"/#%■■:?■.'■.'; 'Z A ProspeB of exterminating the Small Pox PART II, BEING A CONTINUATION OF A NARRATIVE OF FACTS CONCERNING THE PROGRESS OF THE NEW INOCULATION IN AMERICA ; TOGETHER WITH PRACTICAL OBSERVATIONS ON THE LOCAL APPEARANCE, SYMPTOMS, AND MODE OF TREATING THE VARIOLA VACCINA, OR KINE POCK ; INCLUDING SOME LETTERS TO T IE AUTHOR, FROM DISTINGUISH* ED CHARACTERS, ON THE SUBJECT OF THIS BENIGN REMF.DYj NOW PASSING WITH A RAPID STEP THROUGH ALL ranks of society in europe and America. by BENJAMIN WATERHOUSE, M. D. PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE UNIVERSITY OF CAMBRIDGE. A truth constantly to be found in the disposition of all things in the Univerfe, is, that GOD makes ufe of the fmallest means and causes to ope- rate the greatest and most powerful effe&s. In his hand, a pepper corn is the foundation of the power, glory, and riches of India. He makes an acorn, and by »t communicates power and riches to a nation. ^ Bruce's travels to the siurce oft/je Ni>. ft w!y CAMBRIDGE, PRINTED FOR THE AUTHOR, AT THE UNIVERSITY PRESS BY WILLIAM HILLIARD. l802. Published according to att of Congress. V $ To JOHN COAKLEY LETTSOM; AND | To EDWARD JENNER ; PHYSICIANS PREEMINENTLY DISTINGUISHED FOR THEIR ACTIVE BENEVOLENCE 5 < AND PROFESSIONAL SKILL, THIS ESSAY IS INSCRIBED, AS A MARK OF ESTEEM AND RESPECT, BY THEIR TRANSATLANTIC FRIEND BENJAMIN WATERHOUSE. Cambridge New England^ November 1802. PROGRESS OF THE NEW INOCULATION IN AMERICA. X WO years ago, I published a tracl, entitled, " A Prospect of exterminating the Small pox ; being the history of " the Variola Vaccina or Kine-pox, as It appeared In England ; " 'with an account of a series of Inoculations performed in Massa- " chusetts,'" It was said in that pamphlet, that, on receiving the vaccine virus from England,* I commenced the experiment, July 8 th, 1800, on my own children, four of whom, with three of my domestics, passed regularly through the distemper ; and that they soon after went into the licensed small-pox hospital in this neighbourhood, and all seven of them were inoculated by Dr. Aspinwall with the matter of the small-pox, without the least trait of infection. This decisive experiment encouraged others to follow the example set by my own family, so that by the first of September I had inoculated about fifty persons, of dif- ferent ages, sexes and conditions. By this time the public attention was thoroughly excited, and, judging by the very numerous letters I received from all parts of New England, requesting further information, as well * From Dr. Haygarth of Bath ; procured for him by Mr. Creaser, Sur- geon, in that city. 6 Progress of the new as a supply of matter for carrying on the inoculation, we must conclude that there never was any thing, in the medical annals of our country, that excited half the speculation. Nor will this appear extraordinary to thofe who know the peculiar situa- tion and sentiments of this part of the United States. The in- habitants of New England view the small-pox with singular dread; not that they ever suffered any remarkably desolating visitation from it, but the malady has been kept at an awful distance, by restrictive laws, and still stronger popular impress- ions ; fo that in New England, the most democratical region on the face of the earth, the priest, the magistrate, and the people, have voluntarily fubmitted to more restrictions and abridgments of liberty, to fecure themselves against that terrific scourge, than "any absolute monarch could have enforced. We cannot, therefore, wonder that, to a people thus circumstanced, the annunciation of a mild, safe, comparatively pleasant, and non contagious substitute for the small-pox, was received with an ardour bordering on enthusiasm. The very numerous applications at this time for the vaccine virus embarrassed me not a little. Practitioners were not then apprized of the very small quantity obtainable from a single pustule.* I threw out a cautionary hint on this subject, and entreated even my quondam pupils to protract their applica- tions for matter, or virus (denominate it which you will) until die practice was more firmly established by experiment; and observed that some unsuccessful cases, in the beginning, depriv- ed Scotland of the benefits of the fmall-pox inoculation for more than twenty years. But this disinterested hint was mis* construed, and the mischief I dreaded ensued. * By the pustule, the British writers mean the circular sore, or vesicle made in the arm by inoculation ; and not those eruptions, that have, in a few instances, appeared in places remote from the inoculated par$. This difference in our phraseology has misled some among us. It ought not, strictly speaking to be called pustule, UDtil its contents have become purulent. The eruptions on the udder 0/ the cow are more of the pblyiii- n* than of the purulent kind; Inoculation in AWricd* f I had been particularly careful to caution my readers againft srURiOus cases ; that is, a pustule, or an appearance on the arm not possessing the characteristic marks of the genuine vesi- cle ; and which may be excited according to the qualities of the matter applied, or the state of the person inoculated. I warn- ed them, that there were some circumstances, which, if not critically attended to, would bring the inoculation of this re- cently imported disease Into a temporary disrepute. I point- ed out, from the writings of Dr. Jenner, the fallacious sources whence a distemper merely imitative of the genuine kine-pock might arise. I stated that matter, Uiough originally possessing the specific virus, but which had suffered an alteration eitfier from putrefaction, or some other less obvious cause, would produce a spurious disease. I mentioned, that when the pus- tule, or inoculated part, had degenerated into an ulcer, the matter taken from it, though it possesses the power of inflam- ing the arm, and of raising fever in the person to whom it is applied, is nevertheless incapable of securing the system against the infeSion of the small-pox.* I felt it my duty in November of the same year to acquaint the public, through the medium of the newspaper, that die kine-pock had, in many places, degenerated from its original mild character, and that this deviation appeared to have arisen from the" inoculator taking his matter from the pustule at too late a period. To give all possible weight to my cautions re- specting spurious cases, I added this extract from the celebrat- ed Jenner to his learned and indefatigable follower Dr. Pear- son :—" Much caution is therefore necessary in the progress of this inquiry ; and this is my grand fear, that the discovery may fall into discredit from a want of that attention in con- ducting the experiments which the subject requires : for exam- ple, a person may conceive he has the cow-pox on his lancet, when, in fact, there may be only a little putrid pus: with this he inoculates, and excites a disease of some kind, but not such * See Jenner** ad put, or "furll/tr obssrvatitns." 8 Process of the ncvj a one as will prevent the small-pox. Thus a delusive inference would be drawn, at once hurtful to the cause, and particular- ly injurious to me. However truth must appear at last."—» And left the reader's attention fhould not, after all, be fuffi-" ciendy roused, I added—« Instances of this kind are recorded to have happened in England, where the patients were after-* wards inoculated for the small-pox, and took the disorder." But these repeated cautions were disregarded by the young and sanguine practitioner, who saw nodiing but regular cases, little trouble, and great profits. If those whom it most con- cerns will not attend to what is written expressly for their hv formation, diey must alone be anfwerable for die consequences* There are cases where ignorance is converted into a crime. Perceiving that my reiterated warnings were misconceived and misrepresented, and finding some professional gentlemen in the country so wrapt up in ideas of entreme simplicity, that they encouraged women and children to inoculate each other, I ceased from further expressions of that kind, and endeavour- to content myself with predicting the consequences. During this period, viz, the autumn of 1800, a singular traf- fic was carried on in the article of kine-pock matter, by persons not in the leaf! connected with the medical profession ; fuch as ftage-drivers, pedlars, and in one instance the sexton of a church. I have kne^wn the shirt sleeve of a patient, stiff with the purulent discharge from a foul ulcer, made so by unskil- ful management, and full three weeks after vaccination, and in which there could have been none of die specific virus ; I have known this cut up into small strips, and sold about the country as genuine kine-pock matter, coming directly from me. Several hundred people were inoculated widi this caustic mor- bid poison, which produced great inflammation, ficknefs, fever, and in several cases eruptions, with a greater disturbance of the system than what occurs in the trrue disease. It it worthy of remark, that I could not influence these people to believe that Inoculation in America. 9 they had not passed through the true disease, and that they were not secure from the small-pox. So true it is, that a mart need not despair of making the common people believe any thing but truth ! That vagrant quacks should stroll about the country, inoculating for half a dollar a head, and some for less, is not quite so surprising as that they should, in such a country as ours, find people weak enough to receive it from such hands ! This Imprudence ought not, however, to be at- tributed to the common people alone. Many young practi- tioners in country villages come in for a share of iti Not a few first inoculated themselves* and then others, without hav- ing read more than the newspaper publications, and some not even those, and were looking out for eruptions, and foretelling appearances and symptoms that are never attached to the dis« ease ; and if any very disagreeable occurrence arose, in the course of diis imprudent practice, the odium reverted to me. At length a very serious occurrence arrested, in some de- gree, the blind rage for promiscuous inoculation ; and as this accident is much oftener quoted than understood, I shall take some pains to explain it, especially as it has ultimately turned out to the honour of the Jennerian discovery and practice. I had inoculated two Inhabitants of Marblehead, a consider- able sea*port about 16 miles from Boston. The One was a young gentleman, Mr. F. a particular connection of Dr. S. The other was a boy of about ten years old, die son of Dr. D. Dr. S. had obtained some matter from the arm of a common sailor, who came from London to Marblehead, in a ship of which Dr. S's son was an officer. But this matter, which was supposed to have been the cow or kine-pock virus, was in fact the •variolous matter, and Dr. S. began' the use of it on his own children, which sufficiently proves that the parent, as well as his son, was imposed on. The consequence was, die small- pox spread through the neighbourhood, and the municipal au- thority gave leave for a general inoculation. B i o Progress of the new Previously to this sad accident, Dr. D. had inoculated about forty persons, from the arm of his son whom I had vaccinated, but did not adhere to my directions respecting the time of tak- ing die matter. All that he inoculated took the small-pox, either casually, or by inoculation, one excepted.* The consequence was, as might have been foretold, a sudden downfall of the credit of the new inoculation, and not a few execrations cm the origi- nal promoter of it. Although I saw clearly die cause of this disaster, (for I repaired immediately to Marblehead, and saw the chain of their calamity, and examined every link of it in conjunction with Dr. S. and Dr. D.) I found it vain to at- tempt to explain or palliate, but left its developement to time, that infallible test of truth. There was one thing, however, which attracted the attention of a few, namely, that the two persons whom I inoculated escaped the small-pox, although one was an assiftant inoculator, and in some instances nurse, during the whole time that disorder was passing through the town ; and die other slept with his brodier during the whole disease, which was pretty severe. When the popular voice condemned the kine-pock, these two facts plead strongly in the minds of a few for an arrest of judgment. Some of my transadantic brethren feemed to have had a just sense of the anxious situation incident to the first steps in an important experiment and practice, entirely new. For it should be borne in mind that I commenced this new inocula- tion at a period when it was a novelty even in London. To rouse attention, to create belief, to inspire confidence, were la- borious preliminary steps. But to confirm assertion by a public experiment, insulated as I was, and remote from all aid in case of embarrassment, was a task delicate, difficult, and anxious. Few mariners chuse to risk entering the bay of Massachu- setts, and to sail up to Boston, without a pilot; yet how sim- ' The one first inoculated by Dr. D. from his son. Inoculation in Atneriea, 11 pie and easy is that passage now, compared with what it was, when trie first ship entered it ; when it was not merely steer- ing by a known fixed object, but sounding every inch of the way, amidst islands, rocks, reefs, eddies and shoals, in order to determine the safe channel. In like manner, if in our first at- tempts to ascertain the safe passage, we sometimes got aground, or run ashore, we never failed to mark the ground for the be- nefit of those who came after us. We have buoyed the chan- nel as well as we were able, and noted the bearings of every dangerous rock, point, reef or shoal. It should be remember- ed too, that we had not a leading wind, nor a flowing tide. Since that time we have endeavored to make an accurate chart of the coast ; taking care to note the variations of the compass, the predominant winds, and the prevailing cur- rents. Our last labour is to collect materials for erecting a light-house to guide those adventurers, who attempt the same rout in the dark. The Massachusetts Medical Society, impressed with concern for the evil tendency of the many idle and false reports respecting the spurious cases at Marblehead, appointed a committee, censisting of their President, Vice President, and myself, to inquire into facts on die spot, and make report. But their commission was very imperfectly executed, as but one of the three thought fit to attend to It. Dr. D. of Marblehead gave me a very particular account of his inoculation from die matter taken from the arm of his son, and appeared to be thoroughly convinced that all his cases but one, were spurious. He concludes his candid narrative in diesc words : " On the whole, from what I have seen, it is my de- cided opinion that the inoculation for the kine-pock, if properly performed, is a certain preventative of the small-pox. The principal diing to be attended to in this operation, is to take the matter at a proper time, which, in my opinion, as 1 have 12 Progress of the new now learnt, is commonly on the eighth or ninth day, in a hmp» cd state. The matter I used was in npuriform state, and most- ly on thread." In a letter from the Reverend Mr. Story, brother to Dr. S. dated Marblehead May 7, 1801, he says ; " It ever has been, and now is my firm belief that the kine-pock is a sovereign an- tidote against die small-pox. The only point to be determin-. ed is, whether die person has really passed through the genuine disease ; for much spurious matter has been in use, which, though it may produce some eruptions, will be no security against the small-pox, as was the case of the bulk of those in this place. It appears that Dr. D. took matter for his inocu* lations on the thirteenth day. I view die kine-pock inocula- tion as a most important discovery, and, when better under- stood, will be carried on widi safety and advantage to the public." To these respectable evidences I will just add, that I had de- signedly inoculated my chaise driver eight days before I went oa this commission of inquiry from the Medical Society, and the clergymen, physicians, and other respectable characters in Mar- blehead, all declared that their unfortunate cases had a very different appearance from his. I did more : I found a person in the family of one of the practitioners, a stranger, who had not passed through the small-pox, and inoculated him from my servant, that they themselves might see the true disease in all its stages. This completed their conviction, so that now there is no town in New England where the inhabitants are more convinced of the efficacy of the kine-pock as a security against the small-pox. Lynn, a town contiguous to Marble- head, principally inhabited by a people remarkable for not be- ing carried away by every wind of doSrlne,* has given ample proof of their full faith in this new inoculation, by submitting to receive the benefits of it from my hands, * The Tiieadj, Inoculation in America. 13 I have been more particular in narrating the incidents at Marblehead, because they have been so often quoted, miscon-. ceived, and misrepresented, and because the narrative explains similar incidents in other places in America. The like occur- rences took place at Geneva, and at several places in England, especially at Petworth, where the virus first sent by Dr. Jen- ner to Lord Egremont did not succeed in communicating the disease ; and a second supply from another quarter gave a spurious one: the effects produced formed a counterpart to the disasters at Marblehead. See the whole related by Mr. Fer- ryman, and Mr. Andre, surgeon at Petworth, in a letter to.Dr. Jenner and to Dr. Pearson, in Ring's excellent Treatise on Cow-pox. * It is not easy to convey to an European, an adequate Idea of the distress attendant on the commencement of a general inoculation like that of Marblehead, where a very large propor- tion was to have the diseafe. This town is situated on a rocky peninsula. Its inhabitants draw not merely their super- fluities, but their support from the ocean. They have as litde to do with agriculture as the inhabitants of Gibraltar. To confine a Marbleheadman to the dry ground, and to keep a fish out of water, is in effect nearly the same thing. As the casual small-pox was spreading fast, every one was anxious to be inoculated^/?™/. To alleviate this anxiety, prac- titioners went from neighbouring towns to assist in diis opera- tion. A barrier with proper guards, smoke houses &c. were erected at the entrance of the town, and all vessels passing from diat port to the capital were subjected to a quarantine. Nay, the intercourse between Marblehead and Salem, only four miles apart, was impeded as much as if that town was in- fected with the Levant plague. * Mr Ring has collected from every publication, in tvefy country, the most important facts respecting the vaccine discovery, its prac- tice, and progress, to which is added his own experience. The author has happily contrived to engage the mind by pleasure, while lie fills it with clear and instructive idds. 14 Progress of the new Conceive for a moment, a poor widow with her children, of which that town has an uncommon proportion, all about to undergo a dreadful disease, rendered still more so by hedious apprehensions. Let a person of philanthropy imagine such people, so impressed, shut up in a town, as if besieged, and doomed to pass through an " untried scene," aggravated to something horrible by fearful apprehensions of a loathsome dis- ease, of poverty and its direful concomitants. Then let the same person conceive die apathy, the absolute indifference ;—but that is impossible—let him be told that there aie not wanting characters so utterly insensible to the miseries of such a situa- tion as to argue in favour of a general inoculation for the small-pox, at this time in Boston, where there are perhaps 10,000 persons liable to the disease ! But let us dismiss the incredible idea, lest our veracity fhould be questioned. The distressed situation of the inhabitants of Marblehead excited a general regard. A considerable sum of money was raised by subscription among the merchants in different places ; while another class sent in provisions and other necessaries to support the needy in the stagnation of business, and to afford comfort to the sick. When they thus felt the effects of the general sympathy, and found that even the casual cases were uncommonly mild, they went through their trial with compa- ratively few fatal cases, and with a cheerfulness characteristic of these intrepid children of the ocean. I wish not to conceal from the public, that about the latter end of die autumn, or beginning of the winter of 1801, I per- ceived that the vaccine disease had deviated from its original character, and assumed a face with which I was not acquaint- ed. I endeavoured to account for this change of countenance by persuading myself that the virus became milder as it reced- ed from the cow ; and that it would at length become effete by passing through a given number of human subjeds. When Inoculation in America* 15 philosophers or physicians come to a stand in the rough read of experiment, they are very apt to turn into the flowery path of conjecture and there get bewildered. But tiiis notion was en- cumbered with several difficulties, as many cases arose in direct Opposition to it ; for instead of being milder, they were in fact severer in all their symptoms. This induced some to adopt a notion directly opposite ; that the small-pox was at its origin the cow-pox ; and that It increased in force and malignity as it progressed through sinful man from age to age ; for when the small-pox appeared first at Marblehead, it was very uni- versally believed that it was the cow, or kine-pock, verging in malignity to the small-pox ; and the writings of some of the London physicians countenanced this error. Dr. W. and Dr. P. contended that the vaccine matter was capable of producing small-pox puftules with all their phenomena as to contagion &c. and that the vaccine disease was attended, like the small- pox with pustules all over the body. This error is con- spicuous in my first publication. I silendy entertained another whim, that the cold weather aggravated this disease, as it does that one for which mercury is the only specific. But endless are the doubts, whims, and fears while wandering through a perplexed path. At this gloomy period of the business I wrote to my corres- pondents in England for a fresh supply of the vaccine virus, and gave out that the present season was less favourable to the inoculation than the spring. I gave Dr. Jenner a minute his- tory of the whole transaction, and begged him to explain this deterioration, as I conceived of the virus : for I wish not to con- ceal my own perplexity at this period.* This worthy man an- swered that he had heard of our disasters, and that in his anxie- ty, he had at times longed for powers that a mortal ought not * The same disaster has occurred this autumn at New York. Dr. Miller has just written to me to resupply their vaccine institution with matter. Not many days since I had a similar application from Dr. Co*e at Philadelphia. 16 Progress of the new to aspire at; nothing less than a speakIng-trumprt, that would carry these words on the rapid wings of the wind across the wide ocean that divided us ; " Take the virus before the efflores- cence appears." Very early in the spring of 1801, I received a fresh supply of matter from Dr. Lettsom and Dr. Jenner ; and soon after more from Dr.Pearson, Dr.Woodville, Mr. Ring, Mr. Wachsel, Mr. Kerre, Sir Grenville Temple, and the Vaccine Institution of London ; and also from Dr. Haygarth and Mr. Creaser of Bath ; and from Mr. Dunning of Plymouth-Dock. Previously to this second importation, I had reason to believe that the true virus had become extinct throughout America. The inoculation was, however, carried on here and diere in the country, with such matter as they had. The Massachusetts Medical Society, as well as several prac- titioners in Boston and its neighbourhood, imported die matter about the beginning of this summer; but it all failed in com- municating the true disease, one case excepted, owing I suspect to their not softening the thread with water ; or to their not exercising that degree of patience which I have found requisite in the first use of a thread infected the other side of the Atlan- tic. * The same disappointment was experienced by the prac- * The method I have adopted is this. I select a youthful subject, and after gently chaffing the skin, I make an incision about a quarter of an inch long, so superficial, however, as scarcely to draw a drop of blood. Into this incision is lain the infected thread, previously moistened by water. On this I press my finger six or eight minutes ; then I turn it upside down, and press it as before. Then it is taken out and a fresh one put in, treated the same, and pressed in as long ; nay, I sometimes put in a third, which I leave in, covered over with a piece of gold bea- ters skin, the transparency of which admits of our seeing if it retain its exact position ; or if it need more moisture, in which case, I added a very small portion of water from the point of a needle. I can account for my success in the use of transatlantic thread, over my brethren on no other principle than that of using a due degree of moisture, and a greater degree of patience. I have just received virus from Mr. Ring on the points of quills or tooth picks, which was collected obout the first of last August, and used lure the sixth of November ; and although I inserted the matter with* Inoculation in America. 17 t-doners of New York, Philadelphia, Baltimore, Charleston, Newport and Providence Rhode Island, and several other places in the southern parts of the Union. When, and how they were supplied will be related hereafter. With more information and a fresh supply of active virus, I recommenced my inoculation in March 1801, and rejoiced to find the distemper possessing every genuine characteristic. It proceeded like my first cases in my own family, slowly, mild- ly, and pleasantly. I now reinoculated all the doubtful cases within my* reach ; and several of my patients expressed sur- prize that the distemper, which I now pronounced the genuine one, was so much milder, both as it regarded the sore arm and die constitutional symptoms, than the disease they underwent the autumn before, which I had pronounced spurious. But so it was. All those cases, where there were violent inflammation, deep seated ulceration, eruptions, and heavy febrile symptoms, were not the true kine-pock, but a malady generated by an highly acrid, putrid matter; or in one word, poisonous matter, taken from under a scab, or from an open ulcer, long after the specific virus was annihilated. I used in three or four persons Some shining, glazy looking thread, which was dispensed in great profusion in Boston and its neighbourhood, in the autumn of 1800, and it produced in every case very distressing, if not alarming symptoms ; severer, in most respects, than die ordina- ry ones In the variolus inoculation. The quantity of this infect- ed diread excited my suspicion ; for die genuine virus could not be collected and dispensed in such profusion. I am still ignorant of die genealogy of this matter ; I only know, that it was not the vaccine virus then, whatever might out moistening, it communicated the disease in every trial. With three tooth pick I gave the true disease to six persons. I held the point of the tooth pick in a puncture made by a lancet, for perhaps six or eight minutes, but without diluting it with water. This I did at the request of Mr. Ring, who h:is his doubts respecting the propriety of diluting the matter. It is certain that I have seldom succeeded in the use of matter preserved on glass, where dilution with water was always practised. c 13 Progress of the new have been its origin ; for it excited inflammation, and in most c.ises within 24 hours. The arm was in several instances swell- ed and painful from the shoulder to the fingers ends. The pulse was rapid ; die breathing difficult; the thirst great; and the other febrile symptoms severe. I had but few cases of this cast, but nevertheless heard loud complaints from others. And although I dared not, at that period, utter my thoughts as to the cause, I could not but be affected for the credit of the prac- tice, because I had imported the distemper, and held it up to the people of America as a pleasant commutation tax, which a kind Providence had allowed us to pay, in lieu of that horrid and loathsome one, the small-pox. Had these severe cases continued, I should have relinquished the practice, and advised every body else to do so likewise. " I should certainly flatter myself too much," says Dr. Jenner, " were I to conceive that a perfect knowledge of the vaccine inoculation could keep pace with the rapid progress it is making through the world. The vaccine lancet is not to be trifled with."* And again in a let- ter to me dated March 4, 1801, he says, " Dr.-----and Dr. -----have in many of their writings confused the matter great- ly. Is it to be wondered at, that gendemen, who hastily take up a subject, with which they are but imperfectly acquainted, should in presuming to elucidate, create confusion ?" With a fresh supply of matter, then, I recommenced my in- oculation in March 1801, and have continued it with undeviat- ing success to the present time, two short periods excepted. The first interruption in the continuity of my cases happened in the month of July, when the weather was extremely hot, and when I trusted to the infected thread, instead of the fluid warm from the pustule. This accident led to the knowledge of a fact of some importance, and which I suspect is not gene- rally known to those who practice the vaccine inoculation, even * la a letter to Mr. Fermor, Medical Journal, vol. 6, p. 325. Inoculation in America. 10 in England. It has been sufficiently proved, that in moderate weather, when the mercury ranged between 40 and 700 cf Fahrenheit's thermometer, the vaccine virus has retained iu ac- tivity three months, and even longer. But I found, last sum- mer, that perfectly active virus, taken on cotton thread, frcm pases every way satisfactory, (proved so by their recent fluid communicating the disease in perfection) will lose its virtue, when exposed ten or twelve hours, and even less, to 95 or 960 of Fahrenheit's scale. It appears that in such a temperature the virus or vaccine aura, evaporates, Ever since March 1801, J have inoculated more or less almost every day, and have scarcely experienced a single disappointment when I took th-. limpid fluid warm from the pustule ; and but few instances at failure when I had recourse to the infected thread. * But dur- ing the very hot and very dry weather in Julyj the thread has failed in almost every instance. You will see by the abstract from the Meteorological Regis- ter, kept in this University by Mr. Webber, Professor of ex- perimental Philosophy, that the mercury rose almost every day for a fortnight to about 90 ; sometims 96, and once to 97 de- grees in die shade, and that the hygrometer pointed at 40 and even to 390 f That tiiis great degree of heat was accompani- ed with an extraordinary dryness in the atmosphere, whicli was noticed by our hay-makers, there being scarcely the appear- ance of dew at sun-rise for nearly a week. Finding these fail- ures in the use of the thread, I was led to investigate the cause, and am now satisfied, that it arose from the .dryness which reigned for two or three weeks at this season. If a thread, dipped in the oil of lavender, lose its fragrance by art exposure for several hours.to the degree of heat just men- * This is to be understood of patients susceptible of the disease ; for I find some who appear totally insensible to the action of the virus. t The thermometer is Fahrenheit's; the hygrometer De Luc's See Medical and Physical Journal No. xxZu. p. 32'tf. so P regress of the new rioned, can we wonder that the more subtle aura vaccina flioula in like manner evaporate, and the virus become effete ? What tended to confirm me in this opinion was a passage in one of Dr. Jenner's letters, received last year. It is this ; " I shall " just say a word in proof of the extreme delicacy of the nature " of the vaccine fluid, to shew how easily it may be disorgan- *f ized. In the early part of my practice, I used frequently to ,{ evaporate the fluid by the fire upon threads, glass, or lancets, " yet with much caution respecting the degree of heat ; but " experience has taught me, that even this procedure frequent- " ly occasioned an unnatural deviation from its perfect state, " and a failure in communicating die disease." I hope not to be misunderstood. I can never desire more satisfactory cases of kine-pock, (as it is universally denominated in America) than have occurred at this warm season j but they were produced by the recent fluid, transferred from one patient to anodier; whereas thread, ever so well imbued with the fluid of these satisfactory cases, and kept for a week, has lost its virtue ; being as I conceive, evaporated and exsiccated by a series of hot and dry days. It is recorded, that when the Har-, mattan blows (which is a very hot and a very dry wind in Afri- ca, when the backs of books crack open, and cabinet furniture flies to pieces) the small-pox could not be communicated by inoculation. * Is it probable the failure arose from this cause I As the mercury, if I mistake not, very rarely rises above 84* in Britain, the practitioners there could not have been led to these observations. I believe the mercury seldom rises higher than this in die open ocean in any climate. The vaccine virus, sent me from London and from Bath, has demonstrated that it will live nearly four months. The second interruption, in the continuity of my cases, was from relying on some of my brethren (to whom I had given 8 Philosophical Transactions for 1781. Inoculation in America. *4I the matter) for the recent fluid, and thereby relaxing in atten- tion to the continuity of it in my own patient?. This was a source of inexpressible anxiety and perplexity. But for one patient, the virus would have became extinct a second time in Ameri- ca. * I mention this, by way of caution to my brethren. Jen- ner himself informs me that he finds it needful to give and re- ceive assistance, in order to keep up the necessary supply of fresh virus for use. The greatest difficulty, in the vaccine in- oculation is the scarcity of virus. The kine-pock has but one pustule, whereas the small-pox has its thousands. The number of poor people I have inoculated in the hottest weather, in or- der to keep up a diurnal supply of matter; the anxiety I have endured, lest they should fail; and the offence I have given when it was not in my power to transmit an inch of infected thread, are not mentioned in the tone of complaint ;but merely to notify the young practitioner, who may be ambitious to dis- tinguish himself in this department of his profession, that he must not expect to diffuse the blessings of this benign remedy, and reap die rewards cf it, without some trouble and some aiuiety. About this time (the Spring of 1801) I received a number of letters from a variety of people in the southern States, especially from Virginia, exprcffing a strong wish to be better acquainted with the kine-pock, and a desire to introduce this benign reme- dy into that extensive region. As most of the writers were en- tirely unknown to nic, I was at a loss how to act. I might deny a physician of character, and I might entrust it to a per- son who had none. Some untoward oc currences in the past ye~r rendered me cautious ; for I had unknowingly tncourag- * At this critical period I received some matter from Fr><;l;md between plates of glass ; and on application from Dr. A spinwall, 1 divided this English matter with him ; but it all failed, both in his hands, and my own. Ore of my parent? had, without ;ny knowledge, preserved some virus on thread ; this happily communicated the disease, and from it I propagated the distemper afresh, and have continued it in my own cases, from that time to thv. present. 22 Progress of the new ed mere speculators. I use that word in its modern and degene- rate sense. While doubting what course to take, the right road opened to my view. I had heard that President Jefferson was favourably im- pressed by my first annunciation of the Jennerian discovery and practice. Indeed the following letter, written in consequence of transmitting him a copy of my pamplet on this subject, suf- ficiently testifies it, Washington, Dec. 25, 1800. SIR, I RECEIVED last night, and have read with great satis- faction, your pamphlet on the subject of the kine-pock, and pray you to accept my thanks for the communication of it. " I had before attended to your publications on the subject in the newspapers, and took much interest in the result of the experiments you were making. Every friend of humanity must look with pleasure on this discovery, by which one evil more is wididrawn from the condition of man ; and must con- template the possibility, that future improvements and discove- ries may still more and more lessen the catalogue of evils. In this line of proceeding you deserve well of your country ; and I pray you accept my portion of the tribute due to you, and as- surances of high consideration and respect, with which I am, Sir, " Yonr most obedient, humble servant, (Copy.) « THOMAS JEFFERSON." Dr. Waterhouse> Cambridge. " This letter of the President of the United States," says Mr, Ring, " breathes the spirit of philanthropy—the spirit of Wash- ington ; and, his attention to the welfare and happiness of the people, proves him worthy to fill the station of his immor- tal predecessor." Inoculation in America. 21 Hearing by some gentlemen direct from the seat of govern- ment, that the President wished for still more information, and that he was desirous to see the practice introduced into Virginia, and the other southern States, I sent him the vaccine virus, and painted representations of the pustule, in all its stages on the white man, and on the African, together with the follow- ing letter: Cambridge, June 8th, 1801. To THOMAS JEFFERSON, President of the United States, and President of the American Philosophical Society. SIR, THERE rriay possibly seem a want of due considera- tion in sending this letter, and what accompanies it, to draw the attention of the President of the United States from the important concerns of our nation to a subject more nearly al- lied to medicine, than to the affairs of state. On this account, I should have hesitated still longer, were I not constantly receiving letters from unknown persons, in dif- ferent parts of Virginia, entreating me to send them the vac- cine matter, with instructions for carrying on the kine-pock in- oculation. «From one, received very lately, I learn that the small-pox is unknown to half the inhabitants of your extensive and populous state ; that in some quarters of it, the very name of small-pox excites terror; and that your laws are full as se- vere as those of Massachusetts and Rhode Ifland, respecting its introduction by inoculation. From these letters I am con- vinced that there Is, perhaps, no state in the Union more deep- ly interested in the adoption of this new inoculation than Vir- ginia. By letters from Norfolk, I find, diat the inoculation for the kine-pock has been attempted diere, but that the subjects of it did not resist the small-pox. Such failures may bring this admirable discovery into disrepute, and deprive you, for a time, 24. Progress of the new of its blessings ; nay, what is very serious, such accidents i^ar be the means of spreading the small-pox among you, as it has in some places among us. Not merely ignorance, but avarice, rivalship, and some other unworthy passions, have cast a tem- porary shade over this important discovery, in some of the towns in this Commonwealtii; and I suspect you have expe- rienced something similar, though not from the same causes. I presume you will think with me, that too much care and attention cannot be exercised in the introduction of this valua- ble but delicate remedy among you. 1 will do all in my pow- er for its establishment, provided I can obtain die coun- tenance of men of more consequence than myself. Amidst the pelting storm of his adversaries, Dr. Jenner had the coun- tenance of his Sovereign ; and the Duke of York is the patron of the London Vaccine Institution.' Bonaparte took a lively interest in the diffusion of vacctnism in France ; and so did the German nobility at the court of Vienna. Under such patron- age, people in the inferior walks of life embraced the doctrines of this new discovery with entire confidence. Having no personal acquaintance with any medical man in Virginia (some of my own pupils excepted, to whose inexperi- ence I should hardly venture to commit this delicate business)' I cannot see my way clear to transmit the matter to I know not whom. After much thought, and some advice, I have con- cluded to send it to President Jefferson, together with such books and descriptions as may enable a physician experienced in exanthematous diseases, to conduct the process with certainty. My view is this :—The President can at once fix his eye on some proper medical character, to whom the first experiments may be entrusted ; some cautious discerning person, perhaps his own family physician. A series of experiments may be di- rectly instituted by him ; and when the distemper has proceed- ed according to the description herewith sent, the subjects of Inoculation in America. 25 them, may afterwards be submitted to the test of the small- pox inoculation, just as was done at Paris, under direction of the National medical school. As your domestics are principally blacks, I have taken no small pains to procure a picture of the disease, as it appeared on their skins (see fig. xii). Besides being of vast importance to the state at large, I conceive that an exertion to preserve this wretched people from the horrors of the small-pox, cannot but be agreeable to that beneficent Ens Entium, who has seen fit to make that enviable distinction between the situation and faculties of this helpless race and us! By causing this inoculation to pass through the respectable channel here contemplated, Virginia, and of course, the other southern States, will insure to themselves the blessings of this invaluable discovery, and the serious evils that have arisen in some places, will be avoided. Young and unexperienced prac- litioners are most forward in this business; yet such can neidi- er excite attention, nor inspire confidence ; whereas, if it came from Mr. Jefferson, it would make, like a body falling from a great height, a deep impression. Need I then, make any further apology for sending the matter first to you, encumber- ed, as I know you must be, with odier concerns I I here send a little book, compiled by Mr. Aikin, Surgeon of London ; being perhaps, the best manuel for the inoculator, extant. I have it in contemplation to publish something of the kind, more adapted to this country, and containing some let- ters of Dr. Jenner to me, on die best mode of conducting this inoculation. I also transmit for your acceptance, exact pic- tures of the kine-pock pustule, in all its stages, from the third day to its final termination, painted with surprising justness, together with similar representations of the small-pox, on cor- responding days. The dark coloured picture, (fig. 12) 1- a D 25 Progress of the new representation of die kine-pock on the skin of the negro. I haV« never inoculated but three of this colour ; but, as far as I can remember, it is equally accurate. The graphic art never, per- haps, received a greater honour. I likewise send some fresh infected thread, confined between two thin plates of talc, and inclosed in the laminse of a card ; the whole pasted up so as to exclude entirely the external air. In this way, I conjecture, It may be sent to the Cape of Good Hope, the Isle of France, or the hot regions of India, without losing its efficacy.* The red thread marks the place where it is to be opened. I would advise the inoculator, when he makes the incision, Or rather scratch, in the arm, not to draw blood, if he can help it. If this should be unavoidable, it is best to wait a moment until the exudation ceases, lest the blood should dilute the virus too much, and so weaken its power. The thread is then to be covered with a piece of gold'beaters skin, which I generally take off in 24 hours. By the fifth or Mxth day, the inoculator may expect to see the effects of his operation. By the eighdi the vesicle will be found to contain a small quantity of pellucid flu- id, but in no degree resembling matter, or pus ; on the contra- ry, as limped as the dew drop on flowers, at this season. And this is the exact period, and proper condition of the vaccine fluid, for I will not call it matter, for the purpose of inocula- tion. It may be taken on the ninth day, but seldom or never later. The want of strict attention to this important point, has produced all the disasters that have occurred In this inoculation in Europe and America, and therefore, this rule cannot be too emphatically urged. The virus should never be taken after the efflorescence has come on, much less during the febrile .symptoms. Mr. Aikin allows too much latitude. Some give a still wider license, and assert diat the genuine virus is found in a pustule on the twelfdi or thirteenth day ; but Jenner and * It was several weeks after writing this, that I discovered the perni- cious effects of heat on the vaccine virus. See page 19 ; also Medical journal, voL 6, p. 317. Inoculation in America. if experience say otherwise. " I wish you to consider, says Dr. Jenner, in one of his letters to me, this efflorescence as a t( sacred boundary, over which the lancet should tworr pass." I cannot then but reiterate the injunction, to take the vaccine fluid on the seventh, eighth or ninth day, and not on the tenth, eleventh, or twelfth. For want of this knowledge, spurious cases have arisen, and multiplied in our country. It is the most important point in the whole process, the fulcrum on which the whole business turns ; and yet no writer, but the celebrat- ed Jenner, appears to be impressed with its importance. It is natural, say some, to conclude that it is best to take the fluid for inoculation, at the very height of the disorder, that is, of the efflorescence. But I am doubtful whether this be the voice even of a legitimate theory. When the inflammation, or efflo- rescence of the inoculated part commences, it indicates that ab- sorption has already begun ; and after absorption has com- menced, the quantum, or force of the virus in the vesicle, pustule, or inoculated part, denominate it which you will, is diminished. To note the progress and aspect of the pustule, is of prime im- portance in die commencement of this practice. " One of the first objects of this pursuit, says Dr. Jenner, should be to learn how to distinguish with accuracy, between that pustule which is the true cow-pox, and that which is spurious. Until experi- ence has determined this, we view our object through a mist." My insulated situation, and remoteness from all correct infor- mation on this head, has compelled me to the closest observa- tion of the progress of the pustule, even from hour to hour, with the microscope ; and I am convinced of the importance of Dr. Jenner's injunctions to me ; nay more, I am convinced by my own blunders. In people of weak circulation, I have found the progress of this disease more backward, than is here represented : that is to say, the efllorescence described around the pustule on the ninth day, did not make its appearance until the tenth or elev- 2 3 Progress of the new end-!, and continued thus backward through the whole progress. I suspect that this may oftener occur in the southern States, than in the colder regions of the north. I have just inoculated a family from Natchez, where this variation was remarka- ble. In such cases, I take the fluid for inoculation on the ninth, tenth, and even eleventh day. Should the physician, or physi- cians, to whom you would think proper to confide this matter, wish for any further information from me, they cannot be more ready to ask, than I shall be to communicate what little I know on this subject. It is perhaps unnecessary for me to say, that it is found, from the most incontestable experiments, I. That the kine-pock is not contagious. II. That it never has been fatal. III. That it completely prevents the small-pox. IV. That it conveys no constitutional disease. And V. That it creates no blemish, or mark, on the human frame. These properties make this vicarious distemper, one of the most precious gifts of Providence to afflicted man. That it actually possesses them all, we are assured by the united testi- mony of the first physicians in London, which is saying the first physicians in the world. Besides England, this new inoculation now prospers in France, Germany, and at Geneva. The physicians at Gene- va had many spurious cases, and some perplexity, until Dr. Jenner sent them, as he did rne, fresh matter, and clearer in- structions. It has taken the place of the small-pox inocula- tion in the British army and navy, and is spoken of by the surgeons of the latter, as one of the greatest blessings ever ex- tended to it. * By a Madrid gazette, just come to my hands, Address to Dr. Jenner, on delivering him a gold medal.- Inoculation in America. 29 I find that it is introduced there from Gibraltar, by permlfiion of both the British and Spanish governments. Nay more, Lord Elgin has planted it in Constantinople, just about eighty- six years after the Turks helped us to die practice of the va- riolous inoculation. In no place has the vaccine inoculation been received with more prudence, than at Paris, under the conduct of the National medical school. The report of the com- mittee may be seen in the 4th volume of the Medical and Phy- sical Journal ; where it will appear, that they made themselves sure of every inch of ground they passed over. As to the progress of the inoculation in this quarter, it is ve- ry satisfactory. Last autumn we were pestered with spurious cases, and absolutely lost the genuine virus. The most emi- nent physicians in this region, as well as the most distinguish- ed characters, in the two other learned professions, are advo- cates for this inoculation ; net that I would insinuate, that this new practice is destitute of the advantage of having adversa- ries, even among the faculty. It is in such a prosperous state of the business, that I am de- sirous of transmitting the blessings of this new discovery to my brethren of die southern States ; and in order to ensure it suc- cess, I wish it may pass from your hands to them. Should I be the means of introducing this disease, or rather remedy, not merely into Virginia, but into the vast region of the southern States, I sould indeed rejoice in its recollection to the end of life.* With the highest respect, I remain, &c, BENJAMIN WATERHOUSE. The President's answer convinced me, that I had done right in transmitting these things to him-----Should these pages » There are numerous copies of this letter circulating in manuscript, at the southward. * G* 3^ Progress of the new ever be read beyond die bounds of die United States it will not be superfluous to remark, that the elective Chief Magistrates of this new empire, differ somewhat in their habits, manners, and conduct, from those of Europe. Havirg fewer ministers, they feel more nearly connected with their constituents, the people, in whatever concerns their domestic happiness, and personal comfort. Mr. Jefferson has long cultivated that kind of phi- losophy, which Socrates was said to have brought down from die high Heavens, for the use of men ; and still finds time to practise it. Mr. Adam3, while executing the affairs of State, was President of the American Academy of Arts and Sciences ; and was, and still is, esteemed its ornament and pride.—Wash- ington's whole life was a series of benevolent deeds. But, the countenance of this modern Moses shone with a brightness, too dazzling for me to delineate !—I notice but one trait in the character of these three illustrious chiefs, and merely to inform foreigners, that in our eyes, the lively interest which President Jefferson has taken in that discovery, " by which one evil more is withdrawn from the condition of man," has ■ shed a lustre on the supreme officer of our nation. Although the President immediately put the matter into the hands of a long established, judicious, and successful physician, \ it failed in communicating the disease ; so did the second por- ; tion I sent; and so did die third. The President observed, that as great anxiety was produced at Washington to obtain a successful inoculation, he wished me to continue to send it un- till he could inform me it had taken. But, as the weather was extremely hot, thermometer 94, 95, 96, and 97 degrees in the shade, (see page 19) and the distance between Cambridge and the city of Washington 500 miles, he suggested a mode of conveying the infected thread in a small vial, immers- ed in a larger one, filled with water. This portion of matter, thus guarded from the heat, did not rest at Washington, but went* on to the President then at Monticello, and suffered no Inoculation in America. 31 deterioration by the journey ; for Dr. Wardlaw inserted it in- to some of the President's family on the 6th of August 1801, when it communicated the ttue disease. It was from this source that the President supplied Dr. Gantt at Washington, and thus first planted the vaccine inoculation in the capital of the Unit- ed States.----Are not public benefits estimable according to their extent and duration ? Some, as" wise laws, good govern- ment, able and virtuous magistrates, are indeed precious bles- sings, as far as they extend ; but their merit is generally confined within one age or nation. They are like die showers of Hea- ven, blessings for a season. But are there not others still more valuable, such as the application of die discovery of the polarity of the magnet, by which feeble man passes ia safety over die trackless ocean ;—and the Franklinian discovery, by which ourselves and dwellings are secured from the fatal and destructive blasts of lightening ?—and the Jennerian discovery, by which the greatest plague under Heaven is struck out of the catalogue of human evils ? These are not like the former, blessing* for a season, confined to one spot, or nation, and transitory in their nature ; but they are donations to the whole human race, a present to the future race of men, and like die blessings of the Sun, universal and everlasting. The wisdom of antiquity invariably made this distinction, between the value of local and temporary benefits, and such as were universal and permanent. Thus they decreed only heroic honors to foun- ders of states, lawgivers, and'exterminators of tyrants; but^t- vlne honors to inventors and authors of new arts and discove- ries, for the benefit of the whole human race. This is beauti- fully illustrated in the splendid allegory of Apollo, and also of Ceres; one giving food to mankind, and the other health.* That our philosophic President views it in this light, is evident, from a passage in one of his letters to me, where he says, *' It will be a great service indeed rendered to human nature, to * See Bacon dc augment. Scient. 32 Progress of the new " strike off from the catalogue of its evils, so great a one as tha " small-pox. I know of no discovery in medicine equally " valuable." By repeated letters from Dr. Spence of Dumfries, I learn, that none of our States are more deeply interested in the diffu- sion of die kine-pock inoculation, than the large and populous state of Virginia. Indeed the President himself says, " in " planting the disease here, (Monticello) I imagine it will be " as salutary as any where in the Union. Our laws indeed " have permitted the inoculation of the small-pox, but under " such conditions of consent of the neighbourhood, as have ad- " mitted not much use of the permission. The disase therefore '* is almost a stranger here, and extremely dreaded." In another letter dated Monticello, September 17th, 1801, the President says, " I have sent matter to Richmond, Petersburgh, and seve- " ral other parts of this State, so that I have no doubt it will "be generally spread through it, notwithstanding the incredu- " lity which had been produced by the ineffectual experiments " of Richmond and Norfolk." The President sent a portion of diis matter to Dr. John Redman Coxe at Philadelphia, which introduced the true disease, for the first time into that city, November the 9th, 1801. The following letter, from President Jefferson to Mr. Vaughn, printed in Dr. Coxe's pamphlet on Vaccination, will come in here with propriety. " Washington, Nov. $th, 1801. " Dear Sir, " I received on the 24th ult. your favor of the 22d, but it is not till this day that 1 am enabled to comply with your request of forwarding some of the vaccine matter for Dr. Coxe. On my arrival at Monticello In July, I received from Dr. Wa- terhouse of Cambridge, some vaccine matter taken by himself, and some which he at the same time received from Dr. Jenner of London. Both of them succeeded, and exhibited precisely Inoculation in America. *>* the same aspect and affection. In the course of July and Au- gust, I inoculated about seventy or eighty cf my own family ; my sons in law about as many in theirs, and including our neighbours who wished to avail themselves of the opportunity, our whole experiment extended to about two hundred persons. One only case was attended with much fever and some deliri- um ; and two or three with sore arms which required common dressings. All these were from accidents too palpable to bj ascribed to the simple disease. About one in five or six had slight feverish dispositions, and more perhaps had a little head- ach, and all of them had swellings of the axillary glands, which in the case of adults disabled them from labour one, two, or diree days. Two or tiiree only had from two to half a dozen pustules on die inoculated arm, and no where else, and all the rest only the single pustule where the matter was inserted, something less than a coffee-bean, depressed in the middle, fuller at the edges, and well defined. As far as my observa- tions went, the most premature cases presented a pellucid li- quor the sixth day, which continued in that form the sixth, seventh, and eighth days, when It began to thicken, appear yel- lowish, and to be environed with inflammation. The mo:t tardy cases offered matter on the eighth day, which continued thin and limped the eighth, ninth, and tenth days. Perceiv- ing dierefore that the most premature as well as the tardiest cases embraced the eighth day, I made that the constant day for taking matter for inoculation, say, eight times twenty-four hours from the hour of its previous insertion. In this way it failed to infect in not more I think than three or four out of the two hundred cases. I have great confidence therefore that I preserved the matter genuine, and in that state brought it to Dr. Gantt of this place on my return, from whom I obtained the matter I now send you, taken yesterday, from a patient of the eighth day. He has observed this rule as well as myself. In my neighbourhood we had no opportunity of obtaining va- E 34 Progress of the new riolous matter, to try by that test the genuineness of our vac- cine matter ; nor can any be had here, or Dr. Gantt would have trud it on some of diosc on whom the vaccination has been performed. We are very anxious to try this experiment, for die satisfaction of those here, and also those in the neigh- bourhood of Monticello, from whom the matter having been transferred, the establishment of its genuineness here will satis- fy them. I am therefore induced to ask the favor of you to vend me in exchange, some fresh variolous matter, so carefully taken and done up, as that we may rely on it; you are sensible of die dangerous security which a trial with effete matter might induce. I should add that we never changed the regi- men nor occupations of diose inoculated ; a smither at the an- vil continued in his place without a moment's intermission, or indisposition. Generally it gives no more of disease than a blister as large as a coffee-bean produced by burning would occasion. Sucking children did not take the disease from die inoculated mother. These I think are the most material of the observations I made in the limited experiment of my own family. In Aikin's book which I have, you will find a great deal more. I pray you to accept assurances of my esteem and respect. (Signed) " THOS. JEFFERSON. " Mr. John Vaughan." 1 had taken care to acquaint those gentlemen who had writ- ten to me for a supply of matter, from different parts of Mary- land, Pennsylvania, Virginia, and other States still farther south, with the steps I had taken to establish the practice near- er to them, under the auspices of Mr. Jefferson, by whose directions they might be accommodated with less risque of dis- appointment, than if attempted to be supplied from Cambridge. And I have had the satisfaction to hear of his condescending Inoculation in America. 03 attention to dieir applications. So that I believe dicsc parts of the Union are happily supplied, through this respectable channel. It is remarkable, that neither at New York, Philadelphia, Charleston, nor Savannah, did any of the vaccine matter, re- peatedly imported from London, by different practitioners, ever communicate the disease. In the latter end of May 1801, I had the satisfaction of planting it in New York ; which wTas effected by inoculating a servant of the Governor of the Missi- sipi territory, and sending him on to that city, where he arriv- ed time enough to afford the genuine virus. But it was lost before the autumn. In November, I resupplied the physicians of New-York tiirough the hands of Dr. Seaman. Soon aftcr a Vaccine Institution was formed in diat city, en a plan simi- lar to the one in Golden Square London. Many were here inoculated, and afterwards tested with the small-pox, to entire satisfaction. They nevertheless lost the matter a third time, and again I supplied them, November 1802. On this occa- sion, Dr. Edward Miller wrote to me thus ; " For a number " of weeks before die final extinction of the matter here, the " disease began to decline from its original exquisite character, " and gave us some apprehensions that it might not afford en- " tire security against the small-pox. Was this owing to some " unknown neglect, at any one, or more links of the chain of " succession ? Or is it to be ascribed to any degeneracy of the " disease itself, produced by time, climate, temperature, or any " similar cause ? As you have had more experience on this " subject, than any person in the United States, you will do a " great favour to die Medical board of our kine-pock institu- " tion, by giving your opinion on this subject." Dr. Seaman, another phys'cian of the New York vaccine institution, in a letter to me, dated Nov. 15, 1802 says, "the kine pock infection with us has been fairly worn out ; for aotwidistanding a careful attention to taking it w idiin the limit- 36 Progress of the new cd time, it has appeared to undergo a regular degeneracy, in gradually producing a pustule, less and less like the original one ; and being communicable with less and less certainty, till it has finally become perfectly inactive. For the purpose of regenerating the activity of the virus, I inoculated a Cow ; and on die 7th day I Inoculated a person with the pellucid wa- ter, warm from the pustule upon her teat; but widiout in- ducing the disease. We have now to acknowledge, that even at our vaccine institution, die infection Is extinct. AVe have been trying some matter just received from Londor, but it has fail- ed in every instance. Our institution depends therefore en- tirely upon Dr. Waterhouse for a supply." My opinion, in answer to these letters will appear in its proper place ; I shall only add here, that I sent fresh virus on a quill, inclosed in another, by way of case, every three or four days by the mail, until I heard it had succeeded ; and wrote to these physicians, that I had reason to believe, that the vaccine virus would never degenerate, but will remain pure and irreproachable in every climate, and amidst every epidemic, the small-pox excepted. I gave them my idea of the cause of this seeming, degeneracy; and ventured, moreover to say, that if, in taking the matter, for the purpose of inoculation, they did not restrict themselves within a narrower circle, than what is allowed In the writings of Dr. W. and Dr. P. in London ; and of Dr. C. in Phila- delphia, they may expect to see tiiis deviation from the per- fect pustule. In the autumn of 1801, Dr. Ramsay of Charelston, South Carolina, wrote to me, " that every attempt to introduce the vaccine disease into that city from England, or elsewhere, had failed; and earnestly requested me to send him the matter for anodier trial." Besides a particular wish to gratify Dr. Ramsay, I hastened to comply with his request, in considera- tion of die convenient position of Charleston, for diffusing this practice still fardicr soudi. Widi the matter, dicrcfore> I Inoculation in Americc 37 transmitted a set of die pictures of the va. pustule, in all its stages, as well as of the small-pox, from the third day of inoculation to its final scabbing ; together with such rules and observations, as I thought calculated for promptly establishing the business there. Whether the particular matter which I sent, first communicated the disease in South Carolina ; or, whether it was effected from the same stock, by another route, I never could distinctly lcam. I only know, that within a f~w months after my transmission of the virus, a Vaccine institu- tion was engrafted on their Dispensary in Charleston, and the practice now flourishes there, in a manner highly pleasing to the friends of science and humanity. Without being more particular, I shall just mention, diat I have planted the true vaccine disease directly in the Province of Maine;* in New Hampshire ; in the state of Vermont, Rhode Island, Connecticut, New York, Virginia, South Caro- lina, Georgia, Kentucky, and Tennessee ; and in every part of Massachusetts, including the Islands of Nantucket, and Mar- tha's Vineyard. The physicians in the states of Pennsylvania, De.1 r.v.ire, North Carolina, and Maryland, were supplied from my stock, through Mr. Jefferson, agreeably to the plan sug- gested in my letter to diat distinguished philosopher,! who de- serves the praise of every friend of humanity, for extending tie blessings of tiiis benign remedy to the savage nations, by caus- ing a numerous embassy of Indians to be inoculated at the ci- ty of Washington in the winter of 1801, as will appear by the following Ex'.r:itl from the European Magazine for April 1802. " Last winter there was a grand embassy of Indians to the President and Congress at Washington. Little Turtle wns die head warrior. The President and Government had su.;- * A vast district of fortv thousand .-.quare rGus, interposed between the^ British province of Nova Scotia and Massaci.usuts, and under the jurisdiction of this bt.tc f See page 23. 3 3 Progress of the new plied them with ploughs, and every instrument in common use in agriculture ; as well as with spinning-wheels, looms, &c. &c. and, to crown all, the President explained to Little Turtle, how the Great Spirit had made a donation to the enlightened white men ; first to one * in England, and from him to onef in Boston, of the means to prevent them from ever having the small-pox, which had occasioned great fatality among that race ; and, such confidence had the copper coloured King m the words of his Father, the President, that he submitted to be inoculated, together with the rest of the warriors, by the hands of the Rev. Dr. Gantt, Chaplain to Congress. On their de- parture the President caused them to be supplied with the vac- cine matter, and gave their interpreter an abstract of the let- ter of instructions which Dr. Waterhouse had written to him. Not long after, fifteen more warriors came down to Wash- ington to receive the same blessing from the Clergyman who had inoculated Little Turtle and his followers." After the vaccine matter had been planted here and there, over such a vast extent of country, I conceived it would conduce to public benefit, to collect and publish the result of the experiments made with it, in the form of a table. For notwithstanding we could adduce thousands of well attested cases of the kine-pock rendering the constitution unsusceptible of the small-pox in England, and other parts of Europe ; yet, as people are not ready to believe what happened a great way off, or a great while ago, it was found necessary to collect proofs of its prophylactic virtue in our own country. I therefore addressed the American practitioners of physic, as usual, through the medium of the Newspaper, and submitted such a plan to their consideration. My idea was explicidy this,—to establish a central point, to which every thing relat- ing to this inoculation might be directed ; and whence every " * Dr. Jenner, the first inoculator of the cow-pock in Europe." "j- Dr. Waterhouse, the first inoculator of the cow-pock in America." Inoculation in A merit 39 i-*y of light, that came from a single place, might be reflected, and every where extend its power of illumination. I was in hopes that the Massachusetts Medical Society would form such a centre ; In which case the reflected ray would become not on- ly more brilliant, but even generative at die point of repercus- sion. But, I was constrained to pursue a more diminutive plan, and to go on in diis business, as I began it, alone. Scarcely any thing ever occurred in this country, which ex- cited such an universal speculation, as this new and simple mode of counteracting a malady, peculiarly dreadful to the peo- ple of this new world. It may easily be imagined, that per- sonal applications, as well as applications by letter, were nu- merous and incessant. This, however, constituted but a part of the labour. It was necessary to elucidate doubts, remove difficulties, and guard truth, in its disputed march against an host of unbelievers. Indeed, vaccination and its concomi- tants absorbed all my attention, engrossed all my time, and ab- stracted me from all other pursuits. Besides the contest with the incredulous and the indolent, vaccination had to struggle with the interested. They threw many, many obstacles in its way. Of these, the most mischiev- ous was, the discouraging doctrine, that its prophylactic pow- er lasted but for a short time. The common people, when they applied to certain physicians for advice, were taught to believe, that the kine-pock would secure them against the va- riolous infection seven years, and no longer. Though repeat- edly urged, I declined for a long time, the discussion of this pernicious doctrine. Knowing that it sprung from one of those motives which does the least honor to the human cha- racter, I was fearful it would stir up " the angry passions," and then candid discussion would be banished by pe al abuse- But finding that this doctrine was in a fair way < . ■ owing in- to a fixed belief, I published the following refu of it ia the Centincl, July 28di, 1802. 4-0 Progress of the new CN THE ABSURD NOTION OF THE TRANSITORY I FFICACY OP THE COW OR KlNE-PoCK, IN SECURING THE HUMAN CONSTITUTION FROM THE SMALL-POX. I was in hopes it would be needless for me to come for- ward again in the newspaper ; and was especially desirous to be excused from the disagreeable task of discussing the present kubject; but I am called upon both by letters, from the coun- try, and odierwise, to undertake it. The argument urged up-" on me is, that the enemies of the new inoculation have been fairly beaten from every ground they have taken, but this ; and here they are entrenched to the chin, and think themselves per- fectly secure. As I have hitherto met every thing, capable of a speedy experiment, that has been brought forward to impede the advancement of this admirable blessing, with a public con- tradiction, so, in like manner, I will meet this doctrine, and then leave it for common sense to determine, whether this last redoubt, erected and occupied by sordid interest, be, not only commanded, but infiladed, and in great danger of being level- led with the ground. It is well known what a dismal chasm intervened in medi- cine, literature, and the arts, about the sixth century, when all was ignorance, wonder, and credulity. The human mind, neglected, uncultivated, and oppressed, sunk to the lowest grade of debasement. These effects of Gothic, Arabian, and ecclesi- astical barbarity, were discernible in almost every branch of science, especially in medicine, as low down as the reign of James I; for even then, the priest, the conjuror, and the phy- !1 sician were united in the same person. But with Lord Bacon, *" commenced the scrutinizing aera of experiment, or, as it regard-"* ed natural things, the age of reason ; or the philosophy of a sufficient cause. Medicine soon felt the good effects of this im- proved state of philosophy, and anatomists and physicians con- '. templated the human body and surrounding nature, with jlist- er views, and on surer principles. Inoculation in America. 41 From this lucid period, physic, led by experiment, went on improving to the present time, so that now our dieory is put in practice, not by simple imitation, as formerly, but by the knowledge of causes, or the previous knowledge of things to come ; so that from a vague and fluctuating art, physic has now acquired the stability of a science. Hence, at this en- lightened period, It is expected that he, who assumes the honor- able title of a physician, is enabled from experiments, to tell us, not only what is to occur, and what is to be done, but why it is to occur, and why it is to be done. For it is only then, that the empiric quits his name for the more honorable one of phy- sician, when to his experience he adds science, or a knowledge of the principles, on which his art is founded* It is impossble to banish reflections of this kind, when we hear practitioners uttering opinions, which the theory and prac- tice> or in other words, the principles and experience of the pro- fession reject, as not founded in reason, or the nature of things. The opinion to which I particularly allude Is, that the vac- cine or kine-pock secures a person from the small-pox a few years only, after which he will be as liable to that disease as ever! An opinion, or rather docJrine (for all who propagate it do not themselves telieve it, for then they would maintain it to physi- cians, instead of urging it on the ignorant) not justified by ex- perience, analogy, or common sense. But let us leave argu- ments, and turn to facts, entreating our readers, previous- ly to consider that the cow-pock is not a recently discov- ered disease. The distemper has been known among the cows in England and Ireland, time immemorial. It is known in Ireland by a celtic word. As the celtic has not been a collo- quial language there, for more than 500 years, it throws the knowledge of this epizootic malady so many ages back. With a knowledge of this disease has ever been connected an opin- ion, that a person once infected with it was ever after se- cure FROM THE SMALL-POX. F 42 Progress of the new Dr. Jenner was the physician, who with a FranMnian sagaci- ty, first transferred it from diat mild, healthy, and invaluable animal, the Cow, to the human species. Cases proving that the kine-pock secures a person from the small-pott during the whole course of their lives. Dr. Jenner relates the case of Joseph Merret, who was in» oculated with the small-pox twenty five years after he took the kinepock from milking a cowr, widiout the least signs of in- fection ; Sarah Portlock, twenty seven years after j Mary Barge, thirty one years ; Elizabeth Wynne, thirty tight years; William Stinchcomb, ten years ; Hester Walkley, twenty six years; -----Phelps, five years; and John Phillips, fifty three years after taking the kine-pock. [See Jenner's Trea* tise from page 9 to 43.3 Dr. Barry of Cork, relates the case of Cornelius Credon, who was inoculated widi die small-pox ten years after having the kine-pock ; and during three successive inoculations for the small-pox in his family he attended his children while under it, without the least traits of infection. Ellen Goggin suckled her two children under die natural small-pox at an interval of more than seventeen years after having the kine-pock. Johanna Sullivan was carried with some other children to a dairy farm in Ireland, for the express purpose of taking the kine-pock from a cow, in order to be secured from the small- pox, when she was about thirteen years of age ; and when she was twenty, was twice inoculated for the small-pox without any effect ; and afterwards slept four nights with some chil- dren during the height of the small-pox the natural way, and equally resisted the loathsome disease. For more particulars, see the London Med. and Phys. Journal. A lady wrote to Dr. Barry thus: " Thirty years since my mother had the cow-pox, and has been inoculated frequendy since, and exposed to die infection of the small-pox various Inoculation in America. 41 ways, without taking it; and my grandmodier, who is above 80 years old, had the distemper fifty years ago, and has been very frequently exposed to the small-pox, without ever tak- ing It." To these we may add the case of a Mr. Williams, who was inoculated widi the small-pox four times, fifty years after taking the kine-pock. Mr. Crocker, after an interval of forty years. He was a plumber, and frequently employed in solder. ing up coffins of those who died of the small-pox. Mrs. Hutch- ins, after an interval of twenty years ; five years afterwards, she was inoculated with one hundred others. All took the small-pox but herself, during which she attended them. Since then she laid out three persons, who died of the small-pox. Mr. Deacon, inoculated after sixteen years, when the small- pox went dirough his family, while he escaped. It may be said, these are but the testimonies of physicians, Interested in promoting a belief of the permanent efficacy of the vaccine disease. Let us quit then this suspected or- der of men, and turn to die testimony of diose who are not practitioners. The letter of the Rev. Mr. Holt, Rector of Finmore, near Buckingham, to Mr. Abernethey, Surgeon of St. Bartholo- mew's Hospital, may be seen in the London Medical and Phy- sical Journal. This worthy clergyman inoculated his neigh- bours for the kine-pock, because there was no medical practi- tioner in his parish. At die close of the account of his prac- tice he adds, that, B. Cowley caught the cow-pock in 1785. Three years after he entered the Oxfordshire militia, In which he remained five years ; during this time he was thrice inoculated by the surgeon of die regiment, without effect. R. Smidi caught die distemper about the same time, and his large family have, at different times since, had the small-pox, and, although he attended them, he caught not the disease. Ed- ward Stockley's case was very similar. A servant of Mrs. 44 Progress of the new Morris had the cow-pock several years ago, and has been in- oculated seventeen times since for the small-pox, without effect. Lest the testimony of a clergyman should have as litde weight with unbelievers, as that of a physician, let us have re- course to those, who are neither one nor the other. The Earl of Berkley, in a letter to Dr. Denman, relates the ease of a servant of his own on the verge of seventy, who caught the cow-pock when a boy, and who had exposed him- self again and again, in the course of his life to the small-pox, without being infected, William Fermor, Esq. of Tusmore, near Oxford,* relates In his excellent pamphlet, that William Treadwell was inoculated for the small-pox several times, be- tween three and four years after he caught the kine-pock from a cow. Alban Collingridge went through the same experi- ment four years after. Mr. Stevens was inoculated four years after receiving the infection from a cow ; and twenty six years after that, his whole family had the small-pox, and he attended them without receiving the infection. Jane Grey, wife of one of the servants at Corpus Christi College Oxford, caught the distemper by milking twenty five years ago, and slept with and nursed several of her children with the small-pox, at differ- ent periods since, without taking the disease, Thomas Slatter, buder to Sir Digby Macworth in Oxford, had the kine-pock at eighteen years of age ; and at the age of twenty four was sent to the inoculating hospital in London, and was repeatedly inoculated, at a fortnight's interval, without any infection. Six- teen years after this, he attended his own children with the dis- ease, he himself escaping contagion. Henry Collingridge caught the distemper, when about fourteen years of age. Tea. * " A gentleman, says Mr. Ring, blest with the gifts of fortune,but not corrupted by her allurements ; addicted, not to fashionable pleasured but to philosophic pursuits ; and who, actuated by motives of humanity only, caused 326 persons in his neighbourhood, to be inoculated with the kine-pock, and then caused 173 of them to be iuocuUted with the imall-pox, whea every one resisted the infection." Inoculation in America. 45 years after, he was three times inoculated for the small-pox ; after a lapse of ten years more, he inoculated two of his own children with the small-pox ; and again after a lapse of several years, he inoculated another, and although he lived with them all the time, he was in no degree affected. Now, what are all the idle notions, respecting the transitory efficacy of the kine-pock, when confronted with facts like these, asserted too by physicians of the first rank, by clergymen, by noblemen, and by private gentlemen ? Some have triumphed in imagination, because, as our own country could not afford instances to silence their mischievous insinuations, they hoped no other could. But a distinguished British writer, speaking on this very subject, says, " the notion that die cow-pox only secures the constitution from the small- pox for a time, is refuted by volumes of evidence and a cloud of witnesses." What construction ought candor itself to put on such medical advice as this ?—" have nothing to do with the kine- pock inoculation, until it is proved that it will preserve you like that of the small-pox, forever.*" Alas ! do we not all know, that be- fore " truth, in its silent and disputed march, has roused the at- tention of the indolent, converted the supercilious, subdued the interested, and reached the ears of all, an age lhall pass away !" Before which period, how many valuable citizens may perish with the most loathsome of diseases, that might have been sav- ed by this new inoculation! More than two hundred perished under the small-pox inoculation, when it last prevailed in Bos- ton. The apathy, with which they talk of a future spreading of that disorder by inoculation, and the absolute indifference, with which its benign remedy is received, in that large and crowded town, is really astonishing, and will hardly be credit- ed in years to come. Widi what energy do some of our ora- tors declaim on the evanescent subject of party, and local poli- • This is like the wise advice of Patrick to his son, " BCTcr go into the Water, Paddy, until yo» have learnt to swim \!" 46 Progrtss of the new ties! With what pathos, do they appeal to the feelings pf their inferiors respecting objects, delusive in dieir nature, transitory Tfa, their existence, and uncertain, as to their ultimate good \ and yet with what coldness, bordering on torpor, do they speak on a subject that absolutely strikes out, forever, from the cata- logue of human evils, the greatest plague under Heaven! If people will not believe physicians of the first rank, because they are physicians; if they will not believe noblemen, clergy- men, and private gentlemen, because they are Britons, (and however incredible it may appear, even that has been urged) then may they have recourse to one of our own countrymen, who can be consulted every day on the Exchange of Boston, res- pecting die opinion prevalent in England, of the lasting securi- ty which the cow or kine-pock affords against the small-pox ; as the following letter will fully explain. Medford, July 17, 1802. u DEAR FIR, " When in England, seventeen years ago, I was in compa- jay with some persons from one of the dairy counties, togedier with Dr. Williams, an aged physician. They were speaking of die cow-pox diat prevailed at that time among their herds. One observed, that die cows would scarcely suffer themselves to be milked while under die disease. Anodier remarked diat it would be unsafe to milk diem ; as the person would be in danger of taking the disorder. Dr. Williams replied, that he would advise every person, who had never had the small-pox, to milk diem while infected, for then says he, they will take the disorder, which will secure them forever after from the small- pox. This led to many observations on the distemper, which being new to me, I listened to with attention, and learnt, thaU it was a prevalent opinion, in certain parts of England, that if a person caught the cow-pox, he could never after take the small-pox. I then asked Dr. Williams, if this was merely a popular opinion, or the result of certain observation; he an- Inoculation in America. 4j EWered, hi the strongest terms, that there are thousands of instan- ces of persons taking the cow-pox in younger life, and who are now arrived to a great age, and have been repeatedly, exposed to the small- pox without ever taking it. I then enquired how it happened, that the gentlemen of the faculty had never transferred it to men by inoculation ; he replied, that it had been talked of ever since he was a young man, and, that he fully believed it would be put in practice at some future da}'. When I re&d your first publication in the Centinel, in 1799, it brought this conversation fresh to my recollection, and I re- lated it to my family and acquaintance, as a circumstance strongly confirming the truth of your assertion, of the exist- ence of such a disease in England, and of its power to secure a. person forever against the small-pox. I am, &c. JONATHAN PORTER." After the absurd doctrine, respecting the short duration of the efficacy of the kine-pock, is no longer urged, there is but one other scheme, to which the enemies of the new inoculation can have recourse for effecting its disgrace, and that is, throwing it into the hands of improper persons. I have endeavoured to expose the manifold mischiefs that have arisen, and will again arise, from this irregular conduct, in " a narrative offacls, con- cerning the kine-pock inoculation in New England," just published at New York, in the Medical Repository. I should not have glanced at this subject at this time, were not the same practices now going forward in a town close by Boston, where, from the delusive offers of inoculating gratis, or for a very small fee, people have been induced to receive the disease from persons not qualified to judge between the true and the spurious pus- tule ; the consequence has already been, that children have fol- lowed the example, and inoculated one another. The result will be, some of these imprudent people will go into the neigh- bouring hospital, take the small-pox, and then the odium will, as usual, revert to me, because the matter used was taken from 4S Progress of the new my patients. I therefore feel it no more than justice to myself* considering the pains I have taken to mature this business, and a duty I owe to the public, to notice this conduct of ignoranet and presumption. Cambridge, July 21, 1802. Two gentlemen, one in Middlesex, the other In Norfolk, er- roneously supposed themselves/>ar/;War/y aimed at, in the fore- going publication. One of them has forever secured my friendship and respect, for the decent and gentleman like mode of obtaining an explanation. It should be remembered, that at this time, the summer of 1802, the new inoculation had not been generally adopted in Boston. It had made greater progress in every capital of each state in the Union, than in the capital of Massachusetts, although the first annunciation in America, of the existence of such a disease as the cow-pox, was made in Boston, nearly three years before.* The faculty in that town, with but one exception, had not given it their decided approbation and countenance. The younger practitioners inoculated, now and then, a few, but scarcely enough to keep up a continuity of cas- es, for the preservation of the matter. Soon after, persons not of the profession assumed the business in different parts of the country. From such hands, the practice passed into those of journeymen mechanics, apprentices, day labourers, and, in some instances, children inoculated each other. When rebuked for this imprudence, they replied, they might as well inoculate themselves, as Mr. such a one. Many thoughtful people saw what would be the consequence of such conduct; and both by letter, and in conversation, urged me to publish something on the subject. Indeed, I deemed it my duty to hold this prac- tice up, for the public consideration ; which I did in the Co- lumbian Centinel August 2d, 1802 ; but first read it to the * See my fint publication in the Centinel M^rch 1799. Inoculation in America. 49 President of the Massachusetts Medical Society, determining to suppress it, should the principles and design of it, meet his disapprobation. Its publication, notwithstanding, let loose all " the angry passions."* The town of Boston was frequently alarmed by the intro- duction of the small-pox. It was sometimes brought in by sea ; sometimes a patient was infected with it, no one knew how ; and, being too sick to be removed, the* street was board- ed up, the red flag displayed on the house, f the country peo- ple terrified, and the markets affected by it. Such was the actual state of things in Boston, in the month of May 1802. An European can hardly form an adequate idea of the effects of such an alarm in Massachusetts. Thus situated, many ter- rified people, who dwelt near the infected spot, disbelieving the efficacy of the kine-pock, went to the licensed hospital in Brookline, and were there inoculated for die small-pox. The hospital was, at this time, crowded with patients. It was ten years since a general inoculation pervaded Bos- ton and its neighbourhood ; and it was conjectured, that there were nearly fifteen thousand persons liable to the small-pox within that circle. % On this occasion, the forcible expressions of Dr. Jenner, in a letter to my friend Dr. Lettsom, incessant- ly occupied my mind, viz. " The small-pox rages at this time in the metropolis. We have the means in our power of stopping the calamity. Why not employ them ? " We perceive, as it were, our houses on fire, and widi buckets in our hands stand idly gazing on the flames ! * See a specimen in the Centinel, by way of reply to this publication, dated Dorchester August n, signed " John C. Howard." f See my printed correspondence with Dr. Haygarth. + Boston is connected on the north to Charlcstown by a bridge 1500 Feet long ; to Cambridge on the west by one more than twice as long ; and to Roxbury on the south by a long street. Within 3 miles of thesr towns are others nearly as large. G 50 Progress of the new " We bar the door against foreign plagues by our latrs «rf quarantine ; whilst the greatest domestic plague, that ever in. fested us, is suffered to advance without controul. Would U not be wise in the Legislature to interfere in the cause of suffering humanity ?"* Thus circumstanced, I found it, In a peculiar manner, my duty, seeing I had imported the vaccine disease into America, and had held it up to my countrymen, as an easy commutation tax, in lieu of that horrible one, the small-pox, to make a se- rious effort to diffuse the benefits of it, first through the me- tropolis, and then through every part of the Commonwealth, so as even to exterminate the very pabulum, or fuel, on which the small-pox feeds. But how to effect it, was the question— I must have been grossly ignorant of the world and of myself, to have supposed, that the old physicians of Boston, where I was not, strictly and legally speaking, an inhabitant, would follow my lead in any general scheme of vaccination ; and, without dieir hearty co-operation, nothing extensively useful could be effected. A vaccine insJtudon would fall far short of the objects aimed at. Besides, it would be beginning at the wrong end, both of society, and of the profession. There was no legally constituted body of men, which appeared to me so likely to carry this desirable object into effect, as the Board of Health, which is a kind of standing committee of humanity, com- posed of " one able and discreet person," from each of the twelve wards of Boston. Their power is extensive. They put in force the laws of quarantine. They direct the remov- al of filth, or supposed sources of contagion or infection, with- in the town and harbour. They prohibit the sale of unwhol- some provisions. They oblige the keepers of boarding houses to make return to them of all sick sea-faring people under their roof, within twelve hours frorn their seizure. They al- low no person to be removed from any ship at the wharves, into the town, widiout their special permission. But die grand * I.ett.em's ob*ervations on the cow-pox, p. 31. Inoculation in America. 51 ©bject of their vigilance is, to guard against die Introduction ©f the yellow fever, and the small-pox. Three of this board sit every day. And this arduous task they perform without any pecuniary compensation. I knew that the Board of Health of the last year * was averse from the very idea of patronizing such a plan ; for Dr. James Jackson had addressed a letter to them, asking permis- sion to test with the small-pox some of his vaccine patients, when the board voted to reject his application in toto. I was therefore aware, that if my memorial did not carry with it ab- solute conviction, it would share the fate of the letter of my ingenious and esteemed pupil; in which event I was all prepar- ed to transfer my plan from the town to the Legislature of the Commonwealth. In either case, I thought it proper to take a broader ground than that of a private practitioner. I there- fore addressed the board of health as follows ; The Memorial of Benjamin Waterhouse, M. D. Professor of the Theory and Praclice of Physic in the University of Cambridge, To the Board of Health in Boston. Gentlemen, NO one can doubt the propriety of my addressing you on the subject of the new inoculation, who considers, that you areplac- ed by law, as so many guardians of our lives, health, and safe- ty. The authority, which has made it your duty to put in force the laws and rules, best calculated against the introduction of infection from abroad, and to obviate the causes of contagion at home, has made it my duty to investigate and teach the principles, on which such laws are founded. Under this idea, it is probable, your board, or the individuals of it, applied for my opinion, and made use of it, when the quarantine law was before the Legislature. From recollection of that circum- stance, I am induced at this time to address you, not as a pri- vate practitioner, but as the public teacher of the praclice of physic * They are chosen annually. 52 Progress of the new in this Commonwealth ; and am willing to annex to the asser- tions in this memorial the implied responsibility of my official station ; for it has been, agreeably to an early declaration,* under a serious impression of the duty, imposed on me by die medical institution of this University, that I have laboured in- cessantly, for four years past, in the investigation and diffusion of the most important medical discovery, ever made since the world began ; it being no less tiian that of exterminating the most loathsome and widely wasting pestilence, that Providence ever permitted to afflict the human race. Being made acquainted, at a very early period, with tin's extraordinary discovery, I felt it my duty, as a teacher of me- dicine, to collect all the facts for the information of those who attended my public lectures. Having imported the dis- ease itself into America, I feel, if possible, a still stronger ob- ligation to acquaint the public with every step I took in dif- fusing it, even before it passed the limits of my own family, I therefore published all my proceedings from time to time in the newspaper, in a stile so simple, as to require no other pre- paration, than common sense and an unprejudiced mind. But, as they have never yet been collected together in one book, it may be of some use, on this particular occasion, to throw to- gether the leading particulars, and lay them in order before the public, dirough the respectable medium of the Boston Board of Health. For really, gentlemen, (seeing vaccination it marching triumphantly over the globe, and Presidents, Empe- rors, Kings, Consuls, and Parliaments, are giving it public countenance and support) it is time for that town, distinguish- ed as " the head quarters of good principles," to consider, whether they will chuse to be the last in adopting a practice, which has been followed by France, Italy, Spain, Germany, Prussia, and * See page 18 of the pamphlet, entitled " A prospect of exterminating ' the small pox." Inoculation in America. 55 Constantinople, and even received with warmth in the cold re- gions of Russia and Norway ? It has been to me an humiliating reflection, that the very plans I have offered for a Vaccine Institution in Boston, for inocu- lating the poor gratis, and which have been received with a chilling apathy, and a repellent suspicion, have, on being trans- mitted to some of the middle and southern States, been adopt- ed with alacrity. From these places, I am continual- ly receiving letters, replete with the most grateful expressions for transmitting them the matter and directions for carrying on this new inoculation. I pass from these prefatory remarks to A CONDENSED HISTORY OF THE KlNE-POCK INOCULATION. THERE is a mild distemper, which has been noticed here and there among the herds of kine, in several parts of England, time immemorial. This disorder appears first on the teats and udder of the cows, in the form of irregular pustules, or pocks, of a palish blue colour ; and those who milk them, when thus affected, seldom fail of catching the disease. This distemper has existed so long in Ireland, as to be known there by a Celtic name, viz, " Shinnaugh," which word' is found, on dissection to mean, a cow's teat. This carries the knowledge of this epizootic disorder back full 500 years. There are innumerable instances of persons in Britain and Ireland, - who caught the malady by milking cows in their youth, and who have passed through a long life, and have been repeatedly exposed to the contagion of the small-pox without being infected ; so that with a knowledge of this dis- ease, has ever been connected an opinion, that a person once affected with it, is ever after secure from the small-pox.* * The absurd doctrine, that the small pox would secure a person only a short time, was urged eighty years ago to prevent Dr. Boylston from advancing with his inoculation in Eoston. 54 Progress of the r.ew Edward Jenner of B:rklev, a town In the vale of Glouces- tershire in England, a '•earned, skilful, and accomplished phy- sician, was the first who took this knowledge, so long floating on the breath of the vulgar, and impressed upon it the stable form of science. He it was, that with a Franklinian sagacity, first transferred it from diat mild, healthy, and, invaluable ani- mal die Cow, to the human species ; and by a series of experi- ments, demonstrated, that it is a perfi.8 security against that loathsome discus, which has destroyed more thon FORTY millions cf people every century ! wiiereby he has been the means of pre- serving more lives than ever fell to the lot of any odier human being. This extraordinary fact came fordi from his hands in so finished a form, that were all other writings on the cow or kine-pock, but Jenner's, destroyed, posterity might have a clear and perfect Idea of this benign remedy, and its salutiferous con» sequences. For Dr. Jenner has demonstrated, " I. That cows are liable to a pustular disease, which was popularly called in England die cow-pox. II. That the human species might be inoculated with the limpid fluid produced in the pustules of this cow-pox. III. That, in consequence of such inoculation, an action commences, which makes such a change in the constitution of die inoculated persons, as to render it impossible for them to be ever infected with the small-pox. IV. That die disease, induced by inoculating with the cow-pox, is of a slight kind, wholly free from danger, seldom attended with fever, and never with suppurating eruptions, like those of the small-pox. V. That if, by any accident, too much general disturbance is excited in die constitution by inoculating for the cow-pox, it is easy, by a proper application to the inoculated part, t© regu- late, or suppress such disturbance. Inoculation in America. 55 VI. That one child in a family might be inoculated for the coW-pox, without the hazard of infecting any other person in the family ; the cow-pox not being a contagious disease. And none of the facts, or observations, published by Dr. Jen- ner, have been disproved, or refuted."* This vicarious disease retains in England, its vulgar name of cow-pox. It is called la vaccine in France ; vajuolo vaccina in Italy ; vaccina in Spain, Germany, and the Northern Nations; and in the United States of America, die KiNE-pocx.f That I produced the same disease in America, is confirmed by virus taken from my patients here, and sent to England, producing the same disease diere. We Lave, besides, demon- strated the identity of the distemper to the eye, by means of pic- tures of the kine-pock in all its stages, painted in England un- der the direction of Jenner himself, which exquisite representa- tions ascertain die Identity of the local disease beyond the faint- est shade of ambiguity. In like manner, the depicted spurious pustule is an exact description of the impostor that pestered us in the autumn of 1800. That this cow or kine-pock will secure the human constitu- tion from the contagion of the small-pox as certainly, as rods of iron will secure a building from the effects of lightening, no one, who has paid due attention to the subjecl, now doubts in Ame- rica. But as lightening rods may be so injudiciously placed, as not to protect the building from Injury, so the kine-pock inocu- lation may be so unskilfully conducted, as not to secure the person from the contagion of the small-pox. When a building, guarded by rods of iron, is struck with lightening, we conclude they were not adjusted according to die rules laid down by Franklin ; they being founded on a law of nature relative to the electric fluid and a metallic rod. And * Dr. Denman. f Instead of the plural pox, because it has but one pustule.- $6 Progress of the new when we hear of a person having the small-pox, after being supposed to have had the kine-pock, we are as certain that the inoculation was not conducted according to the rules laid down by Jenner ; they being, in like manner, founded on a law of nature respecting the vaccine virus and the human subject. Whenever, therefore, we meet with adverse accidents in apply- ing the Franklinian, or the Jennerlan discovery to practice, we must look for the cause in erring man, and not in unerring nature. It is the business, then, of the philosopher and the physician, to enquire into the causes of these aberrations. Assuming it then, as a fact (and the learned of all nations have admitted it) that Dr. Jenner has demonstrated a new law of nature, respecting the prophylactic, or preventive power of the kine-pock in the human system ; we presume that every one who dreads the small-pox, would gladly shelter himself behind the JEgis of Jenner, from its too fatal effects, had he but a cloudless view of the whole business ; and the ultimate object of this address, Gentlemen, is a plan to help your fel- low citizens to such a view of it ; and thus to relieve them from their present state of doubt and uncertainty, respecting a matter of more importance to your commercial town, than any that ever exercised its deliberations, since our venerable fore- fathers first landed on your renowned peninsula. In the present unsettled state of this practice, the inhabitants of Boston know not what to adopt, or what to reject. Altho' I hold up to you, with confidence, a sure, safe, and effectual method of forever securing your offspring from the worst of maladies, yet I wish not that you should patronize, much less adopt it, without A public experiment performed under YOUR OWN INSPECTION. The only question now remaining on the minds of those whq are well wishers to the new inoculation is, why has this operation ever failed ? Why have not the true prophylactic efifcBs followed every application of the vaccine virus to the abraded skin ? The full Inoculation in America. 57 discussion of these questions is reserved for another place. Suf- fice it to say for the present, that I very early warned the public against spurious cases, or an appearance on the arm not possessing the characteristic marks of the genuine pustule, and cautioned my readers against certain occurrences, which if not critically attended to, would bring the inoculation of this re- cently imported distemper into a temporary disrepute. But my warnings were misconceived, and misrepresented ; so that at length, I ceased from any further expressions of caution, and endeavoured to content myself with predicting the consequen- ces, that would ensue from aiming to walk strait, in an unfre- quented path, blindfold. A public experiment by some learned body, or association of physicians, or some regularly constituted body, as the board of health, is requisite to infuse confidence into the minds of the people. For an individual, however warmly disposed to promote the good of his fellow creatures, can do but little in such a peculiar business is this. More than a year since, an advance of the kind was made by me to the Massachusetts Medical Society. They never acted regularly upon it, but it appeared that they wished for the united authorities of the whole medical world, before they would venture to commit themselves, or the dignity of the so- ciety, on the suggestions of a single enthusiastic member. These discouragements have Induced me to address the Boston Board of Health,—to request them to take this new mode of preventing the small-pox infection Into their serious considera- tion, as a matter of great Importance to the community, and coming with peculiar propriety under their cognizance. The writer of tiiis has for more than three years devoted his undivided attention to maturing, and bringing forward this mode of exterminating an horrid disease. He has, by by suggesting, but not obtruding on the public, held up to their view, a mild and easy substtuite. In the same spirit he would now propose to the Board of Health, as" H 5S Progress of the new a principal mean of effecting this end, that they would take some step toward forming a committee, to enquire, ist, Whether there be sufficient evidence of the efficacy of the kine-pock to justify the expense of a public experiment ; and ample documents are here transmitted to assist in you this inquiry. If this is found to be the case, to establish 2dly, a Committee of Physicians to conduit the experiments. To ensure universal satisfaction, it is suggest. ed, that the Committee should consist of six of the oldest physi* clans of Boston ; men, who from their age and character, arc rather retiring from extensive business, than candidates for It; and that to these should be invited the physician of the small- pox hospital at Brookline. I would further ask leave to pro- pose, that to these medical characters, should be associated as many clergymen, whose information, habits of enquiry, and bene- volent views, would complete a committee, every way adequate to the imporlaat task, of forming, and laying, in conjunction with the board of health, before the public, a correct and unbi- assed report of facts. . .. On this occasion, may I not be allowed to make a remark or two for the consideration of those, who from their daily occu- pations, cannot be supposed to have been in the habit of closely contemplating the works- and operations of Nature ?* Such are apt to imbibe erroneous opinions concerning what they denomi- nate die mean and the noble, the great and the small, the trivial and the magnificent, which he, who is *et in the habit of closely contemplating the great frame of nature, the mutual con- nexion, combination, affinity, and harmony of parts, as well as the never ceasing circulation of causes and effects, cannot ad- mit. Such do not consider, that, however essential the dis- tinction of bodies into great and small may be to wj, they are not so in the view of the Sovereign Architect, with wheto an atom is a world, and a world an atom ! Who then can stig- matize any work, or operation of nature, by the epithets of * Local opinions and prejudices rendered these illustrations necessary, A considerable proportion of the board of health were unbeliever* ia the efficacy of the kine-pock at the time this memorial was presented. Inoculation in America. 59 mean and trivial ? I have been lead to these remarks on hear- ing some declare, that they never could have faith in an opera- tion, or process, that had so mean and trivial an origin as this, bow offered to the public, as their greatest benefit, and as the most valuable discovery ever made in medicine. The fact is gentlemen, the greatest benefits now enjoyed by man, both in art and nature, sprung from what is called mean and trivial ori- gins. A few instances may illustrate my meaning. Two or three people, cast away in ancient times, on the coast of the Mediterranean, made a fire to cook their victuals and repair their boat. In this operation, they happened to burn the plant KaR, which mixing with some sand, or coarse gravel, and all melting together, first produced glass ; by means of which we can not only bring distant objects as if within our touch, but open an intercourse with the Heavens. Nay further, by the help of two or three pieces of glass fixed in a triangle of wood, the seaman can tell to a mile where he is, «outh or north of the equator. But shall we despise the teles- cope and the quadrant because they had so mean an origin ? Some other persons playing with a little red stone, found that it attracted iron ; and at length that a needle touched with it, would always point towards the north-pole. Some lucky mor- tal, like Jenner, took the hint, and with it formed the mariner's compass, by means of which the sailor traverses the trackless ocean, in the darkest night, with perfect safety. If we turn from these instances in art to those of nature, and consider the causes of the wealth and power of nations, do we not see similar instances, full as striking ? Is not a pepper-corn the foundation of the power, glory and riches of India ; as is the acorn of that renowned nation whence we of New Eng- land sprang?* " A trudi, constantly found," says Bruce, • The board of health is principally composed of commercial men and i-ea captains retired from business. Hence the reason for selecting in- stances in the commercial and nautical line. 6o Progress of the ne%9 " in die disposition of all things in die Universe, is, that Gqd makes use of the smallest means and causes, to operate the great. est and most powerful effects." Let us then no longer be told of the contemptible origin of that benign remedy, which Providence has destined for the preservation of your offspring from a loathsome and destructive plague. The earth maintains not a more clean, placid, healthy, and useful creature, than the Cow. She is peculiarly the poor man's riches and support. From her is drawn night and morning, the food for his ruddy children ; while the more con- centrated part of her healthy juices is sold to the rich in die form of cream, butter and cheese. It would indeed be un-( comfortable to live widiout this animal, as she supplies man with more conveniences, and at a less expence, than any odier quadruped in the creation. When we have exhausted her by age, her flesh serves for our nourishment, while every part of her has its particular uses In commerce and medicine. On these accounts she is an useful, though invisible wheel in die great machine of state. * Hence we cease to wonder that Uii& useful domestic animal was consecrated among antient nations, as an object of worship. You will readily see gentlemen, that this memorial, though meant to carry every mark of respect, is not made in the stile of cringing solicitation, like a man exclusively Interested in the event, and actuated by personal motives merely ; but of a man conscious of his duty, and zealous in promoting a public bene- fit every way worthy your patronage ; a benefit of more real value to the town of Boston, than all the riches contained. within its limits. You will also remember, diat die main ob- ject of this address is not to persuade you blindly to patronize • The word wealth was derived from this species of animals, viz, pceu- nia from pecus. Hence it was that the first money ever coined in the world, had a c»i» stamped upen it, as a portable representative of richet, Inoculation in America. 61 the new inoculation, but to induce you to cause a rigid inquiry to be made iiitoTQe truth of my assertions, and to have them suhjeded to the test of a public experiment, by a set of men, whose know- ledge^Jge, and virtues, will create confidence, and inspire satisfaSion. * BENJAMIN WATERHOUSE. Cambridge, May 3 if/, 1802. The Board of Health paid a prompt attention to this ad- dress, adopted and pursued the plan here suggested in every par- ticular, excepting that which related to the physician of the small- pox hospital in Brookline ; and that which regarded the gende- men of the clergy. I grieved in silence that they mutilated any part of my plan, yet would not utter a word, lest it should im- pede their meritorious exertions. Partial to my original idea, I must nevertheless be allowed to remark, that if to die six oldest i Physicians of Boston, had been added the six oldest Divines, they would have formed a weighty and dignified jury, whose verdict would have every where, and forever have silenced the insinuations of the ignorant and mischievous respecting interest- ed and profeffional motives. In 1721, six clergymen of Bos- ton did more in strengthening the hands of Dr. Boylston, than any six hundred people that could have been selected in the Province. For these reasons I have never ceased to regret that that part of my design was not likewise adopted. Had the Board of Health hesitated in pursuing die plan in general, chalked out in my memorial, I had determined to pe- tition the Legislature for a law to prohibit what is called a general inoculation for die small-pox, and to confine the Inocula- tion for it to two or three hospitals. I should have grounded my petition on this solemn truth, that under the most favoura- ble circumstances of the inoculation, some die immediately ,f or That is, a committee of six of the oldest physicians, and six of the •Idest clergymen in Boston, together with Dr. Aspinwall. f More than 2CO died in Boston during the last incculatien. (Jl Progress of the new by some slowly wasting disease ; or if they escape Avith life, are liable to a loss or injury of some of the senses; whereas a kind Providence has now offered us a mild and easy substitute, that has never proved fatal in a single instance. To have expected such a law at present, from the represen- tatives of this land of liberty, savoured more perhaps of the sanguine expectations of a projector, than the cool reasoning! of a politician ; but the great object of my wishes would never- theless have been obtained by such a petition, which was, an examination of the prophylactic power of the kine-pock, by a com- mittee OF THE ELDER PHYSICIANS, DlVINF.S, AND GENTLE- MEN OF THE LAW. The Board of Health however, pursued the main object witB unremitting attention and success. On die 16th of August, 1802, nineteen children were inoculated for the kine-pock at the Health Office in Boston ; and went through the disease to ihe entire satisfaction of the physicians, and of the board. On the 9th of November following, these nineteen children, with anodier who had die kine-pock two years before, were sent to Noddle's Island, which is about a mile from the long wharf of Boston, and there inoculated with variolous matter. Two children were at the same time inoculated for the small- pox, with a view to compare the progress of die local affedioa in each, and also to afford a stock of fresh matter for a re- inoculation ; and to obtain moreover a perfectly variolated at- mosphere, so that the infection might be applied to the lungs, as well as to a wound in the skin. The following is the REPORT of the MEDICAL COMMITTEE. WITH a view of ascertaining the efficacy of the cow-pox in preventing the small-pox, and of diffusing through this country the knowledge of such facts as might be established by a course of experiments instituted for the purpose, and Inoculation in America. 63 thereby removing any prejudices, which might possess the pub- lic mind on the subject, the Board of Health of the town of Boston, in the course of the last summer, came to a determi- nation to invite a number of Physicians to cooperate with them on this important design : and widi a liberality becoming en- lightened citi7.ens, erected a Hospital on Noddle's Island for carrying it into execution. Accordingly, on the 16th of Au- gust last, nineteen boys, whose names are subjoined were inocu- lated for die cow-pox at the office, and in the presence of the above mentioned Board, with fresh, transparent cow-pox mat- ter taken from the arms of a number of patients then under this disease. These all received and passed through the disease to the complete satisfaction of every person present, conversant with the disease. On the 9th of November, twelve of the above children, to- gether with one other, George Bartlett by name, who had passed through the cow-pox two years before, were inoculated for the small-pox at the Hospital on Noddle's Island, with matter taken from a small-pox patient in the most infectious stage of that disease. The arms of diese lads became inflam- ed at the incision, in proportion to the various irritability of their habits, but not to a degree greater than what any foreign, virulent matter would have produced. The small-pox matter excited no general indisposicion whatever, through the whole progress of the experiments, though the children took no me- dicines, but were indulged in their usual modes of living and exercise ; and were all lodged promiscuously in one room. At the same time and place, in order to prove the activity of die small-pox matter, which had been used, two lads, who had never had the small-pox, or cow-pox were inoculated from the same matter. At the usual time die arms of these two patients exhibited the true appearance of the small-pox. A se- vere eruptive fever ensued, and produced a plenteous crop of 64 Progress of the new small-pox pustules, amounting by estimation, to more than five hundred in one, and two hundred in the odier. When these pustules were at the highest state of infection, the diirteen children before mentioned were inoculated a se- cond time, widi recent matter, taken from said pustules, which said matter was likewise inserted into the arms of the seven other children, who were absent at the first inoculation. They were all exposed, most of them for twenty days, to infection, by being in the same room with the two boys, who had the small-pox, so that if susceptible of this disease, they must in- evitably have received it, if not by inoculation, in the natu- ral way. Each of the children was examined by the subscribers, who were individually convinced from the inspection of their arms, their perfect state of health, and exemption from every kind of eruption on their bodies, that the cow-pox prevented their tak- ing the small-pox, and they do therefore consider the result of the experiment as satisfactory evidence, that the cow-pox is a complete security against the small-pox. James Lloyd M. D. John Jeffries M. D. "1 £3 Samuel Danforth M. D. John Warren M. D. > | Isaac Rand M.'D. B. Waterhouse M. D.J ?■" Dr. Charles Jarvis was appointed one of the committee, which completed the number of Boston physicians I had origi- nally in view ; but he did not attend through the whole pro- cedure, and therefore did not sign the report. Several other gendemen, who witnessed the whole, or part of this public experiment, corroborated the testimony of the committee by their signatures. This decisive experiment, which has fixed forever the prac- tice of the new inoculation in Massachusetts, was instituted three years and eight months after my first publication of die Inoculation in America. C$ existence of such an epizootic distemper, as the cow-pox; and about two years and four months after I made the first experi- ment with it in America.* Perhaps it may be asked hereafter, why was this experiment delayed so long ? He who is best acquainted with human na- ture will be the last to wonder at it. Mr. Gardiner, of Framp- ton upon Severn, a benevolent writer on the utility of this in- oculation, in speaking of the slow progress of the practice in Jenner's native land, observes, that " every deviation from es- tablished practice, every medical theory which overturns old and deep rooted opinions, must always encounter opposition. This opposition is natural to the human mind ; and he must be a philosopher possessed of wonderful powers of self denial, who can wholly suppress the sigh of sorrow, when he contemplates another's fame." The whole of this observation is just and ap- plicable to London, and to Jenner, while only a part of it is applicable to ourselves. The following letter must be grateful to every friend of hu- manity, as it gives a pleasing account of the progress of die new inoculation among our brethren of the south. The writer, Dr. Spence, is one of the most zealous, philanthropic, and successful inoculators in Virginia. * The first person inoculated for the kine-pock in the western hemisphere was Daniel Oliver WATERHousE,at the age of 5 years. The second Benjamin Waterhouse, at 3 years. The third Mary Waterhouse, at 1 year. The fourth Elizabeth Watson Waterhouse, at 7 years ; and then three Of hiy domestics—all in Cambridge. Six of these were soon after inoculated by Dr. Aspinwall with the matter of the small-pox without any signs of infection. The first person inoculated in Boston, was Mr. Eliphalet Williams, merchant, August 19, 1800. The persons first inoculated in Charlestown, were two children of the Honourable Mr. Dexter late Secretary of the Treasury of the United States, and two children of the Rev. Dr. Morse ; all on the aid oJ' August 1809. I 66 Progress of the new Dumfries, (Virg.) December 7, 1802. DEAR SIR, AS soon as I received your favor of the 7th ult. request* ing me to inform you of the success of the vaccine inoculation in Virginia, I addressed a few queries on the subject to several of my correspondents, that I might have it in my power to funiish you with the latest and most accurate information. As yet I have not received answers to all my letters, but those that have come to hand are very satisfactory. They give ac- counts of the propagation of die new practice in various dis- tricts, and evince that wherever it has been warmly espoused by the faculty, it has proceeded with every degree of success, popu- larity and usefulness. It is true indeed, that its progress, though great, has by no means been so extensive as might' have been expected, in so populous a State as this ; where it may, without exaggeration be said, nearly five hundred thousand of its inhabitants are strangers to the small-pox* Through your unremitting exertions however, which exceed all praise, a solid foundation is laid for its future advancement, The prejudiced and uninformed people, who in some places, undertook to oppose the new inoculation, are now either con- vinced of their error, and obliged to retract, or subdued into si- lence and shame. This victory over error, prejudice, and pas- sion, is perhaps the most pleasing and important information I can give you. It ensures the triumph of vaccination in this quarter of the Union. The nature and management of the vaccine affection is also, I can assure you, pretty well under- stood among us ; and nothing but the supineness or indiffer- ence of medical practitioners can now retard its rapid and suc- cessful progress. Although I do not wish to swell this communication by quotations from letters of my correspondents, yet I deem the following extract of one I have just received from Dr. Shore of Petersburg, a physician of the first eminence in the south- ern parts of Virginia, too Interesting to be omitteek Inoculation in America. 67 Petersburg, Nov. 27, 1802. " DEAR SIR, . " I have the pleasure to acknowledge the receipt of your esteemed favor of the 20th instant, and am happy that I have it in my power to give you favourable accounts of die progress of the new inoculation in this place and neighbourhood. " With the vaccine virus you sent here, our physicians com- menced their inoculation early in the Spring ; and notwith- standing it had to contend with some opposition, arising from an unfortunate and unsuccessful attempt to propagate it in Richmond, a short time before, yet it soon became general, many hundreds having been inoculated, without a single in- stance, as far as I know, of its failure. " Applications to us for matter extended far and wide, par- ticularly in the State of Nordi Carolina, where I am well in- formed, thousands went regularly through the disease. In- deed in that State it appeared to produce a degree of en- thusiasm. " In all the cases which came under my own observation, great uniformity marked the progress of the symptoms ; nor have I been able to discover any deviations from those describ- ed by Jenner,. Lettsom and odier physicians. " In one instance it was said to be attended with a pretty numerous eruption, and in another to have excited a violent disease, attended with fever, in a person who had undergone the small-pox. Perhaps I ought not to mention those cases, as I took particular pains to inform myself of the circumstan- ces of each, without any conviction as to their truth ; hence I place no confidence in them myself. " Three cases only have been tested here by the small-pox, in all of which it was completely resisted. " I had preserved several infected threads, but have been prevailed upon by physicians, in different parts of the country, 63 Progress of the new to furnish them with matter ; and I could not resist their im- portunities. The physicians here, trusting too much to the providence of each other, have left us without a supply. The difficulty indeed, of preserving the virus is to me, one of the greatest inconveniences and objections in the whole manage- ment of this important discovery." Here I cannot help taking notice of the laudable and ex- emplary conduct of the Petersburg physicians. As soon as they were in possession of the vaccine virus, diey united in a body in its favour, and showed their faith in it, not only by publishing their opinion in the newspapers, but by vaccinating in die first instance their own families and friends, and an- nouncing publicly, that each of them in rotation, would attend one day in every week at the Court house, to inoculate gratui- tously, such poor people as wished to take advantage of the blessings of this benign antidote. How worthy is this of imi- tation. Fortunate would it be for humanity and the healing art, could it be said with effect and authority, to every medi- cal association, and every professional man throughout the United States, " Go, and do diou likewise." I do not wish to conceal, that the advocates of the new in- oculation here, have had to contend with many vulgar errors, as well as much opposition from the faculty. Exanthematous diseases were uncommonly prevalent in this State during last Spring and Summer—particularly chicken-pox, scarlet fever, measles, and a vesicular eruption resembling pemphigus. * This last disease and the chicken-pox no sooner appeared dian they were ascribed to the new inoculation ; but on enquiry, it turned out diat adults who had passed through the small-pox, and children who had undergone neither the small-pox nor cow-pox, were equally subject to these diseases. The measles were unusually severe, in many cases fatal ; but this mortali- • These eruptive disorders were- a: that time, also prevalent.in Mai- lachusettt. w. Inoculation in America. 69 ty was owing, in a great measure, to a violent hocpir.g-cough, which was epidemic at the same time. Reports were again circulated that this bad sort of measles must be ascribed to the prevalence of the new distemper ; but a plain statement of facts soon convinced those, whose minds were open to conviction, that this story was as groundless as the tales about the other eruptive disorders. Such reports should never be suffered to pass uncontradicted. It is owing no doubt, to the remissness of physicians, who laugh at, or regard such vulgar errors with silent contempt, that the public mind has been so often dis- tracted, and the Jennerian inoculation brought, on many occa- sions, into a temporary disrepute. It requires but little pain* in these instances to arrive at truth ; and as little, when the in- vestigation is conducted with candor, and with a respectful deference to the opinions of those, whose doubts respecting new plans often originate from the purest motives, to obviate ob- jections, and repel such idle and sceptical misrepresentations. Since I began the new inoculation here, I have had the pleasure of supplying with virus at least twenty practitioners in different parts of diis State ; all of whom have carried on die practice to a considerable extent. The infected threads were generally accompanied by letters containing your valua- ble instructions. Jenner's sacred boundary has been piously respected. The eighth day is as well known among our people as the most Important day in the calendar; and has been ob- served with every degree of veneration. These circumstances, relative to this nice point in vaccination, must be highly grati- fying to you, particularly at a time when some eminent physi- cians in America have departed with great freedom, and per- haps not a little pride, from this golden rule of Jenner. For more than twelve months past, I have regularly inocu- lated every week with warm vaccine fluid ; during that period several hundreds have passed through my hands in the mildest manner ; and I ought to add, that some of my patients, when 70 Progress of the new removed from this State, have been subjected with Impunity to the test of the small-pox ; and by medical gentlemen too, who at the time they made their experiments on my patients, were hostile to the new discovery. Although I wish not to enter in- to minutiae in this letter, yet it may be proper to observe, that the physicians in this part of Virginia, have generally made a point of watching with a jealous eye, over every case under their care ; and thereby have prevented many a sore' arm, which might have arisen from tight sleeves, scratching the pustule, or by neglecting the necessary applications, when the inflammation happened to be redundant. By this vigilance, the character of the vaccine affection, for safety and benignity, has been preserved here as fair and irreproachable, as in any town in die United States; or perhaps hi any part of Europe. I shall make but one other observation ; that in all the cases which have fallen under my notice, I have seen no eruptions over the body ; and although the virus we have been usingV has passed through so many successive trials, its purity has re- mained untainted, and its activity undiminished. I have lately seen Sir Alexander McKenzle's Voyages dirough North America ; and read with horror, the account he gives of the ravages of the small-pox among the poor de- luded Indians. Fortunate has it been for the Jennerian dis- covery, of which you are jusdy regarded as the Founder in the New World, and which you have supported and propagat- ed with so much judgment and ability, that the vaccine virus was committed to the care of so illustrious an Indian Chief as Little Turtle ; a man no less beloved by his people, than distin- guished as a warrior, a statesman, and a philanthropist. How gratifying to your feelings must it be, on perusing these voyages, to think that under Heaven, you may be the happy instrument of warding off so much human misery, and fur- nishing even the savage tribes in the distant wilds of America, with a shield of protection against the most dreadful foe that ever assailed them 1 Inoculation in America. ji That Heaven may more and more bless your labours, and that you may be blessed widi length of days, to see the univer- sal triumph of vaccinism over one of the most dreadful foes to health, to beauty, and to life, in the whole catalogue of hu- man afflictions, is the sincere prayer of, Dear Sir, Your ever grateful and most obedient humble servant, JOHN SPENCE. Pr. Waterhcwse. It may be thought superfluous to add another word in fa- vour of the new inoculation ; but justice seems to demand the insertion of a letter from a physician, who occupies a great space in the public estimation. The 'enemies of vaccination had made use of the respectable name of Rush, with a view to impede the advancement of this salutary practice among us. It was generally reported here last winter, that this eminent physician had unfavourable impreflions of the vaccine disease, and of the inoculation for it. But the following letter from the " American Sydenham'* himself, will at once dissipate all those idle stories. Philadelphia, Feb. 9, 1801. DEAR SIR, ACCEPT my thanks for your friendly and instructing letter. Our whole city will, I hope, be benefited by it, as well as myself ; for I have put the most important facts into the hands of a printer, and they will appear in a day or two in one of our daily papers. In answer to your letter, I shall send you a copy of part of a lecture I delivered to my class a few weeks ago, upon the new mode of inoculation from vaccine matter ; from which you will perceive that I have adopted the discovery with as much zeal and confidence, as you have done, and that I look forward to the complete extinction of the small-pox by it. 7 2. Progress of the new " There was a time, when the very name of the small-pot* inspired more terror than war, famine, earthquakes, and pesti^ lence ; and with reason, for more of the human race have been destroyed by it, than by any one of them, or perhaps by all of them, in a given time, put together. War has its inter- vals of peace ; famine is often preceded and followed by years of plenty ; earthquakes are extremely limited in their destruc- live effects upon human life ; and even the plague itself is a less evil than the small-pox. The truth of this last assertion will appear, when we consider that the plague is confined to filthy Gities, and marshy countries ; whereas the small-pox pre- vails in all situations* Cleanliness and the cultivation of thfl earth are no securities against it. The plague prevails only in certain years and seasons, and requires die concurrence of a mafignant constitution of the atmosphere ; whereas the small- pox prevails in all seasons and states of die air. The plague now and then ceases, like war, from the face of the earth ; but the small-pox has never ceased for a single year, to spread death over some parts of our globe, since it made its first ap- pearance in the year 572. It has been computed, that fatty millions of people have died of it in different parts of the world, in die course of the last century, during part of which time its mortality was much lessened, compared with former centuries, by means of inoculation. Allowing for its being confined for many centuries, in its ravages upon human life, to its birth place in Africa, it is still probable, several hundred millions of people have perished by it, since its first introduc- tion into the world. In contemplating this immense destruc- tion of our species by a single disease, together with die rava. ges it has occasionally committed upon the senses, upon beauty, and upon health in persons who have survived it, we are struck with horror at die retrospect, and are led to mourn over the wide extended scene which it exhibits of human misery. But happily for mankind, this general mortality and misery will be fslt and seen no more. A new era is begun in the medical Inoculation in America. 73 history of man, and the most mortal of all diseases Is about to be struck out of the list of human evils. Its destiny is fixed, and the day is not very remote, when the very name of die small-pox shall be found only in books of medicine. I need hardly add, that this great revolution in favor of the population and happiness of our species, has been effected by die substitu- tion of a harmless disease, taken from a domestic animal, to the small-pox. Thick and lasting be the honors of that high- ly favoured physician, who first discovered and established this safe and delicate antidote to a mortal and loathsome disease. Unknown, till lately, beyond the limits of the district in which he practised, the name of Dr. Jenner has extended to every part of the globe, and will be coeval with time itself. His extensive and durable fame will be merited, for he has intro- duced into the world, the means of saving millions and mil- lions of lives. u For a full account of the advantages of vaccine inoculation, above inoculation for the small-pox, I refer you to Dr. Aikin's epitome of nearly all that has been published upon this sub- ject. I shall briefly enumerate them. 1. It requires no preparation in diet and medicine. 2. It may be performed with equal safety at all seasons. 3. It is a mild disease, seldom confining a patient to hrS house, or interrupting his busmessi 4. It risks no sense, and does no Injury t® beauty. 5. It is not contagious. 6. It sometimes carries off chronic diseases. 7. It is never mortal, except when it is accidentally com- bined with other diseases. " Let us not be discouraged by the few instances which have occurred of the vaccine matter having failed to produce the disease. Time and experience will soon correct our errors, and perfect our knowledge in diis branch of medicine. I welj K 74 Progress of the new recollect the time when inoculation for the small-pox was at* tended with much less certainty and success than it is at pre- sent ; and when the deaths and sore arms from it, had nearly banished it from our country. So unpopular was it, from those, and other less reasonable causes, that Dr. Boylston had the windows of his house broken for attempting to introduce it into the dien province of Massachusetts. " In expressing our triumph in the conquest, which reason and humanity have lately obtained over the most mortal of all diseases, we are led to anticipate the time, when they shall both obtain a similar conquest, by applying the means which have been discovered, to die prevention and annihilation of the plague. How long the blindness, which has perpetuated thil disease for so many ages may continue, I know not; but I be- lieve it Is as much out of the power of prejudice, error and in« terest, to prevent its final and total extinction, as it is to pre- vent die change of die seasons, or the annual revolutions of our globe around the sun." *«**###**■** ***# * * ***** Continue to diffuse the results of your in- quiries and observations through our country. Dr. Mead's •* non sibi, sed toti" should be the motto of every physician. From, Dear Sir, your friend and brother in the Republic of Medicine, BENJAMIN RUSH. Dr. Waterhouse, Professor of Medicine in the University of Cambridge. P. S. I have presented the curious and elegant engraving you sent me of the vaccine and variolous pustules to Dr. Coxe, who proposes to frame it, and give it a place upon the wall oi his parlour. * A considerable part of this paragraph being complimentary is, for that reason omitted. ( 77 ) PRACTICAL OBSERVATIONS ON THE VARIOLA VACCINA or KINE POCK. CHAPTER I. THERE is a mild distemper, which has been noticed here* and there among herds of kine in several parts of England time immemorial. This disorder appears first on the teats of -tows in the form of irregular pustules, or pocks, of a palish blue colour ; and those, who milk them, when thus affected, seldom fail of catching the disease. This epizootic distemper has existed so long in Ireland, as to be known there by a Celtic name, viz, " Shinnaugh" ; which word is found, on dissection, to mean the cow's teat. There are innumerable instances of persons in Britain and Ireland, who caught the malady by milking cows in their youth, and through a long life, were repeatedly exposed to the contagion of small-pox without being infected ; so that with the know- ledge of this disease has ever been connected an opinion, that a person, once affected with it, is ever after secure from die small pox. * Edward Jenner of Berkley, a town in the vale of Glouces- tershire in England, a learned, skillful, and accomplished physi- cian, was the first who took this knowledge, so long vaguely floating on the breath of the vulgar, and impressed upon it the stable form of science. He it was, that with a Frankllnlan sa- gacity first transferred it from that mild, healthy, and invalua- ble animal, the cow, to the human kind ; and by a series of ex- periments demonstrated that it is a perfect security against that loadisome and widely wasting pestilence, the small pox ; * Sec a series of fadts from page 39 to 4;. J 6 PraHical Observations whereby he will be the means of preserving more lives than ever fell to the lot of any other human being. This extraordinary fact came forth from his hands in so finished a form, that, were. all other writings on the cow, or kine pock, but his, destroy- ed, posterity might have a clear and perfect idea of this benign remedy and its salutiferous consequences ; for he has proved,* " I. That cows are liable to a pustular disease, which is popularly called in England the cow pox. II. That the human species may be inoculated with tin limpid fluid, produced in the pustules of the cow pox. III. That in consequence of such inoculation an action commences, which makes such a change in the constitution of inoculated persons, as to render it impossible for them ever to be infected with die small pox. \ IV. That the disease, induced by inoculating with th« cow pox, is of a slight kind, wholly free from danger, seldom attended with fever, and never with suppurating eruptions, like those of the small pox. V. That, if by any accident too much general disturbance be excited in the constitution by inoculating for the cow pojc, it ii easy, by a proper application to the inoculated part to regulate, ©r suppress such disturbance. VI. That one child in a family may be inoculated for thi cow pox without hazard of infecting any other person in the family ; the cow pox not being a contagious disease. And none of the facts, or observations, published by Dr. Jenner oa this subject, have been disproved, or refuted."f * «* Jenner is not only great by the magnitude of his discovery, but he is alse great by the manner in which he conducted his researches; bj the perfection which he gave to them before he published his work; and by the extreme modesty with which he speaks of himself." De Carro of Vienna. f Dr. Dennta*. en the Kinc Pock. 77 This happy discovery was announced to the world by Dr. Jenner in June 1798. Five months after, it was communicated to the author by Dr. Lettsom, who in his letter said, " Seve- u ral trials have been made with this cow pox on children in Lon- " don, and It has proved not only trivial as a disease, but a cer- *' tain security against the small pox." * At this period not more than three or four persons had been inoculated widi the matter of die cow pox in London. In the beginning of the year 1799, the author received from 11 the same friendly hand the golden Treatise of Jenner. In March the 12th of the same year he published a short account of the cow pox ; a disease totally unknown, and till then unheard of in this quarter of the world. He exhibited this sketch of the Jennerian discovery, with a view to excite the attention of the dairy farmers, should such a distemper appear among their herds ; and to gratify his brethren of the faculty with an ac- count of the very extraordinary discovery of an epizootic dis- ease, capable of being communicated from the brute to die hu- man kind by inoculation ; which when communicated was a certain security against the small pox. This publication excited general attention, but experienced the fate of most others on new discoveries. A few received it as a precious truth, highly interesting to humanity. Some doubt- ed it ; others observed that seemingly wise and prudent con- duct, which would allow them to censure or applaud as the event might terminate ; while a far greater number derided it, as one of those medical whims which arise to day, and to morrow is no more. This vicarious disease retains in England its vulgar name of cow pox. It is called la vaccine in France ; vajuolo vacch.o • The author remarks with pleasure, that the benevolent Lettsom was not only the firit who transmitted the knowledge of the exigence of fuch a disease as the cow pox to this quarter of the world, but actually revived the divine practice, by fending a freih fupply of inattcr, after X^siX feat by Haygarth and Crcafer had become extinct. yS Pradical Observations m Italy; vaccina in Spain, Germany and th» Northern Na- tions ; and in the United States of America, the KINE POCK.* That I produced the same disease in America is confirmed by virus, taken from my patients here, and sent to England, producing the same disease there. We have beside demon- strated the identity of the distemper to die eye by pictures of the kine pock in all its stages, painted in England under the direc- tion of Jenner himself ; which exquisite representations ascer- tain the identity of the local disease beyond the faintest shade of ambiguity. In like manner the depicted spurious pustule is as exact a description of the impostor, that pestered us in the au- tumn of 1800. f That diis cow, or kine pock, will secure the human consti- tution from the contagion of the small pox, as certainly, as rods of iron will secure a building from the effects of lightning, no one, who has paid due attention to the subjccl, now doubts in America. But, as lightning rods may be so injudiciously placed, as not to protect a building from injury; so the kine pock in- oculation may be so unskilfully conducted, as not to secure a person from the contagion of the small pox. * Instead of the plural pocks or pox, because it has but one pustull. Whether vatZiela would not be more proper than variola vaccina, I leave others to determine. Variola means any cutaneous spotted distemper ; but it has been used to signify only one spotted distemper, the small pox. See what Dr. Pearson says on this subject. Consult also the accurate Willan on cutaneous disorders. f These admirably coloured engravings, transcending all verbal des- cription, were sent me by Dr. Jenner. Conceiving they would be of tminent service in the cause of vaccination, I distributed them through the United States,as follows; Two copies I sent to President Jefferson ; one to Dr. Rush, another to Dr. Coxe, which he has copied into his pub- lication on the cow pox ; one to the physicians of New York, which has also been copied ; another to Dr. Ramsay of Charleston, S. Carolina; one to Dr. Spence of Dumfries, Virginia ; one into Vermont ; another for the use of Nantucket and New Bedford ; one to Dr. Hunt of North Hampton ; one to Dr. Samuel Danforth ; another to Dr. Rand in Boston ; and one to the Board of Health Two other copies I have kept in circulation through the country. These pictures have been highly serviceable to physicians and to their patients. No others of the kind have been received from England. on the Kine Pock. yp When a building, guarded by rods of iron, Is struck by light- ning, we conclude they were not adjusted according to the rules, laid down by Franklin ; these being founded on a law of nature, relative to the electric fluid and a metallic substance; so, when we hear that a person has had the small pox, after being supposed to have had the kine pock, we are as certain, that the inoculation was not conducted ac- cording to the rules, laid down by Jenner ; they being in like manner founded on a law of nature, relative to the vaccine vi- rus and the human body. Whenever, therefore, we meet ad* verse accidents In applying the Franklinian, or the Jennerian discovery to practice, we must look for the cause in erring man, tiot in unerring nature. It is the business then of the phi- losopher and physician, to enquire into the causes of these aberrations. Assuming it then, as a fact, (and the learned of all nations have admitted it) that Dr. Jenner has demonstrated a new law of nature with respect to the prophylactic, or preventive power of the kine pock in the human system ; we presume that every one, who dreads the small pox, would gladly shelter himself behind the Mgis of Jenner from its too fatal effects, had he but cloudless view of the whole business ; and the ultimate object of this essay is to help die reader to such a view of it. That task the author is compelled to assume, though unfitted for it by his insulated position, and remoteness from the source of correct information. Dr. Jenner informs us, that during his early investigation of the kine pock* he found that some of diose, who seemed to have undergone the disease, nevertheless on inoculation with the small pox felt its influence just the same, as if no disease had been communicated to diem by the cow. As he proceeded, he * In quoting from British writers I sometimes substitute the term kine pock for their cow pox. Local reason!, I hope, will justify *» liberty. 8& Practical Observations learnt diat the cow was subject to eruptions on her teats, (hat were capable of communicating sores to the hands of the milk- ers ; and that, whatever sore was derived from the animal, was called in the dairy the cow pox. Thus was he led to form a distinction between these diseases, one of which only he de- nominated the true, the other the spurious. A discouraging impediment however arose, which checked for a while the ad- vancement of our philosopher* When the true cow pox broke out in a dairy, he discovered instances of persons, who had milked infected cows, and had thereby apparently gone through the disease in common widi others, who were nevertheless still liable to receive the small pox. The mind of Jenner could not rest satisfied with the idea of want of uniformity in th« operations of nature. He conceived it improbable that the human constitution, having undergone the cow pox, should in some instances be perfectly shielded from die small-pox, and in many others remain unprotected. He therefore started afresh in the pursuit of truth, with redoubled ardour. The re- sult Was fortunate ; for he now discovered that the virus of the cow pox was liable to undergo progressive changes from the same cause precisely with the small pox ; and that, when it was applied to the human skin in its degenerate state, it would produce the ulcerative effects in as great a degree, as when it had not undergone a change, and sometimes in a far greater degree ; but, having lost its specific properties, it was incapable of producing that change in the human body, which is requisite, to render it unsusceptible of the variolous conta- gion. Thus it became evident, that a person might milk a cow one day, and, having caught the disease, be forever se- cure ; while another, milking the same cow next day, might feel the influence of the virus in such a way, as to produce a sore, or pustular eruption, and In consequence of this might experience an indisposition of considerable extent; yet, the spe- cific quality being lost, the constitution would receive no peeu- on the' Kine Pock. 81 liar Impression.* These observations fully explain the source of those errors, which have been committed by many inoculat- ors for the small pox as well, as for the kine pock. « Here then, two important objects of pursuit offer themselves to our view. The first is to learn, how to distinguish with ac- curacy between that pustule, which is the true kine pock, and those which are spurious. Secondly, to ascertain the precise time or state in which to take the matter for the purpose of inoculation. But previous to these enquiries are die doctrines of morbidpoisons, and the investigation of the laws of inflammation, and maturation. Neidier of which however can be clearly un- derstood without a correct idea of the Lymphatic, or absorbent system ; and a right notion of the powers, which excite and govern it. This is a subject of sufficient importance to merit n distinct chapter ; which will be written for the sake of those, who are not educated to medicine. CHAPTER II. Of the Lymphatic, or Absorbent System. IT is a vulgar error, when the poison of the small pox, or virus of the kine pock, is inserted into a little wound, or scratch in the skin, it enters immediately into the blood, and so pervades in the first instance, the constitution through the me- dium of the sanguiferous system. Before the discovery of the Lymphatic system this opinion prevailed even among physi- cians. The human system was an opaque body to the eyes of the old anatomists and physiologists, even to the eyes of the immortal Boerhaave. But the recent discovery, which de- monstrates the lymphatics to be a distinff system, appropriated to the sole purpose of absorption, presents to our contemplation a bo- dy, that is transparent. * See Jenner's small tract, entitled " Origin of Vaccine Inoculation." L 82 Practical Observations The Lymphatic or absorbent system denominate it, which you will, consists of ist the Lacteals, or absorbents of the in- testines. 2dly, The common Lymphatic vessels, running every where through the whole body. 3dly, The Thoracic duct j and 4dily, The Lymphatic glands. The Lymphatics are fine pellucid tubes* They begin with open moudis in every part of the body, and terminate in the Thoracic duct ; which begins at die receptacle of the chyle, and terminates in the great vein under the collar bone, dirough which die lymph and chyle pass into the blood. They arc called valvular lymphatics on account -pi the numerous valves, locks, or floodgates, with which they are crowded in their course ; and from dieir contents appearing colourless, like the lymph of the blood, or the white of an egg. Neither the de- monstration of the nervous system by Willis ; nor the circulation, so called, of the blood by Harvey, has contributed more to the elucidation of the animal economy, than this discovery of the Lymphatic, or absorbent system. For want of this knowledge the indefatigable SanSorlus laboured in the dark ; for, while his whole attention was engaged in detecting the process of insensi- ble perspiration, he had no conception of Insensible absorption. Dr. William Hunter first taught the structure, course, and gene- ral use of these transparent, absorbing vessels ; but the full ex- planation of their economy and particular laws was left to that Prince of Physiologists, his brother. * When the famous Boerhaave likened the human body to a hydraulic machine, explicable on the principles of mechanical philosophy ; he diverted his followers from seeing those powers of action and laws of motion within us, which have scarcely any resemblance of mechanical; or even chemical operations; powers depending on diat excitability and energy, which is the attribute of living organization. This wonderful quality, which • John Hunter was to physiologists what Columbus was to geogra- phers. en the Kine Pock. S3 is the preserver and renovator of beings, leaves no other traces of its presence in the body, dian what are exhibited by the motions of life. Thus in the action of these absorbents, while former physiologists extended not their ideas beyond capillary tubes and other mechanical apparatus, John Hunter, with a sa- gacity transcending his cotemporaries, likened them to the proboscis of a fly, or musquito, or the trunk of an elephant ; or in other words, to a living muscular organ, capable by its own inherent power, not only of filling itself with liquids, but of breaking down, and taking up even solid substances. This novel doctrine opened a new scene of curious operations in ani- mal bodies, totally unknown to the antients. That the coats of these lymphatics are vascular is apparent from the redness, or efllorescence observable when poisons are passing through those nearest the surface. The Lymphatic is the most irrita- ble system of vessels in animal bodies. Beside the absorbents, accompanying the arteries of the arm, there is a set of cutaneous lymphatics which accompany die basilic and cephalic veins. Over and above all these is a set still more superficial, and vastly more numerous, than the cu- taneous blood vessels. We are taught by Professor Mascagni of Sienna, that die absorbents of the scarfskin consist of capillary tubes of a texture more subtle and tender, than those in any other membrane ; and that by these they are enabled to absorb aeriform fluidities. The variolous poison can be im- bibed by them ; but the vaccine cannot. In Scodand they communicate the small pox, by binding infected thread tight to the arm. * We shall not attempt a description of a lymphatic gland. We can only discover an intricate assemblage of tubes of ex- treme minuteness, folded and contorted a thousand different ways. The structure of even the largest gland in the body has never been unraveled. It is scarcely necessary to add, that * See Professor Monro's letter to the faculty of Medicine at Paris. 84 Praclical Observations the lymphadc glands are as really a part of the absorbent sys- tem, as the ganglions are of the nervous. Whether these lym- phatic glands be any more, than mere convolutions of simple lymphatics, we know not; for in dissecting diem the most acute anatomist is soon bewildered. We are certain, however, that their susceptiblity of stimidus is far greater, dian that of the simple lymphatics. They are affected, not only by the passage of a morbid poison, but by simple irritation. A prick in the finger, by a clean needle, produced a red streak all along the inside of the biceps muscle, widi pain and swelling of the lymphatic glands of the arm, togedier with rigor and sickness. Hence says Mr. Hunter the importance, in all affections of the lymphatic system, of keeping these two causes in view. Whether the deeply seated lymphatic glands be affected by the variolous, or vaccine poison, is doubtful. It is conjectur- ed, that morbid poisons affect only those in the proximity of the skin. Although inoculation is the insertion of poisonous matter by a wound that bleeds ; yet the virus enters not directly into the blood vessels, as is vulgarly supposed ; but passes into the con- stitution through the medium of these infinitesimally small co- lourless tubes, denominated lymphatics, or absorbents. Not only original, but morbid poisons, and even the natural fluids, pass through these vessels with surprising celerity. Mr. Cruikshank found that the chyle passes dirough the absorb- ents of the mysentery at the rapid rate of four inches in a se- cond, or twenty feet in a minute. When a morbid poison enters through a wound, for exam- ple in the finger, whether it be variolous, vaccine, or venereal, its effects may often be traced dirough die diseased absorbents up to the lymphatic glands in the armpit. When die poison is passing dirough them, they inflame and tumefy, and there follows soon after a chilliness, shuddering or horripilatio ; and it is said that these symptoms are marked more or less distinct- on the Kine Pock. 85 ly in proportion to the healthy, or unhealthy state of the sub- ject ; or in other words, the irritation and commotion in the system are greater, when they arise from a recent accident in a healthy person, dian where the constitution had long sympa- thized with an old sore, whence the matter was absorbed. Does not the absorption of every kind of morbid poison pro- duce this shuddering, and a correspondent degree of reaction in the system ? Does not every sudden impression, or intrusion of foreign matter, produce these symptoms, which some have mistaken for genuine fever ? The reception of it may be ac- companied moreover, with mental horror from fearful appre- hension of a loathsome and abominable disease,* connected with extreme depression of spirits, and even with slight deli- rium. Such apprehensions operate with redoubled force on delicate frames and acutely sensible minds ; and will produce a train of low spirited symptoms, resembling typhus fever; which however want the pathognomonic symptoms of that for- midable disorder, f There may be variations in the action of particular absorb- ents as well, as of the system in general, altering and modify- ing the imbibing process, which we cannot at present distin- guish, nor are all fully prepared to believe. Who can tell what effects trepidation, sudden fright, or horror, has, on this very ir- ritable system ? We find they have visible effects on the skin, and a sensible one on the largest secretory organs. We shall glance at some of these causes, when we come to speak of the failures and variations in inoculation. We have used the expressions, lymphatics and absorbents, in- discriminately ; but the latter is the more accurate term ; for, although these transparent vessels contain some serum and water; die whole volume is called by the vague name of * As of the Lues from a wounded finger. f See three casts related by Dr. Haygarth in the 3d volume of the London Medical and Physical Journal pag« 198 ; to which these obser- vations may not be e»tirely inapplicable. 86 Praclical Observations lymph. If in the descending series of arteries some of them are so subtle, as to exclude the red globules of the blood ; so in the ascending series of absorbents it is probable some of them exclude the pure lymph, and convey only pure water. * After what has been said need we add that there is no such thing, as transudation, or soaking through the membranes of a living body. Even fat, which in the heat of our bodies is liquid, never transudes. It may however, under certain cir- cumstances, be absorbed by the natural energy of the lymphat- ic vessels. They may however, be immersed for years In a ■fluid without absorbing any ; but this is owing to a morbid in- sensibility, or loss of tiieir natural energy. Thus much being premised of the absorbent system ; let ui next speak of inflammation ; and of the secretion of the pellucid fluid, in which resides the vaccine poison; and of the formation of pus ; and then we shall be better able to contemplate the action of a morbid poison, while passing into the system through a wound in the scarfskin by a process denominated inoculation. CHAPTER III. Of Inflammation, and its consequent secretion. AS perfect vaccine virus is pellucid, as the dew drop, so our suspicion of its deviation from this standard of per- fection should increase in proportion to its opacity. The vac- cine poison is united widi, or contained in a transparent secre- tion, but not with pus, or yellow matter. It is hardly proba- ble, that it is united with pure lymph, which is, according to some, the " primary matter" of the animal organs, possessing, like that, all aptitude and no sensible quality. Be this, as it may, it never is found united with opaque matter. * Saumarez. on the Kine Pock. 87 Our old small pox inoculators have associated the idea of ripeness, or the state of perfection of the variolous virus, to that of a thick yellow matter ; and to that of a transparent fluid they annex the idea of an effete water. Wherefore we must remove some of these prejudices, before we can inculcate an opposite doctrine. We shall endeavour to show that in thift matter there exists a nice coincidence of experience and of die laws of the animal economy. Inflammation ought scarcely to be denominated a disease, because it is commonly a regular process or effort of the vires naturas medicatrice^ lo restore an injured part to its pristine in- tegrity. Inflammation is not only the forerunner, but the ab- solute cause of the formation of pus, and this is the mode of it. During inflammation the smaller blood vessels, the veins espe- cially, are not only considerably enlarged, but become more numerous ; and these new vessels are so constructed, as to make the blood undergo certain changes, by which a pellucid fluid is formed, which is afterward changed into pus. Pus is defined by Mr. Hunter to be " globules swimming in a " fluid, which is coaguldble by a solution of sal ammoniac, while n$ " other secretion is." How is it known, that a pellucid fluid precedes the forma- tion of pus ? By attending to the following experiment we shall be able to ascertain this, and to form just notions of the kind of fluid, which contains the true vaccine virus. See Home's dissertation on the properties of pus. " A blistering plaster, the size of a half crowm piece, was applied to die stomach of a healthy young man. In eight hours a blister arose, which was opened, and the contents re- moved ; they were fluid, transparent, and coagulated by heat; had no appearance of globules, when examined by the mi- croscope ; and in every respect resembled the serum of the blood. The cuticle was not removed, but allowed 83 Praclical Observations to^ collapse ; and the fluid, which was formed upon the sur- face of the cutis, was examined from time to time through a microscope, to detect as accurately, as possible, the changes, which took place. The better to do diis, as the quantity in the intervals stated below must be exceedingly small, a piece of talc, very thin and transparent, was applied to the whole surface, and covered with an adhesive plaster ; and the sur- face of the tale, applied to the skin, was removed, and examin- ed by the microscope, applying a fresh piece of talc after every examination, to prevent any mistake, which might have arisen from the surface not being quite clean." * " The fluid was examined by the microscope, to ascertain its appearance ; but, as the aqueous part in which the globu- les of pus swim, is found by experiment to coagulate by adding to it a saturated solution of sal ammoniac, which is not the case with the serum of the blood, nor the transparent part of milk, I considered this, as a property peculiar to pus; and consequently that It would be a very good test, by which to ascertain the presence of true pus." In 8 hours—from the time the blister was applied, the fluid discharged was perfectly transparent, and did not coagulate with the solution of sal ammoniac. 9 hours—the discharge was less transparent; but free from the appearance of globules. 10 hours—the discharge contained globules, which were very small, and few In number. n hours—the globules were numerous ; but still the fluid did not coagulate with the solution of sal ammoniac. ia hours—no alteration. on the Kine Pock. 89 14 hours—the globules a litde larger ; and die fluid ap- peared to be thickened by a solution of sal ammoniac. 16 hours—the globules seemed to form themselves into masses ; but were transparent. 20 hours—the globules Were double the size of those first observed at ten hours, and gave the appear- ance of true pus in a diluted state ; the fluid was coagulated by a solution of sal am- moniac ; the globules at the same time per- fectly distinct ; so that I should consider this as true pus. 22 hours—no alteration. 32 hours—the fluid was considerably thicker in consist- ence, the number of globules being very much increased; but In no other respect, that I could observe, did it differ from that, formed 24 hours after the application of the blister." Nearly the same changes we have discovered in the vaccine pustule, when much inflamed, though these changes are more gradual. In ulcers of weakened and indolent parts pus is made up of globules and of flaky particles ; but die flaky appearance Is no part of true pus. Their proportion is greatest, where the in- flammation is least perfect. " Pus varies in its appearance according to the different cir- cumstances, which affect the sore, that forms it. Its nature, whedier healthy or unhealth}-, depends upon the state of healdi and strength of the parts yielding the pus ; for example, twen- ty men with worn out constitutions lived in the same apart- ment of a hospital, and had large ulcer? on different parts of M 90 Praclieal Observations their bodies. It was found that, when die weadier was mild, dry, and temperate, these ulcers put on a healing appearance, and formed good matter; but any sudden change in die weath- er, becoming either rainy or damp with fogs, produced so great and sudden an effect on the discharge of diese ulcers, as to change it in twenty four hours from a healthy appearance to the very reverse ; the whole ulcer being covered with coagu- lable lymph, resembling melted tallow. " Pus is always in harmony with the parts, which form it, having no power of irritating them, even when the surrounding parts are affected by it. The parts, which form it, assume a structure, similar to that of a gland, by becoming exceeding. ly vascular ; and, what is curious, those parts appear to re- quire more time to be rendered fit for carrying on this process in proportion, as diey are different in structure from a gland. In internal canals, which have naturally a secreting surface, pus is formed in five hours. On the cutis, which is very vascular, in less than twenty four hours ; and in common muscles in nearly forty eight hours." * After what has been said, the following passage from Dr. Jenner's treatise page 113 and 114 will be read with redoubled relish. " Is pure pus, though contained in a small pox pustule, ever capable of producing the small pox perfectly ? I suspect it is not. Let us consider that it is always preceded by the limpid fluid, which, in constitutions susceptible of variolous contagion, is always infectious; and diough, on opening a pustule, its contents may appear perfectly purulent, yet a given quantity of the limpid fluid may at die same time be blended with it, * The author learnt the general doctrine, contained in this chapter, from the mouth of that celebrated philosopher John Hunter, to whom he owes more, than to any public medical teacher, he ever heard. He is indebted to Mr. Home for the illustration of this doelrine, from whose « dissertation on the properties of pus" a considerable portion of tin* chapter is taksn. on the Kine Pock. 91 though it would be imperceptible to the only test of our sense?, the eye. The presence then of this fluid, or its mechanical dif- fusion through pus, may at all times render active, what is ap- parently mere pus, while its total absence, as in stale pustules, may be attended with the imperfect effects we have seen. '* I consider both the pus and the limpid fluid of the pus- tules as secretions, but that the organs established by nature to perform the office of secreting these fluids may differ effentially in their mechanical structure. What but a difference in the organization of glandular bodies, constitutes the difference in the qualities of the fluid secreted ? From some peculiar de- rangement in the structure, or, in other words, some deviation in the natural action of a gland destined to secrete a mild, in- noxious fluid, a poison of the most deadly nature may be cre- ated : for example—that gland, which in its sound state secrets pure saliva, may, from being thrown into diseased action, pro- duce a poison of the most destructive quality. Nature appears to have no more difficulty in forming minute glands among the vascular parts of die body, than she has in forming blood vessels, and millions of these can be called into existence, when inflammation is excited, in a few hours." CHAPTER IV. Of Inoculation. ITHOUT venturing to define a poison, we presume every one will understand that by this term we here mean any matter, or substance, which will change the action of a part, or the whole constitution, from a healthy to a diseas- ed state. Poisons are derived from the animal, vegetable, or mineral kingdom * Animal poisons are distinguishable into original and * Can destructive airs, or gasses be ranked under the head of poisons ? Do they destroy hfe by means of the attenuated particles of all terrestial w 92 Praclical Observations morbid. Original poisons are certain secretions of venemous reptiles ; such as those of the rattle snake, or viper ; whereas morbid poisons are those, which convey a diseased action from one animal to another of the same, or of a different species j which is generally done through a wound, as from a diseased cow to die abraded hands of the milker, as in the kine pock ; sometimes by simple contact, or by effluvium from man to man, as in the small pox. * If we take on the point of a lancet a drop of that morbid poison, which from its parent is denominated the cow pock virus, and with it slightly puncture, or scratch the scarfskin, we very rarely fail communicating the vaccine disease. If on the punctured part a litde red spot appear on the third day, we have reason to believe that vaccination has succeeded. Even in twenty four hours the part, thus inoculated, frequently appears through a microscope tp be a little more inflamed and elevatedi than is a similar puncture, made by the same instrument, when clean and void of virus. But on the third day from the opera- tion the part appears through a good microscope to have a faint, orange coloured tinge. On the fourth day the colour still deepens, and resembles a mosquito bite,f and feels hard under pressure of the finger. At the close of the fourth day, or begin- ning of the fifth, wre can discern die gathering vesicle, and see the cuticle, or scarfskin, starting, as it were, from the true skin, ,to make room for the collecting fluid. On the sixth day the vesicle is distinctly visible, resembling die seed of creeping mallows; exhibiting,like it, a depression in die middle,^ with similar lines or ribs from that point to its base. bodies contained in them ? or do they extinguish life by mere privatioa of its pabulum ? But, who will venture to define a poison ? * See the Hunterian doctrine of morbid poisons, as expounded by Dr. Joseph Adams in his observations on morbid poisons, phagaedena, and cancer, chap. III. f Our mosquito is the English gnat, only somewhat larger. \ This depression, which is of a darkish colour, is not essential to the pustule, but the effect of the puncture. By making the puncture %o on the Kine Pock. 93 If carefully punctured at this period, the pustule, or vesicle will frequently be found to contain a small portion of a limpid fluid. It is however more frequently found on the seventh day ; almost always on the eighdi, and not once in five hundred cases absent on the ninth. Here then we see (I mean on the eighth day from vaccination) the ripe, perfect, pearl coloured kine pock pustule, resembling in shape and size the plump seed of the mallows* ; and replete with a transparent fluid. The base of the pustule is at this time en- circled by a red border, about two lines in breadth ; and this is the state of the pustule, when the virus should be taken for the purpose of inoculation. In some rare instances this appear- ance has not come on before the fifteenth day ; in some, still more rare, not before the twentieth ; and then die pustule has little or no depression in the middle. This shows that the punBum temporls, for taking the matter, Is not to be determined so much from the age, as from the slate of the pustule. At this period, that is eight times twenty four hours from the vaccination, sometimes a day sooner, and in a few cases a day or two later, the patient first feels a stiffness and pain in the armpit, f When perfect vaccine virus is lodged under the wounded cu- ticle, there arises gradually an inflammation. The first act of the vessels, thus stimulated, is simply an increase, or distention of their natural size ; and the part inflamed appears to become more vascular by it, just like the effect of heat in the punBum vita of an egg in the first stages of incubation. This inflam- slighl in a child, that it skinned before the tardy vesicle was formed, I have created a pustule perfectly hemispherical, clear, and smooth as a pearl. * Called by the children " cheeses." f It is alwavs to be understood in this treatise, that the inoculation is made in the arm ; about midway between the shoulder and the elbow ; or, to speak with more prccison, on the belly of the biceps muscle. 94 Pradical Observations mation is followed by maturation; not suppuration, or inflam- mation producing purulent matter, which never occurs in the true kine pock. Then follows about the ninth day pain, run- ning from the pustule along the course of the larger lymphat- ics. The glands under the arm swell, and become painful. Soon after this fever commences ; which is known by chilli- ness, dizziness, shuddering, aversion to animal food, general heaviness, disinclination to exercise, soreness in the limbs, pain about the loins ; sometimes by painful tension, or uneasiness in the pit of the stomach, and not unfrequently in the upper part of the chest, as if under the collar bone. In patients of a delicate constitution, if a moisture of the skin supervene, there is a temporary mitigation of these symp- toms. The same relief happens, when vomiting occurs ; but otherwise the pulse is quickened, the head dirobs writh pain ; the eyes are watery, as if suffering from die smoke of green wood, and there is a heat, or a slight sensation of scalding in the throat. When the patient drops asleep, he often wakes by a sudden start, and is confused. There are instances, indeed, in which it has amounted to that derangement of the organs of sensation, and of the powers of the mind, which is known by the vague name of delirium. Patients have described their feelings in diis disease, as pervading every fibre, and as differ- ent from what they ever before experienced. But all these symptoms are not present in every patient ; or rather they vary in their degree of violence and duration ; some one symptom being more predominant in one constitu- tion, and less in another. But, whatever the symptoms may be, they generally rise gradually with the efflorescence of the inoculated part ; then as gradually subside ; and on the twelfth or diirteenth day from vaccination leave the patient as well, as ever. This is a description of one of the most strong- ly marked cases ; occurring in those subjects only, we presume, that would have had the small pox in the severest manner. on the Kine Pock. 95 tn the greatest number of cases the indisposition is so slight, as not to prevent a person from following his ordinary occu- pation ; and in a few the sickness Is scarcely perceptible. This is the case with children more especially, who are seldom tak- en off an hour from their amusements. But let it be re- membered that contrary to the ordinary practice of writers on the cow, or kine pock we here record the severest case, that the peculiar nature of the disease may be known by its most prominent features. We believe that writers have in general conceived too lightly of diis disease, and have caused others to err in this respect. As the kine pock pustule has an aspect, progress, and con- tents, peculiar to itself, and unlike the small pox, or any other pustular disorder, so it is probable, that it has symptoms pecu- liar, or pathognomonic,* indicative of its specific nature and essence, which future observers will detect and establish, but which our limited experience, at this early period, cannot per- haps ascertain. Physicians may not always rest satisfied with the name of fever, a term, like that of nature, to which scarce- ly two practitioners of different schools or periods annex pre- cisely the same ideas, f Let us resume our description by remarking, that after the eighth day the red line incircling the margin of the pustule, generally Increases, and the efflorescence spreads over the sur- rounding skin. This increased redness denotes that the cuta- neous lymphatics, stimulated by the recently generated virus, are acttively employed in its absorption ; nature in this case conferring new activity on those delicate and irritable vessels. In nine days, or to speak with due precision, In nine times twenty four hours from vaccination, but sometimes not before * An epithet for a symptom, or a course of symptoms, that are in- seperable from a disease, and found in that only. Pathognomonic symp- toms are therefore those, by which a disease may with certaintv be dis- covered, the enumeration of which forms the most concise definition. f Consult Dr. George Fordyce's dissertations on fever. 96 Praclkal Observations ten times twenty four hours from diat operation, the cutaneous vessels are so affected as to occasion a beautiful efflorescence around the pustule ; which is itself now about the size of a six- teenth of a dollar, or an English threepence. The efflores- cence at this period is of the colour of a damask rose, with here and there a tint of scarlet, which deepens in its progress to crimson. Sometimes we discover a red streak, running up to- ward the armpit in the course of the larger lymphatics, that is, with the basilic and cephalic veins, especially if the inocula- tion, as some chuse, were performed on the hand, between the fore finger and thumb. At this period, that is, about the tenth day, the local affec- tion, designated by the efflorescence, has a small degree of tume- faction, and, if embraced by the thumb and finger, a pretty deep seated hardness is perceptible. Experience forbids us to take the matter at this time for the purpose of inoculation ; and tlieory justifies this prohibition, because the lymphatics, through which the virus enters the blood, have already weakened its force by absorbing it from the pustule, to carry it into the con- stitution ; the areola and the red streak extending up the arm being evidence, that the operation has actually begun. Hence we perceive the reason of this emphatical injunction of Dr. Jenner, " / wish this efflorescence, to be considered as a " sacred boundary, over which the lancet should never pass."* On or about the eleventh day the pustule appears to be dry- ing up ; the colour surrounding it fades by degrees from a crimson to a pink ; and the swelling as gradually subsides. That part of the skin which is in the neighbourhood of the pustule resumes its natural colour first. On the thirteenth day the sore is covered by a dark brown scab with a margin, re- sembling horn, or rather dried glue, containing a core of a black, or dark chesnut colour, which some have, not unapdy compared to a dry tamarind stone. This adheres to die skin a * Jn a letter to the author, dated London July 1801. on the Kine Pock. §f few days longer, then falls off, and the whole process is at an end. Compare this description of the rise, progress, and termi> nation of the genuine vaccine pustule with Jenner's admirably coloured engravings ; and then compare both with the actual distemper in a clear skinned patient. It has sometimes happened, diat the pustule, or inoculated part, instead of regularly healing, or rather exsiccating, as just describedj passes from the maturative process over to the ulce- rative, and creates some trouble. After the specific inflamma- tion and true pustule have proceeded with due regularity to perhaps the eleventh or twelfth day, the Inflammation has re- tired, and a hard, rough scab has come on, when a new irri- tation is discovered, and ulceration commences, accompanied with renewed pain under the arm, rigor, and a stupid head- ach and sickness. Pus has been formed under the scab, and the ulcer has finally healed by granulation* At another time, though the local affection and general symptoms may have progressed in proper order, the inflamma- tion retired, and the febrile symptoms vanished ; yet the an- gry pustule shows no disposition to scabi On the contrary, the aperture in the skin increases ; the inflammation blazes fordi afresh, and the illness keeps pace with the progress of the ulceration ; the pain under the arm recurs with a shiver- ing, and a transparent, glairy fluid fills the cavity, which leaves a hollow space, that granulates very slowly. As the contents of this sore are not purulent, but transparent, some practitioners have not hesitated to use it for the purpose of in- oculation ; erroneously supposing that transparency of the fluid is an infallible test of its goodness. When taken on diread, this matter has a glossy appearance, and is more brit- tle than genuine virus. It is the most virulent of all the dis- charges, I have ever noticed in this new inoculation. This is the caustic matter, which, if used for inoculation, is apt to produce in patients of a certain habit, a crop of eruptions, and N 98 Pradical Observations a heavy weight of constitutional symptoms.* If I mistake not, all the cases of eruptions diat have yet appeared among us, were from matter, taken at too late a period, or where the pustule had been imprudently so irritated, as to create an abundant discharge. Had the progress of this ulcerative pus- tule been arrested about the tenth day as it ought to have been, by proper applications, these disagreeable symptoms would not have arisen ; because drey arise not primarily from the action of the virus, but secondarily from die irritation of the sore. This irritable state of the pustule, in some persons, may be owing to a peculiarity of constitution ; in others to a de- clension from the standard of health toward a typhoid diathe- sis. Thus in the small pox this habit disposes the patient to the confluent kind. In which case the pustules have no well defined inflammatory circle around their bases ; but the weak- ened vis vitce, and its consequence, a flabby skin, allow them to run together. The variolous poison is one and the same in every person, and its effects are differently marked, only as the patient is more or less disposed to synocha, or typhus. It is probable however, diat the circulation may in some cases be so very rapid, as to produce an eccymosis, or effusion of blood, which putrefying produces a confluent small pox of a peculiar kind. Copious well timed bleeding would have prevented thii black confluent small pox. Among children inordinate inflammation of the inoculated part, and its consequence, ulceration, arise from blows, or other injuries, common to rough boys at school. Among those still younger it may arise from inattention of nurses, who neglect * In the autumn of 1800 matter of this kind was lavishly distributed, and even left at the houses of some physicians without ihcir knowing from whom, or whence it came. Whatever was the real intention, it i* certain, the distribution of this spurious matter exceedingly hurt the re- putation of the new inoculation. It occasioned violent sore arms, very heavy constitutional symptoms, and eruptions; and, what was still more serious, it did not secure the afflicted person from the small pox. This matter gave a glossy appearance to the thread ; and it appeared to have been obtained in great quantities, and was evidently the production of a »ore, verging to ulceration, if not already ulcerated. on the Kine. Pock. 99 to gather up the child's stiff sleeve. In children of a certain age it frequently arises from scratching off the vesicle at the point of time when it is beginning to fill with fluid-. Ulcera- tion may arise in all ages from an indelicate mode of taking matter for the purpose of inoculation. A careful puncture widi a lancet, or needle, can do no injury ; but all chaffing, pressing, and squeezing should be carefully avoided. The attentive reader need not be informed, that these disa- greeable occurrences are accidental, and foreign to the true disease, and that tiiey may all be avoided by obviating the causes of inordinate irritation. Most commonly this new inoculation and its consequences ought scarcely to be called a disease. On the eighth, ninth, or tenth day a little shivering with now and then a slight headach, a little nausea, and a transient dizziness are some- times experienced ; but frequently none of these occur. A lit- tle more heat, than usual, and a little more restlessness during the night are noticed by an attentive patient, or an attend- ant. But none of these symptoms trouble the patient so much, as to prevent him from following his ordinary business. As to children, they are rarely kept from school by it ; and in infants it produces no apparent sickness, a little peevishness being all, that distinguishes their condition from that of high health. To this we may add that the true pustule has but a very small degree of soreness, even at the height of die efflores- cence. What a difference this, compared with that loathsome, that horrible disease, the small pox ; especially, when it attacks young children ! " Fancy to yourself one of these little inno- cent sufferers, stretched out, and covered with one continued sore ; threatened with suffocation, uttering the agonies, he feels, by piercing, heartwounding groans. Observe how his mouth foams ; listen to the grinding of his teeth ; see how he thrusts his little trembling tongue betwixt them, and how piteously it is wounded ! Look, how he is agitated with the ioo Praclical Observations most dreadful convulsions ! His feeble limbs arc twisted and contorted, and threaten dislocation ; his frame bends back, wards, is lifted up, and thrown down again ! These fits now increase ; then cease ; alas, only to return with redoubled violence. Misery calls aloud for help, help ; but calls in vain. New convulsions succeed ; he foams, struggles, gasps, gasps again ; and expires !"* " We may now pause," to use the words of the benevolent Lettsom, " to consider, whedier the small pox inoculation be a justifiable practice ? Opinions, and even prejudices, although illfounded, which result from old habits, strengthened by do- mestic sensibility, claim attention, and demand indulgence. But, allowing due condescension to these feelings and preju- dices, can a conscientious practitioner encourage, or give his sanction to the old practice, which he knows to be attended with the sacrifice of at least one victim in five hundred cases, while the vaccine inoculation is never fatal ? Were parents pre- viously informed of the probable proportion of deaths by va- riolous inoculation, and were it, like the vaccine, incapable of communicating infection to others ; some apology might be admitted, and the okf practice in a great measure justified. But, if we take into the ballance the dangerous influence of variolous inoculation by spreading infection, and endangering the lives of those, who have not had the small pox, I can hard- ly consider a professional man as justifiable in supporting this practice in the present period of experience." * I shall close this chapter with the sentiments of that skill- ful physician and excellent historian, Dr. Ramsay of Charles- ton South Carolina, as expressed in a letter of a recent date. " The weight of Dr. Lettsom's name is a great support to " the friends of vaccination here. He is perhaps more known *f and respected in America, than any other European physir " cian now living." * Dr. M'Donald of Hamburgh. f Sec Dr. Lettsom's " Observations on Cow poi.'* on the Kine Pock. IOI CHAPTER V. J Of the Spurious Small Pox. T_T AD all, that Dr. Jenner has advanced concerning the -*- -■- prophylactic power of the kine pock, been erroneous, he ought nevertheless to be ranked among the benefactors of mankind ; for he has rendered clear and intelligible certain va- riations and anomalous appearances in the inoculated small pox, that before were involved in mist and confusion. The spurious small pox had scarcely, if ever, been mentioned in America, before the publications on the* kine pock appeared, notwithstanding its woful consequences had been felt in many families in every part of the Union. We have found it diffi- cult to convey a correct idea of spurious matter, and of its ne- cessary effect, spurious cases. Even the best British writers have used the same term to express failures in communicating the true disease, which have originated from different causes. A few examples will best explain, what is meant by spurious small pox. " A medical gentleman," says Dr. Jenner, " now no more, who many years inoculated in this neighbour- hood, frequently preserved the small pox matter, intended for his use, on a piece of lint or cotton, which in its fluid state was put in a vial, corked, and conveyed into a warm pocket; a situa- tion certainly favourable for speedily producing putrefaction in it. In this state, not unfrequently after it had been taken seve- ral days from the pustules, it was inserted into the arms of his patients, and brought on inflammation of the incised part, swellings of the axillary glands, fever, and sometimes eruptions. But what was this disease ? Certainly not the small pox ; for the matter, having from putrefaction lost its specific properties, w;:s no longer capable of producing that malady ; those, who had been inoculated in this manner, being as much subject to the contagion of die small pox, as if they had never been un- jo2 Pradical Observations der the Influence of this artificial disease ; and many unfortu- nately fell victims to it." This is a well expressed case of spu- rious small pox. Take another related by Mr. Earl of Frampton upon Severn. " In March 1784 a general inoculation took place at Arlingham, when I inoculated several patients with active variolous matter, all of whom had the disease in a fa- vourable way; but my matter being all used, and not being able to procure any more in the state, I wished, I was under the necessity of taking it from a pustule, which experience has since proved was advanced too far to answer the purpose, I intended. Of five persons, inoculated with this last matter, four took the small pox afterward in the natural way ; one of whom died, three recovered, and the other, being cautioned by me to avoid as much, as possible, the chance of catching it, escaped from the disease through life." In each of these cases In- flammation took place in the arm, and fever came on with a considerable degree of pain in the armpit. In some of their arms the inflammation and suppuration were more violent, than is commonly observed, when perfect matter is used. In one there was an ulcer, which cast off large sloughs. It is precisely so in certain cases of the kine pock inoculation, where the matter used was too old, and where every symptom, local and general, was severer, than in the true disease. " From these circumstances," continues Mr. Earl, " I should suppose no medical practitioner would scarcely have entertain- ed a doubt, but that these patients had been infected with true small pox. In the year 1789 I inoculated three children, whose arms inflamed properly, fever and pain in the axilla came on precisely at the same time, as in the former cases, and in ten days eruptions appeared ; which disappeared in the course of two days. The matter, here used, was procured for me by a friend ; but no doubt, it was in an improper state ; for from the similarity of these cases to those, which happened at Ar- lingham, I was somewhat alarmed for dieir safety, and desired on the Kine Pock. 103 to inoculate them again ; which being permitted, I was par- ticularly careful to procure matter in its most perfect state. All the children took the small pox from this second inocula- tion, and all had a very full burthen." * What are we to infer from the foregoing cases ? Assuredly this, that " the small pox matter may undergo such a change from, the putrefactive process, as will render it incapable of giving the small pox in such a manner, as to secure the human constitution from future infection ; although we see at the same time it Is capable of exciting a disease, which bears so strong a resemblance to it, as to produce inflammation and matter in the inoculated part, (frequently indeed more violent, than when it produces its effects perfectly) swelling under the arm, general indisposition and eruptions." f The spurious small pox is indeed so common an occurrence among inoculated patients, that we may with equal propriety put the same query here, that Dr. Jenner did in England, " Where is the village, that hath not yielded its victim to the " small pox, after inoculation for that disease was supposed to " have been properly performed ? Can the metropolis, even " among the higher and more experienced gentlemen of the " medical profession, claim an exemption from fatal errors J " Certainly not." J In the last general inoculation in this quarter, which was in the autumn of the year 1792, a considerable proportion of the first cases were spurious, owing to the difficulty of obtaining a sufficiency of good matter. Two of my own children were inoculated five times, before diey took the true disease. Seve- ral practitioners were satisfied with fewer trials. Since spurious small pox cases have been the subject of con- versation, practitioners as well, as people in common, have- * See Jenner's observations page 81. f Ibid page 84. J Letter to William Termor Esq. inserted in Med. and Pl>ys. Journal IC4 Practical Observations recollected many instances of this fallacious disease. It doci not appear, that our inoculators had any correct ideas of the change, which variolous matter may undergo in the putrefac^ tive process ; or that matter, thus changed, would give rise to a train of symptoms, bearing so strong a resemblance of the true small pox, as to be often mistaken for it; Or that a severe disease, resembling the small pox, wrould arise from variolous matter, taken at too late a period of its pustule. The idea is indeed a recent one even in England, which is evident from the cases that occured in the year 1791, as related by Mr. Kite In the fourth volume of the memoirs of the London Medical Society. That these eight cases were spurious no one at this time can doubt. Yet Mr. Kite, who is a surgeon of repute, had not a just idea of the deterioration of the virus in a Stale pustule at the period, when he inoculated the subjects of his second, third, and fourth cases ; for he inoculated them " from the only remaining pustule on the body of a woman on the fifteenth day after the eruption, when she appeared perfect- ly recovered, and all the other pustules dried away." It is more than probable, that diose cases, mentioned by Baron Dimsdale, wherein the disease came on so suddenly after inocu- lation, diat the whole affair was terminated, purges taken, and the patient returned home perfectly well in a week's time," ought to be ranked under the head of spurious^ The attention of American practitioners is however now di- rected toward this important subject, as numerous letters frorri almost all parts of the United States testify; Most of these were confidential communications, otherwise we could fill pag- ei with deplorable instances of persons taking the small pox, after having been supposed to have passed through that mala- dy. I cannot however resist transcribing a passage from a letter of Dr. Ramsay's of Charleston, South Carolina, dated July 23d 1802 ; because neither names, nor circumstances are mentioned, by which the feelings of any one can be wounded. on the Kine Pock. "105 " It is a remarkable fact, that in Charleston seven or eight per- sons have taken the small pox in the natural way, since last January, who had been inoculated for it three, four, or five years ago ; some of whom had been much exposed to it during the intermediate years. The pious say that this coincidence is a smile from Providence in favour of vaccination. The fact is unquestionable, and has shaken the faith-of many in the secu- rity of small pox inoculation." Such failures in communicat- ing the true small pox have given rise to the opinion, diat a person may have that dreadful malady twice. We shall not be surprised at the number of spurious cases, when we consider that the criteria, by which our small pox in- oculators judge of a constitutional affection, are such, as will not bear the test of theory or experience. Swelling and sore- ness under the arm are thought by many to be certain signs of the virus having entered the constitution. But this opinion must be received with some limitation, since we know that a blister, or an issue on the arm, will cause the lymphatic glands in the armpit to sw^ell and become painful. Nay farther a person may have the true small pox from inoculation in the arm ; the virus may be absorbed from the pustule, and every symptom follow in due succession and order, the tumefacllon and pain under the arm excepted. The explanation of this irregulari- ty depends on an accurate knowledge of the course of me larger lymphatics ; for, if variolous, vaccine, or venereal virus, be inserted in the little, or die ring finger, or near to them, the lymphatic glands on the internal condyle of the humerus, or some one in the course of the brachial artery, will probably inflame, and a swelling and pain of die axillary glands follow. But, If the virus be inserted into the diumb, or fore finger, or near to them, it is probable, that it may not pass Into any glands, before it come to the inside of the clav- icle.* Thus have we seen patients complain of stricture * See Cruikshank on the Lymphatics. o IQ6 Pradical Observations and pain across the chest, who had none under the arm, al- though they possessed every odier characteristic of the vario- lous, or vaccine disease. Another criterion, by some deemed infallible, of constitutional affection from variolous, or vaccine inoculation, is die sense of cold, shuddering, and nausea, fol- lowing after die pain and tumefaction in die axilla. But even these are not pathognomonic symptoms of either of these in- oculated diseases, seeing they all may follow from simple irri- tation of a clean instrument, as has already been mentioned. We hope not to be misunderstood. We look upon die cir- cumstances of tumefaction and pain of the glands under the arm, followed by shuddering and nausea, as decisive symptoms, when they coincide in their series and order with certain pecu- liar aspects and conditions of the pustule or inoculated part. All we wish to convey is, that they alone are not the pathog- nomonic signs of the variolous, or vaccine disorder ; since they sometimes follow the absorption of other morbid poisons, and in a rare instance from simple irritation, void of any acrid sub- stance. We may add too that these symptoms are more strongly marked in the spurious, than in the true kine pock. I have now before me a letter from Dr. Wall, Clinical Pro- fessor inthe University of Oxford, dated April 15 1802, written in consequence of my inquiries respecting certain unfortunate ca&es of kine pock, said to have happened at that famous seat of science, and which had been transmitted to this coun- try with increased deformity, in which the learned Professor, after correcting the mistake, says, " a gentleman of this neigh- bourhood inoculated the inhabitants of two or three villages, as he thought, with variolous matter ; in consequence of which an eruptive fever, and a mild form of disorder, resembling small pox, came on at the usual time. But, after these per- sons had been well some months, nearly one half of them took the small pox by contagion, and some had it very unfa- vourably." en the Kine Pock. 107 Before 1 quit this hitherto neglected subject of spurious small pox, I would ask, who has not heard inoculators boast of the hundreds, they have inoculated for the small pox with- out having failed to convey, in a single Instance, the true dis- ease ? Dr. Woodville, physician of the small pox hospital In the city of London, asserts however, (and who, that knows his great experience and accuracy, will doubt It ?) that about one in sixty, taking mankind, as they rise, is found not to be sus- ceptible of small pox, either by inoculation, or in the casual way. CHAPTER VI. Spurious Kine Pock. THERE is not only spurious small pox, but spurious kine pock ; and, if we mistake not, spurious measles, that is, a morbilious affection so slight, as not to secure the per- son from a second attack of it. It is commonly called the measle rash, and is sometimes the precursor of true measles. It may be questioned, whether the term spurious, as applied to the irregularities and failures, incident to inoculation for kine pock, be sufficiently definite ; since these failures may arise from different causes. A spurious pustule is an appear- ance on the skin, not possessing the characteristic marks of the genuine vesicle. A correct definition, accurately discriminat- ing it from the true, is not to be found in any book, we have yet had opportunity of examining. That purulent variolous matter, taken from under a scab and used for inoculation, will occasion ulcerated arms with pain under them, severe headach, sickness, and fever, wldiout communicating the true disease, is a fact, more and more known and acknowledged in Europe and In America. That vaccine matter, taken at an advanced period of a forward pustule, will occasion nearly the same lo- cal appearances, and give a severe, but fallacious disorder, will require no farther proof, than what appeared at Marblehead, io8 Praclical Observations New York, Norfolk in Virginia, and several other places nearer home. But that the causes are precisely the same in both dis* tempers may not be so generally known and acknowledged. A person may conceive that he has kine pock matter on his lancet, when in fact he has only a little putrid pus ; with this he inoculates, and excites a disease of some kind, but not such a one, as will prevent the small pox. Dr. Jenner com- plains to me in a letter of a recent date diat the most arduous task, he has lately had to execute, was that of making practi- tioners sensible of the absolute necessity of attending to the quality of the vaccine matter, According to my own observation, fallacious cases ap- pear under two forms. The first arises from the ap- plication of matter impoverished, as it respects the spe- specific virus, and weakened by being diluted with lymph, se- rum, or the aqueous portion of the blood ; or else deteriorated by long keeping, by excessively hot weather, or by being froz- en and thawed again ; for " Here frost performs th' effecl of fire."* Matter of this quality appears to affect the skin merely, and seems to struggle on to raise the specific inflammation, and ef- fect the propagation of the specific virus ; but fails for want of sufficient force to carry it on. Moreover its stimulus is not great enough to excite the lymphatics to absorb it.f Hence there are no signs of that operation in the cutaneous lymphat- ics, no efflorescence, nor any constitutional affection whatever. There is only a soft scab formed, creeping gradually round the inoculated part, having a red, cranberry \ coloured base ; which, fading away, leaves behind a crustaceous, amber co- loured scab ; whence a transparent fluid sometimes issues, but * Milton. f The lymphatics may have their mouths immersed in fluids for years, and t-ke up none of them, till a particular stimulus for absorption is given.- Cruiks. % Vulgarly called crambcrry ; Uva gruina. on the Kine Pock. 109 most commonly a purulent one. When this scab scales off, it leaves no durable mark in the skin. Now this abortive pus- tule ought rather to be denominated inefficient, imperfect or defective ; since the matter of this sort of pustule is incapable of generating its kind. Whereas the spurious pustule may be propagated. It seems indeed to possess a venom, sufficiently acrimonious to give birth to a similar impostor. That anomalous disease therefore, to which we would ap- propriate the term spurious, owes its origin to matter taken from a genuine vaccine pustule ; but at so late a period, that all the specific virus is absorbed. Sometimes the scab is thrown off, and the part is ulcerating, and throwing out a glairy fluid, previously to the formation of pus ; or, if at a still more ad- vanced period, when pus is not only formed, but actually changed to a state of putridity. This sore then differs widely from that, first mentioned, which arose from diluted, languid virus, and formed that slow and reluctant scab. This is the inefficient, defective pustule ; that a rapid, virulent boil with a deep cranberry coloured efflorescence ; whose effects on the inoculated part and on the system have in some cases been so quick and severe, as to resemble an original rather, than a morbid poison.* Although, like that, it affects not the part, which secreted it ; yet it operates powerfully on anodier. When such matter has been lodged by a deep puncture on the adipose membrane, it has created alarming symptoms. The whole arm has been swelled, become stiff and painful ; so have the glands under it. To these have succeeded rigor, distress at the praecordia, rapid pulse, pain in the region of the loins, stupefying headach, accompanied with a suffusion of tears, and almost always eruptions on different parts of die body. Many such cases occurred among us in the autumn of 1800, which induced some to suppose that vaccine virus suffered an unavoidable degeneration, as it receded from its parent the * See the distinction in \:::±<~ 92. no Pradical Observations cow ; and that it is necessary to have recourse to that animal for a fresh supply. It was at this period, and in this perplex- ed state of the business, that I wrote to Dr. Jenner, who to- gether with Dr. Lettsom resupplied me with matter, resolved my doubts, and removed all my difficulties, as will more par- ticularly appear from the following letter. "my dear sir, " PREVIOUSLY to the transmission of your letter to me, by Dr. Lettsom, I had heard of the sad embarrassment you had fallen into from the loss of your vaccine matter, and most ardently do I hope that die efforts I have used with the view of your being resupplied, may long before this time have proved successful. " In some of our seaports are practitioners who are inocu- lating with the virus from my stock, and it is from among these, as they have been previously apprized of my wishes, that I entertain the hope of your having been furnished. " By the conveyance which brings you this, you will not only receive vaccine matter, such as I employ with my pa- tients here, and among them I frequently find the offspring of some of the first families in our Realms, but such laws also for conducting the vaccine process, or if you please, such a map of the road you are to pursue, as will in future prevent forever your losing your way. " Allow me ere I proceed to offer you my best thanks for your very excellent pamphlet, and for your very kind and friendly letter, die whole breathing that perfect philanthropic spirit which should ever go forth with the laborer whose search is truth, and the melioration of human nature. tn the Kine Pock. ill " I am about to publish a fourth Tract upon the cow pox, and am sorry that it is not yet in print, or wTith pleasure would I send it to you. My motive for sending this into the world is chiefly with the view of preventing mistakes among those who may unwarily use the vaccine virus, after it has under- gone those changes which render it Incapable of producing that peculiar effect upon the human constitution, which secures it from the small pox. But although I am thus precluded from sending you die pamphlet, diat information which may prove most satisfactory to you will lie in a small compass, and shall form the principal subject of this epistle. " The vaccine fluid must be considered as extremely deli- cate in its texture, and subject from a variety of causes, some of them apparently trifling, to partial and to general decomposi- tion ; to partial, when it retains Its qualities imperfectly; to general when these qualities are entirely destroyed. The per- fect virus only can produce the perfect vaccine pustule, at least the fluid insertedmust contain some particles of it in its perfect state. * " Now I conceive that at some period of your inoculation, which may now have escaped your recollection, an imperfect pustule arose, either from some peculiarity in the constitution of your patient, or some alteration in the qualities of your matter, and that from this stock you propagated. The conse- quence was, that continued degeneracy you complain of in the nature of the disease. The same thing has happened to many in this country, and indeed many other parts of Europe. Now, either from an idiosyncracy, or some change in the nature of the virus, a variety has sprung up in the character of the pus- tule. The practitioner not deeply versed in the nature of th» cow pox has inadvertently inoculated from this variety. He proceeds with his inoculation hoping to call back his original * « This is fully explained towards the conclusion of my fir*: Treatise. J.' 112 Pradical Observations pustule, but alas! in vain ; while this is going forward, his sources for conducting the business properly, are cut ofT. This happened to the celebrated Professor Odier at Geneva ; virus, originally vaccine, had suffered so much derangement In its qualities, that when inserted it produced vesication, extensive efflorescence, and with these an evident affection of the system vrithm forty eight hours after its application ; and having assum- ed this character, it continued to maintain it. This was clear- ly not die true cow pox. I furnished the Professor with per- fect matter, and now die disease is propagated with the most complete success at Geneva. " I shall not detain you with an attempt to describe all the varieties, the vaccine fluid when altered in its properties is capa- ble of exciting. The task would be too arduous ; but that just mentioned Is I think most common, viz, the extensive efflo- rescence, with an affection of the system within forty eight hours. That which appears next in frequency is, according to my observation, a soft scab gradually creeping around the punctured part until it has attained the size of a sixpence, or a larger size, and dien dying away, instead of the hard red spot converting itself in four or five days into a vesicle. " So far diis history must tend to depress rather than cheer you, by leading you to suppose diat human foresight is not equal to the preservation of the virus from degeneracy. But I shall give you immediate consolation by assurino- you diat my opinion is far otherwise, and that we shall not want recur- rences to the animal from whence it sprung for renewal. " I am aware that it is the opinion of some, that the vaccine matter loses its properties after it has passed from the cow through a given number of human subjects. It was certainly very natural for you, insulated as ou are, from all ready in- tercourse with those who could afford you correct information on the subject, to take up this idea ; but what will you say en the Kine Pock. 113 When I inform you that the virus you began to inoculate with came from my stock, and that with a continuation of the same, I am now, almost daily, inoculating children in the metropolis ; and producing with it the vaccine disease with all its characters, as perfect as when it first came into my hands from the cow ? In short there does not appear to be the least tendency towards change inthe nature of the virus from time. " You will excuse my laying before you those rules which I conceive should be perfectly understood by those who practise the vaccine inoculation, confident that if they be adhered to, no disappointment will occur. " First—We should be careful to take the vaccine fluid for the purpose of inoculation at an early period of its formation. " Secondly—We must observe that the pustule excited by the insertion of the fluid goes slowly and regularly through its pro- gressive stages of Inflammation,* vesication, with its concomitant efflorescence and scabbing. " Thirdly—That if any material deviation should arise in the character of the pustule, forming a variety, this pustule should not be used for further inoculations. " I shall make some comments Upon these rules-----With respect to the first, let me observe that the activity of the virus, in my opinion, begins to diminish upon the formation of the efflorescence ; therefore if circumstances will admit, I never take it after the eighth day, and as much earlier as I can, even on the fifth. The surest guide will probably be the progress of the efflorescence. " I do not presume to say that after this period the fluid Is effete, certainly It is not ; but that it frequently occasions dis- * " By inflammation, I mean the red spot formed during the first three or four days. It should appear hard to the touch and be somewhat^ prominent. J." 1i4 Pradical Observations appointments, my early trials sufficiently testify, and those of others in whose accuracy I can rely. " The necessity of attending to the second of these injunctions. must be obvious. Were it neglected even an exanthematous blush excited on the arm by the insertion of the virus might be deemed a sufficient securitv, and a spurious pustule, a mere vesicle, quickly forming and as quickly subsiding, be consider- ed as the real. " I have already anticipated any observation on the third rule. However I shall just say a word in proof of the extreme delicacy of the nature of the vaccine fluid, to shew how easily it may be disorganized. " In the early part of my practice, I used frequently to evaporate the fluid by the fire upon threads, glasses, or lancets ; but yet with much caution respecting the degree of heat. But' experience has taught me that even this procedure frequently occasioned an unnatural deviation from the perfect progress of the pustule produced by it ; as it was apt to commence with a soft, creeping incrustation, which in some instances produced at its edges, as it advanced, the perfect vaccine fluid in a ring round it, and this formed a boundary to the extension of the scab. The proper efflorescence followed, and the constitution was rendered secure. But in other instances the process ended more abrupdy ; no fluid was formed as above describ- ed, nor efflorescence ; and then of course the susceptibility of the action of the vaccine virus remained, which was evinced by Subsequent inoculation with active fluid matter. " It is unnecessary forme to say that the vaccine virus I now convey to you is perfectly genuine, when you may be assured it is from that stock which I am using among all my patients here, and these are of every order from the Peer to the Porter 5 for all ranks of society readily embrace our new doctrine. Prejudice, that undescribable something, which ever has for a on the Kine Pock. 115 while, hung heavily on the wheel destined to bring forth ad- dling new in science, has almost hidden its diminished head, and the vaccine inoculation has decidedly triumphed over the variolous. Through Europe it is now going forward with a rapid step. May it as rapidly march over the continent of America, and I do assure you I have no Wish to entrust it to a more able commander than yourself. m " I perceive, by the perusal of your pamphlet, that you wci r led into some perplexity by IDc. Woodville's first publication on the cow pox. His second has set the affair to rights. An irritable skin may be affected in a variety of ways by the local irritation of the inoculated pustule. It is by no means uncom- mon to see an appearance something like the tooth rash. I have seen too, though very rarely, the vaccine pustule, once upon the chin of an adult, and in two or three instances among children. But every thing of the eruptive kind I have ever seen has been too immaterial to merit notice. « Dr.------as well as Dr.------have in many of their writings, confused the matter greatly. Is it to be wondered at, that gentlemen who hastily take up a subject widi which they are but imperfectly acquainted, should in presuming to eluci- date, create confusion ? " Bodi these gentlemen have insisted diat the vaccine mat- ter Is capable of producing variolous pustules on the human body, with all their phoenomena as to contagion &c. &c. Al- though they now deny their own positions, yet it will be a long time before the first false impression be perfectly effaced. " Cold water with a little vinegar, or strong goulard-water seem to be the best applications, in case you find much inflam- mation around the pustule. And when the scab is rubbed off prematurely and ulceration is direatened, I apply the undilut- ed extract of saturn to the part. n6 Pradical Observations " This letter ought certainly to be written over again, but Dr. Lettsom has just sent a message that forbids it. It is of no less magnitude than that the ship, which is to convey it across the Atlantic, is about to sail, " It wjll afford me much pleasure and satisfaction to be fa- voured with your correspondence on this subject, or any other. Sincerely wishing you health and happiness, and complete sue* cess with your inoculation, I remain Dear Sir, your obliged and very faithful humble servant, EDWARD JENNER. London, ^th March 1801, " P. S. Some of the virus I have sent was taken from a pustule this morning by my friend Mr. Ring, Surgeon in New Street Hanover Square. We occasionally assist each other with the fresh fluid. The whole is from my original stock. I have sent you one of the coloured plates, which will be published with my next pamphlet, to shew the progress of the perfect pustule. E. J. « Benjamin Waterhouse M. D. Professor of the Theory and Praclice of Physic (n the University of Cambridge America.'* on the Kine Pock. 117 CHAPTER VII. Of the mode of performing Inoculation. A LTHOUGH from what has been said It may appear, -*- -*• that the fulcrum, on which the business of this new inoculation turns is an accurate knowledge of the genuine pus- tule, the state of the fluid, and of the period In which it should be taken for transfusion into another person ; nevertheless the operation, or mode of conveying it, is an affair of no small consequence. Inoculation, a term borrowed from gardeners, and synoni- mous with ingraftment,* means here the operation of trans- ferring variolous or vaccine virus from a perfect pustule to the wounded lymphatics of a person, susceptible of the contagion. The directions for performing inoculation in Heister's surgery, a standard book among our old practitioners, are these, " make " a small incision into the arm or leg with a knife, and therein ** lodge some purulent matter, taken from patients labouring " under a mild kind of small pox." These directions are copied into Jame's Medicinal Dictionary. It will not however be difficult to demonstrate that the use of the knife is pernicious ; the use of purulent matter falla- cious, and the idea of a mild kind of variolous virus absurd. We have already mentioned from Dr. Jenner the practice of a certain defunct inoculator, who used to cut deep enough, " to see a bit of fat," and there lodge the matter. The conse- quence of so rude practice was observed to be severe inflamma- tion, abscesses, and in some cases death. Cutting thus deep- * Laht Wortley Montague used the term ingrafting. Emanuel Timonius entitled his book Historia variolarum, qua per insitionem ex- titantur. Conftantinople 171^- That of Jacobus Pylarinus bears this title, Nova et tuta variolas excitandi per transplantationem methodus wiper imtenta, et in Ksmn trail*. Venice 1715. n8 Pradical Observations ly has been, and still is a practice among too many inoculator* in America. Some never fail of cutting through the skin of chil- dren ; and most commonly through the skin of adults. These deep wounds commonly create very sore arms, and febrile commotions, which pass for the small pox. It was the opin- ion of that philosophic physician George Fordyce, that the quantity of the variolous matter made a difference in the vio- lence of die disease. But Dr. Jenner is inclined to the opinion, diat this increased violence of the disease is owing merely to the punctures being made so deep, as to go through the skin and wound the adipose membrane. Both these opinions merit our serious attention. That the use of purulent matter for inoculation is pernicious no one can doubt, after what has been said. Almost all the disasters, that have occurred in attempting to communicate the small pox, have arisen from a injudicious use of purulent mat-, ter in place of that pellucid fluid, which precedes it in the natu- ral order of secretion. If purulent matter very seldom communicates the true small pox, it always fails in communicating the genuine kine pock. The matter, used at Marblehead, was purulent, as was that first used in New York, and at Norfolk in Virginia, and also that, first used in some parts of Vermont. That doctrine, which teaches to select matter from a mild kind of small pox for the purpose of inoculation, in order to se- cure the like mildness in the subsequent disease, has no solid foundation in nature. The small pox poison must always be one and the same. There is nothing, hitherto published, which renders it probable, that variolous matter, taken at a proper time, from the distinct sort, or from the confluent, can create any difference in the disorder, produced by it. The confluent, or the distinct small pox, is not owing to any varia- tion in the quality of the virus imparting more or less maligni- en the Kine Pock. 119 ly, but to habit of body, predisposition, or il 10 7 vm^ta. of the sufferer. The small pox may invade a body already distem- pered. It may attack at a season intensely hot, or otherwise unfavourable. It may surprise debauchees soon after excess- es ; or it may seize the innocent after indispensable watchings, hard labour, or sinking under depression of spirits. In such the small pox virus will produce a disease different from that, which the same poison would occasion in subjects strong, pure, cheerful, and living in an healdiy atmosphere. To all which we may add, that fever operates with increased force on the weakest part of every constitution. In a healthy person, inhabiting a clean place, breathing a salubrious air, and living temperately, a train of salutary pro- cesses are going forward in his system ; digestion is well per- formed, the chyle is proper, blood made from that chyle is per- fect, and the secretions and excretions natural and regular. Should a simple wound be inflicted on such a person, inflam- mation, thence arising, would be regular in all its stages ; die pus formed would be replete with white globules, and perfectly sweet; the consequent granulations, a concomitant effect of the same cause, would be florid and firm, and a perfect resto- ration of the wounded part would soon follow. If such a pet- son be inoculated with matter from the most malignant sort of small pox, taken at the proper time, his pustules w ill never- theless be distinct, the basis of each encircled by a border of crimson, the intermediate spaces will approach to the colour of the damask rose, the matter in each pustule will in due time acquire a yellow colour and laudable consistency. The vires vita, are here strong enough to throw up a redoubt against the enemy, and to repel him. The fever, accompanying such a * Mwcrash, a word which cannot be perfectly translated, mean, fomf itLeVcW oecS«; an^ why the saL person finds some Zgs agree with him at one time, which disagree at another. 120 Pradical Observations •tate, is of die true synocha type. But in a person, otherwise situ- ated, and predisposed, other symptoms will appear, if inoculat- ed with the same matter. In him the eruptions come on soon- er, are more numerous, appear in clusters, like die measles, and do not maintain their circular figure and spheriodal form ; but run one into another and become flat; and, when the pus- tules are in any measure distinct, dieir bases are not bounded, as in the former case, by an inflamed margin, while the skin, that is free from pustules, is pale and flabby. The matter in these vesiculae is a whitish, or brownish sanies, and the accompa- nying fever is typhoid or nervous ; while die concomitant in- flammation is of the erysipelatous species, or that sort, which shows a disposition to spread, or rather no disposition to set bounds to itself, as in the distinct small pox.* At this period, should the depressing effects of fear unfortunately concur, the edges of the eruptions will soon show that they are too weak to resist the encroaching evil, and will all run into one shock- ing sore. Now instead of yellow matter, or pus, only ichor is produced. Soon after purple spots appear, profuse hemorr- hages of thin corrupt blood pass off by die several outlets of the body, and the sufferer sinks under the weight of misery. In such cases the violence of the disease is not occasioned by the greater malignity of the variolous poison, that is used ; but it is owing to the vires naturx medicatrices being too far de- pressed to resist die potentla noclva. Hence the imperfect in- flammation and imperfect suppuration ; hence the symptoms of approaching dissolution, indicated by the incapacity of each pustule to confine its own matter. From what has been said it appears that the choice of mat- ter is of less importance, than the mode of inserting it. The pernicious effects of deep punctures are no less apparent in the * It is a law of our system, that where perfect pus is formed, the sore does not spread. Is it not probable that the matter of* the vesicle of the confluent small pox i. weaker, than that in the pustule of the distinct sort ? on the Kine Pock. Ill kine pock, than in the small pox inoculation. It is indeed sufficient, if we lodge the virus on the skin, nay short of the skin, in the rete mucosum. But, before we can clearly understand this subject, it may be necessary to describe the structure and explain the nature of the CUTICLE or SCARFSKIN, the RETE MUCO- SUM, the TRUE SKIN, and the ADIPOSE MEM- BRANE. BY the vaccine pustule we always mean in this treatise that circular sore with a smooth flattish surface and well defin- ed edge, replete with a pellucid fluid, the consequence of inocu- lation, which about the eighth day from vaccination is of the size and shape of the mallows seed. Before we can have a clear idea of this pustule, it is necessary to acquire an accurate one of the parts, which enter into its composition. These are the cuticle, the rete mucosum, and perhaps the adipose membrane, this being frequently, but unfortunately, punctured in inocu- lating infants. The cuticle, epidermis, or scarfskin, call it which you will, is a thin, transparent membrane, covering the human body every where. It is not only insensible, but incapable of undergoing the corroding process of ulceration. It is not even susceptible of the action of morbid poisons, and must therefore be punctur- ed or abraded, before they can be received into our vessels. When the scarfskin is removed, it is regenerated with surpris- ing quickness. Its organization is hence presumed, but hai never been demonstrated. The rete mucosum is interposed between the scarf ami the true skin ; and is that membrane, which gives the peculiar colour to the different nations of the earth. To make this plainer (for we write this for information of those, who are not educated to medicine) let us say with Mr. Cruikshank that, Q 122 Pradical Observations when a blister has been applied several hours to the surface of a negro, a thin, transparent, greyish membrane Is raised, un- der which we find a fluid. This membrane is the cuticle or scarfskin. When this with the fluid is removed, there appears under it another membrane, which is the rete mucosum. This is white in us, but black in Africans ; and, like the amalgam behind a looking glass, probab'y enables the cuticle to reflect the sun's rays in very hot climates. The rete mucosum is a double membrane, containing a mucus, which gives the peculiar colour to a man through the scarfskin. Immediately under the internal layer of the rete mucosum is a third lamen, on which are situated the pustules of the small pox.* Then comes a fifth membrane, which some have imagined was created by certain eruptive diseases ; but it is more probable, that such inflammatory diseases, like an artificial injection, only demonstrate it. Immediately under this delicate membrane is The Skin, which is crowded with veins, arteries, nerves, glands, and absorbents. The skin is exquisitely sensible ; and when once destroyed, it is never, like the cuticle, regenerated. Hence the indelible pit or mark after a successful inoculation. for small pox or kine pock. The Cellular membrane, which lies immediately under the skin, is called reticular and adipose, according to its situation and office. The universal extension of this membrane may account for the symptoms, that are apt to arise from the lodg- ment of acrid matter. This membrane makes a general bed for all the solids of the body. It covers and unites them one to another. It covers and unites the fibres and fasciculi of the muscles, tendons, and ligaments. It covers and unites all ves- sels and nerves. It unites all smooth investing membranes * This membrane was discovered by Dr. Baynham of Virginia, and confirmed by Cruikshank. See his letter to Mr. Clare p. 96. on the Kine Pock. 123 with the parts, which they cover. It pervades the fat, and is even intermixed with the substance of the skin. Nay it is found in every part of the body, excepting the substance of the hard bones and in the humours of the eye.* From such a view of this all pervading membrane, some eminent physiologists have been led to believe (among whom we may name Bagllvi, Rega, and Bordeu) that through the me- dium of this universal membrane or Aveb is conveyed that con- sent of distant parts, or sympathy, observable in many diseases, and remarkably so in those, popularly denominated " nervous." In die subject before us we know, that virus, whether variolous or vaccine, laid on this membrane will often excite very alarm- ing symptoms. From diis description it will appear, that in such a puncture with a lancet, as is commonly made in the operation of bleed- ing, we first cut through the cuticle ; then through the rete mucosum ; next through that vascular membrane, on which small pox pustules are principally seated ; then dirough a si- milar, but more delicate one ; after this we penetrate the true skin ; and lastly we cut through the cellular or radier adipose membrane, before we touch the vein. After this view of the integuments of the muscles, it is in- deed desirable that it may be determined by experiment, how superficial a puncture will answer the purpose of effectual in- oculation. Is it enough, that virus be laid on the rete muco- sum ? Or must it be laid between this compound membrane and the skin ? Being provided with an acute instrument and a good magnifying glass, I endeavoured to ascertain this point by experiments on several persons, selected for this purpose. Af- ter another set of observations I may possibly publish the re- sult. In the mean time I offer the following, as the naturJ history of the vaccine pustule in the human subject. * See a description of the eellular membrane by Dr. Hunter in Lonci Medical Obscrv. 124 Pradical Observations Soon after the virus is laid on the rete mucosum, it occasions an increased action of that living power, which every part, sus- ceptible of stimulus, naturally possesses, and which is similar to a blush, being a momentary distension of die smallest vessels. For it is a law of our bodies that, when a part has more to do than merely to support itself, the blood is there collected in larger quantity.* The part, thus agitated, actually becomes more and more vascular ; and thus gently commences the beautiful process of inflammation. The effect of vessels, thus roused into new action, is the secretion of a pellucid fluid, similar to the virus applied, but not distinguishable from the coagulating lymph, except by its effects. This process soon destroys the minute vessels, connecting the rete mucosum with the scarfskin. When the puncture is made a little deeper, It destroys those, which connect the rete mucosal widi the true skin. The scarfskin, being in this manner detached, is gradually elevated, and forms the external coat of the incipient vesicle, which is now every minute filling with a limpid fluid, secreted by the newly distended vessels, while the rete mucosum forms its base. Or, if the puncture have been made deeper, it forms one of the coats of the vesicle, while the skin is its base. As the pustule increases, the vessels become distended, or inflamed. Still the newly secreted virus is confined to a small spot, and remains there, until the lymphatics are sufficiently roused to absorb it, and carry it into the blood ; which operation rarely commences before the eighth or ninth day. How differently appears the pustule, so raised, from that, which follows a punc- ture through the skin ? Yer ow peremptorily do some pro- nounce on the aspect of . pustule without attending to the physiology and pathology of the parts, that have suffered their random punctures ? * John Hunter, en the Kine Pock. 125 It appears from what has been offered, that the vaccine vi- rus is not immediately absorbed, (and we have already estab- lished it, that there is no such thing, as transudation, or soak- ing through a membrane in a living body) but that it remains on one or other of the membranes before mentioned, and that it must there excite certain progressive changes, denominated inflammation and vesication.* About the eighth or ninth day from vaccination the inflam- matory process has so far advanced, as to stimulate the lym- phatics to absorb the virus, and bear it into the blood. When this commences, it is known to the eye by the increasing efflo- rescence, and to reason by the soreness under the aim. The efflo- rescence around the pustule is not always precisely of the same colour ; for, to speak with Mr. Hunter, although the colour of every inflammation is red, it is a red of various hues. If the patient be perfectly healthy, it is of a pale red ; if less healthy of a darker, even to a purple, and so on to a blueish down to a state bordering on mortification. Since the vaccine disease has never been fatal, to make these subtle distinctions may, in the opinion of some, be giving importance to trifles. But if they w ill look at the consequen- ces, they will do honour to our principles. It is not improba- ble, that in future time kine pock inoculation will be in the hands of mothers, provided physicians are successful in die discriminating marks of it. It is not every practitioner, who can discriminate that pustule, which may be raised on the arm of one, who has gone through the small pox, from that, which is created on him, who never underwent this malady. Even in diat common distemper, the chicken pox, are practitioners so far agreed in its diagnosis, as to exclude doubts and dis- * " It is not the identical matter inserted which is absorbed into the constitution, but that which is, by some peculiar process in the animal economy, generated by it. Is it not probable that different parts of the human b»dv mav prepare or modify the virus differently ?" Jenner p. 55. 126 Pradical Observations putes ? Does the description of it by Dr. Heberden exactly correspond with what we often meet in America ? Certainly not. We may yet find die variola vaccina among the kine of our own country, and the virus may be applied to other pur- poses beside exterminating the small pox. Every case of hy- drophobia in the human species is an inoculated disease ; and the progress of its virus through the lymphatics into the blood must be by laws, not very dissimilar to those, we have laid down. That dogs may be inoculated with vaccine virus is a new wonder in its history ; and it is said, that inoculation pre- serves them from that malady, which from its universality in the canine race, is called " the distemper." I cannot but In- dulge the expectation, that the application of the vaccine dis- covery will more and more open to us new and pleasing won- ders In the healing art; that even the terrific hydrophobia will be struck out of the catalogue of human miseries ; but by what means I wTill not now pretend to determine. In the preceding experiments, the objects of inquiry were, I. To learn the exact appearance of the pustule, when the virus is laid on the rete mucosum. II. Its appearance, when the virus is laid between the rete mucosum and skin ; or on that membrane which is the princi- pal seat of the small pox pustule. III. Its appearance, when the puncture is made partly through the skin. IV. When the puncture is made through the skin, and the virus is lodged on the adipose membrane. V. To determine, whether the local inflammation and con- stitutional symptoms be always in proportion to the depth of the wound. " Although the skin, adipose membrane, or mucous mem- branes are all capable of producing the variolous virus by the on the Kine Pock. 127 stimulus given by the particles originally deposited upon them, yet I am induced to conceive, says Jenner, that each of these parts is capable of produciug some variation in the qualities of the matter previous to its affecting the constitution. What else can constitute the difference between the small pox when communicated casually, or what has been termed the natural Way, or when brought on artificially through the medium of the skin ?" I perceived however that to make these experiments with precision required the skill and dexterity of a Leeuwenhoek and the knowledge of a Jenner as well, as the discriminating accu- racy of a Wlllan, together with a large portion of that exqui- site graphic art, which adorns their respective works, to ex- press them.* Even this would be insufficient, "for who can paint like nature V • To insure success, these experiments should be made at the » PONCTUM VlT* IN VlT«I.J.O OrBIS." 128 Pradical Observations CHAPTER VIII. Mfdical Treatment. ALTHOUGH inoculated kine pock occasions in most cases so slight disturbance in the system as hardly to justify calling it a disease, it nevertheless excites in a few in- stances fever accompanied with slight delirium, which though void of danger ought not to be considered too trifling for medical attention. That morbid state which is denominated fever is one and the same forever in its nature and essence, but admits vast varie- ties from accidental occurrences. It may for example invade a body already weakened or distempered. It may attack at a season peculiarly unfavourable. Moreover, as fever finds out die weakest part of every constitution, how can we pronounce on the mild progress of it, when raised by application of vac- cine virus ? Mild as is the vaccine disease in general, the reputation of It has been injured by an idea that British physicians have pro- nounced it equally mild in all cases. This erroneous opinion has increased the number of quacks, introduced extreme care- lessness, and multiplied spurious cases. Because none ever died with it, some inoculators have conducted as if no one ever could. The most experienced inoculator will however say with Dr. Jenner that " the vaccine lancet is not to be trifled with." Very sore arms do not necessarily belong to the kine pock in- oculation. They result from either an unskilful mode of inocula- tion, or from some accident after it has been properly performed ; or, in patients of a bad habit of body, from an unfavourable state of the atmosphere.* Sometimes the puncture is made too deep, especially in children, and the virus is laid on the * See page 90. on the Kine Pock. 129 adipose membrane. This, with the unceasing motion of their arms will sometimes create a troublesome sore. In grown persons, laborious exercise, or riding on horseback will often so chaff the arm as to occasion the inoculated part to bleed. If to these mechanical irritations be added intemperance, can we Wonder that a mild pustule is changed into an angry ulcer j Or that fever should sometimes rise higher than is consistent with perfect safety ? Experience teaches Us, that the kine pock is uniformly sever- er in grown persons than in children. This may depend on that condition of the human fibre in the adult state, which de- termines it more to the phlogistic diathesis, than in the infantile. We are taught to believe that, in small pox an inflammatory state of the whole system, particularly of the skin, occasions a greater number of pustules. * Hence the propriety of keeping the skin cool throughout the eruptive fever. It Is not so in the kine pock, which differs from small pox only in not being a pustular disease. In this, we find that bathing the feet in Warm water, on going to bed, has an agreeable effect in miti- gating the pain of the head, heat in the eyes, and scalding sen- sation in the throat. Pedlluvium also abates the soreness of the flesh, and disposes the patient to tranquil and refreshing sleep. Whether certain persons have more itching at the pustule, or only less patience I cannot absolutely determine ; but some, between the fourth and sixth day, complain of it as intolerable. To appease them I direct a leaf of plaintain to be bound on the part with a handkerchief day and night. This at least se- cures the incipient pustule from the violence of the nails. But should the itching increase, let the part be bathed with the satur- nine Wash of Goulard ; or, what i* preferable, sea water. R * C»Ilc«. i$o Pradical Observations If on or about the tenth day the efflorescence should extend to a hands breaddi in a grown person, or in the same propor- tion in an infant, nothing need be done to restrain it. Patien ts and parents however commonly induce us to make some mild application, such as vinegar and water, or a solution of aqua lythargiri acttati. But it must always be remembered, that no application should be made to subdue the action of the pustule, until convincing proof had appeared of die patient's having felt its effects at least twelve hours. * Sometimes die patient feels throbbing pain in the inoculated part about the eleventh day ; the superficial efflorescence in- creases to a deep seated inflammation, and the whole arm be- comes stiff and painful. In this condition we apply Ung. Mercur. fort, not merely on the pustule, but inside of the fore- arm. If febrile symptoms accompany this painful local affec- tion, it is proper that the patient should take a cathartic, and that his feet and legs be bathed in warm water at bed time. Should any nervous irritation, so called, arise, and continue over another day, let it be taken off at night by an opiate. If through inordinate inflammation, or some untoward acci- dent, ulceration appear, as described in page 97, It will require particular attention. It would be digressing beyond the limits.assigned, to go far into the doctrine of ulceration. We therefore only remark here, that whoever closely attends to the procedure of inflam- mation, to the formation of pus, the progress of granulation, together with the process of ulceration, will discern the regular steps, by which Nature advances toward a cure. He may likewise observe how, when baffled in her first intention, She directly has recourse to a second, and to a third, in order to restore a disordered part to health. * Jenner p. 109. on the Kine Pock. 13.1 The human body is guarded and preserved by an innate principle, a vis conservatrix, or medlcatrlx, a pow-er of excite- ment, or reaction against a sudden injury ; and when suffering under a loss of substance, the whole force of this power is bent to restore the injured part to its pristine integrity. It is the peculiar office of the physician to restrain these efforts when too violent, and excite them when too Innert and languid. These pathological laws should be carefully regarded in ulce- ration, which is an attempt to separate a diseased from a sound part. Disregard to them has occasioned a difference in opin- ion respecting the use of escarotics in an ulcerating state of the vaccine pustule. Some dispute the propriety of attempting to subdue the pustule, even when there are signs of ulceration. They think with Baron Dimsdale, that the symptoms of inocu- lated small pox are milder, in proportion as the local inflam- mation is greater. We assert however, from better authority, that inflammation and ulceration on the skin, is not the pro- cess in small pox or kine pock which affords security to the constitution. -J- At one time we find an Irritable state of the integuments in particular, or else of the habit in general, in which escarotics cannot be applied with advantage ; at another, an opposite, or indolent and languid state of the part, or habit, in which they are required. Therefore, when to rouse by escarotics, when to assuage by opposite applications, and when to assist the scabbing process, by ?.n artificial covering of any innocent powder, must be determined by the perspicacity of the prac- titioner, * • Hoping to be able to extend and illustrate the leading pathological doctrines, interspersed in this treatise, in a separate publication on Ulcerated Legs, we merely glance at them in this chapter. f Jenner. *33 Pradical Observations CHAPTER IX. Has this celebrated prophylatlic of the small pox been found in any quadruped In America ? I CONFESS that I am unable to determine this qu^rrir-. Those, who have favoured me with communica^t'i ; \ the subject of indigenous cow or kine pock, will I hope cxouc the postponement of the publication of their accounts, until a previous question be determined, I mean the equine origin of the virus. On the subject of indigenous cow pox I was heretofore more inclined to believe, dian to doubt; but lately I have been more inclined to doubt, dian to believe. In some instances, wiiac \ had connived to be a solid structure, I found on near ap- proach to have neidier bottom, nor sides. In a letter, I received from Dr. Jenner last February, he says, " I have always ventured to predict that the cow pox was not confined to diis Island ; but that, wherever in the same dairy there shall happen to be the peculiar intercourse, I have point- ed out, between the horse, (for we must be compelled to own its humble origin) the groom, the cow, and the milker, that the disease may be called into existence," We learn from Dr. Jenner's publications that, wherever the cow pox appears, the " grease" is generally found to have preceded it. But I have inquired in vain after this distemper in the heels of the horse, and am far from being satisfied, that it exists in this country, Our farmers and farriers know it by name only. They con- found it with the scratches, but no two farriers give the same account of it. It may nevertheless exist ; for, I speak it with sorrow, the Ars veterlnaria is in a miserable state in America, compared with France and England. Not being able to satisfy myself as to the existence of the grease among the laborious horses of New England, I wrotf on the Kine Pock. 133 to Virginia, where the horse is a pampered animal, and devot- ed to the pleasures of the " turf," and often rises in value to a thousand guineas. One of my most intelligent medical cor- respondents in that State, after describing the attachment of the Virginian sportsman to his horse, which fully equals what is related in the histories of Tartary and Arabia, adds—" No fond mother was ever more minute in her attentions to the diseases of her darling child, than these gentlemen are to the diseases of this noble animal." Yet even thence I could ob- tain no satisfactory account as to the existence of the disease in question, much less a description of it.* After diligent inquiry I cannot find that our farriers, grooms, coachmen, or drayman have ever received a pustular distem- per from handling the sore heels of horses ; nor do I know an instance, in which any of this order of men remarkably resisted the small pox. That this famous prophylactic has been found in the horse in England I have no doubt; but that It has an equine origin is the most dubious of all the facts, that have been advanced on die subject. The causes, assigned as generating this pellu- cid secretion in die heels of the horse, with all its extraordinary qualities seem inadequate. The mind revolts at the idea, as at the doctrine of equivocal generation. Beside, I cannot easily admit that the noblest of quadrupeds forms an exception to a law, that pervades all animated nature. Where is another in- stance, in which a strong and noble animal generates a poison ? If we look through creation, we shall find that, where an ani- mal naturally lacks strength, the defect is supplied in venom. To generate a poison is the property of a reptile. * If those gentlemen in the southern States, who are most interested in the welfare of this noble animal, would unite in a plan to send an in- telligent native to pass a year or two in the Vetenirary Cr.lleg? in London under Professor Coleman ; they, and in time the whole country, would reap an advantage, infinitely surpassing the. exptnee of it. 134 Pradical Observations We have domesticated six animals, whose natural home was the forest; and five, to say no more, of diese six are liable to a disease analagous to small pox. In the East Indies diat spe- cies of domestic birds (which, having no name in our language, are called cocks and hens) is subject to an eruptive disorder, so similar to small pox, that the natives of Bengal call it by the same name Gooty ; which is doubtless the origin of the chicken pox. The hog has a pustular disease called swine pox. The dog has " the distemper," which is so analagous to small pox, that inoculation with vaccine virus is said to secure him from a future attack. Have we not then reason to suspect that these analagous distempers in our domestic animals have one common origin, and that they are all derived from the same original poison, generat- ed probably in some reptile or insect, that inhabits places, where these animals feed ? That this original poison is varied and modified in each species of animals will be admitted by those, who recollect that small pox poison is even changed in its malignity by passing through the integuments and lymphat- ics of the human body. But «< nothing, to speak with Mr. Aikin, but positive experiment, can give much assistance in an inquiry pursued in a path so little trodden, as that of the par- ticular modifications, which a disease assumes by passing through animals of different species.'* APPENDIX. BIOGRAPHICAL ACCOUNT OF Dr. JENNER. jLI R. EDWARD JENNER is the youngest son of the Rev. Stephen Jenner, M. A. of the university of Oxford, rector of Rockhampton, and vicar of Berkley in Gloucestershire ; where the subject of this memoir was born, in 1749. Independent of church preferment, his father was possessed of considerable landed property in the same county. His mother was the daughter of the Rev. Henry Head, of att an- cient and respectable family in Berkshire ; who also once held the living of Berkley, and was at the same time a prebendary of Bristol. Dr. Jenner had the misfortune to lose his father at a very early period of life ; but this loss, which too frequently pre- vents the proper cultivation of the mental faculties, was fortu- nately supplied by the well directed and affectionate attention of his elder brother, die Rev. Stephen Jenner; who brought him up with a tenderness truly parental. He had another brother, the Rev. Henry Jenner, many years domestic chap- lain to the Earl of Aylesbury, and Vicar of Great Bedwin, Wilts; father of the Rev. George Jenner, and cf Mr. Henry Jenner, surgeon of Berkley ; whose names so frequently ap- pear in the history of Vaccine Inoculation. After receiving a classical education at Cirencester, and learning the rudiments of surgery and pharmacy from Mr. Ludlow of Sodbury, a man of high professional eminence, he was placed under the immediate tuition of the late celebrated t^G Appendix. John Hunter; with whom he lived two years as a houii pupil. * In liberal minds a congeniality of talent and pursuits lays the foundation of sincere and lasting friendship. This obser- vation is fully exemplified by diat friendship which ever after subsisted between the celebrated preceptor and his pupil. A constant correspondence was kept up between them, which on- ly ceased with the deadi of the former. As a proof in what estimation Mr. Hunter held the abili- ties of Dr. Jenner, we may remark, that he offered him a partnership in his profession, which was extremely valuable. Mr. Hunter was desirous of giving lectures on natural history upon an extensive plan ; and, justly appreciating the abilities of his pupil Jenner, and his ardour and perseverance in those enquiries, he well knew the ample support he should derive from the acquisition of his talents. After finishing his studies in London, Dr. Jenner settled at Berkley. His attachment to this situation was so strong, that nothing seemed capable of seducing him from it ; neither the offers of a connection with Mr. Hunter, nor the allurements of the Eastern world, though held up to him in the most dazzling point of view, could tempt him to desert it, for no mortal was ever more charmed with the place of his nativity than Dr« Jenner. He continued the practice of physic and surgery at Berkley^ with increasing success and reputation ; and, did the limits of our publication permit, we could enumerate many instances of his eminent skill in die healing art, during this period of his life. From the extent of his practice, his professional duties be- came extremely laborious j and, as it continued to increase, * So called in Britain, to distinguish them from ordinary pupils, who attend only the public lectures. Appendix. 137 He was under the the necessity of relinquishing the most fa- tiguing part of his business. In 1788, Dr. Jenner married Miss Catherine Kingscote, sis^ ter to Colonel Robert Kingscote, of Kingscote in Gloucester- shire ; a family of the highest antiquity and respectability in the county, by whom he has three children, two sons and a daughter. Having disengaged himself from surgery, he had leisure for the pursuit of other studies more congenial to his mind ; physiology, and natural history. But, even previously to this event, notwithstanding the pressure of numerous avocations, he frequently found opportunities of indulging his favourite propensity. By the joint aid of actual observation, and apposite conjecture, he completely elucidated a very obscure and much disputed point in ornithology.* The originality of this disqui- sition excited much attention among naturalists. He was soon after elected a fellow of the Royal Society. Among other discoveries in the early part of his life, we may notice a mode of producing pure emetic tartar by a new and easy process, which was published in some of the medical journals of that day. We may also refer our readers to a late publication by the ingenious Dr. Parry, of Bath, wherein it appears, that the discovery of the cause of that dreadful ma- lady, the angina pectoris, originated with Dr. Jenner. Strong as was the attachment of Dr. Jenner to his native valley, yet circumstances soon occurred, which rendered his presence in London absolutely necessary. We allude to his most happy discovery of Vaccine Inoculation For the discovery of the divine art of vaccination, we are indebted to a fortunate concurrence of circumstances ; talents, S * Relative to the eutie*. r3° Appendix. education, and situation : to the talents of Dr. Jenner, his education under the celebrated Hunter, and his situation in the vale of Gloucester. His inquiry Into the nature of the cow pox commenced about the year 1776. His attention to this singular disease was first excited by observing, that among those whom he inoculated for the small pox, many were insus- ceptible of that disorder. These persons, he was informed, had undergone the casual cow pox, which had been known in the dairies from time immemorial, and a vague opinion had prevailed, that it was a preventive of the small pox, Vaccine Inoculation is beyond all comparison, the most valuable, and the most important discovery, ever made. It is a discovery, to which even that of Harvey must yield the palm. " It strikes one out .of the catalogue of human evils."* It annihilates a disease, which has ever been considered as the most dreadful scourge of mankind. The mind, satiated and disgusted with the contemplation of the political world, with the revolution of Empires, the inordinate ambition of potentates, die sanguinary deeds of heroes, and die artful machinations of statesmen, turns with pleasure to an object where it can find repose. On such a theme, the pen of pane- gyric dwells with delight. « Saul may have boasted of his thousands slain, and David of his ten thousands ; but the al- tar of Jenner is not consecrated by hecatombs of the slain ; his? claim is that of having multiplied the human race, and happily invoked the goddess of health, to arrest the arm that scatters pestilence and death over the creation."f " Te mater omnis, te lachrymabilis jtccur.ret uxor, ne caducum Orba virum, puerosque ploret: Appendix. 139 Seu confluentes forte timet not at Decora virgo,—tufaclem eripit Periclitantem, proteglsque Delicias juvenum futuras." HoRACS. traslation. To thee shall weeping wives and mothers fly, Or see their husbands and their children die > To thee the virgin trust her lovely face, Or some rude blemish rifle ev'ry grace. Oh, ward the perils that around her wait! Oh, shield her beauties from impending fate I Nor let a cruel pestilence destroy, The hope of youth, and pledge of future joy ! Errata. 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