z > H 1 ► > t- £ ^ 55 vt ?0 ET > 3' 5W ire •< r+ © 3 o m o o z pi .s «J? V x ... ,r i- *. > "$# i r '" ■>. '\ CONCISE VIEW */ C OF / ALL THE MOST IMPORTANT FACTS WHICH HAVE HITHERTO APPEARED CONCERNING THE COW-POX. 5rC. R. AIKIN, "'- ,^ Member of the Royal College of Surgeons in iLondon.tinJ * Honorary Member of the Medical and Phyfical Society at Guy's Hofpital. Third Edition, Corre&ed and Enlarged. PRINTED BY SAMUEL ETHERIDGE, FOR E. and S. L A R K I N; No. 47, Comhill, Bos ton. 1801. I J PREFACE. 1 he general intereft which every nov- jtf' felty in the fcienre n£ medicine excites in this country, whilft it affords a temporary fuccefs to impoftures of every kind, pro- duces this great advantage, however, that no ^ very material improvement in the healing Tart, when once fairly brought before the bar of the public, is likely to fink into neglect, fo long as it ponefles fuch intrinfic value as really to merit the patronage of the candid 2nd liberal part of the community. It is to the credit of the inoculation of the cow-pox, that it has been introduced by no illiberal arts or impirical pretenfions : on IV PREFACE. the contrary, its fupporters have contented themfelves with laying before the public the event of experiments conducted with ability and perfect impartiality ; fo all the reputa- tion which the practice has hitherto acquired, may be confidered as moft fairly earned. The zeal which is always kindled in a purfuit after novelty has here been confined to the laudable endeavor at exterminating a very ferious and formidable difeafe, by fug- gefting, but not obtruding on the public, a mild and eafy fubftitute. The refult of thefe inquiries has afforded fuch favorable teftimony to the merits of this undertaking, that the vaccine inocula- tion has fpread to diftant parts of the king- dom and has been introduced into fome neighboring countries of Europe under very favorable aufpices j and, in this ifland at leaft, there are few medical practitioners who Preface. v do not begin to turn their attention to this fubject. Under thefe circumftances I have thought that it would not be unacceptable to thofe who are interested in medical improvements, to prefent a concife view of the moil inter- esting facts relative to the cow-pox in every form, and the practical directions to be fol- lowed during its inoculation. The follow- ing pages will perhaps be efpecially conven- ient to thofe who have not an opportunity of entering more at large into the fubject, and confulting all the fources of information (which even now are not a few) in order to gain that general knowledge which may de- termine their practice. There are, it is true, feveral curious and important branches of inquiry, connected in a more diftant manner with facts here mentioned, which it would be foreign from the purpofe and extent of A 2 VI PREFACE. this little work to notice. The reader who is fond of thefe interefting purfuits will find feveral valuable hints in the excellent works that have afforded the materials for this compilation ; fo that both a considerable im- mediate benefit to the health of mankind which the vaccine inoculation promifes, and theiight which may be thrown by its means upon the fubject of contagion in general, render it highly worthy of the public atten- tion. Broad-Street Buildings. CONTENTS. CHAPTER I. ftp THE NATURAL OR CASUAL COW-POX. I. OF THE Cow-Pox as affecting Cows i< Pufules on the udder arifingfrom feveral catfes, as flinging of f lis, &c. The genuine coxv-pox a difiina difeafe from the above ; its fymptoms andprogrefs in the coiv ; parts of the kingdom in -which it has been found ; its ori- gin from the greafe of horses as maintained by Dr. Jen- ner. II. OF THE Cafual Cow-Pox as affecting the Human Species o 2 Symptoms and progrefs of the diforder in perfcns who mill difeafed coins ; enumeration of the moft important points relative to this difeafe -which are already fully efablifhed; circumflances in -which the cczv-pox refembles the fmall- pox, and thofe -wherein it differs. Vlll CONTENTS. CHAPTER IL OF THE INOCULATED COW-POX 5* The co-w-pox is rendered milder by inoculation ; but equally prefer-ves againji variolous contagion ; differences betivcen the cafual and inoculated co-w-pox. The folio-wing circumfances in conduBing the vac-cine inoca* lation confdered : viz. Selection of Matter : Proper Subje&s and Seafons for Inoculation : Method of performing this Operation : Progrefs of the Dif- eafe ; varieties that occur, fuch as rafb,fulfeqt.ent ulcer- ation of the arm, and a truly pufular eruption ; caufes of this latter fytnptom. Medical Treatment, what re- quired for the general fever, and local fore. Method of taking and preferving Matter for future Inoc- ulation ; Comparifon bet-ween the fmall-pox and co-w- pox puftule in appearance and contents : catefes of failure in vaccine inoculation and diftinguijhing maris. CHAPTER III. GENERAL OBSERVATIONS CONCERNING VACCINE INOCULATION I09 Whether the co-w-pox is the parent difeafe to the fmall-pox ; effecls of each difeafe in exciting fcropbtda ; peculiar val- ve of the vaccine inoculation in not cxpofng life to haz- ard ; in ivhat infance the variolous inoculation ispreftr- eble ; conclufon. A VIEW 0» THE INOCULATION FOR THE COW-POX. CHAPTER I. OF THE NATURAL OR CASUAL COW-POX* ' In feveral parts of this king- dom where cows are kept for the purpofes of the dairy, a peculiar erup- tive difeafe has been occafionally ob- ferved among the herd, affecting the udder and teats of thefe animals, which has pretty generally obtained the name of the cow-pox. 10 Vn the Cafual Cow-Pox. \ Till within thefe laft two years, the j knowledge of this diftemper has been j chiefly confined to the perfons im-'j mediately employed in the dairies,, and to farriers and cow-doctors prac-j tifing in the neighborhood ; but, by the latter, it appears to have beei obferved with considerable accuracy, and judicious means to have been employed for its removal. Wherever it has been known, how- ever, the circumftances which now render it an inquiry of the moft in- ' terefting kind have likewife been re- marked : they are that the diforder is communicated, by actual contact, to the milkers who handle the teats of the difeafed cows, and from them again is often fpread through a nu- On the Cafual Cow-Pox. 11 merous herd ; that, when affecting the human fpecies, it is not merely confined to the local difeafe of the k hands and arms, but alfo occafion9 [ a general indifpolition, often fevere, I but never fatal, which runs a regu- lar courfe ; and that the perfon who has once undergone it, is ever after fecure againft the infection of the fmall-pox, either in the natural way by contagion, or by inoculation. Thefe circumftances, efpecially the latter, appear to have been known, time out of mind, to the inhabitants of the particular diftricts where the difeafe has from time to time appear- ed, and only to thefe j a fact wor- thy of note in the hiftory of the fpread of human knowledge, and I i 12 On the Cafual Cow-Pox. |i which might perhaps appear improb- able, if we were not affured that the j fuppofed Oriental method of inocu- -j lation for the fmall-pox, foon after 4 its introduction into England as a I foreign invention, was difcovered to have exifted from time immemorial in a corner of South Wales not ver\ obfcure or unfrequented.* The above mentioned facts relat- ing to the cow-pox have at different times been carnally communicated as curious circumftances in the hiftofy of difeafe, to fome men eminent for . their refearches into phyfiology.- However, they failed to exite that * See Dr. Woodville's Hlflory of the Inocu- lation of the Small-Pcx, a work teller- with cu-' rious and valmM? matter. On the Cafual Cow-Pole. I <\ , high attention which they deferved; till, in 1798, Dr. Jenner of Berk- ley in Gloucefterihire (a diftrict cel- ebrated for the extent and excellence | of its daires) publifhed feveral high- ly curious and interefting particulars concerning this difeafe,* which have IruIIy prefented it to general notice, and will not fail to place his name on the honorable lift of public bene- factors. The fubject having been fince il- | luftrated by further remarks and ex- Sec Dr. Jenner's Inquiry into the Caufis and Effe£ls of the Variola Vaccina^ &c. London, 1798 ; which interefting work it is unneceffa- rv here to refer to continually, as a great part | of its contents have been incorporated in the following pages. B 14 On the Cafual Cow-Pox. periments, both by the fame author,* and by other medical praftitioners of acknowledged abilities, it may fairly be regarded as no longer in its infancy, and may claim from the public the attention due to every thing in which the general welfare is decidedly interefted. I. OF THE COW-POX AS AFFECTING COWS. The cow, though in general a healthy animal, is fubject to fome pe- culiar difeafes, many of which flie probably owes to her domeftication * See Further Obfervations on the Variola Vaccina, 17^9» by Dr. Jenner ; and A Con- tinuation of Fails and obfervations relative to the Variola Vaccina > 1800, by the fame. (>• On the Cafual Cow-Pox. % '> i-e £nd intimate connection with man. Some of them have their feat in the udder, efpecially whilft it is perform- ing the important office of the fecre- tion of milk ; and thefe it is now become of peculiar confequence to attend to, and to difcriminate with accuracy. From the obfervations of thofe who are the moft converfant with this animal, it appears that there are feveral caufes which may produce fores upon the udder and teats, ef- pecially fuch as excite any irritation upon thofe organs during the feafon when the fecretion of milk goes on with the greateft vigor. The Hing- ing of flies, rough handling during milking, and other external irrita- 16 On the Cafual Cow-Pox. tions of this kind, will often occafion fmall white blifters on the parts, which, however, never extend more than fkin-deep, and generally are very eafy of cure. Another, and a more ferious difor- der in thefe parts, is fometimes pro- duced by fuffering a cow, while in full milking, to remain for a day or two unmilked in order to diftend the udder when naturally fmall. This is a common artifice practifed at fairs and cattle markets, in order to increafe the price of the cow, as a large udder is reckoned an important point in the value of the animal. By this cruel and unworthy fraud, the veffels that fupply this organ are kept for an unufual length of time in a On the Cafual Cow-Pox. 17 ftate of high diftention, and this fre- quently terminates in violent inflam- mation of thefe parts, fucceeded by large eruptions over the teats and udder, which fometimes leaves deep and troublefome fores. The matter difcharged from thefe ulcers will communicate a iimilar puftular difor- der to the hands of the milkers, when the fkin is broken in any part; and often effects them with foul and exteniive ulcers that-fometimes occa- lion puftules on the arms and fhoul- ders, and prove tedious and difficult of cure. A fuppreffion of the milk in puerperal women often affords a parallel inftance of the formation of . abfcefs, though in them the progrefs E2 18 On the Cafual Cow-Pox. and form of the local difeafe is fome^ what different. ■ But the genuine cow-pox is a dif- tinct difeafe from thofe which have been hitherto mentioned. It general ly makes its appearance in the fpring, and fhows itfelf in irregular puftules on the teats or nipples of the udder. They are at firft of a palifh blue, or rather a livid color, and contain a thin watery acrid fluid. The fur- rounding parts are fwelled, harden- ed, and inflamed. Thefe puftules are very apt, unlefs timely remedies be applied, to degenerate into deep erod- ing ulcers, which eat into the fiejh, as j the cow-doctors very properly term it, and conftantly difcharge a matter j which commonly grows thicker as On the Cafual Cow-Pox. 19 the difeafe lafts, and hardens into a fcab. Now and then the cow be- comes generally indifpofed, lofes her appetite, and gives lels milk than ufu- #1 ; but it often happens that the diforder, though very fevere, is en- tirely local. With regard to the cir- cumftance of yielding lefs milk, it may be obferved, that this may per- haps be partly owing to the pain giv- en in drawing the nipples ; for the cow feems to have fome voluntary command over the yield of milk. It is a well known fact in dairies, that a perfon who has a foft hand in milk- ing will draw more from the udder than one who handles it roughly. The cow-doctors generally fucceed in checking this diforder in its earlier 10 On the Cafual Cow-Pox. ftages, by applying to the fore fome ftrong and rather corrofive metallic folution, fuch as that of white or blue vitriol. The cow-pox never proves fatal to cows, nor is it infectious i» the ufual manner of contagious dif- tempers, but can only be communi- cated to them, or to men, by actual contact with the fpecific matter from i the fores. Hence it is, that cows which are not in milk efcape the dif- eafe entirely, though conftantly in the fame field with thofe that are highly infected ; and, as far as obfervations have hitherto been made, it is only from the circumftance of the milker handling the teats of the found cows immediately after touching thofe of the difeafed cattle, and receiving On the Cafual Cow-Pox. 21 thereby on his fingers fome of the matter difcharged from the fores in their udders, that the cow-pox ever fpreads among the herd. This will esplain another obfervation which has been made, which is, that the in- fection will often keep long confined to the cattle of a fingle farm, in the midft of other herds, and only fepa- rated by a hedge, fince particular milkers are employed in each. Both cows and men may fuffer under this diforder repeatedly, but, after the firft time of infection, the fucceeding attacks are generally much lefs viru- lent (to the human fpecies at leaft) and much eafier of cure. The cow-pox is more particularly diftinguiftied from the flighter fores 22 On the Cafual Cow-Pox. of the udder by having a great ten- dency to produce a deep hollow fore ; and differs from the other ulcerations of this organ, by a livid bluenefe which conftantly attends it, and per- haps by a peculiar characteristic ap- pearance which is only to be learnt by actual obfervation. This difeafe, in its natural ftate, is only partially known throughout the country, but is pretty widely dif- fufed ; and, wherever it has been traced, the opinion of its being a prefervative againft the fmall-pox^ when extended to the human fubject, \ feems to be equally prevalent. The cow-pox is familiar to the inhabi- tants of that highly valuable and cel- ebrated dairy country, the Hundred On the Cafual Cow-Pox. 23 of Berkley in Gloucefterfhire, where, fortunately for the public, it attracted the attention of Dr. Jenner. It has likewife been difcovered in various parts of the counties of Wilts, Somer- fet, Buckingham, Devon, and Hants; in a few places in Suffolk and Nor- folk, where it is fometimes called the Pap-pox,* and. in Leicefterfliire and Staffordftiire. It is not unfrequent in the very large milk farms contiguous to this metropolis, on the Middlefex fide. It is here obferved generally to at- * See An Inqmry concerning the Hifiory of tie Conv-pox, by Dr. Pearfon, whofe early attention to this fubject, and zeal in the profecution qf it, have much contributed to the intereft which it has generally excited. = 4 On the Cafual Cow-Pox. tack firft fome cow newly introduced into the herd, and is fuppofed to orig- inate in a fudden change from a poor to a very rich and partly unnatural diet, which it is the practice to ufe in order to bring the yield of milk to its higheft point. The cow-pox has likewife been known in Ireland, from time immemorial, and in the neighborhood of Cork, is called Shin- agb, a term which belongs to the ancient language of the country, and appears to have been applied to this difeafe, as far back as oral teftimony can be carried.* It has not yet been traced to the extenfive dairies of Chefhire, or to any of the northern * See the Medical and Phyfical Journal, vol. iii. p. 503, and vol. iv. p. 425. On the Cafual Cow-Pox. 25 counties. Probably, however, it will be frequently detected in a much greater number of places than have hitherto been found ; for thofe that have been juft mentioned include a confiderable variety of country, and the difeafe has in general been rather concealed by the fervants, and milk- ers, as throwing fome imputation on the neatnefs and good order of their dairies. Befides, as it is not a native of towns and does not naturally fall under the eye of the more obferving part of the community, and as its powers of contagion are very limited, and little calculated to excite alarm or general attention, the induftrious inquirer has a fair field open to him c 2b On the Cafual Cow-Pox. for collecting much new and valua- able information. The hiftory of the cow-pox would be imperfect, without mentioning the following very fingular origin which has been attributed to it by Dr. Jen- ner. The horfe is well known to be iiibject to an inflammation and fuell- ing in the heel called the greafe, from which iflues a very acrid matter capa- ble of exciting irritation and ulcera- tion in any other body, to the fur- face of which it may be applied. This matter is fuppofed to be conveyed to the cow by the men fervants of the farm, who, in feveral of the dairy counties, affift in milking. One of thefe, having dreffed the horfe, goes immediately to bear his part in milk- On the Cafual Cow-Pox. 27 ing ; and, having fome particles of the difcharge from the greafe upon his hands, he thus applies it to the udder of the cows ; where, if the animal be in a proper ftate for receiving the infection, it produces that fpecific change upon thefe parts, which gives rife to the difeafe of the cow-pox. The origin here afcribed to this diforder is principally founded on the circumftance that, wherever the cow-pox appears, the greafe is general- ly found to have preceded it ; and the opinion of the propagation of the difeafe from the horfe to the cow is likewife as commonly current in fome of the dairy countries, as thofe other obfervations concerning the difeafe which have been confirmed by accu- ?» 28 On the Cafual Cow-Pox. rate examination. Still, however, we muft as yet confider this as one of the moft dubious of all the facts that have been advanced on the fub- ject ; and nothing but pofitive ex- periment can give much afliftance in an inquiry purfued in a path fo little trodden, as that of the particular modifications which a difeafe affumes, by pafling through animals of differ- ent fpecies. Among the collateral advantages to be derived from this fubject, though not immediately con- nected with the adoption of the cow* pox in medical practice, we may ex- pect with fome confidence to receive fome new ideas upon feveral momen- tous queftions which regard conta- On the Cafual Cow-Pox. 29 gion in general ; a fubject highly in- terefting to the phyfiologift. It may be mentioned, that, as foon as this opinion concerning the origin of cow-pox was ftarted by Dr. Jenner, attempts were repeat- , edly made, to introduce the difeafe in the nipple of the cow by direct in- oculation of the recent matter of greafe from the horfe's heel. The confequence, (when any) which fol- lowed this operation, was a flight in- flammation, and the production of a fmall pimple or puftule, the common • effect of a wound made with any poifoned inftrument, but which dif- appeared in a few days, without ex- citing the fpecific difeafe of the cow. c 2 3b Oil the Cafital thw-Totx. pox. The failure of thefe firft 'experi- ments, however, could by no means overthrow the opinion which, if fuc- cefsful, they were meant to eftablifh ; fince it feems to be fully afcertained that a certain predifpofition in the conftitution of the cow to receive the difeafe is alfo requifite for its produc- tion ; and hence it firft appears in farms only at certain feaftms, chiefly the fpring, though, when once it has got footing in the heard, it will prob- ably be communicated by contagion at any time.* * Later experiments have decided this point, for Mr. Tanner of the Veterinary College has actually fucceeded in producing the difeafe on the nipple of the cow by inoculation with limp- id matter, from the greafe of a horfe's heel, and the vaccine puftule thus produced was proved to be genuine, by infecting again Loth human fubjects and cattle. On the Cafual Cow-Pox. 31 We may add, that the matter dif- charged from the fores in the horfe's heel is likewife found to occafion, at times, very troublefome ulcers on the hands of the men that drefs it, attend- ed with a very confiderable degree of indifpofition ; both of which appear to be full as fevere as in the genuine cow-pox, and in many points to re- femble this latter diforder. However, the perfon who has been infected by the horfe, is not rendered thereby entirely fecure from afterwards re- ceiving the fmall-pox; though it is certain that his liability to receive this contagion is much leffened.* On the whole, therefore, though we cannot reafonably doubt that the * See Jenner, parts ift. and 2d. 3 2 On the Cafual Cow-Pox. matter of greafe may often be the parent of cow-pox, yet it ftiJl re- mains to determine, whether this is always the cafe. The frequent ap- pearance of cow-pox, apparently in a fpontaneous manner, in filiations and circumftances very remote from any connection with the difeafed horfe, have been often urged with great force and unanfwerable weight againft admitting as an univerfal truth, the origin afcribed to the cow- pox by Dr. Jenner. II. OF THE CASUAL COW-POX AS AFFECTING THE HU- MAN SPECIES. Thofe puftular fores on the udder and teats of the cow, which confti* On the Cafual Cow-Pox. 33 tute the genuine cow-pox, (whatever. be the way in which they are pro- duced) are found, by undoubted ex- perience, to poffefs the power of infecting the human fubject, when any part of the body, where the fkin is broken or naturally thin, comes into actual contact with the matter which they difcharge. Hence it is that, with the milkers, the hands are the parts that acquire this diforder accidentally, and it here exhibits the following appearances: Inflamedfpots begin to appear on the hands, wrifts* and efpecially the joints and tips of the fingers; and thefe fpots at firft refemble the fmall blifter of a burn, but quickly run on to fuppuration. The puftule is quite circular, de- 34 On the Cafual Cow-Pox. preffed in the middle, and of a blueilh color, and is furrounded with a confiderable rednefs. The blue color which the puftule almoft invariably affumes* when the difor- der is communicated directly from the cow, is one of the moft charac- teriftic marks whereby the genuine cow-pox may be diftinguifhed from fome other difeafes which the milkers are likewife liable to receive from the cow. The matter of the puftule is at firft thin and colorlefs ; but, as the diforder advances, it becomes browner and more purulent. In a few days from the firft eruption, a tendernefs and fwelling of the glands in the arm-pit come on, and foon after, the whole constitution becomes On the Cafual Cow-Pox. 3$ difordered, the pulfe is increafed in quicknefs, and to this fucceed fliiver- ings, a fenfe of wearinefs, and aching pains about the loins, vomiting, head- ach, and fometimes even a flight de- gree of delirium. Thefe fymptoms continue with more or lefs violence from one day to three or four, and, when they fubfide,. they leave ulcerated fores about the hands, which are very apt to become ill-conditioned and heal very flowly; refembling, in this re- fpect, the ulcers on 'the nipple of the cow, from which they originate. It is to be obferved, that the cow- - pox eruption, though very fevere on the hands, and though occasioning much general illnefs, never produces 36 On the Cafual Cow-Pox. i fpontaneous crop of puftules over diftant parts of the body, as the fmall-pox does. It does, indeed, often happen, that puftules are form- ed in various places which accident- ally come in contact with the difeafed hands, as on the noftrils, lips, and other parts of the face, where the ikin is thin ; or fometimes on the forehead, when the milker leans with that part upon the udder of an infected cow. . From this account, it appears that the cow-pox, as it affects the milkers, or what may be termed the cafual cow-pox in the human fpecies, is often a fevere diforder, fometimes confining the patient to his bed during the period of fever, and gen- On the Cafual Cow-Pox. 37 crafty leaving troublefome fores ; but it has never been known to prove fatal j nor are thefe fores, if properly attended to, followed with iny lafting injury of the affe&ed parts, though they fometimes leave fears for life. The very accurate inveftigation which this diforder has lately under- gone, has eftablifhed fome very im- portant points relative to its peculiar nature, which require to be particu- larly noticed, as upon them is found- ed the profpect of invaluable benefit which may arife to the public at large from fubftituting the inoculation of this difeafe to that of the fmall-pox. D 3 8 On the Cafual Cow-Pox. The following facts may be con- fidered as fully afcertained by the faireft experiments and moft accurate obfervations : Firft. The-cow,pox-in its natural ftate, or, when propagated ammedV ately from an infected cow to the hands of the milkers, is capable of affecting the human fpecies repeated- ly to an indefinite number of times ; but, after the - firft attack, it is gener- ally much milder in its iymptoms, and efpecially it is much lefs liable to produce the fever and general indif- pofition which always attend the firft infection. There are inftances, how- ever, where the fecond, and even the third attack has been as fevere in every refpect as the firft ; but thefe are very rare. On-thi-GufiialComi-Pox. 39 ■'■tyd&JZtyz The fmall-pox in a con- ficksable degree fecures a perfon from the infection of the cow-pox, and in this r«efpect. appears to. ait in a man* ner verjLfimilar to a previous attack of th& latter* <&feafe;. tixtt is,tp con- fine its'operation to t£e formation of local puftules, but unattended with general fever. Hence it is, that where all tl$e fervants of the dairy take the infection from the cows, thofp of them who have previpufly undergone the fmall-pox are often the only persons ampng them able to go through the Ufual work. s Tbbvdly. The cow-pox, in its gen* uine ftate, when it has been" accom- panied* with general fever-, and has 40 On the Cafual Cdw-Pcta run its regular courfe* ever after pre- ferves the perfon who has been in- fected with it from receiving the fmall-pox in any manner, in which this diftemper can be communicated; This moft important fad, which has been the fubject of popular obferva- tion in feveral parts of the kingdom, long before the introdudion of the cow-pox In medical pradice was thought of, and therefore has the ftamp of unbiajfcd evidence, may be now afferted with that confidence which is given by the uniform refult of the moft candid examination, con, duded with fcrupulpus care, carried to a confiderable extent, andauthen. ticated by teftimony of ma*y years Om the Cafual Qow-Pstc^ 3*1 ftandi«g.* This affertion is however to betaken - with eata&ly the fame limitations as that of one infection with the fma&pox preventing a fec- ond attack of the fame difeafe. No previous infedion will entirely coun- tered the local effed on the arm, produced by the infertion of vario- lous matter in common inoculation ; * See Jenner, Woodville, Pearfon, and every other writer on the fubject, for numerous cafes to thig point. Thofe from the dairy Countries of perfons who took the cow-pox When young, by milking infected cows, and afterwards were frequently; expofed to the variolous contagion in every poflible way, are 'among the moft ftriking and decifive examples. In feveral cafes related by Dr. Jenner, the dif- tance of'ttjae.fe^^feft the firft infection and the fubfequent attempts to infect, has been twenty^ 't.hirtv. and even fifty year?. d 2 41 On the Cafual Cbw*J?ox. this may in a few cafes even go fo far as to induce a degree of general fe- ver, flight indeed, but perhaps equal to that of the mildeft indifpofition caufed by a firft infedion with this diforder. By the inoculation of ei- ther difeafe, however, the fmall-po* is equally and completely difarmed of its virulence againft any fubfe-i* quent attack ; which, in fad, is the circumftance which renders this oper- ation fo peculiarly defirable. Fourthly. A comparifon of the two difeafes as to the mildnefs of their fymptoms, and the hazard to life which they may occafion, will mow a very decided advantage in favor of the cow-pox. Compared Ot* the Cafual Cow-Pox. 43 with the natural fmall-pox, the nat- ural or cafual cow-pox is both mild- er, and beyond all comparifon fafer ; as no fatal, inftance of the cow-pox as it affeds the perfons employed in daires, has ever been recorded, When both difeafes are introduced by artificial inoculation, they are each rendered, much lefs fevere, and here too the cow-pox preferves the fame fuperiority as a fafer and mild- er difeafe. Fifthly. The cow-pox even in its moft virulent ftate, is not communi- cable by the air, the breath, by efflu- via, or in fhort, by any thing which conftitutes contagion in the general eftimation of this term ; but can 44 Owthe- Cafual Cow-Pok. only be propagated by the adual co>*t tad of matter from a cow-pox pus- tule, with fome part of the body of the perfon who receives it. We can- not exactly determine whether in all cafes an infertion of the fpecific virus under the fkin be neceffary; at leaft We know that when the infect- ing matter is in its moft adive ftate, as it is when formed in the cow's udder, the vafcular fkin which covers. the lips and noftrils readily takes tb$ infedion without being broken. In this refped therefore the cow-pox virus feems to equal that of the fmall-pox in adivity, for the latter will readily produce the difeafe when merely introduced within the nof- On the Cafual Cow-Poxv 4£ tril ;* but the ftriking difference be- tween the two difeafes in the non- contagious nature of the cow-pox is a fad that is fully and fatisfadorily afcertained. In the dairy farms, in- feded fervants fleep with the unin- feded ; infants at the breaft have re- mained with their mothers whilft on- ly one of the two have had tiie dif- order upon them,t and in no in- ftance has the difeafe of the one been communicated by contagion to the other. * This is the method of inoculating in fome of the eaftern nations. +. Mr. Henry Jenner gives his teftimony to this fa£t from experiments made by him for this exprefs purpofe. 4<5 Q* the Saftiat- Canv-Pax. A review of the fads that have been advanced will fliow- a'number of points in which the fmall-pox re- fcmbles the cow-pox in a very ftrik- ing manner; but it will at the fame time mark a very decided difference in others. Both the difeafes are puf- tular, that is, they produce inflam- mations of a fmall extent, whidh gradually increafe, and naturally and fpontaneoufly terminate in the for- mation of matter: they both agree moft ftrikingly in occafioning general fever, which comes on whilft the puftules are advancing towards a ftate of fuppuration ; and they fhow a confiderable fimilarity of nature by Ofythe Cqfuak Cow-Fox* 47 the change which each makes upon ^he conftitution, lb as in one cafe en- tirely, in another, to a confiderable degree, to prevent the body from re- ceiving the fame or the other difeafe a fecond time. Another point of re- femblance is, that each diforder is rendered much milder by inocula- tion, which hke wife obferves in each nearly the fame period in its various changes ; alfo, that fome and the fame perfons refift entirely each infec- tion from fome peculiarity in the con- ftitution, which cannot be explain- ed -* and laftly, that a certain pro- * Dr. Woodville, whofe experience on this fubject carries the higheft authority, eftimates the number of thofe that refift common inocu- 48 On the Cafual Cow-Pox. grefhve advance of the local affediOn, together with the regular acceflion of the febrile fymptoms at a rtated time, is requifite in each, in order to pro- duce that change upon the animal frame which tends to prevent a re- currence at any period of life. With regard to the points in which the two difeafes differ, fome are only in degree ; as, that the fmall-pox entirely prevents its own recurrence (one or two rare cafes excepted) but only partially renders the conftitution unable to receive the coW-pox : and vice verfa, that the cow-pox com- lation for the fmall-pox to be about one in fix- ty, and thefe alfo refift the reception of the cow-pox. Obfervations on the Cow-Pox. On the Cafual Cow-Pox. 49 pletely preferves the body from the infedion of the fmall-pox, and makes it only lefs fufceptible of a repetition of the fame difeafe. But the moft ftriking point of difference, and that which renders the cow-pox fo pecu- liarly-valuable as a fubftitute for the other, is, its not being communicable by effluvia, or by any other method than by adual inoculation or contad with the fpecific puftular matter. It is this circUmftance which gives it its great importance, confidered in an enlarged and extenfive view-; fince, by adopting this difeafe to fupply the place of the fmall-pox, all the dread and all the mifchief that is occafioned by the unfeen agency of an adive and E £o On the Cafual Cow-Pox. formidable contagion is entirly re- moved ; no anxious precautions are required in order to avoid and infu- late an infeded perfon, whofe breath can fpread difeafe on every fide ; and thus too the time of communicating the infedion, which is ever after to afford complete fecurity againft the variolous contagion, may be feleded fo as at all times to fecure the moft favorable condition of the body. S' CHAPTER y. ON THE INOCULATED COW-POX. Every one is acquainted with the important diftindion which exifts between the fmall-pox as propagated by contagious effluvia, and that com- municated by artificial infertion of matter beneath the fkin ; and the decifive advantages which the inocu- lated difeafe poffeffes over the natural are univerfally acknowledged, though the precife caufe of the fuperior mild- nefs of the former is as yet but im- perfedly known. 52 On the Inoculated Ccv-Pox. The comparifon between this dif- eafe and the cow-pox entirely fails in the circumftance of contagion ; for, as has been before obferved, the lat- ter has never been obferved to be communicated in this method j and therefore, too, the term natural cow- pox cannot be employed in the fame diftindive fenfe, as when applied to the variolous infedion. It is a curious and important fad, however, that the operation of in- oculating with the cow-pox virus, performed in the fame method as is ufually pradifed with that of the fmall-pox, appears to produce a very fimilar change with regard to render- ing the difeafe more uniformly mild On the Inoculated Cow-Pdx. $3 and favorable ; though it cannot, Kke the other, fliorten the period between the firft moment of infedion and the time of affeding the conftitu- tion in general, fince the cow-pox in its moft natural ftate, as it affeds the milkers of difeafed cattle, is really re- ceived by a kind of inoculation, though accidental. Therefore, as fome very charac^ teriftical differences in the form of the diforder depend on the mode in which the cow-pox is introduced into the human fyftem, we may be allowed to mark that diftindion by employing the term natural or rather cafual, cow-pox in the human fpecies, to exprefs that difeafe which is contrad- e 2 54 On the Inoculated Cow-Pox. ed by thofe who, in milking, handle the teats of an infeded cow ; and ufing the phrafe inoculated cow-pox, to imply that diforder which is excited by the artificial introdudion beneath the fkin of fome of the fpecific mat- ter fecreted by a cow-pox puftule ei- ther in the cow, or more commonly ■••# in another human fubjed. As it is this form of the cow-pox with which the public are, and will be, the moft concerned, and which will probably be adopted to affume a confpicuous place in medical nofology, there will be no great impropriety in confining to this form the term vaccine difeafe, which .will exprefs its orign from the cow, though probably it may never be On the Inoculated Cow-Pox. re again- neceffary to return to the pa- rent ftock in this animal. In treating of this difeafe as com- municated by inoculation, it is firft neceffary to fhow that, in this form of the diforder, all the advantages are mfured which attend the cafual cow- pox ; and it is not difficult to prove that the difeafe is as much the fame in thefe two forms, as that the natural . fmall-pox is the fame diftemper as the inoculated. In the cow-pox, the courfe that is run by each is very fimilar ; they each produce a general fever at a certain period, and the puftules in each equally fecrete the fpecific virus which alone can commu- nicate the difeafe to others by fubfe- 5 6 On the Inoculated Cow-Pox. quent inoculation. What is very re- markable, and unparalleled in the hiftory of difeafe, is, that the cow-pox virus, after having paffed through fev- eral perfons, may be again commu- nicated to the cow by dired inocula- tion in the nipples ; and this again will return to the ftate of cafual coW- pox, in the milkers who handle the udder of the animal thus difeafed, which abundantly proves that the na- ture of the infedion continues the fame under thefe varieties.* Hence we fhould exped that the fecurity which the inoculated cow-pox af- fords againft the contagion of the fmall-pox, (which conftitutes its chief i * SeeWoodvuVs Reports, SsV, of Inoculation: for the Cow-Pox, page 62. On the Inoculated Cow-Pox. 57 value) would be equal to that which the cafual cow-pox infures, and ac- cordingly this is confirmed by the moft authentic and unequivocal tefti- mony.* From the comparatively re- cent date of the experiments made with the inoculated cow-pox, the au- thority of forty or fifty years (which the other form of the difeafe poffeffes in the dairy countries) is wanting. But as the very end of all thefe trials * To quote particular authorities for this facl, would be to refer to almoft every ac- count which has been given of every inocula- tion made in different parts of the kingdom with vaccine matter ; as in fact they would be all quite futile without the experimentutn cruris of refilling variolous contagion. 5 8 On the Inoculated Cow-Pox. has been to prove the vaccine inocula- tion to be a complete prefervative from the variolous contagion, and as they have been attended with entire fuccefs, there is no reafon to fuppofc that any number of years will pro- duce fuch an alteration in the confti- tution, as to renew the hazard of variolous contagion in any habit where it has been once completely extinguifhed. The uniform experi- ence of inoculation for the fmall-pox, which may be recurred to by fair analogy, would contradid fuch a fuppofition. Like this latter difeafe, too, certain precautions are to be. taken, and obfervations made, in order to diftinguifh the cafe of a fpu- On the Inoculated Cow-Pox. 59 rious and incomplete cow-pox, from that which is perfed and genuine. The chief differences which exift between the cafual and the inocu- lated cow-pox are in the degree in which each affeds the body. As much of the feverity of the difeafe depends on the extent of topical ulceration, the former, by producing larger and deeper puftules, generally occafions a much feverer difeafe ; and thefe likewife are more liable to leave deep and extenfive fores, long after the eruptive fever is fubfided, which are difficult to heal. Another differ- ence between the two forms of this difeafe is in the appearance of the puftules. Thofe which are formed 60 On the Inoculated Cow-Pox. by immediate infedion from the cow are more prominent, and have a blueifh caft, which is very charac- teriftic. This particularly happens in the cafual difeafe, though it is alfo retained in the firft inoculation from the cow,* but is undiftinguifhably loft after it has paffed through one generation (if it may be fo called) in the human fubjed. There are feveral important cir- cumftances belonging to vaccine in- oculation, which deferve the atten- * Woodrille. On the Inoculated Cow-Pax. 6\ tion of the medical praditioner, and which require to be given in detail with that minute and circumftantial defcription which alone is able to give afliftance in direding real prac- tice. Thefe will be conveniently ar- ranged under a few diftind heads. Of the Selection of Matter. Dr. Jenner has laid down with great precifion thofe fourccs of the fpurious or imperfed cow-pox, that depend on the ftate and nature of the infeding matter employed for inoculation ; and fubfequent obfer- vation has proved more than ever the, neceffity of attending to this part of the fubjed. They are j % 62 On the Inoculated Cow-Pox. F>rft. When the puftule that af- fords the matter is not the genuine fpecific cow-pox. This it is of great importance to be aware of, both when the difeafe is.to be introduced immediately from the cow, and from the human fubjed. As we often find that almoft any acrid matter from any kind of puftule, when applied by inoculation to a found furface, will there excite inflammation and a pus- tule fore, a miftake as to the nature of the virus thus introduced might cafily happen, and wpuld lead to much error and falfe fecurity with re- gard to variolous contagion. The diftinguifhing marks of the true dif- eafe in the cow, have been already On the Inoculated Cow-Pox. 6$ mentioned. Thofe wjjch charader- ife the genuine difordef|n the human fubjed, will be afterwards enumer- ated. Secondly. When the matter is gen- uine, and would be perfedly unex- ceptionable if employed on the fpot, but by being kept in a manner favor- able to fpontaneous alteration, or pre^ ferved in a carelefs way, it has loft its fpecific properties. This will apply to infeding virus procured either from the cow or the human puftule $ and from the frequent failure of mat- ter to produce the difeafe * when it has been kept for a certain length of time, though with care, it feems to be probable that the vaccine virus is 64 On the Inoculated Cow-Pox. more liable to lofe its peculiar prop- erties than the variolous, and requires greater precautions to be' preferved in fufiicient adivity. This circum- ftance, however, (that is where good and proper matter has loft by keep- ing its power of giving the genuine infedion) is much more commonly a fource of total failure produce any effed from inoculation, than of ex- citing a fpurious puftule, provided the matter had been taken at a prop- er period of the diforder, and in the moft unexceptionable manner. Thirdly. When the matter has been taken from a true cow-pox puftule, but has been furnifhed, not by the clear limpid fluid, which forms the On the Inoculated Cow-Pox. 6 c contents of the puftule in its earlier ftages, but by the purulent matter which is to be found under the fcab at that advanced ftao-e of the difor- o der, when all the firft fluid is dried up, and the puftule has either degen- erated into a fimple ulcer, or has loft its infeding properties. This par- ticularly applies to the difeafe of the human fubjed ; but both in man and in cow, it is not very eafy to fix the exad limits, when the local affedion ceafes to have any thing fpecific in its nature, and confequently to have the power of communicating the dif- eafe. f 2 66 Cn tJj£ Inoculated Ccw-Pox. Thefe three circumftances (in any of which a partial and therefore high- ly deceitful difeafe may be excited by fpurious inoculation) will dired the praditioner in the choice of the mat- ter which he employs. The uniform mildnefs of the inoc- ulated vaccine difeafe has hitherto afforded no grounds for any fuch diftindion as good or bad, a healthy, or unhealthy fort of matter, which obtains (perhaps without foundation) in the fmall-pox ; and no perceptible difference of quality has been afcer- tained, between matter procured from the inoculated puftule as foon as it begins to afford any fluid, and that which is taken juft at the time. On &he Inoculated Cow-Pox. 67 when it is receding, and the fcabbing procefs commences. We may add, that hitherto no fuc- ceflive inoculations from one human fubjed to another have made any alteration, either in the nature of the diforder, or the appearance of the puftule after the firft time of infertion from the animal; when, as has been mentioned, it retains fome of the charader of the cafual cow-pox. Therefore, as long as the fupply of vaccine virus is kept up by propagat- ing the genuine difeafe through fuc- cefiive inoculations, there will be no occafion to return to the cow for a, new parent ftock. S$ Oh the Inoculated Cow-Pox. Of the proper fuhjecls and feafons for Inoculation. The vaccine difeafe, when proper- ly introduced by inoculation, appears to have almoft as great a fuperiority in point of mildnefs and fecurity over the variolous inoculation, as this has over the natural fmall-pox : fo that the fame precautions which would be highly requifite in communicat- ing the latter, (where the time can be chofen) become lefs fo where the diforder is to be introduced by inoc- ulation ; and ftill lefs where the vac- cine is fubftituted for the variolous difeafe. The experience which the On the Inoculated Cow-Pox. 69 inoculated cow-pox already affords, feems to fhow that it may be prac- tifed with great fafety at any age, even from the earlieft infancy.* In general, we may fay that fimilar pre- cautions are to be ufed here^as with variolous inoculation, fo that even the vaccine difeafe fhould be avoided during the time of teething, or any particularly unfavorable ftate of bo- dy ; but we may affert with confi- dence that at any time it is preferable Mr. H. Jenner inoculated with the cow-pox an infant a few hours old. The child went through the difeafe with the ufual appearances in the puftle on the arm, but without any per- ceptible fever. It afterwards, however, refift- ed the fmall-pox completely. jo Oh the Inoculated Cow-PdX. to running any confiderable rifk of I the fmall-pox contagion. Of the method of performing the Inocula- tion. The objed to be fulfilled in per- forming this operation is to fecure j the infertion of the infedious matter, with as little injury to the parts as is compatible with the end propofed. Uniform experience fhows that in inoculating either with this or vario- lous matter, the method of making the incifion is not a matter of indif- ference ; for, on the form and depth of the wound will in fome meafure depend the decree of violence in the i On the .Inoculated Cow-Pox. 71 fubfequent inflammation. In mak- ing the pundure in the arm, we can- not follow a better method than that recommended by Dr. Woodville,* who advifes " that the lancet fhould be held nearly at a right angle with the fkin, in order that the infedious fluid may gravitate to the point of the inftrument; which in this direc- tion fhould be made to fcratch the cuticle repeatedly, until it reach the true fkin, and become tinged with blood." The moft certain method of fe- curing the infedion is to inoculate whilft the matter is fluid, and frefh * Obfervations on the Cow-Pox, 1800. 7 2 On the Inoculated Cow-Pox. from the puftule ; but as this is oft- en impradkable, it is advifable to hold the infeded lancet for fome time over the ftcam of boiling water, to foften and diffolve the hardened matter. Where the virus has been procured upon thread, the fame means are to be purfued as when inoculating with variolous matter ; that is, to make a fmall longitudinal ; incifion upon the arm, to apply to it the infeded thread, and detain it there by adhefive plafter, till the dif- cafe is communicated. This method is found to be more apt to fail than when the matter is received upon a lancet, provided it be fluid from the puftule ; but dried matter will fel- dom long preferve its efficacy, except ^ On the Inoculated Cow-Pox. 73 it be taken and kept with particular precautions. Thefe will be men- tioned in a fubfequent fedion. Progrefs of the Difeafe. The progrefs of the vaccine inocu- lation, from the time of infertion to that of the drying up of the puftule, is commonly very uniform, the dif- ferent ftages of the local and general affedion well marked, and the fuc- ceflive changes occur for the moft part at regular periods. The fol- lowing, therefore, may be confidered as the hiftory of this diforder which G 74 On the Inoculated Cotu-Pox. it will reprefent the moft ufual progrefs of the vaccine inoculation. The firft indication of the fuccefs of the operation, is a fmall inflamed fpot at the part where the pundure j lias been made, which is very dif- tinguifhable about the third day ; this continues to increafe in fize, 1 becomes hard, and a fmall circular ! tumor tis formed, rifing a little a- ! bove the level of the fkin. About the fixth day, the centre of the tu- mor fhews a difcolored fpeck, owing to the formation of a fmall quan- tity of fluid, and this continues On the Inoculated Cotu-Pox. 75 to increafe, and the puftule to fill, and become diftended, till about the tenth day. At this time it fhews in perfedion the charaderiftic features which all along diftinguifh it from the variolous puftule. Its fhape is circular, or fometimes a little oval, but the margin is always well defin- ed, and never rough and jagged j the edges rife above the level of the fkin, but the centre is depreffed, and has not that plumpnefs which marks the fmall-pox puftule. As foon as the puftule contains any fluid, it may be opened for future inoculation, and about two days before and after the eighth day affords a period of four 7 6 ' On the Inoculated Cow-Pox. days, when the matter is found to be in its greateft adivity. After the eighth day, when the puftule is fully formed, the effeds on the conftitution begin to fhew themfelves, the general indifpofi- tion is commonly preceded by pain at the puftule and in the armpit, fol- lowed by head-ach, fome fhivering, lofs of appetite, pain in the limbs, and a feverifh increafe of pulfe. Thefe continue with more or lefs violence for one or two days, and always fubfide fpontaneoufly without leaving any unpleafant confequence. During the general indifpofition, the puftule in the arm, which had been On the Inoculated Cow-Pox. 77 advancing to maturation in a regular uniform manner, becomes furround- ed with a circular inflamed margin, about an inch or an inch and a half broad, and this blufh is an indication that the whole fyftem is affeded ; for the general indifpofi- tion (if it occurs at all) always ap- pears on, or before, the time when the efflorefcence becomes vifible. Af- ter this period, the fluid in the puf- tule gradually dries up, the furround- ing blufh becomes fainter, and in a day or two dies away imperceptibly ; fo that it is feldom to be diftinguifh- ed after the thirteenth day from in- oculation. The puftule now no longer G2 78 On the Inoculated Cow-Pox* increafes in extent, but on its fur- face a hard thick fcab of a brown or mahogany color is formed, which, if not pulled off, remains for nearly a fortnight, till it fpontaneoufly falls, leaving the fkin beneath per- fedly found and uninjured. The above is the uniform progrefs, of the difeafe in the greater number of cafes, with only the variation of a day or two in the periods of the dif- ferent changes. The fucceflive alter- ations that appear in the local affedion appear to be more conftant, and more neceffary to the fuccefs of the inocu- lation, than the general indifpofition. On the Inoculated Cow-Pox. 79 With regard to this latter, the de- gree is very various ; very young infants often pafs through the whole difeafe without any perceptible ill- nefs ;* with children it is extremely moderate ; but with adults it is fometimes pretty fevere for a few hours, though never in any degree dangerous. Among the occafional circumftan- ces and varieties which now and then occur, and which the praditioner fhould be aware of, though they do * See note, p. 69. 80 f^-'i the Inoculated Co^u-Pox^ not alter the nature of the difeafe itfelf, or render the patient at all lefs fecure from receiving the advan* tages of the vaccine inoculation, are the following : i. In a few inftances a flight erup* tion or ram comes on around the inv oculated part about the third day, which fubfides fpontaneoufly in a day or two without becoming puflv ular, and is entirely the effect of local ' irritation. j 2. Sometimes, about the twelfth day, or after the general fever has ceafed, the puftule, inftead of fhow- ing a difpofition to fcab, remains confiderably inflamed, the furround- ing efflorefcence increafes in extent, On the Inoculated Cow-Pox. 81 and the puftule, if not properly treated, is apt to degenerate into a fmall ulcer, which will continue long in a purulent ftate, and at laft become difficult to heal. This, we have feen, is much more liable to follow the caf- ual cow-pox, than the inoculated ; and in this ftate the matter which it fecretes probably foon lofes its fpecific power of communicating the cow- pox by inoculation. 3. A more important variety which has been obferved fometimes to oc cur under particular circumftances, is the formation of complete puftules, both in the neighborhood of the in- oculated part, and on other parts of the body. Thefe puftules, run a 82 On the Inoculated Cow-Pox. regular courfe, fimilar to that formed by inoculation, and become filled with a purulent fluid, which has like* wife the fpecific property of commu- nicating the difeafe by infertion. The appearance of thefe puftules may certainly be confidered as a rare occurrence in the genuine cow-pox, and this has given rife to fome dif- ference of opinion concerning their origin. Among the probable caufes of a truly puftular eruption, we may men- tion two which appear to be fully afcertained. The firft is a rough and unfkilful method of inoculation, where the wound is made deeper than necef- On the Inoculated Cow-Pox. *3 fary, and an infertion of the infeding matter takes place within the cellular membrane. In this cafe, feveral puf- tules Will often appear on different parts of the arm, and (as in the fmall- pox) the local affedion of the inocu- lated part will be more liable to fe- vere inflammation.* The fecond is the circumftance of * A farmer inoculated feveral perfons with vaccine virus on the point of an awl ; many of thefe had puftules which regularly filled with matter ; but other patients, inoculated from thefe puftules with a lancet in the ufual way, had no eruption, but went through the vaccine difeafe in the mildeft and moft regular manner. See in the Medical "Journal, No. 14, a letter from Mr. Grofe of Winflow. 84 On the Inoculated Cow-PoX. the patient being expofed to the con* tagion of fmall-pox, during the time 'that the vaccine inoculation is mak- ing its ufual progrefs. The large proportion of puftular eruptions, and the greater feverity of the difeafe, that occured during the firft experi- ments on the vaccine inoculation at the Small-Pox Hofpital near London, are to be accounted for on this ground.* It is an important circumftance that the caufe of thefe latter puftular cafes is now fully cleared up. The vaccine inoculation, in its earlier ftages, is not able to fecure the pa* tient againft the contagion of the * Woodville's Obfervations on the Cow-Pox. i On the Inoculated Cow-Pox. 8$ fmall-pox. In this it differs very ef- fentially from the variolous inocula- tion ; which laft, it is well known, will fuperfede the effeds of the con- tagion of natural fmall-pox, even after the body has been expofed to it for four or five days. Therefore, when a perfon inoculated with cow- pox matter falls in the way of fmall- pox contagion during the firft four or five days from inoculation, each difeafe will make their progrefs in fome degree feparately. The inocu- lation will produce its proper effed on the arm, whilft the fmall-pox con- tagion will occafion the puftules in other parts of the body. The mat- ter, however, taken from the inocu- H 86 On the Inoculated Cow-Pox. lated vaccine puftule has no difpofi- tion to produce puftular cafes, and therefore under any other circum- ftances there is no reafon to appre* hend a mixture of variolous infec- tion. It may likewife be remarked, that when the two difeafes mix in the manner above-mentioned, the vaccine puftule is not in general fur- rounded with the ufual efflorefcence. Sometimes, in one or two rare cafes, puftules will be formed with- out any aflignable caufe : this has happened in the inoculation of a con- fiderable number of perfons, by far the greater , part of whom have nor On the Inoculated Cow-Pox. h'.< had any appearance of this fymp- tom.* The puftules do not always come to maturity, but often dry up and difappear before they contam any notable quantity of fluid. When they do advance to fuppuration, they bear a perfed refemblance to the diftind puftules which are formed in the fmall-pox in its moft favorable ftate. * In the Rev. Mr. Holt's inoculation, (Med- ical Journal, No, ioj three cafes out of three hundred proved to be puftular: but in a fub- fequent inoculation of eight children w'th the matter taken from thefe puftules, no fi <:h ap- pearance was produced, but the difeafe aftumed the .mildeft form. See alfo note, p. 69, and Dr. Wcodville's Obfervations. 88 On the Inoculated Cow-Pox. Medical Treatment. It is a particular recommendation of this difeafe, that, though much atten- tion and difcrimination be neceffary in feleding the matter for inoculation, and performing this flight operation in fuch a manner as to infure fuccefs, and (as we fhall prefently mention) in afcertaining, in fome doubtful cafes, whether or not the infedion has fully taken, very little medical care is necef- fary in order to condud the patient through it with perfed fafety. Much of the hazard incurred in the fmall- pox is owing to a larger eruption upon the fkin than the conftitution can fup- port ; and the degree of rifk to life is Oh the Inoculated Cow-Pox. 89 in a great meafure proportioned to the quantity of eruption : whereas, in the cow-pox, this fymptom may for the moft part be avoided, by guarding againft fome of the caufes which produce it, and is feldom fo fe- vere as to give any ground for alarm. The inoculated vaccine difeafej with infants and children, is uni- formly mild during the whole courfe from the firft infertion to the fcab- bing procefs ; and even in moft cafes is attended with fo little fever as fcarcely to be deteded even by an attentive eye, and requires no medi- cal treatment. Indeed, as the great objed is to produce the difeafe in a form fo perfed as to leave no doubt h a 90 On the Inoculated Cow-Pox. about its appearance, and abfolutely to fecure the patient from any fubfe- quent contagion of fmall-pox, it feems hardly advifable to take any meafures to check the approach of fever about the eighth day, any otherwife than by preferving ftridly that ftate of tem- perance which well regulated chil- dren are generally kept to during the earlier part of life. Therefore, the preparing medicines which ufually make a part of the remedial procefs during inoculation with the fmall- pox, are fcarcely requifite here, efpe- cially when children are the patients ; except in thofe habits that fuffer con- fiderably at all times from any febrile attack. When the fymptoms of fever t On the Inoculated Cow-Pox. 91 are manifeft, and threaten to become at all fevere, a brifk purgative, fuch as a dofe of falts, generally produces very fpeedy relief. This is particu- larly ufeful when the patients are adults. In the fmall-pox, after the eruptive fever has fubfided, the puftule formed by inoculation is apt to degenerate into a tedious fore, and even abfceffes form in the arm, which, in infants, have fometimes been followed by the moft ferious confequences. The fame caufe of ccfmplaint exifts in the inoc- ulated cow-pox, but the inflamma- tion may generally be checked with- out difficulty, before it proceeds to any great height. 92 On the Inoculated Cow-Pox. When the efflorefcence comes on around the puftule about the tenth day, and the fever has fubfided, we may confider the conftitution as having done with the difeafe for every purpofe of future fecurity ; and therefore the local affedion of the arm may be put an end to, as foon as it can be done conveniently. In by far the greater number of cafes, the fcabbing or cicatrization fucceeds the puftular procefs with perfed reg- ularity. Where this happens, no application of any kind to the parts fhould be employed ; but, when the inflammation increafes, when the inoculated puftule becomes pain- On the Inoculated Cow-Pox. 93 fill, and the arm ftiff, the mnchief that is then threatened, may, if neg- leded, give more trouble and indif- pofition than all the preceding part of the difeafe. To prevent this, feveral local ap- plications to the puftule may be em- ployed, all of which for the moft part check the inflammation very readily, and induce the healing procefs. Mercurial applications, from anal* ogy with their known good effeds in the local ulcers of the fmall-pox, have been tried, and with great fuccefs. The part affeded fhould be daily dreffed with common mercurial oint- ment, or, what is a more adive preparation, the Red Precipitate 94 On the Inoculated Cow-Pox. of Mercury, (Hydrargyrm Nitratus Ruber J in the form of an ointment. In two or three days after ufing this remedy the fore generally puts on a better appearance, and becomes dif- pofed to heal, after which a fimple drefling may be employed. • In many cafes, however, nothing more is neceffary to check the threat- ening inflammation, than to keep the part conftantly moiftened with vin- egar and water, or Goulard's extrad and water, till the puftule is dried up^ and only a hard fcab left. In order to put a fpeedy period to the local diforder when no longer neceffary, it has been recommended, by Dr. Jenner and others, to apply On the Inoculated Cow-Pox. g c for a very fhort time fome very active and corrofive folution, which may haften the procefs of cicatrization, and prevent any trouble that might arife from frefh ulceration at the pu£ tule. A drop of ftrong vitriolic acid taken upon the head Of a probe and thus applied to the puftule for a few feconds, and afterwards wafhed off; or the undiluted Goulard's extract (Aq, Lithargyri Acetati) will anfwer this purpofe, and fhorten the cure of the local diforder. It is to be ob- ferved, however, that it is only very rarely, and in unufual inflammation protraded beyond the eighth or tenth day, that we fhould employ any of thefe remedies : and we fhould alfo g6 On the Inoculated Cow-Pox. be aware that, as they will any time induce a premature fcabbing, they would in all probability, if ufed too early, entirely extinguifh the difeafe before it had rendered the conftitu- tion fecure againft the variolous con- tagion, and thereby the end of the vaccine inoculation would be de- feated. Method of taking and preferring Matter for future Inoculation. There are few praditioners of the vaccine inoculation, who have not ex- perienced repeated difappointments in attempting to introduce this in- fedion, from the circumftance of thej On the Inoculated Cow-Pox. on virus lofing its efficacy in a very fhort time after having been taken from the puftule. This certainly depends in many inftances on a want of ac- tivity in the matter itfelf, for frequent failures have happened, even where every poflible precaution has been obferved, and where no great dif- tance of time has occurred between the time of taking the matter and the attempt toinoculcate the difeafe. And yet it has alfo happened, that the inoculation has fucceeded, with mat- ter preferved with, no unufual care, and even after having been carried acrofs the Atlantic. A few obfer- vations may therefore be made with regard to the method of taking and. i 98 Ov the Inoculated Cow-Pox. preferving the infeding matter. Where the virus is to be ufed diredly after being taken from the puftule, nothing is fo convenient for receiving it as the lancet with which the fubfe- quent inoculation is to be performed; and it has frequently happened that this method of inoculating has fucceeded, both with variolous and vaccine mat- ter, after repeated failures from every other method. As, however, this mode cannot always be conveniently ufed, the matter muft be allowed to dry on the fubftance on which it is received, and afterwards diluted with - water, that it may be fufficiently li- quid for infertion. A lancet will very commonly anfwer the purpofe -> On the Inoculated Cow-Pox. 99 in this cafe alfo, if ufed within a very few days after the matter has been taken ; but it feems to be well eftablifhed, by repeated obfervation, that this method is very precarious for conveying infedion to any con- fiderable diftance, or for fome length of time before it is to be ufed. It becomes then much fafer, either to moiften a piece of cotton thread in the matter frefh from the puftule, or to receive it upon a fmall plate of glafs, over which, when the matter is dry, another piece of equal fize fhould be laid. In all cafes the li- quid virus fhould be fuffered to dry gradually and thoroughly in a warm temperature, and then fhould be loo On the Inoculated Cow-Pox. fecured from the accefs of air by cementing together with fealing-wax, or fome fimilar fubftance, the plates of glafs, or by well clofing the phial into which the thread is put. Pre- vious to inoculating from the glafs plate, the matter muft firft be diluted with a very minute drop of warm water, well mixed by the point of a lancet, which laft fhould then be made to take up as much as will be neceffary for inoculation, and held with the point downwards, till the fluid which is upon it has acquired rather a thicker confiftence. After which, the pundure may be made in the manner already mentioned. It may be obferved, that though we On the Inoculated Cow-Pox. i p I fhould avoid doing fuch violence to the puftule which furnifhes the matter, as to make it bleed, yet the virus itfelf does not feem to lofe any of its infeding power, by being accidentally mixed with a drop of blood.* * As the citcumftance of the vaccine virus becoming very hard and not eafily again fol- uble when once dry, has been confidered by fome, as a principal caufe of the frequent failure in this inoculation ; an ingenious friend of mine has fuggefted, and in one inftance at- tempted, a method of prefervrng the matter in its fluid ftate, by receiving it in a very minute hole, not bigger than a pin's head, drilled in glafs, and carefully cementing the hole again, to prevent the inclofed matter from drying by l % 102 On the Inoculated Cow-Pox. There is only one way of tranfmit- t.li:)& "his infedion from one country to 111 taer, which is ftill more fecure than eitr-er of the above, and this is, tv» keep r> a conftant fucceflion of puftules by :..-..emulation of different perfons (on board of fhip for inftance) which may be done : c all times with- out the leaft n. of any general in- fedion, and with very flight trouble and inconvenience to the perform fo inoculated. As a p°rfed pnft -!e may commonly be form d, by inocu- lating perfons who have already had evaporation. From fome imperfection in this minute apparatus, the firft experiment failed, tin the idea merits attention. On the Inoculated Cow-Pox. , the fmall-pox, though they are un- fufceptible of any general vaccine diforder, the feries of infedion may be kept up, though proper fubjeds for the difeafe be wanting. To conclude the comparifon be- tween the variolous and the vaccine difeafe, we may obferve that there are two points in which they differ very fenfibly ; in the form, and con- tents of the puftule. That which is formed by vaccine virus, in by far the greater number of inftances, con- tinues perfedly circular during its whole progrefs ; ,at all times the 104 On the biennialcd Cow-Pox. edges are elevated, and the furface flat, and it does not fhew that prom- inence in the centre which arifes from being quite diftended with its contained fluid. The fmall-pox puf- tule at the place of infertion, while advancing-*o maturation, generally becomes jagged at its edges, and the outline is rendered irregular by cluf- ters of fmall puftules^ Thefe, in the end, often become confluent, and leave a fore of a much greater extent than that of any fingle puftule, the fubfequent progrefs of which, as has been mentioned, is frequently the caufe of much trouble, and fometimes of danger, to infants. The inoculated cow-pox puftule, On the Inoculated Cow-Pox. 105 on the contrary, continues well de- fined through every ftage ; and this perhaps is the reafon why it much lefs frequently leaves any open fore at the time when the fcabbing pro- cefs fhould come on. The contents of the refpective puftules alfo differ. The fluid which the vaccine puftule fecretes does not progreflively change from a watery to a thick purulent matter, as in the fmall-pox, but continues thin and almoft limpid, till it entirely difap- pears. It is alfo fucceeded by a hard brown fhining fcab, which latter is harder, fmoother, and of a darker color than that which attends the variolous puftule. *o£ On $he Inoculated Cow-Pox. Where the vaccine inoculation is followed by no local diforder, or only a flight rednefs at the pundured part for a day or two, we can have no doubt that the operation has failed ; but cafes fometimes happen where the failure is equally certain, but which require much more difcrimi- nation to be diftinguilhed from thofe in which the diforder is complete and genuine. The regularity with which the lo- cal difeafe at the place of inoculution runs through its feveral ftages, feems to be the principal point to be at- tended to ; for the acceffion of fever is certainly not neceffary to confti- tute the difeafe, fince the greater On the Inoculated Cow-Pox. 107 number of infants have no apparent indifpofition. Therefore, when the puftule advances in a very hafty and irregular progrefs,-* when the inocu- lated pundure on the fecond or third day after infertion fwells confider- ably, and is furrounded with an ex- tenfive rednefs, this premature in- flammation very certainly indicates a failure in the operation. Even when the inoculation has advanced for the firft few days in a regular manner, but when, about the fixth day, inftead of exhibiting a well formed puftule and veficle of fluid, * See the excellent practical obfervations in the latter part of Dr. Woodville's Obfervations on the Cow-Pox. io8 On the Inoculated Cow-Pox. the part runs into an irregular fetter- ing fore, the purpofe of inoculation is equally defeated j and thefe varie- ties require to be watched with an attentive and experienced eye, fince they might readily lead to a falfe, and perhaps fatal idea of fecurity againft any fubfequent expofure to a variolous contagion. 109 CHAPTER HI. GENERAL OBSERVATIONS CONCERNING THE VACCINE INOCULATION. A question of confiderable importance has been fuggefted, arif- ing diredly from a review of the foregoing fubjed : namely, whether the cow-pox is not originally the parent difeafe to the fmall-pox, whilft the obferved differences only depend on the length of time in which the latter diforder has paffed through various conftitutions in the human race. a. 110 General Obfervations, &c. The great fimilarity in the opera- tion of each infedion, and efpecially the change that the one makes upon the human conftitution in rendering it either partially or intirely infenfi- ble to the power of the other, (a fad without example in the hiftory of phyfic,) would imply at leaft a very intimate refemblance in the nature of each. If this queftion were anfwered in the affirmative, the immediate in- ference would be, that, by convey- ing the vaccine difeafe into the hu- man conftitution, it would in a feries of years, through imperceptible gra- dations, at length affume the vari- olous nature. Hence it would hap- pen, that the inoculated cow-pox General Obfervationr, &c. in would gradually become a more fe- vere diforder, and would at the fame time be communicable by contagion, and no longer be the mild and fafe difeafe that we now find it. Experi- ence, however, as far as it has hith- erto been carried, does not fhow any approach to this ftate : the vaccine inoculation continues to promife as many and great advantages as it at firft held out ; the puftular cafes (which are the moft fevere) are not more frequent than formerly, but on the contrary, we are now generally able to avoid them, by removing the caufes from which they origin- ate.* * In the laft 1500 inoculations at the Small- Pox Hofpital (where puftular cafes are moft X 12 General Obfervations, &£> We may therefore fafely continue the vaccine inoculation, without any probable profped of finding at laft that we have only been introducing the variolous infedion under a differ- ent form ; but, even fhould this hap- pen, there can be no rifk as to the fecurity from fubfequent contagion of the fmall-pox (the ultimate end of inoculation,} fince it cannot be fup- pofed that this fecurity, which even at prefent is complete, fhould be at all diminijhed when the inferted difeafe approaches to a variolous nature. The poflibility of fuch an event, how- to be expected) thefe cafes have been even lefs than three or four in the hundred, according to Dr. Woodville's report. General Obfervations, tsV. 11 j ever, fhould be an inducement to at- tend accurately to the difeafe in the cow, that, if neceffary, we may at any time refume the original infedion from the fountain head. It has been often remarked, and is confirmed by conftant experience, that the fmall-pox, long after all its immediate effeds have difappeared, is apt to leave the conftitution pecu- liarly liable to fuffer from fcrophuli, where a tendency to this difeafe ex- ifted in the body before the introduc- tion of the fmall-pox. Therefore, although variolous inoculation will not convey the feeds of fcrophula along with its own infedion into a found habit of body, it may be the k 2 114 General Obfervations, tSfc. caufe of confiderable trouble during the early part of life, in certain in- ftances. The cow-pox has not been found to refemble the fmall-pox in this refped ; whether from its great mildnefs, or from fome more obfcure caufe depending on a peculiarity of its nature, we are not able to deter- mine : but, if the daily accumulating obfervations that are making on this difeafe continue to confirm this im- portant circumftance, it will be an additional reafon for its adoption in preference to the fmall-pox. It is a peculiar advantage belonging to the vaccine inoculation, that in any ftage of this diforder the rifk of endangering life is fo fmall as fcarcely General Obfervations, £sV. 11 - to be eftimated in any certain propor- tion. In the natural fmall-pox, the number of fatal cafes is very confid- erable,* and even in the inoculated difeafe, a certain portion,, varying ac- cording to the feafon of the year, * In the London Bills of Mortality (which by no means include all that die in the metrop- olis) the number that annually perifti by the fmall-pox is, on an average, upwards of two thoufand ; fo that this diieafe generally ftands the third or fourth in the order of fatality. For further particulars oh this fubject, the reader will find fome interefting matter collect- ed from different authorities in a paper in the Medical Journal, No. 21, by Dr. Cappe of York, whom I am happy to call my friend, and whofe active and judicious inquiries into this fubject, have highly contributed to prefent it to public notice in the city where he refides. 116" General Obfervations, tsV. and the mild or malignant nature of the infedion, fall a facrifice to this diftemper. In common inoculation, this proportion is very fmall ; fo fmall indeed, as, where it occurs, to be generally an unlooked-for event, at leaft with the friends of the fuf- ferer. Still, however, the rifk to life may be eftimated, and will always be felt in the anxiety of the parent. With the cow-pox the hazard is not appreciable. One folitary inftance of a fatal event* makes a very fmall ratio * In the former edition of this treatife, this fentence alluded to a fatal cafe which happened at the SmalhPox Hofpital. Later inquiries, General Obfervations, C3V. 117 with the fuccefsful cafes already on record ; and the daily accumulation of thefe latter, renders the difpropor- tion fo fmall as almoft intirely to ex- tinguifh every idea of danger. and efpecially the difcovery now made, that the Vaccine infection will not preferve from fmall-pox contagion in the' earlier period of vaccine inoculation, render it fcarcely queftion- able, that the death which here unfortunately occurred, fhould really be contributed to a very active contagion of fmall-pox. The child died before any eruption could appear, but with the fame fymptoms as occur in other in- ftances of fatal convulfions, previous to the time of variolous eruption. Another fatal cafe oc- curring after inoculation with vaccine matter, which has lately taken place near this metropo- lis, has ferved to fhow the great importance of attending to the directions to be followed in ft- 118 General Obfervations, &r. This circumftance, it may be prc- fumed, may have a very important operation on the minds of thofe who have long uniformly and confiftently oppofed on religious grounds the in- trodudion of the inoculation of the fmall-pox. To thefe, this widely diffufed pradice has only been the fource of mifchief, by extending this contagious diftemper on every fide and in every corner of the kingdom ; and, being withheld from enjoying the immediate benefit which it offers, letting matter for inoculation ; and when in- tirely explained, we may expect with confidence, ( j that this will enable every medical practitioner to avoid a fimilar unfortunate event. General Obfervations, csV. I iq they have not reaped an adequate re- compenfe from the more indired ad- vantage of a better knowledge which inoculation has led to in the general treatment of the difeafe. To thofe, therefore, who hefitate to endanger human life by a volun- tary difeafe, however fmall the rifk, and however great the promifed ad- vantage the vaccine difeafe will ftand in peculiar eftimation, as it offers all the benefit which the variolous in- oculation is known to infure, and re- moves to an extreme diftance every hazard of a fatal event. 116 General Obfervations, &V. One more obfervation may be ad- ded, which is, that as the cow-pox inoculation has not the advantage of anticipating the contagion of the nat- ural fmall-pox, there are fome cafes in which the variolous inoculation is preferable. If a perfon, who has never had the fmall-pox, be accident- ally expofed to its contagion, it has been always reckoned the fureft method of diminifhing the rifk thereby incurred, to inoculate im- mediately, and thus to convert (as it Were) the natural into the inoculated fmall-pox ; or rather to extinguifh the former, by introducing the latter into the conftitution, in a much more dired and fpeedy manner. In thefe General Obfervations, cifr. 121 inftances, and perhaps only thefe, in- oculation with the fmall-pox is ftill to be retained, for it is now fully eftablifhed, that under fuch circum- ftances, the cow-pox cannot be truft- ed to. If future experience fhall continue to confirm the important advantages which the cow-pox now offers to the human race, and if the eftablifhment of this inoculation, fo happily intro- duced to the world by Dr. Jenner's able inveftigation, fhall continue to advance with the rapid progrefs that has hitherto attended its fteps, it will foon become an objed of fufficient magnitude for univerfal attention, in 132 General Obfervations, cifV. every part of the world that is con- ftantly experiencing the ravages of the fmall-pox ; and the extirpation of this formidable malady from every civilized country will no longer be a very impradicable undertaking. That the vaccine inoculation is peculiarly calculated to bring about this moft defirable end, appears from a review of its leading features. Were even the advantages which it offers much lefs perfed than we find them to be, were it only to fecure from variolous contagion the greater part of thofe inoculated with it, or only to exercife its prefervative pow- ers for a certain number of years, General Obfervations, &c. 123 the mere circumftance of not being itfelf communicable by contagion might ftill render it worthy of notice in any general and national plan for extirpating the fmall-pox, though it would then no longer recommend itfelf to individuals. But, fince it poffeffes all the fecu- rity of the infeded perfon which the inoculated fmalhpox affords, it may be* an additional motive of preference with many, that, whilft the welfare of the individual is eminently confulted by employing the vaccine infedion, no contagion is fpread abroad of a difeafe, which, when acquired by contagion, is one of the moft diftreff- 124 General Obfervations, Z*fc. ing in its fymptoms, -formidable in its appearance, and doubtful in event, of any to which the greater part of mankind are expofed. [ I25 ] THE following collection of written teflimoniah, will at once fhow the degree of credit 'which the Kine-Pox difeafe has gained and the progrefs of the inoculationy Jince the firft publication upon the fubjed, by Dr. Edward Jenner, in June 1798 ; and therefore it may be of ufe to annex it to the foregoing work. Dr. John Ring, London, July 6, 1799. " THE fuccefs of the practice has, on the whole, been fuch as to gratify every reafonable expectation ; efpecially if allowance be made for the error of taking the matter from an im- proper puftule ; an error eafy to be avoided in future." Again, " I am happy in being able to add my teftimony to that of Drs. Jenner, Pear- fin and Woodvilkt in confirmation of the effi- cacy of the new practice." Dr. Ward, of Manchefier, Jidy 12, 1799. " May I not indulge a hope that the era is probably not far diftant, when we fhall be able to congratulate mankind at large on their hav- ing a fair profpect of being exempted, at no very remote period, from that moft destructive malady"—Small-Pox. London* July 19, 1799. " Many unfounded reports having been cir- culated, which have a tendency to prejudice the mind of the public againft the inoculation L 2 r 126 ] of the cow-pox, we, the underfigned phyficians and furgeons, think it our duty to declare our opinion, that thofe perfons who have had the cow-pox are perfectly fecure from the infection of the fmall-pox. We alfo declare, the inocu- lated cow-pox is a much milder and fafer difeafe than the inoculated fmall-pox." " William Saunders, m. d. Matthew Baillic, M. d. Henry Vaughan, m. v. Maxwell Gartfoore, M. d. J. C. Lettfome, m. d. James Situs, m. d. John Sims, m. d. William Lifter, m. d. Robert Ionian, m. D. Thomas Bradley, m. d. Thomas Denman, m. d. John Squire, m. d. Richard Croft, m. d. R. J. Thorton, m. d. John Abemethy, William Blair, S. Chilver, Henry Cline, Afiley Cooper, Edward Ford, J. M. Good, James Hofs- ford, Jofeph Hurlock, Francis Knight, James Leighton, James Moore, Thomas Paytherus, Thom- as Pole, J W. Phipps, John Ring, James Simp- fon, H. L. Thomas, Jonathan Wathen, Thomas Whately. Dr. Thorton, London, Augufl 4, 1799. " The cow-pox is an era in the annals of med- icine, and muft redound eternally to the honor of Dr. Jenner, who was fent to detect and generally apply this noble difcovery. [ 127 ] September, 1799. Dr. Kelson of Severn Oaks, Dr. Mitchill, cf Chatham, Dr. Harrison of Horncaftle, had each inoculated nearly 100 patients, and afterwards with matter of Small-Pox ; but none took the difeafe. September, 1799. Dr. Pearson made a communication to the public, of the progrefs of the new inoculation ; at which time nearly two thoufand had been inoculated in England. His paper concludes with the following intelligence : " The fenfation excited on the Continent by the vaccine inoculation, has been much more confiderable than even in our own ifland, as I learned, firft from Dr. Marcet, and fince, by a letter from Dr. Pefchier. At Vienna, Dr. Farro inoculated two of his own children with vaccine matter, which I tranfmitted ; and next Dr. De Carro inoculated two of his own chil- dren. An accurate journal of thefe two laft ca- fes was kept by Dr. De Carro, which he has had the complaifance to communicate to me through the hands of Dr. Pefchier. The above patients had the vaccine difeafe in the ufual mild way that they have had in England, and were inoculated fubfequently for the fmall-pox, hut without taking the dikafe." C *28 ] " It is expected that Dr. Frank will adopt the hew inoculation, as it is likely to be gener- ally done at Vienna." " I expect reports from Portugal, and other parts of the continent." " In Scotland the new inoculation has not been lefs fuccefsful. Dr. Anderfon, of Leith, informs me he has inoculated above eighty per- fons ; that Dr. Duncan, and others, have be- gun the practice at Edenburgh ; and that it has been introduced in Dundee, Paifley, and Dalkeith." " If the vaccine inoculation proceeds with equal mildnefs as it has done the laft four months, doubtlefs the variolous incifion muft, in no remote period, be fufpended. And if fuch an event fhould take place, pofterity will behold with amazement, the prejudices and in- attention of their predeceffors to the application of a fact in practice, by which a formidable and loathfcme difeafe was extinguifhed—a fact well known, time immemorial, to almoft every farmer in half a dozen counties of England, but neglected till Jenner had the courage to in- dicate the advantage of it to fociety." September 11, 1799. Dr. Evans of Ketley, in ShropfAre, fays, " In confequence of the experiments I have I ™9 ] made,and the confidence! have in the " reports'' of the extenfive experience of my ingenious friend, Dr. Woodville, on the fubject, I am de- cidedly of opinion, that the cow-pox is a cer- tain preventative againft the fmall-pox." At this time he had inoculated above fixty perfons for the cow-pox, and a confiderable portion of thefe fubfequently for the fmall-pox. December 2, 1799. The inftitution for the inoculation of the vaccine-pox, was founded, at which time it is ftated in the official addrefs to the public, that *' above 6000 perfons had had the inoculated cow-pox difeafe. Not a fingle well attefted in- ftance has been produced, among more than 2000 of the above perfons, known to have had the inoculated vaccine-pox, and who were fub- fequently inoculated for the fmall-pox, of this difeafe being fubfequently taken, although many of them were alfo expofed to the infec- tious effluvia of the natural fmall-pox. And, traditionally, this fact has been eftablifhed, time immemorial, with regard to the cafual cow-pox." Dr. A. Huggan, Plymouth, Dece?nber 31, 1799. " The introduction of the cow-pox into prac- tice, as a fubftitute for the fmall-pox, having been found to be expedient, in the moft exten- [ 13° 1 "five fenfe of the word, the difcuffion of the fubject^will, of courfe, be confidered as clofed. This is a circumftance truly honorable to Dr. Jenner, by whom this beneficial improvement, doubtlefs one of the moft important in Medi- cine, has been firft made known to the world." * * * " As I am perfectly fatisfied from the proof already before the public, of a perfon who has had the vaccine, being thereby ren- dered unfufceptible of variolous infection, I have not thought it neceffary to inoculate any of my patients with the poifon of the latter dif- eafe, having feen feveral of Mr. Stewart's, on whom the experiment was made, and with it, almoft needlefs to add, the ufual effect." Dr. Richard Dunning. " From the mafs of evidence already before the medical world, and from what has fallen under my own obfervation, I am intirely difpof- ed to give ci edit to the prefent advantages faid to be derived from the new inoculation ; and to thofe much greater confequences which promife to refult from it to pofterity. • I experi- enced the greateft fatisfaction on finding a man of Dr. Denman's great and juftly acquired ce- lebrity expreifing himfelf fo difpaffionately on the important fubject of cow-pox. His letter will undoubtedly give a weighty fupport to the intereft of the vaccine inoculation." [ 131 1 Front a communication by Dr. Thomas Den man, London, March, 1800. " Entertaining no doubt of the advantages which will refult to fociety, when Dr. Jentierys propofal for inoculating with the cow-pox fhall be generally adopted, I have thought that fome good might be produced by an attempt to remove prejudices ; for it appears to me, that none of the facts' or obfervations mentioned by Dr. Jenner have been difproved or refuted," &c. &c. J. H. Grose of Winflow, March 15, 1800. " A more valuable difcovery cannot be made for the public than this, as it may be the means under providence, if not of banifhing, at leaft diminifhing, the fatal influence of a diforder which has fo long defolated mankind ; and I am happy to add that the practice is daily ex- tending. Dr. T. Trotter, May 6, 1800. " The Jennerian inoculation has been intro- duced into this neighborhood by Dr. Huggan, and earneftly fupported by all the fcientific part of the medical profeffion. Like the early prop- agation of Chriftianity, by its divine leader, it was firft " preached to the poor." The chil- dren of poor foldiers and poor fifhermen, firft partook of its bleffings : publicans and finners havq fince embraced it ; and the purity of its [ *32 ] doctrine and practice is making profelytes to the very land's end in Cornwall." Dr. Marshall ef Eaflington, Gloufceflerflnrc, to Dr. Jenner. " Dear Sir, " Since the date of my former letter, (Apr1 26, 1799) I have continued to inoculate with the cow-pox virus. Including the cafes before enumerated, the number now amounts to foui hundred and twenty three." " I have already fubjected two hundred and eleven of my patients to the action of variolous matter, but every one re- Jijledit." " The refult of my experiments (which were made with every requifite caution) has fully convinced me that the true cow-pox is a fafe and infallible preventative from the fmall- pox ;" and, " if the many important advan- tages which muft refult from the new practice are duly confidered, we may reafonably infer that public benefit, the fure teft of the real merit of difcoveries, will render it generally extenfive." Dr. Kelson, Severn Oaks, May 19, 1800. " The facts I can ftate to be clearly demon- ftrated by my extenfive inoculation, (between 3 and 400 patients) are thefe : That the dif- eafe is a thoufand times more trifling than fmall- pox, fcarcely having had a patient fufficiently t m ] , ill to prevent amufement or labor :—That it is not an infectious difeafe ; to determine which, 1 feledted about 40 people in our work-houfe, « and inoculated half of them, fome in both ams, and fixed them to fleep with thofe who had not had it j but in no inftance was it com- jmunicated to the others. I broke the puftules, and frequently made them fmell the parts, but to no effect. After giving the difeafe to the re- mainder, I, beyond cavil, afcertaii«ed it to be a perfed! fecurity againft the fmall-pox, for I im- mediately inoculated the whole party with the moft virulent variolous matter I could procure ; but nothing enfued, except local fuperficial in- flammation for the firft fix or feven days. I then introduced a wretched family, juft recov- ered from very bad fmall-pox, their dirty clothes unchanged, and divided them in different beds among them, but to no purpofe. I then inoc- ulated with cow-pox an infant, and as foon as I was fatisfied it had taken, I put it, and kept it in the bed with its fifter who had the moft dreadful confluent fmall-pox, but no inconven- ience enfued. Moft of the work-honfe chil- dren, I have this fprmg inoculated again, both with variolous and vaccine matter, but nothing happens : this ftiews the vaccine effect to be a. lafling fecurity againft itfelf, as well as the fmall-pox. Befides the. cafes above noticed, tf t 134 1 moft of the others whom I have inoculated, have had variolous matter inferted afterwads, for the fatisfaction of themfelves or friends." To Dr. Bradley, from Dr. Charles Cooke, Glocefler, May 29, 1800. " If I had waited for the prefent increafing numbers of impartial teftimonies and indubita- ble facts in favor of vaccine inoculation, I need not have. troubled you to infert this letter in your ufeful publication ; but as, in the outfet, I did (with more zeal than prudence) oppofe, what I then confidered an innovation in prac- tice, (by confounding the uncertain effects of I the advantages evidently arifing from this dif- ! eafe when inoculated) I now think it right, in juftice to Dr. Jenner and the medical public, to declare, that, in the courfe of my practice, I had occafion to make trial, and do approve of i vaccine inoculation ; yet, I think it ihould be j conducted by practitioners, who have taken ' proper care to afcertain the genuine difeafe." Dr. Andrew Duncan, Profeffor of the Infiitutes \ of Medicine in the Univerfity of Edenburgh, in , a letter to Dr. Miller of New-Tor k, dated Oclober 2, 1800. States, that " vaccine inoculation is making great progrefs at Edenburgh, and promifes fair to render the fmall-pox much milder than varif - C . 135 1 olous inoculation. The medical practitioners here have given the lead ; the children of Dr. Gregory, Dr. Spens, Mr. Bennet, &c. having been inoculated with vaccine matter. Though many hundreds have now been inoculated at Edenburgh with vaccine matter, yet, among all thefe, not one cafe has occurred where the patient was ever in the fmalleft dan- ger, or had a fymptom in any degree alarming. Not one inftance has occurred, where the child, after vaccine inoculation, has taken the fmall- pox ; though repeatedly inoculated with vario- lous matter, and intentionally expofed to natural contagion." [Medical Repo/itory.~] From Dr. Lettsom of London, to Dr. Barton of Philadelphia. " Vaccine inoculation is becoming more and more general in England ; and on the Europe- an continent about 16,000 have had the dif- eafe, if difeafe it can be termed, without any cafe, of fatality ; and about 3000 have been in- oculated again with the common fmall-pox without conveying any difeafe ; fo that, prob- ably, foon, no other than the cow-pox will be adopted here. I imagine a fatal cafe will never occur, as there is rarely more than one puf- tule." [ I3« 3 Dr. Robert Ca*pe, Tork, September 6, 1800. '* Dr. Woodville had, feveral months ago, in. oculated 1000 people with the fmall-pox, who had previoufly had the inoculated cow-pox ; not one of them received the infection. Many el- derly people, who had received the cow-pot cafually, were inoculated for the fmall-pox after many years, one at the diftance of 53 yeafsj but did not receive the infection. From Dr. Jennet's firft pamphlet, and a letter lately pub- lifhed, addreffed to him by William Fermor, Efq. I have made the following lift pf per- fons, who had had the cow-pox many years be* fore and did not receive the fmall-pox on inocu- lation. Many were often expofed to them in their own families when epidemic." " Interval of years between the infection of cotu-pox, and inoculation of fmall-pox? " From Dr. Jenner. *' Jofeph Merret, 25 M Sarah Portlock, 27 " John Philips, 53 " Mary Barge, 31 " Elizabeth Wynne, 3 8 ** Wm-Struchcomb,io »' Hefter Walkley, 26 " We have reafon to be infinitely thankful to providence for the meansnowput into our power, " From Mr. Fermor. " William Tredwell, 3 " Albin Collinbridge,4 " Mr. Stephens, 4 " Thomas Stales, 6. '< Mr. Collinbridge, 10 [ -37 J of immediately checking the ravages of one of the moft fatal plagues ;* and for the cheering hope of intirely exterminating the fcourge from the face of the earth. With thefe fentiments I feel it not lefs than a duty to lend my aid in fpreading around the knowledge of the advan- tages which the vaccine inoculation offers." [Addrefs to the Inhabitants.~\ N. B. The above extracts are principally from communications in the Medical Phyfical Jour- * More than 2,000 perfons in the city of London die annually of the fmall-pox; but the malignity of the difeafe is incalculable, whenever it becomes epidemic, as it fometimes does, owing to fome peculiar tempera- ture of the feafon and climate affedting the human con- ftitution with an influence of fuch kind and degree as to favor its cafual fpread : then, indeed, its ravages become truly alarming, and, under thefe circumftances, it often affumes all the deftrudUve qualities of the moft deadly plague : at fuch time even inoculation will not materially leffen the mortality, as appears from the fol- lowing : " We learn from Halifax (Nova-Scotia) that a gen- eral inoculation for the fmall-pox has been lately ad- mitted there ; (laft autumn, 1800) and that the mor- tality has been very confiderable, particularly among children. One letter mentions 800 deaths, infants and adults, and that one family had loft feven per- fons." [National Intelligencer.] M 2 I 138 3 nal, pulifhed monthly in London: a work pop^ ular andextenfively circulated upon the continent of Europe and in America. Thusfpontaneous,refpectable and unequivocal are the teftimonials which have from time to time appeared before the European public, fa- voring the Jennerian doctrine ; and fo forcible and abundant are the evidences in confirmation of the moft favorable reports of the kine-pox inoculation as has feemingly precluded doubt and bid defiance to fkepticifm: even preju- dice ftands abafhed, and determined oppofition has foftened into, what is termed, prudential caution. What more can be done or faid than has" been, to produce a general conviction of the utility of the kine-pox inoculation ; in that it is a perfed fecurity againft any after infection from the fmall-pox P and when once this fact is acceeded to as indifputable, what reafonable be- ing will hefitate a moment in giving it the pref- erence to the inoculated fmall-pox as a fecurity againft a cafual infection ? Its comparative adr vantages are certainly very great and ftriking 1 [Fr&n Dr. Henry Jenner's addrefs to the publk,] t x39 ] Small-Pox, Very frequently calls la- tent difeafes into action ; in thefe are included the various fpecies of fcro- fuia. Is contagious and com- municable by effluvia. Cannot be communicat- ed wi^h fafety to children when cutting teeth. In fickening with the fmall-pox, children are frequently afflicted with aj- larming fits ; and when their conftitutions are del- icate, they fuffer materi- ally in their heajth during life. Is often fatah Is attended with erup- tions and very often dis- figures the countenance. Cow-Pox, ■ We may fafely conclude, ; from a long and careful : obfervation of this difeafe, as communicated from the Cow, and from no limited experience in its inocula- tion, that it excites no dif- pofition to other com- plaints. Numerous experiments teftify, that this never hap- pens in the cow-pox. This circumftance forms i no objection to inoculate with vaccine matter—nu- merous experiments jufti- fy the aflertion. Nothing of this kind has ever appeared in this dif- eafe ; and the conftitutions of children have been im- proved by its communica- tion. No inftance of the kind has ever happened. In this difeafe (even in the natural way) I nevej." obferved any puftules. [ Mo ] Perfons afflicted with ' this difeafe cannot mingle with thofe, who have nev- er been afflicted by it. Medicines are neceffary to be administered. Notwithftanding the prefent improved ftate of. inoculation, parents and friends muft feel a confid- erable degree of anxiety for the fafety of relatives, &c. Requires a Nurfe. This objection docs net apply to the cow-pox, as it is neither contagious, nor communicable by ef- fluvia. Here no medicines art required. Little anxiety can be felt in this difeafe, as it is nev- er attended with the leaft danger. This difeafe does not. " The above comparifon of the advantages which are to be derived from the fubftitution of the vaccine difeafe for the fmall-pox, is founded upon principles which experience has proved to be fixed upon the folid bafis of truth. I am certainly entitled to fpeak with confidence on the fubject ; as, in conjunction with my un- cle Dr. Jenner (who with indefatigable induf- try, har. completely inveftigated the nature of cow-pox) I have had a very extenfive acquaint- ance in this part of medical practice," &c. " Since my former publications on the vac- cine inoculations, (fays Dr. Jenner in his third C M* ] treatife upon this fubject) I have had the fat?s? faction of feeing it extended very widely. Not only in this country is the fubject purfued with ardor, but from my correfpondence with many refpectable medical gentlemen on the continent (among whom are Dr. De Carro of Vienna, and Dr. Ballhorn of Hanover) I find it is as warmly adopted abroad, where it has afforded the great- eft fatisfactioru I have the pleafure too of fee- ing the feeble efforts of a few individuals to de- preciate the new practice, are finking faft into contempt beneath the immenfe mafs of evi- dence which has rifen up in fupport of it." " Upwards of 6,000 perfons have now been inoculated with the virus of cow-pox, and the far greater part of them have fince been inocu- lated with that of fmall-pox and expofed to its infection in every rational way that could be de? vifed, without effect." The kine-pox inoculation, ere this, no doubt, would have been fanctioned by the united tefti- mony of American Phyficians could they have had the privilege and means of collecting fuch data from their own experiments as fhould be thought neceffary for an accurate and juft de- cifion upon fi> important a fubject. In other countries and with communities in general, the £nall-pox has become a domefticated difeafe [ M2 ] propagated and continued by fucceffive inocu* lations, at the pleafure and confent of parties ; while here, in New-England, private inocula- tion for the fmall-pox is recognifed as a crime to which a fevere penalty is annexed ; a cir- cumftance operating as a complete barr to any thorough inveftigation of the nature of the dif- eafe in queftion, and thus fubjecting gentlemen of the faculty to the neceffity of remaining either in a ftate of fufpendad judgment, or of founding their belief upon the teftimony and experience of others : and it fo happens that there are fome if not many of the faculty who are unwilling to come to any pofitive decifion in a cafe like the prefent, until from their own experiments they fhall have afcertained thofe facts, and pofTeffed themfelves of fuch evidence, as guided the decifion df others. On an occafion like the prefent it is truly un- fortunate that there fhould be any unnecefTary obstructions in the high road to improvement ; inveftigation fhould be free and unembarraffed, nay, encouraged by every legitimate aid. Ought not the authority of law, if found to oppofe, to be foftened into kind indulgence ? and is it unreafonable to expect that the public voice will cheerfully acquiefce and concur in fuch purfuits as bid fair to terminate in the gen- eral good ? [ 143 ] With fuch accommodation of law, and fuch encouraging difpofition of the public mind, Phyficians will be without excufe if they do, not harmonize among themfelves, and begin, the work of inveftigation with fuch liberal and beneficent views as fhall evince that their con- cern for the public welfare is not mere pretence, but genuine and fincere. Actuated by thefe motives of benevolenee and under a determination to conduct and profe- cute the inquiry with all the attentive dili- gence and perfeverance which every important inveftigation demands, whatever may be the refult, all will be ready to bellow their willing acknowledgment of well done ; and fuch honeft endeavors muft ever meet the fincere thanks of the wife and good. V&* 7 < ' a"7 »'\ • \ - , i I vi y4A - 7 / 5N." •'- /, 4 \ ^ Q