrofu-
la, cough, and shortness of breath.  As soon  as  the  pus-
tules began to appear, the  cough  became less frequent,
the complexion  improved, the  glands of the neck  dimi-
nished ;  and at the  time of his  writing  he speaks  of the
child as being quite well.  See p. 51 et seq.
   Dr.   Moreau, in his  " Historical  and Practical Treatise
on Vaccine Inoculation," has given  us a case of scrofulous
opthalmia cured by the Vaccine.   In another instance the
discharge from a fistula in  the neighbourhood of the elbow,
was lessened.  The latter patient was inoculated on a sur-
face covered with an herpetic eruption.   Others were ino-
culated with the virus produced from this scrofulous and
herpetic subject, without injury.  See Ring, p. 792.
 .. Mr.  Ring, p. 799,  says he has seen  a  letter  from the
Count  de la Roque, stating,  that he has received informa-
 tion of the Cow-pock being a corrector of some other dis-
 orders.  He  mentions^ a  severe epidemic  hooping-cough,
which  they who had undergone Vaccination, either escaped
 altogether, or had it mildly.   This  I suspect to be only an
accidental coincidence.   Mr. Fournier, first surgeon to the
Military hospitals at  Brussels, in a  treatise  on this  disease,
 gives   the  following fact, which was certified  by citizen
 Lebroussart, Professor of  ancient languages in the  Central
 School.  " One of his children, four  years of age, was a 
103
long time affected with deafness, which grew worse  and
worse.   Two months ago  he was  inoculated with  the
Cow-pock.   On the ninth or tenth day,  when the arm in-
flamed, the deafness began to diminish, and on the twenty-
first it entirely ceased."  See Ring, p. 855.
   Mr. Ring further states  from a communication of  Mr.
Garsed, that an infant four months  old  had been troubled
with a violent cough about  three months, which did  not
yield  to medicine.  The  fifth day after Vaccination  the
cough suddenly left her, and did not again return.    Mr.
Garsed also informed  Mr.  Ring, that Messrs. Jones  and
Powell of Neath, mentioned to him  " that a boy sixteen
months old,  full of scrofulous  tumours, was brought to
them for assistance :"  they supposed it could not  live a
vear.  The mother laboured under the disease and had lost
a child by it; she died also herself shortly after,  from  the
vast discharge of different  scrofulous abscesses.  The child
having never had the  Small-pox,  was vaccinated  on the
twenty-third March 1801, the disease running its course in
the most favourable way.   At this time he had several ab-
scesses about the arms, neck and shoulders, which soon be-
gan to heal, and  the cnild enjoys perfect health.  All which
was attributed to the Cow-pock.  See Ring, p. 856.
   I have met with one case, in wdiich for ten days or  two
weeks preceding Vaccination, a disagreeable eruption  had
appeared on  the  arms and face, attended with great itching.
About the time  the areola began its progress, this declined,
and by the fourteenth  or fifteenth  day was nearly gone.
Whether it would not have gone of itself, I cannot pretend
 to say.
    A  remarkable case occurred also at  Burlington,  to  Dr.
 Shippen, in a young lady who had had the Small-pox in
 early life, and was troubled with a disagreeable eruption,
 (which did not yield to medicine) on her face.   She  sub-
mitted to Vaccination and had it very finely and perfectly: 
104
The disease however.declined,  and she still I believe conti-
nues free from it *
  In addition to these cases, I shaii add the following, given
me by Mr. John  Vaughan,  and woic'i was procured from
the parent  of  the child.   " Samuel Swift son  of Edward
Swift of Bustletown, Philadelphia County, born January
3d, 1801,  three weeks  after  binh was attacked  with a
violent eruption,  chiefly  of the  cheeks, forehead, and chin,
which baffled all medical applications. About January '""Oth,
1802, he was  vaccinated by Dr. Worthingtoiy, a chief rea-
son for which was to try  the efficacy of the case in  the above
complaint.   The face was worse than ever  at the time the
Vaccine was.at its height.   As the arm healed, the face grew
better, and he now continues well; at times in cool weather,
a little redness but no eruption  has been perceptible."
 . I might go on  to accumulate cases, but I apprehend these/
are sufficient to awaken  attention on this point; and surely
the subject deserves it.   By Females it certainly deserves to
be tried, since in  many instances, the most pernicious appli-
cations are employed without effect, to remove those erupti-
ons which  frequently take place on the face and neck.   It
is to be observed  I speak only of such chronic cases, which
have baffled every application.   In  those only would I wish
to recommend it.   Experience  however will daily augment
our knowledge on this point, and I sincerely hope its truth
may be confirmed.

  It will not be improper here to give a  comparative view
of the superiority of the Vaccine  over  the' Small-pox, in
order to confirm the friends  of  this disease in their estimati-
on of it, and in hopes to awaken conviction in the minds of
its opponents.

  * I was in hopes to have had it in my power to detail this case; I
wrote to Dr.  S. for the particulars, but have not ye* received  an answer.
I have met with a case of almost constant head-ach since birth, which
I vaccinated a short time past, since  which there has been  no return.
Time must determine if the effect is permanent. 
             105

   COMPARATIVE VIEW OF THE
Vaccine  and Small-pox.
         Small-pox.
   First. This disease is in
the highest degree contagi-
ous: hence those who never
have had it, cannot without
extreme hazard,   mix  with
such as labour under it.
   Second.  The eruptive fe-
ver of the Small-pox  is not
unfrequentlyattendedby con-
vulsions of the most alarming
nature, the effects  of which
are often felt through life;
This  is  even  often the case
when the subsequent erupti-
on is comparatively small.
   Third.   The  numerous
pustules produced by this di-
sease  in many instances, in
opposition to every attention,
whilst  they  exhibit by their
temporary presence, a sight
of die most horrid kind; are
not less to be dreaded from
their frequent disfiguration of
their unfortunate victim, by
the pits they leave behind.
   Fourth. That attention to
diet and to medicine, which
is often necessary in guarding
against  the  violence of  this
terrible disorder, is a frequent
source of evil, as hundreds of
mothers can testify.
                    [  I* ]
         Vaccine.
  As this disease is not con-
tagious, the separation of the
well from those who are un-
der its influence is entirely
needless.

  None of these dire effects
are to be dreaded in the mild
process of Vaccination.
  An eruption in this disease
is so  rare an occurrence as
never to be expected:  And
where it does exist, the num-
ber  is so small,  as to render
it of little moment.
  There seems to be scarce-
ly an instance in which either
regimen or physic would be'.
requisite in the Vaccine. 
io6
        Small-pox.
  Fifth.  The season must
be attended to in inoculating
for  the Small-pox;  as well
as the age and present condi-
tion of the  system;  hence
pregnancy and teething  are
invincible barriers against in-
oculation.
  Sixth.  The frequent, and
often long continued nursing;
the extreme anxiety which all
parents must feel, although
every precaution be made use
of,  because the issue of  the
disease is at all events preca-
rious,  must forcibly contrast
the two diseases.
  Seventh.  The Small-pox,
it is agreed,  often calls into
existence the dormant germs
of disease, or so  alters  the
constitution  of the  patient,
that it more readily receives
such impressions,  as dispose
to various diseases, as  scro-
fula, white  swellings,  con-
sumption, opthalmia, blind-
ness, and many more.
  The comparison might  probably be  considerably extend-
ed :  enough  is said however, to shew the vast  superiority
of the Vaccine over Variolous inoculation.
         Vaccine.
  One season is scarcely pre-
ferable to another in this mild
disease: Age and existing cir-
cumstances are of little mo-
ment;   hence teething and
pregnancy are no objections
to its use.

  Nursing, anxiety and death
are almost equally strangers
to the Vaccine.   Death, we
may confidently  affirm, has
never employed the Vaccine
as a  besom of destruction.
  As much as we know of
the Vaccine, we  find it effi-
cacious in  frequently remo-
ving many formidable com-
plaints, and in benefitting  a
weakly constitution.
  I cannot bring this treatise to a conclusion without re-
marking, that as it is of infinite consequence to mankind, to
determine accurately, if the Vaccine originates in the Grease 
107
of the horse, I hope  it will  induce persons who  have lei-
sure and opportunity to attend to such investigations,  to ex-
periment fully on this importanr point.  This is a work of
greater facility in the  country than in the town.   1 have in
vain endeavoured for several weeks, to procure the matter of
the Grease from the inns and livery stables of this city, and
from other sources, where I thought I might  be likely to
obtain it.   My wish was to inoculate a cow, and also to try
to produce the specific disease on myself  with  it,  and from
this source to transplant it to another, in order to determine,
whether the passage of this matter through the human sys-
tem would not produce a disease perfectly similar in appear-
ance and effects.   It appears  probable from  the eighteenth
case mentioned by Dr. Jenner,  and to which I  have already
referred, see p.  15.
   Is no other animal  than the cow  capable of perfecting
this invaluable Prophylactic? What effect would take place
by inoculating the dog,  sheep,  &c.  with the matter of
Grease, and also of the Vaccine? If the Vaccine is produ-
ced by the Grease originally, what would  be  the effect of
Vaccinating a horse ?  Is he capable of keeping up the true
infection in this  manner as the cow;  and what effect  would
the matter of Grease itself have on the horse by inoculation ?||
   It has been asserted that the Cow-pox had been discover-
ed among the American cows to the northward.  In the
Medical Repository,  Volume 5, p.  93,  three Physicians,
Doctors Buel, North, and Trowbridge, acquainted Dr. Mil-
lar with this fortunate  occurrence about the same period;
in consequence of which I addressed the following letter to
those gentlemen.

      " Dear Sir,
                      " Will you excuse the  trouble I am
about to give you, in  requesting an accurate account of the
important discovery you have made, of the Vaccine amongst
the American cows, as stated in the fifth volume of the Me-

  || See the extract of Dr. Jenner's letter to Dr. Waterhouse,  p. 115. 
io8
dical Repository.  I feel particularly interested in this inqui-
ry, from having been the means of introducing it into Phi-
ladelphia; and having collected a considerable number  of
facts on this interesting disease, I am anxious to learn every
particular of its origin amongst us.
   " The particular points 1 wish to ascertain are, whether the
disease has long been known;  and whether it is supposed to
originate in  the animal itself,  or by transmission from some
other? Is the Grease or Scratches a common disorder among
horses with  you?  Are men on large  farms in the  habit  of
milking the  cows? And  has the  disease produced, always
opposed the Small-pox?
   '• An  answer to these queries as early as convenient, will
very much oblige,
                     " Sir, Your Humble Servant,
                         "  JOHN REDMAN COXE.
  il Philadelphia, March  17,  1802."

   To this I  received the following  valuable  and  interest-
ing communications,  for which I return the gentlemen my
very sincere thanks.
       " Sir,
               " I cheerfully attempt to answer the request
contained in your letter of the 17th of March last, relative
to the Vaccine disease among the American cows, discover-
ed in this place  in June,  1801.   No traces of the disease
can be discovered here, previous to the time abovemention-
ed.  It undoubtedly originated in the animals from  which
the matter was communicated  to the two women who milk-
ed them, and no other persons, either men or women ever
milked those cows.  The Grease or Scratches is not an un-
common disease among the horse kind  here,  especially  in
the winter season, but I cannot discover any case of it in that
neighbourhood at that time, or for many months previous.
   " Men are not generally in the habit of milking in our
farms, and particularly in this family, where it is clearly
ascertained that none but women had milked.   In answer to 
109
your last question,  viz. ' jias the disease produced,  always
opposed the Small-pox ?'  I will give a short account of its
discovery and progress, and leave you to  judge.  In June
last, my anxious researches were gratified, by  discovering
what I judged to be the genuine Kine-pox on the  hands of
two respectable  women, a mother and her daughter in my
neighbourhood.   From those  I inoculated  about twenty,
including my own family, in the months of July  and Au-
gust.  People's  prejudices were hard to overcome, and so
few applied that I lost the matter,  but soon found that  the
children were for mere pastime inoculating one another at
school, without  any guide, excepting a small caution which
I received from  Dr. Waterhouse,  and published, viz. ' ne-
ver to take matter for inoculation after the  eighth day.'  On
the 9th of  December last  I inoculated Mr. Lemuel  Taylor
and  ten children, in  consequence  of Mrs. Taylor  having
broke out that day with the Natural Small-pox.  The whole
of this family took  the Small-pox from this first inoculation,
excepting four of his eldest children, who had received the
Vaccine disease  about five  or six weeks previous.   This wo-
man had  the confluent pock to  an alarming degree;  the
whole   family   attended her throughout   (excepting  the
youngest,  a  sucking infant,  which expired  convulsed in
the eruptive fever); the four abovementioned were  inocu-
lated with  Variolous matter seven different times without
the least effect,  and yet remain so.
  " A young man  aged twenty, received the Vaccine di-
sease in July, and a little girl aged five years, also received
it in January; both  have been  thoroughly inoculated with
Small-pox  by a neighbouring  Physician (an  unbeliever)
without effect.   Those few experiments awakened the minds
of the  people to conviction, and as is usual, unlimited con-
fidence succeeded extreme scepticism; the Vaccine inocula-
tion pervaded every class  of citizens so generally, that of
three thousand three hundred inhabitants  contained  in  the
town,  two thousand at least are judged to  have received it:
of those, fifty or sixty may be found who have from vari- 
no
ous motives, repeatedly visited the different Small-pox hos-
pitals, with indifference, yet no one has  yet taken the  dis-
ease.   I shall be very happy to hear of its success,  or  any
unfavourable appearances that may happen in Philadelphia,
or elsewhere: At present my faith in the utility of this new
disease is unimpaired, but should it prove fallacious, I think
the public have a right to the earliest information.
              " With sentiments of respect,
                  " I am your humble servant,
                       " JOSEPH TROWBRIDGE.
   tlDanbury, April 1th,  1802."

                         " Sheffield, 15 th April, 1802.
   " Doctor John  Redman Coxe,
        " Sir,
                     " I delayed replying to your favour
of the  17th ultimo, that I might  communicate  some  facts
in relation to the subject of domestic Kine-pox,  which, at
the time of my receiving your favour, wanted time to  de-
velope.
   " That the genuine J/accine-pock has  been derived from
cows in one or more  instances in  my neighbourhood,  is a
fact, the truth of which I do not myself  in the least doubt.
The evidence on which  my belief is founded 1 will attempt
to detail to  you in a  brief and circumstantial  manner.  I
was requested in the month of March, 1801, to visit a son
of Colonel Joseph Goodrich, who  I was informed  was
affected with  sores  or boils of peculiar appearance.   I
found him  with several  tumors  upon  his face  and hands
of the size  of large boils, but fiat upon  the  apex  of each
to the extent of a half dime piece,  and having underneath,
a small quantity of an  almost  colourless fluid.   I was at
once struck with the singularity of the appearance of these
tumors.   I had at that time a few patients under my care,
whom I had caused to have the Kine-pox by inoculation; it
occurred to me that  the tumors  resembled Kine-pox,  but
they were  considerably  larger and more  prominent than 
Ill
any I had seen in that disease.   At my visit the next day, I
strongly suspected the identity of his disease and Kine-pox,
and that  it was dissimilar to any thing else.   I requested
permission of the Colonel to inoculate some of his  family
with matter from the  tumors,  and  others with  Kine-pox
matter, which [ had in my possession, which was accord-
ingly done.   In two (which  if my recollection  serves me
were all who received infection from  the  boy), the parts
inoculated soon began to inflame, as in Kine-pox, and about
the eighth day they had pyrexial symptoms.   The progress
was similar in one of those who received  Kine-pox mat-
ter.   The tumors were  larger, the local inflammation more
extensive, and the symptoms ail more violent, in those  ino-
culated from the boy than in  the other  person.   One of
those  in  particular had  much local  inflammation  which
continued several days,  followed with the sloughing off of
a  sufficient quantity  of substance to leave a pretty  deep
seated ulcer. The ulcer however, after digestion took place,
healed kindly.  I was now satisfied for myself that I had dis-
covered the Vaccine-pock.   It now remained that the man-
ner in which the boy obtained  it  should be  investigated.
The Colonel I well knew kept  a large number  of cows:
upon enquiry I found, that his son had  been in  the prac-
tice of milking them, and  that  it  was recollected  by the
boy and  others of the family, that one  of the  cows  had
been affected with sores upon  her teats.   It was also  well
remembered, that this boy  a  few  days  before  the com-
mencement of  his disease, had in play with his  compani-
ons,  received several scratches  upon his face  and hands.
Into these lacerations it is not improbable that matter  from
the cows (taken upon the hands, and they accidentally ap-
plied to the face) might have  been insinuated, and  in this
way a complete inoculation come to be effected.
   " In about three weeks from the time when those whom
I  had inoculated in this family were diseased,  I inserted
into  the  arm of one  of those  who  had been  inoculated
from the boy, and into that of the  one who had had Kine- 
112
pox otherwise, some good Variolous matter which had been
taken  the day before,  from a  person in Small-pox,  but
with no other effect in either, than a little inflammation of
the part,  which  subsided' in five  or six days.    This  I
thought  pretty  satisfactory  evidence,  that  my domestic
Vaccine disease was a preventive of  Small-pox.    I regret
that experiments with  this matter were not repeated while
the matter which I had saved was active.  But owing part-
ly to a press of other avocations, and partly to the difficulty
of obtaining subjects for experiment,  the business was  not
prosecuted until the matter had lost its activity.
   " Fourteen days since  (which is the circumstance that
caused my delay in replying to your queries), I inoculated
the whole four of my abovementioned patients with Vario-
lous matter without effect.   The matter was unquestion-
ably good, and the insertion faithfully performed.    I shall
not swell this epistle  with comments, but attend to your
query with regard to the origin of the disease in  the cow.
My own mind with regard to the origin of the  disease in
this case, as well as to the general principle, is in suspense.
There is an air. of improbability in the theory of  the origin
of the Vaccine disease from the heels of the  horse, that  I
cannot get over.  But to  well authenticated facts I ought,
as I hope I ever  shall, yield  conviction.   Facts  of this
kind sufficient to establish the theory,  I do not know  that
we are yet in possession of; circumstances in the case which
I have related were not unfavorable to the  truth  of  the
theory.  The Colonel had a large  number of horses,  and
some of them I  was  informed, were  affected  with  the
Grease in the heels; the same persons also who  milked
the cows  dressdd the  heels  of the horses.   The disease
therefore might have originated in this way.
   " I  will just add that I have no doubt in my own mind,
but that the Vaccine disease, was, in the course of the win-
ter before last, derived from  cows to the human  species in
two other families in this  town.   Several  persons I  be-
lieve had the true disease.    But as the facts did  not  come 
                          "3

under my own  observation, and as no  experiments  have
been made on them  with Variolous matter,   I  shall not
swell this communication,  already protracted beyond my
expectation,  with any particulars.
   " There have been inoculated* by me, and under my
inspection, in this town, about fifty patients, who have had
the Vaccine disease in a mild manner, and about half of them
have been tested with Variolous matter without effect in
any instance.
   " Should you wish Sir for any further information  from
me, in  relation to this subject, 1 will ever cheerfully attend
to your commands.   If in the progress of your business in
this line any new facts should occur,  I  will thank  you to
communicate them to me.
                 " I  am Sir, respectfully,
                         " Your Humble Servant,
                                    " Wm.  BUEL,"

   Dr. Waterhouse, to whom I wrote on the same subject,
politely furnished me with the  following reply.   It  com-
mences the letter from which I have given an extract at
p. 70.
  " Dear Sir>
     " Your letter of the 17th instant came to my  hands last
evening.  In answer to  your query respecting the indige-
nous, or domestic origin  of the Vaccine disease, I must in-
form you that I have my  doubts.  I had early  information
from Drs.  Buel,  Trowbridge,  and if I mistake not from
Dr. North,  on  that subject.   The matter  sent me by the
first never produced the disease, although the thread was as
stiff as  a wire widi it: that was however no proof that it
was not genuine.   I  have had information from  perhaps  a
dozen  quarters  respecting this  disorder among our cows;
one was to  me so un-equivocal, that I wrote to Dr. Jenner

   * The necessity of employing the term Vaccination in contradis-
tinction  to Inoculation will I hope soon  be generally admitted.
                 [ 15  ] 
U4
that we had certainly  found it among the American kine'j
you will see however, in the  London Medical and Physical
Journal for  September, that we were deceived.  A young
woman at Dorchester in the county of Norfolk, had an e-
ruptive disease which  she  caught by milking a cow whose
udder was-covered with pustules;  this person had a severe
febrile affection, and painful pustules on her hands and arms;
she was therefore sent into the Small-pox hospital and took
the Small-pox from inoculation.   I doubt not the accuracy,
much less the veracity of these Practitioners, but suspect they
have been deceived in a way similar to that  I  have related
in the Medical Journal, under the communication  respect-
ing *'  the effects of heat on the virus."  Medical pupils
and others have slyly  inoculated  cows, merely for the sake
of the experiment, or for a supply of matter.  I inoculated
one of my cows for that purpose and succeeded to my wish.
That the Cow-pox has arisen spontaneously (if a person may
use that term who believes, that strictly speaking, there is no
such thing in nature)  in the kine of our country is a matter
of which 1 am far from being entirely satisfied.  I shall not
therefore cease a rigid enquiry relative to  the domestic  ori-
gin of this distemper."
   If the disease whose history  is  recorded by  Dr.  Trow-
bridge, was really the genuine Cow-pox, and of this there
scarcely seems a doubt, how can we account for its producti-
on where there appears no vestige of the Grease? This must
require the strictest attention to determine, as it will tend to
prove the origin of the disease to be in the cow herself, or
else that there has been some other source of communicati-
on from the horse.  It is not impossible to suppose a cow to
take this disease from  the matter of the Grease, even though
we cannot trace it to its source from the  horse through the
hands of a man who may have previously  dressed the diseas-
ed heels.  The matter of  Grease or  Scratches is  a limpid
fluid oozing from the cracks of  the heels, and from thence
consequently, must not unfrequently fall  down upon, or be
brushed off, by the herbage of the field in which the animal 
JI5
may be feeding.  Whilst still fluid upon the grass, we may
easily imagine a cow might accidentally lay  down in this
very spot, so that her teats and udder should come in imme-
diate contact with the  infection, and thus  by a species  of
inoculation produce the disease.   There are many things of
whose truth we are certain,  which appear far more impro-
bable.   Some persons have supposed the disease could not
originate from the horse, because it could not be traced com-
pletely in every instance, through the hands of men employ-
ed to milk.   I think this mode of  accounting for it may
serve to reconcile these opponents,*
   I hope these and the subsequent valuable communications
will influence Practitioners to pay attention to the subject, in
hopes of discovering the disease nearer at home.  Dr. Jen-
ner's idea that the virus, is as perfect in its Equine  as in its
Vaccine  state at its first formation, is of the utmost import-
ance, and will certainly meet with the attention it deserves,
from every one disposed to forward his philanthropic views.

   I shall here introduce the following important  commu-
nication from Dr. Jenner to Dr. Waterhouse which he has
very politely forwarded to me,

                       Cambridge,  May 26th, 1802.
     " Dear Sir,
                       "  I  am induced to write to you at
this  time to give you a short extract of a  letter from  the
worthy Jenner, which I received not long  since, respecting
a new source of the Vaccine virus, not knowing but what
you would wish to insert it in your  publication.  It is this;
   " *  I have sent you also some  virus from  a new stock.
' The old stock now  in use near three years, has  not  lost

  * If the Grease does not give origin to the Vaccine; it certainly
seems to depend upon some common cause, with this last diseasej the
came season and kind of weather disposing to both. 
n6
* any  of it's original properties, nor do  I  suppose it ever
' wnl.   A medical gentleman at Milan, Dr.  Sacco,  (who
* informs me he has inoculated  8,000 persons in that city),
' has lately sent me Vaccine virus taken from a dairy on the
* plains  of Lombardy.    It has  produced again and again
' the perfect pustule here.  I alwaysventured to predict that
' the Cow-pox was not confined  to this island;  but that
' wherever, in the same dairy,  there should happen to  be
' the peculiar  intercourse I have pointed out  between the
' horse, the man, the cow,  and the milker,  that there the
c disease may be called into existence. Abundant testimonies
' of the source of the Vaccine virus have lately appeared, and
' I have long been convinced that it is as perfect in all its ex-
* traordinary qualities in it's  Equine as in its Vaccine state;
' perfect on it's first formation,  and imperfect when secreted
* at a late period of the disease;  just as it is,  when transfer-
* red, and subjected to  go through it's progressive stages in
* the human body.' "

  The following  account of the discovery at Milan,  in the
words of Dr. Sacco himself, I shall be pardoned for intro-
ducing in this  place.   It is extracted fiom the Philosophi-
cal Magazine, No. 46, for March 1S02,  page 184.
  " In our last wc mentioned  that Dr.  Sacco,  of Milan,
had sent to Dr. Pearson, Cow-pox matter, taken  from the
Milanese cows.   In a  work published  by Dr.  Sacco, in
Italian, entitled * Practical Observations  on the Use of the
Cow-pock,  as a Preservative  against  the Small-pox,'  he
gives the following  account of the manner  in  which he
procured the pus for inoculation, and also a  representation
of a cow's udder infected with  the malady.
   " For some time I had been  extremely desirous to repeat
the experiments of Jenner, and for  this purpose made dili-
gent search to discover the Cow-pox in Lombardy, it being
extremely difficult, especially in the present circumstances,
to obtain the pus from England.  A fortunate combination 
U7
of circumstances, by which it became necessary for me to
go to the large tov/n of Varesc, in the beginning of autumn,
procured me an opportunity of examining a number of cows
on their way from Switzerland to the fair of Lugano;  and
by this means, I had a favorable opportunity to  make such
researches, as might discover in some 6ne of them the Cow-
pox.  It was on this occasion, that, conversing  with  some
dealers in cattle, and countrymen who had  large dairies in
Lower Lombardy, I learnt that the cows among  us are sub-
ject  to the Cow-pOx.  In this inquiry I took care to propose
my questions in such a manner as to prevent the risk of be-
ing imposed upon.  A farmer of Cremona, who  had bought
forty cows in Switzerland, and had  driven them from thence
as far as Varese, assured me, that  almost all  of them had
been successively attacked with pustules on the extremity of
their nipples, and some  of these  were now converted into
incrustations.   1 visited the cows,  and had  an opportunity
of verifying his assertions.   1  picked off some of these in-
crustations with an intention of applying them in fomenta-
tion, if, perchance, I could not procure the true pus for
inoculation.  The same farmer promised me an opportunity
of seeing this disease with my own eyes, and for this purpose
conducted me to a neighbouring meadow, in which we found
a herd of cows belonging to a friend of his.  We examin-
ed these cows, and discovered on two of them different red
spots,  which the farmer assured  me was the  first stage  of
the disease;  no other symptom appeared on the cows, but
a slight  degree of dejection.  He  assured me that this was
the  very disease I was in quest of,  and that,  in  the course
of two  days, the pustules  would  unfold  themselves.  At
this visit which I made to the cows, there was present  a
dealer in the Grison's cows, who  fully confirmed the truth
of these assertions.   He also  added, that in his  country, he
had seen the cows afflicted with a similar eruption on  their
 uu"-s  and to remove the incrustations,  it was  common  to
anoint them with boiled oil used for varnish; and that by 
n8
this means they fell off in the course of two or three days.
Early next morning I went again to see the cows, examined
them anew, and found on one of them  four red spots, alrea-
dy tumid and  raised into pustules; three of these were spread
over the nipples,  and the fourth lay  in the  middle of the
dugs.   The other cow had six.pustules; two on the nipples
and the rest scattered above them.   These were larger than
those  of the first cow,  and around them appeared a slight
red circle.  Apparently these pustules occasioned much pain
to the cow, for, on my approaching  to examine them more
minutely,  they would scarcely permit me to  touch them for
one moment.  Although the pustules were already  large
and prominent, they did not yet  appear to  me sufficiently
mature to  yield the  matter  1 wanted.  As  the cows were
that day to go forward on their way  to Milan, 1 found my-
self under he necessity of following them  to their first halt-
ing-p.a= .M in  order to  examine them  again next day.  I
walke>' out at an earjfijhour to the meadow where  they were
at pasture, I  examined the pustules,  which  appeared to me
to be now arrived at maturity.   They  were  lucid, and of a
pale red colour, with a brown  spot in  the middle more de-
pressed;  and 1 thought this a favorable moment  to collect
the matter, which,  through the assistance of the herdsmen,
I was easily enabled to do by repeatedly soaking a thread in
it.  Although I saw no reason to doubt  that this was the true
Cow-pox, yet,  this being the first time 1  had  ever seen  it,
I began to suspect,  that the pustules might be of that kind
which Jenner calls the  spurious Cow-pox.   I determined,
therefore to decide the matter by experiment.  A consider-
able number of experiments, all uniform in  their  symptoms
and progress, and always constant in* theit results, put the
matter beyond doubt, and gave me full conviction that this
was the true Cow-pox.   Such and so  many are  the obsta-
cles to be overcome on the introduction of any innovation,
•however salutary,  that I for some time despaired of being
feble to induce any one to submit to inoculation  with the 
u9
matter I had collected.  In  fine, after many fruitless per-'
suasions,  1 succeeded in my design;  the success  which  at-
tended the first inoculations  encouraged others to submit to
the same  process.
   " Dr. Sacco then proceeds to detail three hundred cases, in
which he applied the pus he  had obtained in the manner des-
cribed above.  These cases  were attended with various cir-
cumstances ; but the inoculation succeeded  to produce  the
Cow-pox in all of them;  and in a considerable number  the
inoculation for the  Small-pox was afterwards applied,  but
without any effect."*

   A6 connected  in some degree  with the progress of Vacci-
nation in different parts of the world,  I trust it will not be
uninteresting to  give a short history of its introduction into
this metropolis.                                 J1J-
   Having perused with much satisfaction Dr. Jemx, 's trea-
tise on the " Variolas Vaccinas," toge ' er with som^ M" the
various periodical publications on the same subject about the
close of  1800,  I became  very desirous  of ascertaining  the
truth of so extraordinary a discovery.  My desire was how-
ever checked by learning  through the  medium of the daily
papers, that the Small-pox  had been  introduced into Mar-
blehead,  instead of the Vaccine, from which,  (from  my
imperfect knowledge of the subject),  I  concluded the  dis-
eases were not easily discriminated.   The  history of  this

   * It may not be amiss to mention  that the pock represented on the
infected udder, very much resemble the pock, on the hand in Dr.  Jen-
ner's first  plate.  They are not  however coloured;  and are apparent-
ly more depressed in the centre.
   I wish we could generally fall upon  some expression  which might
become general in the  place of pustule.  This is certainly an impro-
per term,  and the word pus, as  used by Dr. Sacco and the English
editor to imply the contents of such a vesicle, is yet more improper,
for no such thing as pus is known in the Vaccine, except from acci-
dental causes.  The word pock  will perhaps answer. 
120
Unfortunate  event Is minutely detailed  by Doctor Water-
house, in a communication dated February 1st. 1802, to the
Editors of the New-York Medical Repository,  and which
has lately been published in the last Number of that valu-
able work, Volume V, page 873, &c.  This circumstance
(with the particulars of  which I was unacquainted),  toge-
ther with the introduction of a  spurious disease  Into New-
York,  Norfolk, and other places, persuaded me it was bet-
ter toadhere  to  the  old mode of  Variolous,inoculation,
rather than depend on a  disease I considered so very uncer-
tain.   For some months I thought no more about it;   but
finding by  the publications from Europe,  it was  gaining
ground, and  that many who at first opposed it, were now be-
come its strenuous advocates, I resumed my favourable opi-
nion of it, and determined if possible to procure the infection.
Through the politeness of Doctor Bradley and Mr. Ring, I
obtained from London, several successive portions of infec-
tion about the end of September 1801.   These failed in e-
verv instance.   A subsequent portion however succeeded,
which I received on the  13th or 14th of November.   Pre-
vious to this, I had fortunately  obtained an infected thread
from President Jefferson, wdiich lie kindly procured for me
from Doctor Gantt, in consequence of my request through
Mr. John Vaughan.  The infection was accompanied with
the following highly satisfactory letter on the subject, which
I have the President's permission to make public.

                    "  Washington, November 5, 1801.
     " Dear  Sir,
                       " I received  on the 24th ult. your
favor of the 22d,  but it is not till this day that I am enabled
to comply with your request of forwarding some of the Vac-
cine matter  for Dr.  Coxe.  On my arrival at Monticello in
July, I received from  Dr. Waterhouse of Cambridge, some
Vaccine matter taken by himself, and some which he at the
same time received from  Dr. Jenner  of London.  Both of 
121
them succeeded, and exhibited precisely the same aspect and
affection.  In the course of July and August, I inoculated
about seventy or eighty of my own family; my sons in law
about as many of theirs, and including our neighbours who
wished to avail themselves of the opportunity, our whole
experiment extended to about  two hundred persons.  One
only case was attended with much fever and some delirium;
and two or three with sore arms which  required common
dressings.  Ail these were from accidents too palpable to be
ascribed to the simple disease.   About one in five or six had
slight feverish dispositions, and  more perhaps had  a little
head-ach,  and all  of  them had swellings  of the  axillary
glands, which in the case of adults disabled them from  la-
bour one, two, or three days.  Two or three only had from
two to half a dozen pustules on the inoculated arm,  and no
where else,  and all the rest only the  single pustule where
the matter was Inserted, something less than a coffee-bean,
depressed in the middle, fuller at the  edges, and well defi-
ned.   As far as my observations went, the most premature
cases presented a pellucid liquor the sixth day, which con-
tinued in that form the sixth,  seventh, and eighth days,
when it began to thicken, appear yellowish, and to be en-
vironed with inflammation.  The  most tardy cases offered
matter on the eighth day,  which continued thin and limpid |
the eighth,  ninth,  and tenth  days.   Perceiving v therefore
that the most premature as well as  the tardiest cases  embra-
ced the eighth day, I made that the constant day for taking
matter for inoculation,  say,  eight  times twenty-four hours
from the hour of its previous insertion.   In this way it fail-
ed to infect in not more I  think  than  three or four out of
the two hundred cases.  I have  great confidence  therefore
that I preserved the matter genuine, and in that state brought
it to Dr. Gantt of this place on  my return,  from whom I
obtained the matter I now  send you, taken yesterday, from a
patient of the eighth day.  He has observed this  rule as
well myself.   In my neighbourhood we  had no opportuni-
ty of obtaining Variolous matter, to try by that test  the ge-
                 [ 16  ] 
122
nuineness of our Vaccine matter;  nor can any be had here,
or Dr. Gantt wouid have tried it on some of those on whom
the Vaccination has been performed.   We are very anxious
to try this experiment, for the satisfaction of those here, and
also those in the neighbourhood of Monticello, from whom '
the matter having been transferred,  the  establishment of
its  genuineness here will'satisfy  them.*   I am therefore
induced to ask the favor of you to  send  me in exchange,
some  fresh Variolous matter, so carefully taken and  done
up, as that we may rely on it; you are sensible of the dan-
gerous security which a trial with effete matter might induce.
I should add that we never changed the regimen nor occu-
pations  of those inoculated ;  a smither at the anvil continu-
ed in  his place without a moment's intermission, or indispo-
sition.  Generally it gives no more of disease that a blister
as large as a coffee-bean produced by  burning would occa-
sion.   Sucking children did not take  the disease from the
inoculated mother.   These I think are the most material of
the observations 1 made in the limited experiment of my own
family.   In Aikin's  book which  I have, you will find a
great  deal more.  I pray you to  accept assurances of my
esteem and respect.
                   (Signed)  « THOS.  JEFFERSON.
   " Mr. John  Vaughan."

   This letter together with the Vaccine  infection, was re-
ceived by Mr. Vaughan on the  9th of November, 1801; A
day which I trust will be memorable among the citizens of
Philadelphia, from the great benefit connected with it.   I
immediately employed  the  infection  which  Mr. Vaughan
put into my hands on myself and four others; although these
last had never had the Small-pox, (which I had passed through
in early life),  my system nevertheless seemed more suscep-
tible  than their's, for I  took the disease by the first attempt
In two  of three places, whilst I was  necessitated to repeat

   * In consequence of this request, I  forwarded some recent  Vario-
lous matter, but am ignorant of the result of the trials made. 
123
 it in all the others.   It has been said my disease was local;
 on this point I certainly feel myself competent to decide.   I
 have in the Tables in the Appendix given the outlines of the
 case.*   However this be,  the-matter from my arm proved
 a considerable source  of  infection, and  either directly,  or
 indirectly, has aided very extensively in propagating the di-
 sease.  By the commencement of March I had supplied up-
 wards of one hundred persons with Vaccine infection, with
 most  of  whom I believe it  succeeded; amongst  these  are
 Practitioners of  Physic in this and the adjoining states, and
 also in those to the southward;  I have likewise  forwarded
 it to  the Natchez,  to  New  Orleans, and  to  Martinique;
 whether it has proved successful in these places I know not.
   Whilst I sincerely thank many gentlemen for their high-
 ly important communications,  I  have to apologise to others
 for my apparent  neglect, in not supplying them with the in-
 fection which they have written for.   It frequently happen-
 ed that I received such applications when I had scarcely any
 of the infection, f  and they must be sensible it  would not
 have been right to have deprived  myself of that small stock,
 by  which I trusted I should have been able to extend the di-
 sease.


  * It affords me pleasure to be able to say,  that the disease  on  my
 arm, though advanced to the sta,te of a scab, was at once recognised
by an old English farmer, (from Suffolk, now residing near Chester),
of the  name of Ashford,  to whom it appeared perfectly familiar,  as
 well as at the less advanced period which is represented in Dr. Jen-
ner's first plate.   This man, though he has now resided several years
in America, told me, he remembers the efficacy Of the Cow-pock in
resisting the Variolous contagion, but knew nothing of its having been
effected through the medium of inoculation.
  f I have already said, that many of my experiments  were made
with infection of  various dates, in  order to try the extent of time du-
ring which it retained its powers ; hence it is  no wonder I frequently
failed ;  this, together with the various sources of failure I have former-;
ly enumerated, will  I doubt not, excuse me. 
124
  The advantages of Vaccination to the southern and seve-
ral of the middle states, where Variolous inoculation is rare-
ly permitted, are  incalculable.   The same may be  said of
Kentucky, where I am informed, there are nearly one hun-
dred thousand persons who never have had the Small-pox.J
The advantages of this disease are scarcely less considerable
to some of the eastern states.
  In the army and navy it doubtless deserves the attention
of government, inasmuch as it seldom requires any confine-
ment, or particular regimen;. so little, I have already noti-
ced, that in England the soldiers are not even entered on the
sick-list In consequence of this disease.  It is not long since
I was asked for matter for the Constellation frigate, in which
the Small-pox made its appearance after leaving the city.  I
had unfortunately at the  time but  little  to spare; whether
that which I sent took effect  I know not.  I was informed
by her Commander Captain Murray,  that in her last cruise,
one hundred of his crew had the Small-pox,  five or six of
whom died.  I need not say how great must  have been the
anxiety and inconvenience excited  thereby, nor how much
more serious such an occurrence might prove, should a ves-
sel thus half unman'd, meet with an enemy.   The simple
knowledge of the fact will I  trust,  lead those in whose de-
partment this is placed, to attend to the subject.
  I  think it proper here to mention the  great necessity of
investigating every idle tale which is brought forward to de-
preciate the. Vaccine.   I have heard of a Practitioner of this
city having a case with so bad an arm after Vaccination, as
to make it expedient to amputate it; whereas this gentleman
had not experienced the slightest inconvenience on this score.
In another instance the Small-pox was said to have appear-
ed after Vaccination.  So far the story was true, but it  was

  X I regret I have  it not in my power to give any account of a disease
among the cows in  some parts of Kentucky, which Dr. Brown in-
formed me he had reason to believe was the genuine Cow-pox, and
the particulars of which he promised to transmit. I have not yet re-
ceived them. 
125
not added that the child  had never taken the disease, and
was  therefore inoculated to preserve it  from the Small-pox
which was in the neighbourhood.  This was to be detected
only by strict investigation!  Such are the falsehoods which
impede the progress of  the brightest discovery which has
ever been  made!  But the contest is in vain!   Time has
drawn aside the veil which obstructed our knowledge of this
invaluable  blessing;  and in the examples of the Emperor of
Constantinople,* of the  Dowager Empress of Russia,§ and
the King of Spain,  we may date the downfal of further op-
position.
   I have thus brought to a conclusion the relation of the facts
which'have  come under  my notice, and have endeavoured
faithfully to detail the result of my experience in the Vaccine
from its first introduction to the present period.   Most of the
facts stated, I have myself observed, and have only to add, that
I have never depended upon my memory, but have each day
committed to paper  every circumstance which appeared de-
serving of notice, of those cases which have come under my
care.  The infection when taken was  always noted, both
from whom I obtained it, and also the day  of the month,
and of the  disease, so that I can trace to its origin almost e-
very portion of matter,  which I have  either used myself,
or sent to others.  I hope this treatise, imperfect as it doubt-
less is, will still have the effect  of aiding  the extension of
the most beneficial discovery which has ever been made, by
tendino to allay improper prejudice, and imprudent  fears,
both in Parents and in Physicians; and also  of awakening
the philosophical researches of the curious,  in order to as-
certain with due precision,  what is the  real origin of this
wonderful  Prophylactic.


  * The favorite Sultana of the Emperor it is  said, had herinfant
Vaccinated.
  § " The first child that was inoculated for the Cow-pox in Russia
was named by the Empress Dowager, Vaccinoff, and a pension was
settled  on her." 
 
             append


                     CONTAINING

First—Various Letters on the subject of the spurious cases
  of Vaccine which occurred in New-York, Norfolk, and
  elsewhere.

Second—A set of Tables and Notes comprising the outlines
  of some of the first cases  of the  Vaccine  which came
  under my care.

Third—Sundry Remarks  and  Observations, Kc.  which
  have occurred to my notice  since the publication was
  put into the hands of the Printer,  and which I must
  have introduced here, or have altogether omitted.
Extract  of a letter to Doctor Hosack, dated Philadelphia, the
                 loth of January, 1802.
    " IT has been reported in this city,  that you have had
under your care,  a child who took the Smalbpox, after having
passed through the Vaccine disease, and it has been urged by some
as a cause for doubt of the efficacy of the  latter in preventing the
former.   As this case militates so strongly against the  present
received opinions on this point in Europe, as well as against the
experience I have had in several instances,  I can scarcely doubc
that the account has originated in some misrepresentation,  and in
consequence,  most earnestly desire to have it from the fountain-
head,  as the only method of coming to the truth, &c.
      « I am,  Dear Sir,
          " Your very obedient Servant,
                         « JOHN REDMAN COXE." 
128
            To this I received the following Answer.

                          " Niw-1'ork,  January 15, 1802.
   " Dear Str,
            " IN reply to your polite letter of the 10th  instant,
I beg leave to assure you,  that the report of a child having had
the Kine-pox under my  care,  and afterwards taking the Small-
pox,  is incorrect, though not perhaps altogether without  founda-
tion.
   " As it may not be uninteresting,  I will relate to you the whole
circumstances relative to the Vaccine  inoculation,  as far as 1 have
hitherto had any concern it.
   •' Very early after the discovery of Docfor Jenner,  my friend
Doctor George Pearson, of London,  sent me some of the Vaccine
matter ;  but the thread imbued with it being only inclosed in a
letter, I was not surprised to find it had lost its virulence : Imme-
diately upon receiving  it, I obtained permission from the inspec-
tors of the state prison, to  introduce  it in that house,  and inocu-
lated two of the prisoners.
   " Although  I was careful to introduce the thread below the skin,
and afterwards to retain it in its situation by adhesive plaister, it
did not in either case  excite more inflammation than  the  thread
uninfected,  would have occasioned.   Upon  receiving a second
thread from Dodtor Pearson, and the testimonies in favour of Vac-
cine inoculation contained  in his and Doctor Jenner's  publicati-
ons upon that subject, I did not hesitate to  inoculate some or my
private patients with it.  1  accordingly,  with every possible pre-
caution,  inoculated six children with it;  the  result was the same
as had occurred in those I had inoculated in the  prison ; very lit-
tle inflammation  was excited,  not more  than  was produced  by
the wound and thread alone.  Still confident of the advantages of
Vaccine inoculation, and  being informed thai Doftor Jackson,
of Boston,  had lately arrived from England, and was supplied
with the genuine matter, which he was  at that time successfully
employing  at  Boston,  I   applied  to Mr. Quincey to procure
me some of it from Doftor Jackson ; he accordingly obtained it
and carefully enclosed it in  a phial,  in such manner that  it could
undergo no change from the air : Without delay, I again inocula-
ted six children with it; among others, a child of Mr. Charles
Wilkes,  Cashier  of the bank of New-York ;  upon the third day,
I examined  the arms,  and found them all very much inflamed,  so
much so, that  I had no doubt of my success, with  this third  at-
tempt ;  the inflammation continued,  and extended about  an inch
around the  part inoculated, and in each  a pustule was formed,
which filled with  a watery matter, and did not  heal in less than
ten or twelve days from the time of inoculation. 
                             I2p

   "Upon  the  eighth and  ninth  days, Mr. Wilkes's child  had
manifestly  a degree of fever;  in  the other children there was no
observable  indisposition ; there was no eruption upon the skin in
either of them ;  but the inflammation of the arm was so great in
all,  th.it I had no doubt of the success of  this inoculation ; but
to ascertain it,  I afterwards inoculated them with  the Variolous
matter :  to my great surprise,  the arms inflamed,  they  all  sick-
ened, and  each had a CJisiderble number of puitules. The con-
clusion I drew from the above circumstances was, that the matter
sent me by Doctor Pearson had to.al'y lost  its activity,  from the
open manner in which it had been conveyed,  a,id the great length
of time that necessarily elapsed  before 1 received  it;  that  the
matter sent me  by Doctor  Jackson, was either not the genuine
Vaccine  matter,  that it was not taken at a perod of the disease
in which it possesses t >e m-st  active properties ; or, t'-'.at it had
undergone  those changes   which  Doctor  Jenner has   rated it
to be subject tc.
   " My  want of success has, however, not altered my >ith upon
this  subject ;  the almost unanimous testimonies in its favour  are
not to be resisted ; in our own  country, we have abundant proof
ofits utility,  &c. &c.
       " 1 am,  Dear Sir,  with great regard,
                           " Your's,  DAVID HOSACK.
   " Dr.  John Redman Coxe."

The following  is  an  extract from my reply  to the  above,  dated
                   January iSth, 1802.
   *' Allow me to thank you for your satisfactory letter ; I had ac-
ccur.teJ for the cases  which came under  your  inspe&ion,  in the
manner you have done, and am  happy  they have not  damped
your ardour.   Permit me to ask the form  and progress of the pus-
tule, the colour of the scab, and whether you  vaccinated with
the matter  of the pustules ?   How long after the disease was it
before you  inoculated  f r the Small-pox ?  Have you had any in-
formation fVom Dodtor Jackson, relative to the matter he supplied
you with ?
  " I hope you will pardon the trouble I give you,  and believe
me to be, Sir,
                       "  Your's sincerely,   J. R. COXE."

       To which I received the following satisfactory reply.
                           « New-York, June  %th, 1802.
   " Dear Sir,
                  " YOU will  think me remiss in not having
replied to your favour of January the 18th ;  but I purposely post-
poned my reply to the questions it contains, until my observations
                  L  n] 
i3°
wpon'the  Kine-pox have made  me  more  familiarly acquainted?
with the characters, which distinguish the Genuine from the Spurieuti
ki I'd.
  "I'am now perfectly satisfied that the pustules which  were
produced  upo.i the arms of those children I inoculated  wit-i the
matter  t had received  from Doctor Jackson, were  very different
from those or the genuine Cow-pox I have since  employid,  and
am at present in the use of: li the former a brown scab  appeared
very early after inoculation, which  does not take place in the
genuine  C> w-pox ; the pustule had not in any stage  of it that pe-
culiar pearl colour, which  characterises  the genuine species ; the
matter discharged frum it was Itss limpid, more approaching in
its  app> arance and consistence to  common  pus ;  the pustule
was not of so long duration, nor  did it termi' ate in th.  black
scab, as in the genuine disease.   The failure of those ca  es inocu-
lated with the spurious matter stated in my first account, I learn,
with great regret, has given rise to  a report in this city, which
has prejudiced many families against the introduction of  the Cow-
pox ;  but ihis prejudice must in a short time yield to the numerous
testimonies which we now possess,  to shew that the  genuine Cow-
pox is a perfect security against the Small-pox.
          "I am,  Sir, with great regard,
                           " Your's,   DAVID HOSACK.
  '/ Dr. John Redman Coxe."

  The following letter I received  from Doctor Balfour, of Nor-
folk,  in consequence of a request to obtain for me  every possible
information relative to the spurious disease excited there.

                               " Norfolk, March 25,  1802.
     "To Doctor  John  Redman  Coxe,  Philadelphia.
  " Sir,
       "  WHEN I last had the p!easu-e of seeing  you  in Phila-
delphia, you were so good as to furnish me with some of the fresh-
est  Vaccine fluid in your possession.  I then promised to give you
an account of the success I should meet with in propagating it in
this place, and the  history  I could collect (for I did not then reside
in Norfolk),  of the spurious disease  which existed  here the last
year, and at that time was called  Cow-pox.  That it was a spurious
disease  there is now no doubt; the event  too truly  proving—for
unfortunately those who had this false infection,  afterwards  took
the Small-pox, and some,  it  is said, fell victims  to the decep-
tion.
  «« The  impression made on the public mind,  in consequence of
this error, is a perfect horror at the  name of Cow-pox : It has
been further increased  by the true Vaccine matter (with which
several have since been inoculated), having failed to produce anv 
*3*
disease at all; its infecting powers from keeping being lost.  The
females of this city are particularly opposed to the Vaccine inocu-
lation ;  so violent  are they,  that  they generally  declare  xhey
would rather their children  should have the Small pox, and  run
their chance."
   " 1 will now give you an account of the success of my practice :
On the 7th of February,  the day after I saw you, Doctor Currie
of Philadelphia,  kindly  permitted me to take the fluid from the
arm of a child under his care.  It v/as on the 10th day, the areola
just  beginning,  (I should have  preferred it scorer).   The  sam«
evening   I left Philadelphia by water, and  arrived  here on the
 17th following—1 immediately inoculated a gentleman's child of
this  place, (Mr.  Martin Fisks), and his negro woman: On the
fourth day it was evident the infection had taken.  In both cases
the disorder progressed and declined in its most regular form  ; by
the 2zd of March  there  remained  nothing but  a  hard shining
scab, when I inoculated  them both with fresh Small-pox matter ;
their arms were inflamed a little on  the second  day,  but  by the
sixth were perfectly dried up,  without producing  the smallest af-
fection of the system.  Not perfectly satisfied with this assurance,
 knowing the public prejudice, I again inoculated both the child
and  negro woman with fresh Variolous matter from different per-
sons.  At the same time I inoculated  with different Small-pox
matter,  a child of Mr. Lynch's, and a negro child of Mr. Beale's,
both of whom had just got over the Vaccine disease j  but in every
case the re<u't was: just the same, a small inflamed spot was visi-
ble on the second day and  beginning of the third,  but by the
sixth was dried universally.
   "Thus have we at length succeeded  after so many unsuccessful
trials,  in introducing  into this town the mild antidote to Small-
pox.  So many attempts had- been made before,  without success,
that even medical men declared they did not believe  the disease
could be brought here.
   " It will, no doubt, taks some time to remove the obstinate pre-
judice of the public ;  but iike all great truths, it ultimately must
prevail, and surmount every obstacle ignorance can oppose.
  " Eighteen have had the disease in its mildest form, and numbers
are now under inoculation.   Not the least medicine has  been
requireJ in either of the  cases—not one has been kept for a mo-
ment from their labour or business—in  no instance has there been
an eruption of any kind ; their arms have not  been  sufficiently
 sore to require  any  attention,  not nigh  as much so,  as in Small-
 pox. The fluid has universally been  taken on the seventh, eighth
or ninth day.,  never later,  and always before the appearance of
 the  areola.
   " There is one circumstance I must remark ; I observed that the
 threads  I  have seen impregnated, have always been fine flaxen 
IJ-
 thread, the matter, whether Vaccine or Varick.us, formi.ig a cruse
 on the outside. A thread of this kind is generally extremely stiff,
 and on being handled is apt to crack and make the dry matter fly
 off;  to avoid this, I have pre/erred a cotton thread of double  or
 treble  the  size commonly used,  and but - slightly  twisted:  I am
 much mistaken,  if to this  apparently trifling circumstance, 1 am
 not in a great measure  indebted for the facility with  which I have
 communicated the disease; for with the cotton thtead,  I can  as
 freely give the infection when the matter is a number of days old
 (by m  listening it wi.h  a little warm water or steam) as  with the
 fresh fluid from the arm.
  " I  have inoculateJ  myself and another person,  b ith of  us had
 Small-pox  in  our infancy,  decisively,  having had  fever, and a
 large number of pustules ;   but the result ha'j been quite different
 from th •  experiments made in  Europe by Doctor Pearson, for our
 systems were both considerably affected,  (and in the same man-
 ner), indeed more so than  any of those I  have vaccinated,  who
 have not  had Small-pox.  The appearance of cur arms was, how-
 ever, quite, different from theirs ; we were inoculated with fluid
 t idee si warm from the^arm on the eighth day ;  on the fourth, there
was considerable inflammation  ; on the same day the efflorescence,
or a'eola, to k place,  extending three-fourths of art inch from the
point of inoculation ; no pustule wa_- formed, as in those who had
 not had  Small pox ; but a very small sore, depressed,  and not a
 tenth part as big as in the regular infection ; on the  sixth day we
 both had considerable fever,  puking,  violent head-ache,  and
 creeping chills over the whole body, particularly ihe back.   Our
 appe:ite  forsook us at the same time, and the glands of the axilla
 swelled and were painful : On tlie eighth day those symptoms aba-
 ted,  the  inflammation of our arms gradually subsided, (sooner
 than in the  regular disease) and  on the thirteenth day,  little re-
 mained but a scab  (not much bigger than a large  pin's head) ;
 and a peeling of the scarf-skin as far as the areola had extended :
 As  I  observed before,  I have not had a single patient  who had
 not had  the Small-pox, who had  the disease nearly  as severe  as
 we had.
  " We  have a third time inoculated for the Small-pox without ef-
 fect:  One person of seventy years of age has gone through  tie in-
 fection, and afterwards  perfectly resisted Small-pox—forty odd are
 no.v under Vaccination.
       " I am, with great respect,
              " Your obedient servant,
                                " GEORGE  BALFOUR."
  On the 10th of January, 1802, I wrote to Doctor Taylor,  of
 Nonolk, requesting him to give me every information,  relative
 to the same subject.  I had previously wrme;i to Doctor Barraud,
 of the same place.   Those gentlemen did me the lavour of reply-
 ing, as icliu'ws: 
133
                              " Norfolk,  April 15th,  1802,
   " Dear. Sir,
                 " WE feel ourselves obliged by your late com-
munications on the subject of the Kine-pox, and ter the trouble
you have taken in possessing us with  the Vaccine infection.  Our
acknowledgments would have been made more ptomptly, but that
we wished to give you the fullest result of our labours ; and al-
though we have again to regret that this benign antidote to Vario-
lous contagion has another unlucky   incident thrown  in  its way
by this late attempt  to propagate if,  yet we will relate to you the
effects of our endeavours to  introduce i: in  the lust and  present
year.
   "In the first of the year 1 801, some thieads were sent hither by
Doctor Spense,  of Dumfries,  with assurances that they contained
the ge mine Vaccine  infection ; coming in a ciireu way from Pro-
fessor Waterhcuse—We had  for some t rm: anxiously wished for
the means of introducing the df ease, and we aeized the opportu-
nity of immediately  essaying it.
   " Parts of these threads were distributed  to several gentlemen
of our faculty in the  town, and were severally used—Appearances
were flattering in a high degree ; an early inflammation followed
the insertion of every thread almost without anexception ;  a pus-
tule formed in the ordinary time, and tl e several characteristics
of this inoffensive disease seemed to us complete.   A sufficiency
of infection was readily produced to  proceed in our  work—in se-
veral cases the arm was troublesomely sore,  and in four instances
under cur immediate care there" was  fever  that proved inconveni-
ent for a day or two,  attended with eruptions as abundant as gene-
rally are found in the milder  Small-pox.   About eighty persons
had been subjects  of this  inoculation,  when  we procured some
Variolous matter which for some weeks we had not been able to ob-
tain : That we  might defeat all the scruples of those who ever
oppose innovations,  we determined to test it with this infect on.
   "The experimentwas wholly unfortunate.   Every person took
the  Small-pox,  and went through it under all the  ordinary cir-
cumstances.
   " Our disappointment was extreme—It was increased  by our
having circulated this infection among our  distant  medical  bre-
thren j with accounts of our own success and the progress we  were
making__Several of these gentlemen used  it  extensively,  with
disappointments similar to ours. Dr. G. of Williamsburg, had
several patients as much distressed with the  fever as is seen to be
the case in inoculated Small-pox ; two arms were sore enough to
 require the surgeon's aid for seme weeks.
    '■ Doctor Dick, of Alexandria, anotherof our correspondents,
relates,  that a person i; cculated with seme  of this  maaer,  after
 having gone through the disease,  resisted the Small-pox  with
 which he was several times inoculated,  and :!ut at  the  end of 
»J4
H
some few months,  he took it in the natural way, and had it se>
verely.
   " Here then we seem to have unluckily received an  anomalous
disease, tiiat  late  experience in Kine pox shews us to follow an
untimely regard in taking Me fluid from  the pustule  '
   "In  he late winter v.c had some commu;i,caaonswi.h Mr.Jef-
ferson, who vvas mide acquainted with our  disappointmen .   Pie
was obliging enough to send us a phial conta ning some infection
that he recomme'ded as fie'shand genuine : Af tnis  very moment
your own  favours were received. With  these authorities we were
enabled to make Iresh exertions to promote this work  of humanity,
this most  estimable discovery of all the last  century.   To quiet
all objections,  we commenced with one of our own infants,  and
very soon after seventeen  others submitted to the experiment.—
Again we exposed  ourselves to r.e\v mortifications  ; our threads
all proved ineffectual to our purpose,  although we inserted them
again and again.  It follows that the  delicate fluid, in these last
cases,  had suffered in travelling the short distance to us; or that
some unlucky incident occasioned its destruction.  Yet the phial
received from the President,  came to  our hands most  carefully
sealed, in a few days after the fluid was collected ; and the inge-
nious method of coating  it with  the gold-beater's  skin would seem
to have defied a'l hazards.  I mention these circumstances, merely
to evidence the peculiar nicety  that must be regarded in keeping
or transporting this  infection.
   " While we  were  determining these last trials, Doctor Balfour
brought  with him  from Philadejph'a,  some infection  that  has
proved good  ; but for this, we should  have  intruded on you  once
more.
   " We have some patients now under  inoculation  with  some of
this last infection, and  if we meet with  any circumstance worthy
your notice,  we will make it knowu to  you.
  " It is desirable thai the friends of Medical science should watch
over this  new subject in the healing art, that they may entrench
it from the accidents, and secure it against the  factions to which
it seems  exposed from  its  novelty and  its nature.  Assuredly it
falls forth the patrons of humanity, and the ingenious enquirer.
       " With respect we are,
             "  Your obedient Servants,
                                    " JAMES TAYLOR,
                                    " P. BARRAUD "

   These important and interesting communications will,  I trust,
be a  guard  against future danger, by  shewing the great atten-
tion which is  necessary to beceme acquainted  with  the  respec-
tive characters of the two diseases. I now proceed to the tables. 
V
135
ni
Subject.
Name and Age.  whence obtain
Vaccine  Infection.
how in-
John R. Coxe
     5 attempts
     6 th
J. RiCiut 6 mo.
lictsy Ginn
 6 yrs. 1st atpt.
       2d
       3d
       4th
       5th
Mr. Kir.'g,Lon-
          don.
Mr. Jefferson
Andrew Bozier
 28yrs. 2d atpt.
■Mr. Ring
Mr. Ring
     do.
Mr. Jefferson
Case 1
_____7______
is 11. Jeilei son
     do.
day taken
unknown
 8th
unknown
unknown
 do.
 8th
 8th
 9 th
Richaro iJuzier
 3 years,  2d ,
          3d
>4
*5
Moily Boz/er
 1 yr. ' 1st atpt.
       2d
       3d
       4th
       5th
       6th
       7 th
       8th
       9th
Maxwell
Sibella Peale
 3 years.
Lyttleton Ginn
 29 years.
Joseph Lee
 3oyrs. 2datpt.
Geo. Patterson
 25 years.
Asa Warren
 5 years.
Mr. Jefferson
     do.
Mr. Ring, Lon-
           don
Mr. Jefferson
     do.  -.
Mr. Ring
Case 1
     8
  unknown
     26

     33
8th
8 th
 how old troduced
         1
unknown 13 punct.
5 days   3 threads
unknown
unknown
 do.
 5 daYs
7 punct
 Sth
 do.
unknown
5 days
8
3 punct.
  do.
3 threads
3 punct.
3  do.
3 threads
1 do.
 5 days
 8
10 weeks
8 th
do.
5 days
8
Case
Case 8 from ihe
  pock produ-
  ced by the 3d
  attempt.
Case  8
unknown
Mr. Jefferson
CdsC  Si
Case 10
9th	1 day
8th	recent
unknown	unknown
1 5-!i	39 <%s
10th	54
8th	4
Stii	2
gth	1
8 th	4
8 th	22
8 th	10
9 til	2
threads fails
Issue of the
 attempt.
fads
2 successful
fail
fails
do.
succeeds
fails
succeeds
tails
succeeds
3 threads
2 punct
 thread:
J»o.
punct.
Jo.
hicisn.!
punct.
do.
4o.
 -Jo.
succeeds
succeeds
punct.
punct.
2 tuieads
2 punct.
r thread
2 incision
i  punct.
fails
 do.
 do.
 do.
 do.
 do.
 do.
 do.
succeeds
succeeds
succeeds
succeeds
succeeds
  do.
:cecds
    || By inckion is meant merely a long division of the cuticle,  without the insertion
jthrcad
                   General Disease.
Constitutional indisposition.   |      Eruption,  and where.
Non;
   Head-ach, lever, diowsy,  com-
mencing on the fifth day,  continu-
ing three or four days.

  As all these cases failed in repeated attempts with the first infection I
received from London, I had inoculated them for the  Small-pox before
I obtained a fresh supply.
Scarcely perceptible
  A scratch of a cat upon ti.o wpst,
in consequence  I suppose  of the
Vaccine matter coming  111 ccnta,:,
produced a perfect pock.
  About the tweltth much indispo-j   At least iliirtv small fiery looking
sition, consequent to the too free use p;mples around the pustules, which
of his arm whilst the axillary glands disappeared in about three day?-.
were ir.flamed.
   No  indisposition till the scabs
were rubbed of on the eleventh, when
an ugly ill-condiionedulcer, consi-
derably deranged the constitution.
  Five pustules,  on the vaccinated
{.arts alone ; three or four fiery look-
pimples on the eleventh day within
the  limits of the areola, they were
gone bv the fourteenth.-:
None  perceptible.
None.
Slight fever and head-ach for three or four days.    |     None.
                                  A considerable eruption of the
                                Chicken-pox on the back, face, and
                                extremities,  amounting  nearly to
                                  ghty in number.
  Chilliness,  succeeded byl  On the 12th day several minute pimplesap-
fever  head-ach,  and pa:n:peaied around the pock.  On the 15th day of
 Drooping ninth and tenth days, on
the eleventh lively, on the thirteenth
feverish and restless.
Seventh day, feverish, chilly, head'.  On the 16th
:h,&c. continuing a i'ewdavs 5 ii.er, al^ve  thirty  Vaiicl
                               nine  days from   inoculatio
ach, &c con.........L,
subsiding, when a new set of symp-
toms more  violent ^tended,  with
nausea and-vomiti r, about the ele-
venth d;y.
eighteen from first exposure to the
Variolous contagion.
   Nn th~dav considerable fever;
nausea and vomiting on the ioth.
the 16th day an eivipticn f
         aiicleus   ptstuie.
and
  On the 10th day a Variolous erup-
tion ; bein^ ti.e 25th day from expo-
sure  to the contagion.
  Head-ach. and drov«i-j   On the 29th day the Chicken-pox in cor.side-
ness the 3d day, slight fe- rable number broke out, large, and filling with
and 29th. 
f    SurjjCT.
},  *."inn  ndAce.
xC
Jas. 1' ittcrton
 3 months'
     Vaccine infection
whence obtain.
day taken how old

  ^jf  2 days
« " {Katy bmitli    | Ca -   i
   I  7  months.  z:\       ''
Ji  i-- ill Rubers    t -<. i '
     i  year,  id   I       14
             j I   I  I4,i5,i6.nixd.
»■>
Benj. Rush, jr.  Case 15,  16.
  10 years.
»o  .Mr.. M.ii.s
H. C. Meade
   6 weeks.
Case 11
(Enjifhftock)
C'jse 15
W:i..an> \\ ebb
23  Miss  Foiaia:i
-4-  Jacob Clarksun
      20 years.  2d
25  JcnnyBoon, 1st
      40 years.
26  Kb.
Air.  Idler son
Case 10
Ca e   6
      10
C. 15 16 mix'd
  9th
  gth
  7th
  9th
various
various
9th
Sth
9th
4th *
91I1
3th or 9th
12th
:■■) : L. J.unci L'iu: j Lase 23
  J        23 days
9th
3 day*
35 days
'3
'7
"4
     ' This instead of the 4"h. was in fact the 21st dav fr
was Ukca.
I36
| how in-jiioduced.	Issue of the attempt.	General Constitutional indisposition.		Disease. Eruptions, and where.
1 punct.	succeeds	Fretful on the 9tti from the puck being much rub-bed. From the 13th to 15th feveris.i at night.	On the 16th day, 3 or 4 very distinct Vari-olous pustules appeared on the face, which maturated rapidly ; both diseases were well by the 20th. In 7 weeks from Vaccination, an eruption of Chicken-pox.	
|i punct. 1 punct.	succeeds	Slight indisposition on Restless and fretful the probably from her teeth w through about this time.	the 10th.	None.
1 punct. 1 da. 1 do.	tails do. succeeds		8th day, rich came	None.
1 punct.	succeeds "	Very slight.		None.
1 pun. in each arm	Succeeds;the Inns were in-flamed but notmuch evi-dence of pus-tules at the late period of the 8th day.	On the 6th day pain of the ax-illae, restless and considerably fe-verish on the 7th, chilly on the 8th and 9th, with fever dull and hea-vy.		At about 12 days from Vaccina-tion four pustules were discovered in different places; I could not as-certain by the account I received if they possessed the true Vaccine cha-racter. I rather imagine they were adventitious pimples.
1 punct.	succeeds	Drowsy on the 6th with slight starting occasionally at night.		A small pimple on one leg the 5th day, gone the next.
1 thread	succeeds	Eyes painful, feverish on the 10th continuing two or three days.		None.
1 punct.	succeeds	Drowsy on the 6th, slight indis-position about the nth day.		None.
1 punct. 1 punct.	both succeed	Considerable fever 9th to i2th; itching considerable.		None.
2 punct. i punct.	Creeping scabs consi-dered as spu-rious. Succeeds. A-bout the 13th all 3 scabs rubbed off.	Slight fever about the nth day, on the 15th violent fever, tension and inflammation of the arm, ending in ulceration with aggravated symp-toms.		None.
thread 1 punct.	fails succeeds	Drowsy with slight head-ach on the 7th and a fullness of the eyes on the 12th.		6 or 7 minute pimples near the pock about the 12th day, speedily retiring.
1 punct.	A creeping scab considei ed as spin ions	But slight indispostion, much itching.		
1 punct. 1 do. 1 do.	faded do. do.			
1 punct.	succeeds	Ino indisposition apparent		Nu.,1.
Vaccination.  I have marked it as the 4th,  as it was at this period from its prog-»-;"i       -he infs;;i ■>+ 
i37
Oj   Subject.
£  [Name and Age.

30
31
Titian Peale
2 yrs. 2d  atpt.
      3d
      4th
      5th
      6th
      7th
      8th
      9th
     10th
     1 ith
     1 21 h
     13th
     14th
     JSth
     16th
M.
Jones
10 months.
Vaccine  Infection.
whence obtain, (day taken
Case  n
      do
      29
      23
      31
      37
       9
      22
      25
      41
      44
      75
      76
      81
  Variolous
Case  77
      77
      84
  Variolous
Case  25
Bridget Kerlin  From a case of
34
35
3*
37
5 years.
John Kerlin
  3 years. 2d
Mary Kerlin
10 months. 2d
Nisa Rogers
 35 years. 2d
           3d
           4th
           5th
           6th
Pyrrhus
 14 years.
Robert
  11 vears.
40
41
John  Heineken
  2 years.
Sally  Dunn
  7 months.
Betsy Dunn
 4 years.   2d
Dr. Hewson's
Case
Case 26
     do
Case  23
Mr. Jefferson
Case  33
      43
obt. elsewhere
Case  44
John Dunn
 % years.   2d
           3d
           41 h
Case	22 37
Case	22
Case	32
Case	37
Case	37 ?.9
nth
do.
8 th
1 ith
8th
8th
7 th
12th
6th
7 th
8 th
7th
Sth
7 th

10th
10th
8th
7th
18th, see
ease p. 27
 15th
  do.
 15th
  do.
how old
34 days
38
 5
33
recent
recent
 4 days
54    J
57    1
recent
recent
 5 c1ays
 7
 how in-
troduced
'7
1 punct.
  do.
  do.
  do.
  do.
  do.
  do.
  do. in
each arm
  do.
  do.
  do.
  do.
  do.
1 do.
2 do.

2 do. mix
ed.
17
 10th
  8th
  8th
  7th
unknown
  9th
nth
 6th
Case
37
39
40
42
12th
8th
6 th
 6th
 9th
~67h—
 xoth
 9th
 7 th
n
13
32
unknown
 recent
 36 days
 recent
36 days
1 punct.

1 punct.
punct.
do.
punct.
do.
4
recent
4 days
recent  .
recent
15 days
 punct.
 thread
 punct.
. do.
 do.
 do.
1 £unct.
  do.
1 punct.
1 punct.
  punct.

1 punct.
1 punct.
1 punct.
1 punct.
1 punct.
1 punct.
Issue of the
  attempt.
Fails
 do.
 do.
 do.
 do.
 do.
 do.

 do.

 do.
 do.
 do.
 do.
 do.
 do.
 do.

 do.
fail
succeeds
fails
succeeds
fails
succeeds
fails
spurious
  do.
fails
spurious
succeeds
fails
spurious
succeeds
succeeds
succeeds
fails
succeeds
fails
 do.
 do.
succeeds*
                   General Disease.
Constitutional indisposition.   I     Eruptions,  and where.
  This  case was not vaccinated  a second time  in consequence of some
doubts in the mother's mind.
Slight indisposition, and ramb-ling on the 7th day.	None.
Fretful the ninth i,:a'ht.	None.
  Restless and feverish!  On the gth, 3 or 4 small  pimples appeared on
the 9th and 10th days.ithe arm above the Vaccine  pock,  which by the
                    [13th had all  but one disappeared ;  This shewed
                    [the genuine Vaccine character.
  Much nausea and vomiting from the spurious disease, pi
duced by the 2d attempt, attended with high  fever, head-ach,
pain of back, hssitucl.-, great local itching from 4th to 6th
day, with shooting pains and great axillary inflammation. The
spurious disease by the 3d attempt was attended with great itch-
ing. Head-ach,  fever, pain of the axilla, &c. from 5th to 8th
day.  In the spurious disease by the 5th attempt the symptoms
were less violent. The 6th and genuine disease was very slight,
although the part was much irritated.
None.
But very slightly indisposed.
None.
  Fever 9I1 day, with nausea and vomiting,
considerably indisposed to the 12th._______
None.
  Slight fever 10th day, with nau-
sea and vomiting.
None.
  Fretful the ninth right,  slight
fever the tenth.
None.
  Feverish 10th and nth; conside   One bttie pock formed on the verge
rable fever with vomiting the  13th.  of the large one and ran  into it. _
  Considerable fever  on  the  10th
day :  Violent symptoms at a later
period  from  repeated  irritations of
the scab.
None.
  * With matter taken on the sevemh day, I immediately Vaccinated
punctures in a week afterwards,  with matter of  case 47 and case 49.
time 2-ie v/i'di \ ;ung -.What influence  this might have, I know not.
a cow on  the  teats in two places; they however both failed, as did also a second trial by three
The cow was nearly dry when I first attempted it, and it was soon discovered that she wa; som: 
£|  Subject.
Yw  J Name and Ajrc
4.1 k.  y K.t
     7 year
Vaccine Infection?
4.3 M^ig. iJarnhill
   I   2 years.
44 Mne. Davidson
   1  2 years. 2d at.
   !         3li
            4th
4 s 'Jjiucj Wilson
   I  17 yrs. i6tal.
2d
Case 39
Case- 39
     43
     42
     4'
     47
3d
Wilkinson
Tom
  24 yrs. do,
        2d
        do.
        3d
        do.
Case 43
     43
39
25
43
C;,sc
48|N'j.:!i M.. Kiui
   |  24 vrs. 2d at.
            3d
            ith
            sth
            6 th
            7th
49
5°
51
Matilda Evans
  5 months.
obtd. elsewhere
Case  33
      26

Mr.  Jefferson
elsewhere
elsewhere
Mr. Jefferson
Case 47
elsewhere
Case 44
     51
     51
9th
 6th
10th
7th
unknown
 9th
 s.h
 8ih
 gih
 7th
how old
 ecent
 4
 5
recent
 3
n
J>5
Unknown
 -7
 49
 90
119
unknown unknown
C\u
41
Theodos. Pctlil
 t inon.  2d
Cast
43
44
1 hi.in.ib Jjurns
 4 mon.  2d
 Sth
 8th

 8th
 8th
P±
 7th
120
  3
 46
  2
recent
  5
4th & 5th 24.
7'h     recent
Case
4th & 5th 24
l7{h     recent
 how in-
troduced
1 punct.
punct.
1  punct.
 do.
 do.
 do.
 do.
1 punct.
  do.
1 do. in
each arm,
and also
put on a
sore from
whence 1
rubbed a
scab.
1 p.in ea
thread in
each arm
1 punct.
1 punct.
1 thread
1 incision
2 do.
thread
incision
2 punct.
thread
1 punct.
1 do.
  do.
  do.
2 do.
1  punct.
1 punct.
do.
i  punct.
t  do.
Issue of the
  attempt.
succeeds
succeeds
fads
 do.
 do.
 do.
succeeds
fails
fails
>fails
one succeeds
fails
fails
succeeds
fails
do.
succeeds
fails
fails
do.
do.
do.
do.
do.
do.
succeeds
fails
succeeds
scab not off
till 6 weeks
tails
succeeds
          *3«
                     General  Diseask.
Constitutional indisposition.   |      Eruptions, and where.
     Restless  the 8th,I  One pock on the inside of the right thigh, ap-
scab complete the 12th, patently Vaccine.  It had an areola, -'■ of "an inch
oft the 18th.           |but was considerably rubbed before I saw it.
  Drowsy the 5th and 6th days, slight indispo-
sition .the 10th,  probably from a violent cold.
None
No indisposition.
Nons
  Went tj) the country as soon
infected.  '                  ..-''■'■
Never ailed,again,  1 know not if it took effect.
  On the (Jth day from the 2d attempt, during
which  I made the other trials, a very fine pock
was  advancing,  from which I obtained  some
limpid fluid, a pain of the back and head, andjlhe 16th from first expo-
                      p to the axilla attended:sure.  It was very thick
                                            lupon.him.
  The small-pox broke
out on the evening of the
nth day ; which makes
of the Mdc,  shooting uj
with considerable fever.
Did n® take effect.
See the Note.
  Indisposition
scarce evident.
  On the 20th day several little pimpics appeared on the
"ace and neck which soon dried away.
Slight indisposition on the 13th.
   An eruption of small  red  pim-
ples on the hands and neck, on the
15th which soon  subsided.
  Drowsy the 8th, slight indispo-
sition the 12th, scab rubbed consi-
derably.
  On the 21 st an eruption of smafl
red pimples, continued a few days.
I rcccivLT^T  ,  1  W°Uld 'PPW.tfcat of filty.0„e cases, we must, to form an accurate statement, deduct cases 2 3, 4> *>f 5. ^h were vaccinated (w.A mftctioa
' "S'l ,  °^S  d) rePeated'y. w"hoUt any effect: hence I conclude its activity was totally destroyed :■ Cases 27, 28, 36, and perhaps 48, which had previously had the
--^-,.x,  «nd hence v.ere not altosetherfuirsubject   Cases 31,  46  (in one of whom it was not repeated a second time, and the other 1 know not the «sue of), making i« 
   NOTES referring to  the preceding Cases,

   Case  i.  In this case (my own), head ach, fever, and drowfi-
ness, indicated a constitutional afiiction on the 5th diy,  towards
the close  of which an areola commenced  its progress.   Two out
of three attempts succt-eded, the areolae of which uniting, formed
one large  one of an oval fhape, and full six inches in its longest
diameter.—O 1  the sixth day  the  axillary  glands were swelled
and  attended with considerable pain, especially on pressure.—On
the seventh day of the disease 1  was called unexpectedly from town
at 10 P.  M.  to see a person at twenty five miles distant.  The
night was dark and rainy, and at four in the morning the carriage
was  completely overset,  by which I was compelled to stand in the
mud and rain for half an hour  before it was  righ ed.   Added to
this, I  experienced much anxiety  and  fatigue during the day, in
my  endeavours  to  reduce  a strangulated hernia.   I returned to
town at  four  in the afternoon,  which  I  dii   not  reach  till
near midnight.    During all this period I did not get any sleep,
or but for a  few minutes.   I fully  anticipated from all  these cir-
cumstances, considerable augmentation to  the  symptoms  of  the
Vaccine, but was agreeabbjfcdisappointed in finding no increase of
symptoms.   It gave me great confidence in the disease, as it 6a*
tisfied me of its mildness and perfeft safety.
   Since  that  period I have endeavoured to  excite the disease in
myself a second time, during a space of upwards of five months.


all, t-n cases:   Of the remaining forty-one, it will appear that
   the first attempt it succeeded in    23,   or nearly  three-fifths
seconJ
do.      in   10     do.      on=-founh
      third          do.     in    a     do.      one-twentieth
      fourth         do.     in    I     do.      one-fortieth
      fifth          do.     in    2     do.      one-twentieth
      s]xtrl          do.     in    1     do.      one-fortieth
      njnth         d->.     in    I     do.      one-f.wtieth
      feventeenth    do.     in    1   fails         one-fortieth
Of the twenty-three, who took it by the first attempt, the Virus was obtalneJ
      on the  4th   day in   1
6th    do.
7th    do.
8th    do.
 9th  day in   7
nth    do    1
12th    do.    2
mixed, &c.     3
  It also appears I have succeeded with matter taken on the eighteenth day be,,
fore the areola was formed;  with matter on the fifteenth day, taken at the re-;
ttss of the areola; and on the twelfth taken at i:s height.
  Of these cafes I have, inoculated ab ut twenty,  ineffectually, once, twice,
ibrice, and oftener, b sides exposing several of them to the Small pox.
  For the particulars of each  cafe; the reader  is referred to the Notes, ths
numbers annexed to which, refer u the fame in the lift of c...cs, 
140
In twenty two successive attempts J failed, although In most in-
stances 1 employed recent matter.   In ecme few instances an in-
tolerable itching,  (commercing sometimes in three or four hours
from inserting the'in ection), preceded and accompanied  a little
pimple which die J away in two, three, and four days.
   In a twenty third and twenty fourth attempt, with matter taken
from a most perfect pock on the eighth day,* I at length succeed-
ed in producing a spurious  pock.   About  twelve hours after Vac-
cination the pu ictures were attended with an intolerable itching,
and an inflamed circle was very conspicuous.   By  the third  d*y
a considerable pock had risen in both places, which by the fourth
had rapidly increased, more especially in  one fthe other gradual-
ly declined),  which  new  had a 1 ght but  well  defined  areola
around it of about three fourths  of an inch diameter,  with a hard
base ; the flat surface of the true disease was absent, yet something
like depression of the centre was obvious.  As it  augmented,' it
assumed  more of the Variolous character,  the matter though lim-
pid at first, putting on a purulent  appearance in  a  short time.
On the close of the seventh day  a scab was forming, the itching,
areola, and hard circumscribed base were nearly gone ; and the
scab came off about the  tvvelrth. day, without assuming so dark an
aspect as that  which forms in the genuine disease. A slight eschar
still remains.   No indisposition was evident.
   Since this period I have renewed  the attempt four or five timei
ineffectually.
   It may not be  amiss to remark  that all my first  attempts by
above a  dozen punctures  with  infection  sent  me  from England,
failed;  as well as  in cases 2.2.4  5.6.
   From a perusal  of the case above related, T think it musr, (in-
dependently of  the constitutional afrVction) be credited bv most
persons, taat I really underwent the genuine disease; were this not
the case,  I cannot suppose 1 fhould have failed so uniformly  in
every succeeding attempt, as certainly, to a mere local affection,
my system could not have been le^s  susceptible  than before.
   Case  2. Four  days  after my last attempt in this case, the pa-
tient broke out with the chicken pox.   I  have n*t fince repeat-
ed it.                                                    v
   Cases 3. 4.  5. After the ineffectual attempts T made here with
the matter sent me from England, as I had no immediate prospect
of procuring more, I inoculated the patients.
   Casf.  6. The third  attempt  succeeded, as may  be feen by.tTie
tables,  but it did not advance till  the eighteenth day  fix days

  * With  matte  taken the  preceding day from the same pock, I excited
a genuine case of Vaccine,  which was as  perfect  in its appearance and pro-
gress as any I have seen. 
                             I4I

 after I had  succeeded  in exciting the disease by other infeo
 tion.
   In this case the scabs were repeatedly rubbed off, but the sores
 healed kindly without any application.  On the eighth day I ino-
 culated her with recent Variolous matter,  taken from her mother.
 who was then labouring under a very  full  burden of the .Natural
 Small pox, to which she had been exposed constantly for seven days.
 The  three punctures 1 made, inflamed, and produced three fmall
 local pock, unaccompanied with fever or any eruption ;  they dried
 away by about the twelfth day.
   Case 7.  Considerable  inflammation and increase of fever fol-
 lowed the imprudent use of his arm,  which swelled greatly, but
 yielded to a smart purgative and saturnine applications.  On the
 fourteenth  day I sent him to see the woman abovementioned (mo-
 ther to the preceding case) and inoculated  him on the seventeenth
 and twenty-second days, by two punctures each time, with recent
 Variolous  infection.   No effect but a slight inflammation for
 three or four days was  produced.   It was the first case I inocula-
 ted after passing through the Vaccine, and interested me  very
 much.
   Case 8. This is the first sore arm I witnessed.   The child was
 remarkably gross  in his habit, and subject to a purulent discharge
 from the ears.  The weather at the time  was very  vauable with
 easterly winds.   Being anxious to see the progres*of lHw^ise>sej
 I omitted both medicine and  diet, which prcbagrV^ woHtd, hawt^,
 checked the violence of the disease. To this I  must atTd,f'lkat I
 had produced three pock on the arm about one fourth of atr)nch
 apart, forming a triangle,  with  infection received from the  Pre-
 sident :  I vaccinated the child three days  after,  in two other pla-
 ces, about an inch on each side of the above pock, (with matter
 just received from England), in consequence of my belief that
 the  other had failed.   Both attempts  however  succeeded, and
five pock were the result.   The three  first were repeatedly rub-
 bed off and at length formed one sore  of considerable magnitude,
 and accompanied with great tension and inflammation of the arm
 and of the axillary glands.   Citrine ointment checked the ulcera-
 tion, and some  active  physic reduced  the  febrile symptoms ; On
 the  twentieth day I inoculated him  with  recent  Variolous in-
 fection ;  The punctures inflamed  two or three days when  an at-
 tack of measles  supervened,  followed  by  dysenteric  symptoms.
 The healinp of the ulcer was checked  considerably ; and was net
 completely healed for two months.   About ten weeks from the
 first attempt  to vaccinate him I again inoculated him ineffectu-
 ally.
 -  Case q.  This case I vaccinated  as the tables shew,  eight
 times ineffectually, by  seventeen  different  punctures  during   a
                   L  13] 
142
space ol  two months and an half.   The ninth attempt succeed-
ed ;  an areola appeared on the eighth day.   I inoculated  her in
two places  ineffectually on the twenty  first day.   The matter
which produced the disease in this case was taken from axpatient
in whom the disease was excited  by infection of  the  eighteenth
day.   The1 infection of this case  I  forwarded to London, to try
whether re-transplanting altered its efficacy,
   Case  io. This case was  a student of  medicine from  Ken-
tucky.  He was  inoculated on the eighteenth  day with recent
matter, which produced  slight  inflammation  for a  few days:
about seven weeks after it was ineffectually repeated.   He several
times also exposed himself to the infection from others.
   N. B.  From his arm a  fellow student in the  same  room  who
had  had  ^he Small pox, vaccinated himself,  and produced two
most perfect pock, accompanied  with a  constitutional affection
unequivocally marked.
   Case  ii. This case had no areola.    On the  thirteenth day
the scab, which had been progressing,  was suddenly suspended ;
early on the fourteenth an eruption of the Chicken pox,  contin-
nuing to appear for three days, and drying on  the fourth.   Dur-
ing this period the Vaccine was  completely stationary.   On the
fifth  day the eruption was nearly dry, when immediately the
Vaccine  resumed  its  progress,  and terminated  favourably  the
twenty eighth day.   Soon  after  this she had the Measles.   Six;
months afterwards I inoculated her  ineffectually by three punc-
tures ; a  local irritation for a  few days  was the oidy  effect  pro-
duced.
   Case 12. This is the father of cafe 6, and was exposed to the
Variolous contagion from his wife one whole day previous to Vac-
cination, as well as during  its whole progress.   On the sixth day
I inoculated him with matter from his  wife, as I feared the Vac-
cine might not be sufficiently advanced to secure the system.  The
Vaccine  progressed, and in proper time the Small pox  made its
appearance,  about forty in number,  producing around  the cir-
cular Vaccine a zone of confluent pustules,  which gave it an an-
gulated appearance in a short time.
   Case 13. This  man had been exposed to the contagion of the
Small pox two days before Vaccination. On the eighth day of the
Vaccine I inoculated him.   He  broke out with the Small pox en
the ninth day from inoculation, violent fever preceeding.   About
thirty pustules, which maturated quickly.   The Vaccine by ir-
ritation produced a sore,  which healed kindly in a few days. In
these as well as most of the blacks, the local inflammation was no;
to be distinguished except by a hard and tumid base.
   Cases  14 & 16. The particulars of these case*  are  detailed
at p. 76, et sey. 
H3
  Case 15. The disease  was very mild.   A month afterwards
I was told he had the Small-pox.   It proved however only a case
of Chicken pox; his father who had had the Small pox long before,
took the disease from him  and broke out in two weeks with a pre-
cisely similar eruption,  after a slight indisposition of two days ;
The eruption dried  away  in four or five days.   From this case
the  subject of C.  16, also took the disease. See p. 78 1079,
  Case 17,  In this case the  pock was rubbed  off six or seven
times successively ;  it did not  however appear to have destroyed
the  Vaccine disposition ; I am not positive, as I have  never ino-
culated her.
  Case 18.  The pock on this child's arm was rubbed off at least
six  times without any bad consequence.  A month after Vaccina-
tion,  I inoculated  her,  under a firm persuasion the Small pox
would  follow, 3S I supposed the Vaccine disposition was certainly
destroyed.   A  half filled pustule  alone was produced with mode-
rate local  inflammation ;  no eruption nor any fever  but  what I
ascribed to some teeth (mo]ares'), which came through at this pe-
riod with considerable difficulty.
  Case 19. This  case had been twice  inoculated when an  in-
fant,  but it was  doubtful if he had taken the disease.   Much
itching attended.
  Case 20. I  have noticed this case, more in consequence of its
having been mentioned by some as a proof of the  violence of
the  Vaccine.  This lady on the  3d day of Vaccination travel-
led  down  to Washington, which it is highly probable  at that
inclement season  (December)  might of itself induce a febrile  in-
disposition, independently altogether of the Vaccine, which had
scarcely on the  9th day enlarged itself to a pock,   General Mor-
ris in a letter to me of  January 1 ith,  after mentioning the pus-
tules,  adds, " though she has been indisposed since-, which I  at-
tribute entirely to a cold."  Mrs. M. afterwards suffered from an
attack of Measles;  yet  all her subsequent indisposition,  was by
many friends ascribed to the Vaccine.—This lady it will be seen
by the tables, was vaccinated with matter which derived its source
from the English  stock I had received.  The day after I  had  in-
troduced the virus, I  found the child from whom  I obtained
it had broken out with an eruption, which I satisfied myself was
the  Chicken-pox, but as it was the first eruptive case which cams
under my notice, it gave me some uneasiness.—These circum-
stances, which I stated to several, I afterwards heard  mentioned
in a way,  that I could scarcely recognize the original account.
  C as e z \.  To this case no areola existed ; she has however  re,
sisted the Variolous inoculation,
  Case 22. Areola about three inches diameter.  On the 12th
diy when it was retiring, I obtained a considerable quantity of 
144
matter.   On the  19th  day he visited a patient in  the  natural
Small-pox and  inoculated himself with the matter; since that
time I have repeated it  ineffectually ;  and he has frequently visit-
ed Variolous patients.   A species of herpes  existed on his arms,
&c.  wh'ch  I hoped would have been removed; it  was however
not effected.
   Case  24.  This man, I  have understood, has,   since he has
crossed this  " adamantine bridge," nursed  several persons in the
Small-pox,
   Case  25.  The violence of this case I have noticed at p. 50,
as also the abundant supply of infection it yielded at p. 31-
   Case  26.  From this case I obtained matter nine days succes-
sively, from  the 7th to the  15th.  The areola had nearly gone
when I took the last portion,  on  the 15th day,  with which I ex-
cited the genuine disease in  c. 33, 34.  Before it began to scab
(on the 16th dayj it was I think full half an  inch diameter.  The
scab did  not fall off for five  weeks.   No sore arm  was produced
although the pock was punctured perhaps 50 times.
   Cases 27, 28.  The subjects of both these cases were study-
ing medicine :  both  had had  the Small-pox when  young.  The
first bad  a small tumour of a spurious nature, produced, attended
with considerable itching and axillary inflammation.   In the last,
a slight inflammation appeared for a few days.   I believe he has
since ineffectually repeated the attempt several times.
   Case  29.  The scab came offthe 21st day ; when I inoculated
him with recent matter by one puncture.   I  repeated  it  on the
31 st day  by two punctures, and in seven weeks from this time by
three punctures without any other effect than  slight local inflam-
mation for three or four days.  The matter was fluid from persons
labouring under the Natural Small-pox.  In four weeks from this
last attempt, I sent him to see -c. 47 on the 8th day of an ample
eruption, of Small-pox.   This man held the child one quarter  of
an hour  in his arms ; but as may  be expected without effect.
   Case 30.  This child had just recovered from the  Chicken-
pox, taken from his sister c. u.  On the third day after the third
attempt, he burnt his  arm near the Vaccinated part.   Is it pro-
bable any effect was produced by the  different irritation of the
burn,  or by the constant application of lead-water ?   At this pe-
riod he  became restless, eyes watery, &c. which  continued the
4th, §th and 6th days,  when the Measles made their appearance ;
they soon disappeared :  The speck at  the Vaccinated part conti-
 nued to afford hopes it  would succeed.  It soon  however came  to
 nothing.  Between the 11th and 12th  attempt, a period of nine
 weeks elapsed, when I vaccinated his infant sister of four weeks.
 §he took the infection without difficulty by the first attempt, and 
r45
had it in the highest degree favourably.   With  recent infection
from her arm I again repeated it on him without effect, and five
days afterwards I tried ineffectually to produce  it by first rubbing
the arm well,  and then scraping off the cuticle with the shoulder
of my lancet, making also several slight  punctures, over which
I deposited a large portion of infection.  Variolous infection after
a few days of local irritation dried  away, as did likewise  a mix-
ture of Variolous and Vaccine  infection-:----What can  be the
reason of  so constant an opposition to the Vaccine infection ?
The  system doubtless would be equally uniform in opposing the
Small-pox.
   Case 31.   Some  doubts arising  in the mother's mind,  I did
not repeat the attempt.
   Case 32.   The scab came off the twenty-ninth  day: On the
thirtieth,  I inoculated her with  recent  matter by two punctures.
They inflamed a day or two and disappeared.
   Case 33.   The pock in this case augmented  in size, after
the subsidence of the areola,  to nearly an half inch diameter. The
scab did not appear till  the fifteenth  day;  on  the twenty-sixth  I
inoculated  her with recent matter,  which  inflamed  a day  or two
and disappeared.  This and the next case were produced with in-
fection of the fifteenth day.
   Case 34.   In this case  the scab was repeatedly rubbed off,
but eventually  healed kindly.   The pimple remaining had every
evidence of the Vaccine pock, the circular form,  depressed  centre
and flattened surface, with a beautiful areola  of half an inch ex-
tent.   With the matter I vaccinated her sister, c. 42.
   Case  35.   This is a curious case ; of six attempts two proved
abortive and three produced a  spurious disease, with a creeping
scab or incrustation, containing a purulent fluid.   The constitu-
 tional symptoms  ran very  high in these spurious products, and
the local irritation and pain was excessive, whereas the genuine
disease"was very mild.
   Case  36.   This boy is  supposed  to have  had the Small-pox.
 The  pock  never assumed the  character of  the Vaccine.   It was
 accompanied  with great  itching and ran its course very quick;
 On the nineteenth day I  inoculated him with no effect.
   Case  37.   The symptoms in this  case,  seem to  have run
 higher than usual.  They arose however,  I believe,  from irritar
 tion produced  by too free a use of the arm : The pock was very
 large.   On the twenty-fourth day he was ineffectually inoculated
 in three places.
   Case  38.    This child was teething at the timeof Vaccination,
 r,.ealso had a cough, and  a complaint of his bowels arising probably 
14-6
 from  the teeth ;  and probably giving rife to the slight indispos],
 tion on the ninth day.  On the  eleventh the areola commenced,
 continuing to the fourteenth  or fifteenth.   The pock increased
 after the subsidence of the areola till the seventeenth day,  when it
 was,  I think, nearly anhalf inch in diameter. Thescab now began
 to form, and  soon perfected itself.  Although this pock had a most
 flattering appearance, I repeatedly punctured it without obtaining
 any matter, once alone  I procured an inconceivably small quan-
 tity.   After the areola had subsided, I did  not  attempt to obtain
 it,  though I  might probably have  then got a  considerable por-
 tion.
   Case 39.  The areola in this case was the most perfectly cir?
 cular I have seen ;  it came on the tenth  day.   The matter I ob-
 tained on  the seventh day,  I forwarded to England.  About six
 weeks after I inoculated it  ineffectually with recent matter ;  a
 slight inflammation for a few days only occurring.
   Case 40.  This child had  the scab rubbed  off  repeatedly,
 and received several knocks upon it, which produced  great  irri-
 tation and the consequent symptoms.  By the end of  six weeks
 it was nearly  well.
   Case 41.  This child was a fat gross  habit, much troubled
 with v/orms and very fretful at the time of Vaccination.  I gave
 no orders as to diet or physic,  which doubtless tended  to  increase
 the symptoms.   The pock  was repeatedly rubbed off,  and much
 irritation produced.  The weather also was  raw  and wind at east;
 the child was always in the streets, till at length  the symptoms in-
 creased greatly,  with extreme pain and inflammation of the axil-
 lary glands.  It was difficult to induce physic to be  taken, but
 it was astonishing how rapid a change  for  the  better took place
 after the operation of an active purgative,  Poultices were requi-
 red to allay the inflammation, and the  citrine ointment followed
with advantage.  It took up eight weeks.
   Case 42.   I have said in the  tables trnt this case was vacci-
nated with infection of the twelfth day.   It was in fact  only of
 the fourth day,  as it was taken from a secondary pock.   The are-
ola here commenced the  seventh day and was nearly gone by the
 ninth.  On the fifteenth day I inoculated her in  three places with.
 matter taken  the preceding day from a person labouring under the
 natural disease.   A slight  inflammation for a few  days  was all
the effect produced.
   Case 43.   In this case I obtained  matter on the ninety-third
hour from Vaccination, or less than four days; I might probably
 have obtained it sooner.   I procured  it  six successive days,  by
 repeated punctures, yet without producing a sore arm, or in the
 least injuring the pock.   She had  a bad cold previously to,  and
during Vaccination. 
*47
  Case 44.  A short time after the first  attempt,  she was at
tacked with cynanche trachealis, which she  recovered from in twti
or three days ; after passing through the Vaccine she was inocu-
lated  with recent matter, which appeared  to  inflame  for a few
days,  and then disappeared.   She has also  been exposed to the
natural contagion ineffectually.
  Case 45.  This young man was sent to Philadelphia for Vac-
cination,  in  order  to insure obtaining the infection, by Dector
Chapman of Bucks  county, to whom 1 had  ineffectually forward-
ed matter.  The disease after repeated attempts, was excited by
infection fifty-eight days old.   From him I understand the disease
has been extensively communicated.
  Case 46.  I understood this gentleman, he had had the spu-
rious  disease at Norfolk, or some place to which it had been sent
from thence.  I know not if my attempt succeeded, as  he did not
favour me with a second visit.
   Case 47.  The original  matter which I  received  from Mr.
Jefferson  appeared  to take  effect  here, but as the  Vaccination
was performed only five days previously to the  eruption of the
Small-pox, the  pock which  was  apparently rising with  great
regularity,  soon assumed the angylated irregular form of that dis-
ease from the confluence of the pustules.  I have no doubt but for
this circumstance, a true Vaccine  pock would  have  advanced to
maturity,  from matter then nearly four months old.   This  man
had been exposed to the Variolous contagion  from a fellow-ser-
vant,  five days before the first Vaccination.   It will be seen that
one "of the first attempts likewise succeeded with infection twenty--
seven days old, but which advanced so slowly  that I had renewed
the attempt, under  the idea of its having  failed.  I obtained in-
fection from this pock before the Variolous eruption.
   Case  48.  At the time of my last trial, he told  me that  in
autumn  last he  had an eruption,  which was supposed to be the
Chicken-pox, accompanied with fever, head-ach and  pain  of
the back  ; it was not violent,  though a considerable  crop attend-
ed__a few pits were left.  Whether this might have been a light
attack of Small-pox I know not:  I however  emitted any further
attempt, intending to try again at a future period.
    Case  49.  On the  fifth day a circular inflammation was ex-
tending around the  pock,  and, by night had increased  to nearly
an inch in diameter ; by the morning of the sixth it  had entirely
gone.  On the ninth day the true areola commenced its course,
 terminating on the twelfth day.   She has withstood the Variolous
infection by inoculation.
    Case 50.  On the nineteenth day I inoculated this child with
 recent infection ineffectually.  On the fifteenth day an eruptica 
ij.8
of small pimples appeared on  the  head,  extending to the face
and neck, which in three or four days subsided.
  Case 51.  On the twenty-first  day an eruption resembling
that in the preceding case.  In about  ten weeks  an eruption of
small  pimples attended with great itching ; it  much  resembled
urticaria, coming  out successively  on the face, arms and body.
It soondisappeared,  and in a week  or ten days was  succeeded by
a larger eruption, more resembling Chicken-pox, which also took
place  in the nurse.
            Remarks,  Observations,  &c.

  THE following highly interesting case, whilst it proves the pos-
sibility of passing through the Vaccine after having had the Small-
pox, proves likewise, that the infection can be occasionally ab-
sorbed,  even without any previous injury to the cuticle.   In fact
this must be  frequently  the case among the cows in its communi-
cation from the hands of milkers;  and why  should not the  same
occur in the human species ?
  On Saturday the 8th of May, Dr. Sermon vaccinated the daugh-
ter of Mr. E. of five months old, on  the right arm above the el-
bow, which not  appearing to have succeeded,  was repeated  in a
few days in the other arm.   This last attempt altogether failed ;
but about eight days from the first trial, a pock commenced its
progress, going  through its various stages with great regularity,
and at the present  period (June 7th) a perfect scab exifts upon the
part.
  Mrs. E. was accustomed  to lay the child constantly upon her
left arm, so, as  that the Vaccine pock on the right arm of the
child was in contact with Mrs. E's left arm above the elbow.  No
abrasion or scratch of the  cuticle existed, nor can the minutest
trace of such having  been the case, be discovered.   On Saturday
29th of May (or about two weeks from the commencement of the
Vaccine pock in the child) a pimple  was evidently progressing,
with considerable itching.   As this itching had  been perceived,
but not attended to, for two or three days previoufly,  we may
safely state this day as the third from  the absorption of the infec-
tion.   On  Sunday (the fourth day if  my conjecture is right) she
felt considerably indisposed with heaviness of the limbs, fever,
pain of head and back;  pain and  swelling of  the axillary glands,
which  still continue slightly, all indicating a constitutional  in-
disposition. 
149
   On Wednesday (seventh day) an areola commenced,  and Was
 at its height  as  large as a dollar on the eighth and ninth days;
 after which it gradually  declined.  This day, (Monday June 7th;
 the twelfth of the disease) a scab  is commencing in  the centrel
 The pock is depreffed in the centre,  is perfectly circular, with
 edges raised and flat surface ;  some limpid matter is still  evident,
 part of which I employed for Vaccination, but it failed of taking
 effect.
   This lady  was inoculated  twenty years ago by the late  Dr.
 Glentworth,  and had at least two hundred pustules in  her face
 alor^rj  as her  mother  informed me.  Her  imagination could
 scarcely have induced a  belief of the symptoms, if they had not
 actually existed.



   THE following case which has resisted the action of Variolous
 infection, I introduce from its extraordinary rapidity:
   On the 26th and 31st of May, I vaccinated Lewis Calansalin-
 go, a black child of six years of age,  a Dispensary  patient, with
 infection of thirty-two, and of three days old, ineffectually. /At
 the same time I  also vaccinated his sister of four months with the
 same matter.   In this case the last attempt succeeded and pro-
 gressed finely.   On the eighth day, I vaccinated her brother with
 fluid matter from the arm.   This  took effect,  and on the sixth
 day I obtained matter from it.   It was a perfect pock in every
 respect.  On the 14th June  (the  eighth day) a perfectly hard
 dark coloured scab was completely formed ; no indisposition at-
 tended,  and no hardness had  existed around the  base of the tu-
 mor ; so  that I  am fatisfied  there  was no areola.  On the ele-
 venth day the  scab  was  quite black, when I inoculated  him by
 three punctures,  which produced  a  slight inflammation for three
 or four  days, and then dried away.   The scab came off about the
 14th or 15th day.



   THE following outlines of a case which occurred to Dr. Otto, I
introduce, to shew the Vaccine is not to be regarded as a perfect
presei 'ative against Small-pox, if the system has been exposed to
the contagion  before the  Vaccine  has exerted its full effect.
   On the 30th January, Miss P. was attacked with  fever, &c.
ivhich continued the two  following days, when an eruption of the
Small-pox took place,  between two and three hundred of which
filled.   Her sister, who never had had the disease, was constant-
ly exposed to the contagion till the 3d of February, when she was
Vaccinated.   The  symptoms of constitutional  disease occurred

                 [  >9   ] 
150
 with more than usual violence on the tenth, eleventh and twelfth
 days, when they entirely ceased.   On the evening of the sixteenth
 day, she had a chill, succeeded by fever during the night, though
 trifling  compared with the previous attack ; the next morning an
 eruption of Small-pox occurred to the amount of one hundred, of
 which only two filled.
   Was  the Small pox in this inftance moderated by the Vaccine ?



   I think I have f ;.nd no difference in the susceptibility of the
 systems  of whites  and  blacks, to the impression of the Vaccine.
   From what I can collect, I think fifteen hundred or two thou-
 sand persons in  this city, must now have been subjected to the in-
 fluence of the Vaccine, of  which probably one hundred and fifty
 may have been  tesied with Variolous infection.
   It has appeared  to me,  that whenever the Vaccine is received
 by a person, who has previously undergone the Small-pox, it runs
 its course more  rapidly than usual.
   The warm months  appear to have nearly suspended the  fur-
 ther progress of Vaccination  for  the present.   I may now ask
 where' are our reservoirs for its future  continuance ? Those who
 imagined it was possible to keep it  up  in our charitable institu-
 tions, have taken no pains to realize  their ideas ;  which  ideas
 have tended to  subvert the attempts  to establish a Vaccine
 Institution.  The necessity of such an Institution will,  I ap-
 prehend, be soon felt, which 1 hope  will lead to its speedy form-
 ation.
   This disease has yet to struggle with  much opposition :—Many
 yet doubt its efficacy, which I can only account for, from the know-
 ledge that some of our Practitioners still persevere in the practice
 of inoculation.   This apparent proof of  their own want of faith in
 it, must  certainly bias those who look up with deference to their
 medical  opinions.   The  testimonial  of our oldest Physicians
 would strongly tend to accelerate  its progress.  With Mr.  Ring
 we may  say, "  It is no want of candour to affirm that those who
 are hostile to Vaccine inoculation are total strangers to it ;  those
 who  are  doubtful, are almost total strangers to it;  and I defy the
 whole world to produce one  single instance of a person that has
 had any experience in the  disease, who  is not a decided friend  to
 the practice."   See p. 720.



  I HAVE  it fortunately in my power before concluding these ob-
servations,  to give an important document relative to the domes- 
15"i
tic origin of the Vaccine among some cows  in the neighbourhood
of Philadelphia.   I regret the informant n is not mere extended,
as it is of so interesting a nature to our inhabitants ;  it is extract-
ed from a letter of Dr. James  Reynolds  to me,  dated  Philadel-
phia, June  28,  1802, and is as follows:                  -\ -

     " Early in March  having Vaccinated Mr.  Harwood's little
son, at Mr. Bache's seat at Settle; the family, after my departure
recollected that a young heifer on the estate  had sores on her teats.
On my rjext visit, in  six or eight days, they-nentioned  the  cir-
cumstance ; the parts  were by  that time  unfortunately covered
by dry incrustations.
   " The idea however,  naturally occurred,  that  as the  habits
and constitution of the cow, (some varieties of which are  indige-
nous) are nearly or precisely the same in Pennsylvania as  in  Bri-
tain, by  analogy, the same affections of the system are like to
exist, and of course,  the  Cow-pox.
   " To  ascertain this, 1  spent some time in  fruitless  search,
among the people who bring milk to our markets ;  most of whom
were shy, an J offended by my inquiries.  At last,  one Mulvaney,
who supplies my house,  informed me, that  a cow of his had sore
teats, but he " gu esse d they were only scratched with briars."
I called at his farm that evening,  and had the gratification of pro-
curing a considerable quantity of matter*. The next day I insert-
ed portions of it in three cases,  which exhibited the most  perfect
appearances in all their stages.   I have since used none but what
is derived from this  source, and have, by the desire of sceptical
parents,  successfully subjected several to the test ot Variolous in-
fection."
      \

  The following extract of a letter from Doctcr Samuel Brown,
of Lexington,  (Kentucky),  to  Mr.  John Vaughan, dated June
loth, will certainly afford pleasure to every humane mind.

  " It will give you satisfaction to hear that the Jennerian  ino-
" culation has  gone  on here with  astonishing  rapidity.  Many
" thousands have passed through that disease.   People of all de-
" scriptions communicate the infection,  and although it is to be
" apprehended  that some spurious  cases may  have occurred, un-
" der the management of such untutored Practitioners,  yet  it is
" believed that the genuine  disease is pretty generally known and
*' diffused.  Not  less th;;n one hundred  and fifty thousand of our

  *  This communication would have been rendered much more v"'a:bh, by
an account of the  appearance of the d^ease in the cow ;  :»;;i ot its supposed
01 i irt. 
152
i' inhabitants,  have never had the Small-pox. What obligations
" do we not owe to Doctor Jenner,  for the discovery of so  safe
?c. and  easy a mode of  escaping  the  ravages  of  that  horrid dis-
" temper.''



   By a letter from Mr. William Dunbar, dated " Natches, 30th
May, 1802,"  to  Mr. John Vaughan, we have the pleasing in-
formation of the certain introduction of the Vaccine into that place.
The prelude I hope of  the final extinction of  Small-pox in  that
part of America.



   I SHALL here conclude with a short remark on the still t/k." --
ing  prejudices  of many  against inoculation  generally, under a
false impression that, as all diseases are in the hands of the Al-
mighty,  it is a species of impiety to tempt him, by thus usurps.
ing  his  prerogative in  producing  a  disease, which  probably
might have been escaped ! But should not all who argue thus, to
act consistently, refuse medical assistance in every instance ? Does
not accepting a dose of physic from the hands of a Physician, argue
the same impiety,  inasmuch, as without fuch aid, health may be
restored  by the blessing of Providence? But the fact is, the
error consists in blindly refusing to employ the means which are
placed in our power, to remove the evils to which we  are expo-
sed.—That same bounteous Creator who has provided us with
food necessary to our existence, has likewise supplied those medi-
cines which are administered to our relief in a state of disease ;
and has given reason to man,  to enable him to distinguish what
may benefit, from what may injure  him.  Inoculation then should
be viewed as a medicine, disagreeable  in itself, yet administer-
ed to escape a greater evil.—In the same light ought we to view,
and to prefer, this new species of inoculation ; as it possesses every
advantage, exempt from the disadvantages, of that dreadful  dis-
ease the Small-pox.
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