Chapters 4
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1 01 - An Inquiry into the Causes and Effects of the Variolae Vaccinae 1:14:00
An inquiry into the causes and effects of the varioli vaccini by Edward Jenner, M.D., F.R.S. etc. Publication One. An inquiry into the causes and effects of the Variellae Vaccini, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cowpox. Quid nobis curtius ipsis sensibus esse potest, qui vera ac falsa notemus. Lucretius. To the King. Sir, when I first addressed the public, on a physiological subject, which I conceived to be of the utmost importance to the future welfare of the human race, I could not presume, in that early stage of the investigation, to lay the result of my inquiries at your majesty's feet. Subsequent experiments, instituted not only by myself, but by men of the first rank in the medical profession, have now confirmed the truth of the theory, which I first made known to the world.
Highly honoured by the permission to dedicate the result of my inquiries to your majesty, I am emboldened to solicit your gracious patronage of a discovery which reasonfully authorizes me to suppose will prove peculiarly conductive to the preservation of the lives of mankind. To a monarch no less justly than emphatically styled the father of his people, this treatise is inscribed with perfect propriety. Four. Conspicuous as your Majesty's patronage has been of arts, of science, and of commerce, yet the most distinguished feature of your character is your paternal care for the dearer interests of humanity. I am, sir, with the most profound respect, your Majesty's most devoted subject and servant, Edward Jenner.
Barclay, Gloucestershire, December 20th, 1799. An enquiry, etc., etc. The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases. From the love of splendour, from the indulgences of luxury, and from his fondness for amufement, he has familiarized himself with a great number of animals, which may not originally have been intended for his associates. The wolf, disarmed of ferocity, is now pillowed in the lady's lap.
The late Mr. John Hunter proved by experiments that the dog is the wolf in a degenerated state.
The cat, the little tiger of our island, whose natural home is the forest, is equally domesticated and caressed. The cow, the hog, The Sheep and the Horfe are all, for a variety of purposes, brought under his care and dominion. There is a Difeafe to which the Horfe, from his state of domestication, is frequently fubjec. The farriers have termed it the Grease. It is an inflammation and swelling in the heel, accompanied at its commencement with small cracks or fissures, from which issues a limpid fluid, possessing properties of a very peculiar kind. This fluid feems capable of generating a difeafe in the human body after it has undergone the modification I fhall prefently fpeak of which bears fo ftrong a refemblance to the small pox that i think it highly probable it may be the fource of that difeafe In this dairy country a great number of cows are kept, and the office of milking is performed indifcriminately by men and maid-fervants.
One of the former, having been appointed to apply dreffings to the heels of a horfe affected with the malady I have mentioned, and not paying due attention to cleanliness, incautioflly bears his part in milking the cows, with fome particles of the infectious matter adhering to his fingers. When this is the cafe, it frequently happens that a difeafe is communicated to the cows, and from the cows to the dairymaids, which spreads through the farm until moft of the cattle and domestics feel its unpleasant confequences. This difeafe has obtained the name of the cow pox. It appears on the nipples of the cows in the form of irregular puftules. At their firft appearance they are commonly of a palifh blue, or rather of a colour fomewhat approaching to livid, and are furrounded by an inflammation.
These puftules, unlefs a timely remedy be applied, frequently degenerate into phagodenic ulcers, which prove extremely troublefome.
They who attend sick cattle in this country find a speedy remedy for stopping the progress of this complaint in those applications which act chemically upon the morbid matter, such as the solutions of the vitriolum zinc, the vitriolum cupri, etc.
The animals become indifpofed, and the fecretion of milk is much lefened. Enflamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and fometimes on the wrifts which run on to fupuration, first affuming the appearance of the small vefications produced by a burn. Moft commonly they appear about the joints of the fingers and at their extremities, but whatever parts are affected, if the fituation will admit, these fuperficial fupurations put on a circular form, with their edges more elevated than their centre, and of a colour distantly approaching to blue. Abforption takes place, and tumours appear in each axilla. The fiftem becomes affected, the pulse is quickened, Fiverings, succeeded by heat, general latitude, and pains about the loins and limbs, with vomiting, come on.
The head is painful, and the patient is now and then even affected with delirium. It will appear in the Fequal that these symptoms arise principally from the irritation of the sores, and not from the primary action of the vaccine virus upon the constitution.
Thefe fymptoms varying in their degrees of violence generally continue from one day to three or four, leaving ulcerated forres about the hands which, from the fenfibility of the parts, are very troublfome and commonly heal slowly, frequently becoming fadgenic like thofe from whence they fprung. During the progrefs of the difeafe the lips, noftrils, eyelids and other parts of the body are fometimes affected with Fores, but thefe evidently arise from their being heedlefly rubbed or fcratched with the patient's infected fingers. No eruptions on the Fkin have followed the decline of the feverifh Fimptoms in any infiance that has come under my inflection. One only excepted, and in this cafe a very few appeared on the arms.
They were very minute, of a vivid red colour, and foon died away without advancing to maturation, so that I cannot determine whether they had any connection with the preceding fymptoms. Thus the difeafe makes its progrefs from the horfe, as I conceive, to the nipple of the cow, and from the cow to the human fubjeft. Morbid matter of various kinds, when abforbed into the fytem, may produce effefts in fome degree fimilar, But what renders the cow-pox virus fo extremely singular is that the perfon who has been thus effed is for ever after fecure from the infection of the small-pox neither expofure to the varialous effluvia nor the infertion of the matter into the skin producing this diftemper In fupport of fo extraordinary a fact, I fhall lay before my readers a great number of inffances, but firft it is neceffary to obferve that puftular fsrs frequently appear fpontaneofl on the nipples of the cows, and infances have occurred, though very rarely, of the hands of the fervants employed in milking being affected with fsrs in confequence, and even of their feeling an indifpofition from absorption.
These puftules are of a much milder nature than those which arise from that contagion which confitutes the true cow pox. They are always free from the bluish or livid tint fo confpicuous in the puftules in that difeafe. No eryfipelus attends them, nor do they fhow any phagenic difpofition, as in the other cafe, but quickly terminate in a fcab without creating any apparent diforder in the cow. This complaint appears at various feafons of the year, but moft commonly in the spring, when the cows are firft taken from their winter food and fed with grafs. It is very apt to appear alfo when they are fuckling their young. But this difeafe is not to be confidered as fimilar in any refpeft to that of which i am treating, as it is incapable of producing any specific effects on the human constitution.
However, it is of the greateft confequence to point it out here, lest the want of discrimination should occafion an idea of fecurity from the infection of the small pox, which might prove deluifive. Case One. Joseph Merritt, now an under-gardener to the Earl of Berkeley, lived as a servant with a farmer near this place in the year, and occasionally Affited in milking his master's cows. Several Horfes belonging to the farm began to have sore heels, which Merritt frequently attended. The cows foon became affected with the cow-pox, and foon after, several forres appeared on his hands. Fwellings and ftiffnefs in each axilla followed, and he was fo much indifpofed for several days as to be incapable of purfuing his ordinary employment.
Previously to the appearance of the diftemper among the cows, there was no fresh cow brought into the farm, nor any servant employed who was affected with the cow-box. In April 1795, a general inoculation taking place here, Merritt was inoculated with his family, so that a period of 25 years had elapsed from him having the cow-box to this time. However, though the variolous matter was repeatedly inserted into his arm, I found it impractical to infect him with it, an efflorefcence only, taking on an erifipelitous look about the centre, appearing on the skin near the punctured parts. During the whole time that his family had the small pox, one of whom had it very full, he remained in the houfe with them, but received no injury from expofure to the contagion.
It is neceffary to obferve that the utmost care was taken to accertain with the moft fcrupulous precision that no one whofe cafe is here adduced had gone through the small pox previous to thefe attempts to produce that difeafe had thefe experiments been conducted in a large city Or in a populous neighbourhood, some doubts might have been entertained. But here, where population is thin, and where such an event as a person having had the smallpox is always faithfully recorded, no risk of inaccuracy in this particular can arise. Case Two. Sarah Portlock of this place was infected with the cowpox when a servant at a farmer's in the neighbourhood 27 years ago. footnote, I have Purpofefully Felected Feveral Cafes in which the Difeafe had appeared at a very Diftant Period Previous to the Experiments Made with Varialous Matter, to Few that the change produced in the Constitution is not Affected by Time.
In the year 1792, conceiving herfelf from this circumftance, secure from the infection of the small-pox, she nursed one of her own children, who had accidentally caught the difeafe, but no indifpofition enfued. During the time, she remained in the infected room. Varialous matter was inserted into both her arms, but without any further effect than in the preceding case. Case 3. John Phillips, a tradesman of this town, had the cow-pox at fo early a period as nine years of age. At the age of sixty-two I inoculated him, and was very careful in felecting matter in its moft active ftate. It was taken from the arm of a boy juft before the commencement of the eruptive fever, and inftantly inferted, It very fpeedily produced a sting-like feel in the part.
An efflorefcence appeared, which on the fourth day was rather extensive, and some degree of pain and stiffness were felt about the shoulder. But on the fifth day the fymptoms began to difappear, and in a day or two after went entirely off, without producing any effect on the fytem. Case Four. Mary Barge of Woodford in this Parifh was inoculated with variolous matter in the year 1791. An efflorefcence of a palifh red colour foon appeared about the parts where the matter was inferted, and fpread itfelf rather extenfively, but died away in a few days without producing any variolous fymptoms.
It is remarkable that variolous matter When the system is difpofed to reject it, should excite inflammation on the part to which it is applied more speedily than when it produces the small-pox. Indeed, it becomes almost a criterion by which we can determine whether the infection will be received or not. It seems as if a change, which endures through life, had been produced in the action, or disposition to action, in the vessels of the skin, and it is remarkable too, that whether this change has been affected by the smallpox or the cowpox, that the disposition to sudden cuticular inflammation is the same on the application of varilus matter. End of footnote. She has since been repeatedly employed as a nurse to smallpox patients, without experiencing any ill consequences.
This woman had the cowpox when she lived in the service of a farmer in this parish 31 years before. Case v mrs h a refpedable gentlewoman of this town had the cow pox when very young she received the infection in a manner that is not common it was given by means of her handling fome of the fame utensils which were in ufe among the fervants of her family who had the difeafe from milking infected cows footnote When the cow-pox has prevailed in the dairy, it has often been communicated to those who have not milked the cows by the handle of the milk-pail.
Her hands had many of the cow-pox saws upon them, and they were communicated to her nose, which became inflamed and very much swollen. Foon after this event, Mrs. H. was expofed to the contagion of the smallpox, where it was scarcely poffible for her to have escaped had she been fufceptible of it, as she regularly attended a relative who had the difeafe in fo violent a degree that it proved fatal to him. In the year 1778, the small-pox prevailed very much at Berkeley, and Mrs. H., not feeling perfectly satisfied, refpecting her safety, no indifpofition having followed her expoafure to the small-pox, I inoculated her with active variolous matter. The fame appearance followed as in the preceding cases, an efflorescence on the arm without any effect on the Constitution.
Case Six. It is a fact so well known among our dairy farmers, that those who have had the smallpox either escape the cowpox, or are difpofed to have it slightly, that as soon as the complaint shows itself among the cattle, assistants are procured, if possible, who are thus rendered less susceptible of it, otherwise the business of the farm could scarcely go forwards. In the month of May 1796, the cowpox broke out at Mr. Baker's, a farmer who lives near this place. The disease was communicated by means of a cow which was purchased in an infected state at a neighbouring fair, and not one of the farmers cows, consisting of 30, which were at that time milked escaping the contagion. The family consisted of a man-fervant, two dairy-maids, and a servant-boy, who, with the farmer himself, were twice a day employed in milking the cattle.
The whole of this family, except Sarah Wynne, one of the dairy-maids, had gone through the small-pox. The confequence was that the farmer and the servant boy escaped the infection of the cow-pox entirely, and the servant man and one of the maid-fervants had each of them nothing more than a saw on one of their fingers, which produced no disorder in the system. But the other dairy-maid, Sarah Wynne, who never had the small-pox, did not escape in so easy a manner, She caught the complaint from the cows, and was affected with the symptoms described in the fifth page in so violent a degree that she was confined to her bed, and rendered incapable for several days of pursuing her ordinary vocations in the farm.
March 28th, 1797, I inoculated this girl. and carefully rubbed the varialis matter into two slight incisions made upon the left arm. A little inflammation appeared in the usual manner around the parts where the matter was inserted, but so early as the fifth day it vanished entirely without producing any effect on the system. Case Seven. Although the preceding history pretty clearly evinces that the constitution is far leff fufceptible of the contagion of the cow pox after it has felt that of the small pox and although in general as i have obferved they who have had the small pox and are employed in milking cows which are infeded with the cow pox Either escape the disorder, or have sores on the hands without feeling any general indisposition, yet the animal economy is subject to some variation in this respect, which the following relation will point out.
In the summer of the year 1796, the cowpox appeared at the farm of Mr. Andrews, a considerable dairy adjoining to the town of Barclay. It was communicated, as in the preceding instance, by an infected cow purchased at a fair in the neighbourhood. The family consisted of the farmer, his wife, two sons, a man, and a maid-fervant, all of whom, except the farmer, who was fearful of the consequences, bore a part in milking the cows. The whole of them, exclusive of the man-fervant, had regularly gone through the small-pox, But in this case, no one who milked the cows, escaped the contagion. All of them had sores upon their hands, and some degree of general indifpofition, preceded by pains and tumors in the axillae.
But there was no comparison in the severity of the disease as it was felt by the servant-man, who had escaped the small-pox, and by those of the family who had not For, while he was confined to his bed, they were able, without much inconvenience, to follow their ordinary bufinefs. February 13th, 1797, I availed myfelf of an opportunity of inoculating William Rodway, the servant-man above alluded to. Varialous matter was inserted into both his arms, in the right by means of superficial incisions, and into the left by slight punctures into the cutis. Both were perceptibly inflamed on the third day. After this, the inflammation about the punctures foon died away, but a small appearance of eryfipalus was manifest about the edges of the incisions till the eighth day, when a little uneafinefs was felt for the space of half an hour in the right axilla.
The inflammation then hafedly difappeared without producing the moft distant mark of affection of the fytem. Case Eight. Elizabeth Wynne, aged fifty-seven, lived as a servant with a neighbouring farmer thirty-eight years ago. She was then a dairymaid, and the cow-pox broke out among the cows. She caught the difease with the reft of the family, but, compared with them, had it in a very slight degree. One very small fore only breaking out on the little finger of her left hand, and scarcely any perceptible indifpofition following it. As the malady had fown itfelf in fo slight a manner, and as it had taken place at fo distant a period of her life, I was happy with the opportunity of trying the effects of variolous matter upon her constitution, and on the twenty-eighth of march seventeen ninety-seven I inoculated her by making two fuperficial incisions on the left arm, on which the matter was cautiously rubbed.
A little efflorefcence foon appeared, and a tingling fenfation was felt about the parts where the matter was inserted until the third day, when both began to fubfide, and so early as the fifth day it was evident that no indifpofition would follow. Case, nine, although the cow-pox fhields the conflitution from the small-pox, and the small pox provides a protection against its own future poifon, yet it appears that the human body is again and again fucceptible of the infectious matter of the cow pox, as the following history will demonstrate. William Smith of Perton in this parish contracted this difeafe when he lived with a neighbouring farmer in the year seventeen eighty. One of the horfes belonging to the farm had sore heels, and it fell to his lot to attend him.
By thefe means the infection was carried to the cows, and from the cows it was communicated to smith. On one of his hands were feveral ulcerated fores, and he was affected with fuch fymptoms as have been before defribed. In the year, 1791, the cow-pox broke out at another farm, where he then lived as a servant, and he became affected with it a second time, and in the year 1794 he was fo unfortunate as to catch it again. The difeafe was equally as fevere the second and third time as it was on the first.
This is not the case in general. A second attack is commonly very slight, and so, I am informed, it is among the cows. The reader will find further observations on this subject in the sequel. These repeated indifpofitions must have arisen from the local irritation, and not from the specific action of the vaccine virus.
In the spring, Of the year 1795, he was twice inoculated, but no affection of the Fyflem could be produced from the variolous matter, and he has fince affociated with thofe who had the smallpox in its moft contagious fte without feeling any effect from it. Case X. Simon Nicholls lived as a fervant with Mr. A gentleman who refides on his own farm in this parifh in the year seventeen eighty two he was employed in applying drefings to the fore heels of one of his mafters horfes and at the fame time affisted in milking the cows the cows became affected in confequence but the difeafe did not fhew itfelf on their nipples till several weeks after he had begun to drefs the horfe he quitted mr bromage's fervice and went to another farm without any Fores upon him, but here his hands foon began to be affected in the common way, and he was much indifpofed with the Ufual Fymptoms.
Concealing the nature of the malady from Mr. Cole, his new mafter, and being there alfo employed in milking, the cow pox was communicated to the cows. Foon afterwards, Nicholls was employed in a farm where the small pox broke out, when I inoculated him with several other patients, with whom he continued during the whole time of their confinement. His arm inflamed, but neither the inflammation nor his aflociating with the inoculated family produced the leaft effect upon his constitution. Case Eleven William Stinchcombe was a fellow-fervant with Nichols at Mr. Bromage's farm, at the time the cattle had the cow-fox, and he was unfortunately infected by them. His left hand was very severely affected with several corroding ulcers, and a tumour of confiderable fize appeared in the axilla of that fide.
His right hand had only one small fore upon it, and no tumour difcovered itfelf in the correfponding axilla. In the year seventeen ninety two stinchcomb was inoculated with variolous matter, but no confequences enfued beyond a little inflammation in the arm for a few days. A large party were inoculated at the fame time, some of whom had the difeafe in a more violent degree than is commonly feen from inoculation. He purpofely afociated with them, but could not receive the smallpox. During the fickening of some of his companions, their fymptoms so strongly recalled to his mind his own fate when fickened with the cow-pox that he very pertinently remarked their striking similarity. Case Twelve. The paupers of the village of Tartworth in this county were inoculated by Mr.
Henry Jenner, Surgeon of Berkeley, in the year, 1795, among them, eight patients prefented themselves who had at different periods of their lives had the cow-box. One of them, Hester Walkley, I attended with that disease when she lived in the service of a farmer in the same village in the year 1782. But neither this woman nor any other of the patients who had gone through the cowpox, received the varilus infection either from the arm or from mixing in the society of the other patients who were inoculated at the same time. This state of security proved a fortunate circumftance, as many of the poor women were at the fame time in a state of pregnancy. Case, one instance has occurred to me, of the Fyflem being affected from the matter issuing from the heels of horfes, and of its remaining afterwards unfufceptible of the variolous contagion, another where the smallpox appeared obscurely, and a third in which its complete existence was positively ascertained.
First, Thomas Pearce is the son of a smith and barrier near to this place. He never had the cow-pox, but, in confequence of dressing horses with sore heels at his father's, when a lad, he had sores on his fingers which fupurated, and which occasioned a pretty fevere indifpofition. FIX years afterwards, I inferted variolous matter into his arm repeatedly without being able to produce anything more than a slight inflammation, which appeared very foon after the matter was applied, and afterwards I expofed him to the contagion of the smallpox with as little effect.
It is a remarkable fact, and well known to many, that we are frequently foiled in our endeavours to communicate the small-box by inoculation to blacksmiths, who in the country are farriers. They often, as in the above instance, either refift the contagion entirely, or have the difeafe anomalously. Shall we not be able now to account for this on a rational principle?
Case Fourteen. Secondly, Mr. James Cole, a farmer in this parish, had a difeafe from the fame fource as related in the preceding case, and fome years after was inoculated with variolous matter. He had a little pain in the axilla, and felt a slight indifpofition for three or four hours. A few eruptions fowed themfelves on the forehead, but they very foon difappeared without advancing to maturation. Case Fifteen. Although in the two former instances the system seemed to be secured, or nearly so, from varilus infection, by the absorption of matter from sores produced by the diseased heels of horses, yet the following case renders it probable that this cannot be entirely relied upon until a disease has been generated by the morbid matter from the horse on the nipple of the cow, and passed through that medium to the human subject.
The succeeding part will give further explanation of this subject. and a footnote. Mr. Abraham Ridderford, a farmer at Stone in this Parif, in Confequence of Dressing a mare that had Faw heels, was Affedded with very painful Faws in both his hands, Tumours in each Axilla, and Fever and General Indifpofition. A Furgeon in the neighbourhood attended him, who, Knowing the similarity between the appearance of the Fores upon his hands and those produced by the cow pox, and being acquainted also with the effects of that disease on the human constitution, assured him that he never need to fear the infection of the small pox. But this assertion proved fallacious, for, on being exposed to the infection upwards of twenty years afterwards, he caught the disease, which took its regular course in a very mild way.
There certainly was a difference perceptible, although it is not Eafly to Defcribe it, in the general appearance of the Pustules from that which we commonly fee. Other practitioners who visited the patient at my request agreed with me in this point, though there was no room left for Fufmition as to the reality of the Difeafe, as I inoculated some of his family from the Pustules who had the smallpox, with the Ufual appearances in Confequence. Case Sixteen Sarah Nelms, a dairymaid at a farmers near this place, was infected with the cow-box from her master's cows in May 1796. She received the infection on a part of the hand which had been previously in a slight degree injured by a scratch from a thorn.
A large pustular sore, and the usual symptoms accompanying the disease were produced in confequence. The puftule was fo expreffive of the true character of the cow pox as it commonly appears upon the hand that i have given a representation of it in the annexed plates. The two small puftules on the wrist arose alfo from the application of the virus to fome minute abrasions of the cuticle. But the livid tint, if they ever had any, was not confpicuous at the time I saw the patient. The pustule on the forefinger fows the difeafe in an earlier stage. It did not actually appear on the hand of this young woman, but was taken from that of another, and is annexed for the purffe of reprefenting the malady after it has newly appeared.
Case 17. The more accurately to obferve the progrefs of the infeclion, I selected a healthy boy about eight years old for the purpose of inoculation for the cow-pox. The matter was taken from a saw on the hand of a dairy-maid. From the saw on the hand of Sarah Nelms, see the preceding case and the plate.
Who was infected by her mafters cows? And it was inserted, on the 14th of May, 1796, into the arm of the boy by means of two superficial incisions, barely penetrating the cutis, each about half an inch along. On the seventh day he complained of uneasiness in the axilla, and on the ninth he became a little chilly, lost his appetite, and had a slight headache. During the whole of this day he was perceptibly indifpofed, and spent the night with some degree of reftlefnefs, but on the day following he was perfectly well. The appearance of the incifions in their progress to a state of maturation were much the fame as when produced in a similar manner by variolous matter.
This appearance was in great meafure new to me, And I ever shall recollect the pleasing sensations it excited, as, from its similarity to the pustule produced by Varialus Inoculation, it incontestably pointed out the close connection between the two diseases, and almost anticipated the result of my future experiments.
The only difference which i perceived was in the ftate of the limpid fluid arising from the action of the virus which affumed rather a darker hue and in that of the efflorefents fpreading round the incifions which had more of an eryfipelatous look than we commonly perceive when varialous matter has been made ufe of in the fame manner but the whole died away leaving on the inoculated parts fcabs and fubfcquent efchars Without giving me, or my patient, the leafl trouble. In order to accertain whether the boy, after feeling fo flight an affedtion of the fyftem from the cow-pox virus, was fecure from the contagion of the small-pox, he was inoculated the first of july following with variolous matter, immediately taken from a puftule.
Several slight punctures and incifions were made on both his arms, and the matter was carefully inferted, but no difeafe followed. The fame appearances were observable on the arms as we commonly fee when a patient has had variolous matter applied, after having either the cow pox or the small pox. Several months afterwards he was again inoculated with variolous matter, but no fensible effect was produced on the constitution. Here my researches were interrupted till the spring of the year seventeen ninety eight when from the wetnefs of the early part of the feafon many of the farmers'horfes in this neighbourhood were affected with fore heels in confequence of which the cow pox broke out among several of our dairies which afforded me an opportunity of making further obfervations upon this curious difeafe A mayor, in the property of a person who keeps a dairy in a neighbouring parish, began to have sore heels the latter end of the month of February, 1798, which were occasionally washed by the servant-men of the farm.
Thomas Virgo, William Werrett, and William Haynes, who, in consequence, became affected with sores in their hands, Followed by inflamed lymphatic glands in the arms and axillae, shivering, fucceeded by heat, lassitude, and general pains in the limbs. A single paroxysm terminated the difeafe, for within twenty-four hours they were free from general indisposition, nothing remaining but the sores on their hands. Haynes and Virgo, who had gone through the smallpox from inoculation, Defrived their feelings as very similar to those which affected them on fickening with that malady. Where it never had had the small pox. Haynes was daily employed as one of the milkers at the farm, and the difeafe began to fhew itself among the cows about ten days after he firft affisted in washing the mare's heels.
Their nipples became fawre in the ufual way with bluish pustules, But as remedies were early applied, they did not alterate to any extent. Case 18. John Baker, a child of five years old, was inoculated March 16, 1798, with matter taken from the pustule on the hand of Thomas Virgo, one of the servants who had been infected from the mare's heels. He became ill on the sixth day, with symptoms similar to those excited by cow-pox matter. On the eighth day he was free from indisposition. There was fome variation in the appearance of the puftule on the arm. Although it fomewhat resembled a small-pox puftule, yet its similitude was not fo confpicuous as when excited by matter from the nipple of the cow, or when the matter has paft from thence through the medium of the human fubject.
See plate number two. This experiment was made to ascertain the progress and subsequent effects of the disease when thus propagated. We have seen that the virus from the horse, when it proves infectious to the human subject, is not to be relied upon as rendering the system secure from varilous infection, but that the matter produced by it on the nipple of the cow is perfectly so. Whether its passing from the horse through the human constitution, as in the present instance, will produce a similar effect remains to be decided. This would now have to be effected, but the boy was rendered unfit for inoculation from having felt the effect of a contagious fever in a workhouse, soon after this experiment was made.
Case 19. William Summers. A child of five years and a half old, was inoculated the same day with Baker, with matter taken from the nipples of one of the infected cows at the farm alluded to in page 32. He became indisposed on the sixth day, vomited once, and felt the usual slight symptoms till the eighth day, when he appeared perfectly well. The progress of the pustule formed by the infection of the virus was similar to that noticed in case 17, with this exception, its being free from the livid tint observed in that instance. Case 20. From William Summers, the disease was transferred to William Peade, a boy of eight years old, who was inoculated March 28th. On the sixth day he complained of pain in the axilla, and on the seventh was affected with the common symptoms of a patient sickening with the smallpox from inoculation, which did not terminate till the third day after the seizure.
So perfect was the similarity to the varialus fever that I was induced to examine the skin, conceiving there might have been some eruptions, but none appeared. The efflorefcent blush around the part punctured in the boy's arm was fo truly characteriftick of that which appears on variolous inoculation that I have given a representation of it. The drawing was made when the puflule was beginning to die away, and the areola retiring from the centre. See, plate number three, case twenty-one, April Fifth, Several children and adults were inoculated from the arm of William Pead. The greater part of them fickened on the sixth day, and were well on the seventh, but in three of the number a secondary indifpofition arose in confequence of an extensive eryfipelatous inflammation which appeared on the inoculated arms.
It seemed to arise from the state of the pustule, which spread out, accompanied with some degree of pain, to about half the diameter of a sixpence. One of these patients was an infant of half a year old. By the application of mercurial ointment to the inflamed parts, a treatment recommended under similar circumstances in the inoculated smallpox, the complaint subsided without giving much trouble. Hannah XL, A healthy girl of seven years old, and one of the patients above mentioned, received the infection from the insertion of the virus under the cuticle of the arm in three distinct points. This was not done intentionally, but from the accidental touch of the point of the lancet, one puncture being always sufficient.
The puftules which arose in confequence so much resembled on the ninth day, thofe appearing from the infertion of variolous matter, that an experienced inoculator would scarcely have difcovered a fhade of difference at that period. Experience now tells me that Almost the only variation which follows consists in the pustulous fluids remaining limpid nearly to the time of its total disappearance, and not, as in the direct smallpox, becoming purulent. See plate number four. Case 22. From the arm of this girl, matter was taken and inserted April 12th into the arms of John Marklove, one year and a half old, Robert F. Jenner , Mary Pede , and Mary James . Among these, Robert F. Jenner did not receive the infection.
The arms of the other three inflamed properly, and began to affect the system in the usual manner. But being under fome apprehensions from the preceding cases that a troublfome erycipalus might arise, I determined on making an experiment with the view of cutting off its source. Accordingly, on the eighth day, after the patients had felt an indifpofition that was just perceptible, of about twelve hours, I applied in two of these cases out of the three, on the vesicle formed by the virus, a little mild caustic, composed of equal Perhaps a few touches with the lapis septicus would have proved equally. It seemed to give the children but little uneasiness, and effectually answered my intention in preventing the appearance of erysipelous.
Indeed, it seemed to do more, for in half an hour after its application, the indisposition of the children ceased. Footnote. What effect would a similar treatment produce in inoculation for the smallpox?
These precautions were perhaps unnecessary, as the arm of a third child, Mary Pede, which was suffered to take its common course, scabbed quickly, without any erysipelas. Footnote. The fubfquent part of this treatise will fufficiently fhew the proper practice in cafes of inflammation of the inoculated arm.
Case twenty three from this child's arm matter was taken and transferred to that of j barge, a boy of seven years old. He fickened on the eighth day, went through the difeafe with the ufual slight fymptoms, and without any inflammation on the arm beyond the common efflorescence surrounding the pustule, an appearance so often seen in inoculated smallpox. After the many fruitless attempts to give the small-pox to those who had had the cow-pox, it did not appear neceffary, nor was it convenient to me, to inoculate the whole of those who had been the fubjects of these late trials, yet I thought it right to fee the effects of varialous matter on fome of them, particularly William Summers, the firft of these patients, who had been infedted with matter taken from the cow, He was therefore inoculated with variolous matter from a fresh puftule, but, as in the preceding cases, the fyftem did not feel the effects of it in the smallest degree.
I had an opportunity also of having this boy, Barge, and William Pede inoculated by my nephew, Mr. Henry Jenner, whofe report to me is as follows, I have inoculated, peed and barge, two of the boys whom you lately infected with the cowpox. On the second day the incisions were inflamed, and there was a pale inflammatory stain around them. On the third day these appearances were still increasing, and their arms itched considerably. On the fourth day the inflammation was evidently subsiding, and on the sixth it was scarcely perceptible. No symptom of indispofition followed. To convince myfelf that the variolous matter made ufe of was in a perfect fteat i at the fame time inoculated a patient with fome of it who had never gone through the cow pox and it produced the small pox in the ufual regular manner."
These experiments afforded me much satisfaction. They proved that the matter in passing from one human subject to another through five graduations lost none of its original properties, Jay Barge being the fifth who received the infection successively from William Summers, the boy to whom it was communicated from Macau. I shall now conclude this inquiry with some general observations on the subject, and on some others which are interwoven with it. Although I presume it may be unnecessary to produce further testimony in support of my assertion, quote, that the cowpox protects the human constitution from the infection of the smallpox, end quote, yet it affords me considerable satisfaction to say that Lord Somerville, the President of the Board of Agriculture, to whom this paper was shown by Sir Joseph Banks, has found upon inquiry that the statements were confirmed by the concurring testimony of Mr.
Dollin, a surgeon who resides in a dairy country remote from this, in which these observations were made. With respect to the opinion adduced, quote, that the source of the infection is a peculiar, morbid matter arising in the horse, end quote, although I have not been able to prove it from actual experiments conducted immediately under my own eye, yet the evidence I have adduced appears sufficient to establish it. They who are not in the habit of conducting experiments may not be aware of the coincidence of circumstances necessary for their being managed so as to prove perfectly decisive, nor how often men engaged in professional pursuits are liable to interruptions which disappoint them almost at the instant of their being accomplished.
However, I feel no room for hesitation respecting the common origin of the disease, being well convinced that it never appears among the cows, except it can be traced to a cow introduced among a general herd which has been previously infected, or to an infected servant, unless they have been milked by someone who, at the same time, has the care of a horse affected with diseased heels. The spring of the year 1797, which I intended particularly to have devoted to the completion of this investigation, proved, from its dryness, remarkably adverse to my wishes, for it frequently happens, while the farmers' horses are exposed to the cold rains which fall at that season, that their heels become diseased, and no cowpox then appears in the neighbourhood.
The active quality of the virus from the horfes heels is greatly increased after it has acted on the nipples of the cow, as it rarely happens that the horfe affects his drefsler with fores, and as rarely that a milkmaid efcapes the infection when she milks infected cows. It is moft active at the commencement of the difeafe, even before it has acquired a puf like appearance. Indeed, I am not confident whether this property the matter does not entirely cease as soon as it is secreted in the form of pus. I am induced to think it does cease, and that it is the thin, darkish looking fluid only, oozing from the newly formed cracks in the heels, similar to what sometimes appears from the eryfipelatus blisters, which gives the disease.
It is very easy to procure pus from old sores on the heels of horses. This I have often inserted into scratches made with a lancet on the sound nipples of cows, and have seen no other effects from it than simple inflammation.
Nor am I certain that the nipples of the cows are at all times in a state to receive the infection. The appearance of the disease in the spring and the early part of the summer, when they are difpofed to be effected with spontaneous eruptions so much more frequently than at other seasons, induces me to think that the virus from the horse must be received upon them when they are in this state, in order to produce effects. Experiments, however, must determine these points. But it is clear that when the cow pox virus is once generated, that the cows cannot refift the contagion in whatever state their nipples may chance to be if they are milked with an infected hand. Whether the matter, either from the cow or the horse, will affect the found skin of the human body, I cannot positively determine.
Probably it will not, unless on those parts where the cuticle is extremely thin, as on the lips for example. I have known an instance of a poor girl who produced an ulceration on her lip by frequently holding her finger to her mouth to cool the raging of a cow-pox-faw by blowing upon it. The hands of the farmer's fervants here, from the nature of their employment, are constantly expofed to thofe injuries which occafion abrasions to the cuticle, to punctures from thorns and fuch like accidents, so that they are always in a fate to feel the confequences of expofure to infectious matter. It is fingular to obferve that the cow pox virus, Although it renders the Constitution unfurceptible of the variolus, should, nevertheless, leave it unchanged with respect to its own action.
I have already produced an instance to point this out, and shall now corroborate it with another. Elizabeth Wynne, who had the cowpox in the year 1759, was inoculated with varialis matter without effect in the year 1797, and again caught the cowpox in the year 1798. When I saw her, which was on the eighth day after she received the infection, I found her affected with general lassitude, shiverings, alternating with heat. coldness of the extremities, and a quick and irregular pulse. These symptoms were preceded by a pain in the axilla. On her hand was one large pustulous sore, which resembled that delineated in plate number one. Footnote. As I have before observed, these symptoms probably arose from the irritation of the sore, which was very painful.
It is curious also to observe that the virus which with refped to its efleds is undetermined and uncertain previous to its passing from the horfe through the medium of the cow. Further observations will be adduced on this subject. Should then not only become more active, but should invariably and completely poffef those specific properties which induce in the human constitution symptoms similar to those of the variolous fever, and effect in it that peculiar change which forever renders it unfufceptible of the variolous contagion. May it not then be reasonably conjectured that the fource of the small-pox is morbid matter of a peculiar kind generated by a difeafe in the horfe, and that accidental circumstances may have again and again arifen, still working new changes upon it, until it has acquired the contagiof and malignant form under which we now commonly fee it making its devaftations amonft us?
from a confideration of the change which the infectious matter undergoes from producing a difeafe on the cow may we not conceive that many contagious difeafes now prevalent amongft us may owe their prefent appearance not to a fimple but to a compound origin for example is it difficult to imagine that the meafles the scarlet fever and the ulcerous fore throat with a fpotted flin have all fprung from the fame fauce Affuming some variety in their forms according to the nature of their new combinations, the same question will apply respecting the origin of many other contagious diseases which bear a strong analogy to each other. There are certainly more forms than one without considering the common variation between the confluent and distinct in which the smallpox appears in what is called the natural way.
About seven years ago, a species of smallpox spread through many of the towns and villages of this part of Gloucester-shire. It was of so mild a nature that a fatal instance was scarcely ever heard of, and consequently so little dreaded by the lower orders of the community, that they fcupled not to hold the fame intercourse with each other as if no infectious disease had been prefent among them. I never saw nor heard an instance of its being confluent. The most accurate manner, perhaps, in which I can convey an idea of it is, by Faying, that had fifty individuals been taken promifcuously and infected by Expofure to this contagion, they would have had as mild and light a difeafe as if they had been inoculated with variolous matter in the Ufual way.
The harmlofs manner in which it fhowed itfelf could not arife from any peculiarity either in the feafon or the weather for i watched its progrefs upwards of a year without perceiving any variation in its general appearance i confider it then a variety of the small box Footnote. My friend, Dr. Hicks, of Bristol, who, during the prevalence of this distemper, was resident at Gloucester, and physician to the hospital there, where it was seen soon after its first appearance in this country, had opportunities of making numerous observations upon it, which it is his intention to communicate to the public. End of footnote. In fome of the preceding cafes i have noticed the attention that was paid to the ftate of the variolous matter previous to the experiment of inferting it into the arms of thofe who had gone through the cow pox this i conceived to be of great importance in conducting thefe experiments and were it always properly attended to by thofe who inoculate for the small pox it might prevent much fubfequent mifchief and confufion With the view of enforcing fo neceffary a precaution, I shall take the liberty of digreffing so far as to point out fome unpleasant facts, relative to mifmanagement in this particular, which have fallen under my own obfervation.
A medical gentleman, now no more, who for many years inoculated in this neighbourhood frequently preserved the varialous matter intended for his use on a piece of lint or cotton which in its fluid state was put into a vial, corked, and conveyed into a warm pocket, a situation certainly favourable for speedily producing putrefaction in it. in this fate not unfrequently after it had been taken several days from the puftules it was inferted into the arms of his patients and brought on inflammation of the incized parts, fwellings of the axillary glands, fever and fometimes eruptions. But what was this disease? Certainly not the smallpox, for the matter having from putrefaction lost or suffered a derangement in its specific properties was no longer capable of producing that malady, those who had been inoculated in this manner being as much subject to the contagion of the smallpox as if they had never been under the influence of this artificial disease.
And many, unfortunately, fell victims to it, who thought themselves in perfect security. The same unfortunate circumstance of giving a disease supposed to be the smallpox with inefficacious variolous matter, having occured under the direction of some other practitioners within my knowledge, and probably from the same incautious method of fecuring the variolous matter, I avail myself of this opportunity of mentioning what I conceive to be of great importance, and, as a further cautionary hint, I shall again digrefs so far as to add another observation on the subject of inoculation. whether it be yet afferftained by experiment that the quantity of variolous matter inserted into the flin makes any difference with refpect to the fubfequent mildnefs or violence of the difeafe i know not but i have the ftrongeft reason for fuppofing that if either the punctures or incifions be made fo deep as to go through it and wound the adipof membrane that the rifk of bringing on a violent difeafe is greatly increafed I have known an inoculator, whofe practice was, to cut deep enough, to use his own expreffion, to see a bit of fat, and there to lodge the matter.
The great number of bad cafes, independent of inflammations and abfceffes on the arms, and the fatality which attended this practice was almost inconceivable, and I cannot account for it on any other principle than that of the matter being placed in this situation, inftead of the skin. It was the practice of another whom i well remember to pinch up a small portion of the skin on the arms of his patients and to paff through it a needle with a thread attached to it previously dipped in variolous matter. The thread was lodged in the perforated parts and confequently left in contact with the cellular membrane. This practice was attended with the fame ill fuccefs as the former. although it is very improbable that any one would now inoculate in this rude way by design, yet these observations may tend to place a double guard over the lancet when infants whose skins are comparatively so very thin fall under the care of the inoculator.
A very refpedable friend of mine, Dr. Hardwick, of Sodbury in this county, inoculated great numbers of patients previous to the introduction of the more modern method by Futton, and with Fuch Fucceff that a fatal infiance occurred as rarely as fince that method has been adopted. It was the doctor's practice to make as flight an incifion as poffible upon the Fkin, and there to lodge a thread Faturated with the variolous matter. When his patients became indifpofed, agreeably to the cuftom then prevailing, they were directed to go to bed, and were kept moderately warm. Is it not probable then, that the fuccefs of the modern practice may depend more upon the method of invariably depositing the virus in or upon the fkin, than on the fubfquent treatment of the difeafe?
I do not mean to insinuate that exposure to cool air and suffering the patient to drink cold water when hot and thirsty may not moderate the eruptive symptoms, and lessen the number of postules. Yet, to repeat my former observation, I cannot account for the uninterrupted success, or nearly so, of one practitioner, and the wretched state of the patients under the care of another, where in both instances the general treatment did not differ essentially, without conceiving it to arise from the different modes of inserting the matter for the purpose of producing the disease. As 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 body may prepare or modify the virus differently?
Although the skin, for example adipose membrane or mucose membranes, are all capable of producing the varialus virus by the stimulus given by the particles originally deposited upon them, yet I am induced to conceive that each of these parts is capable of producing some variation in the qualities of the matter previous to its affecting the constitution. What else can confititute the difference between the small-pox when communicated cafually or in what has been termed the natural way or when brought on artificially through the medium of the skin? After all, are the variolous particles possessing their true, specific and contagious principles ever taken up and conveyed by the lymphatics unchanged into the blood-veffels?
I imagine not. Were this the case, should we not find the blood sufficiently loaded with them in some stages of the smallpox to communicate the disease by inserting it under the cuticle, or by spreading it on the surface of an ulcer? Yet experiments have determined the impracticality of its being given in this way, although it has been proved that varialis matter, when much diluted with water, and applied to the skin in the usual manner, will produce the disease. but it would be digreffing beyond a proper boundary to go minutely into this fubject here. At what period the cow-pox was first noticed here is not upon record. Our oldest farmers were not unacquainted with it in their earliest days, when it appeared among their farms without any deviation from the phenomena which it now exhibits.
Its connection with the small-pox seems to have been unknown to them, Probably the general introduction of inoculation first occasioned the discovery. Its rise in this country may not have been of very remote date, as the practice of milking cows might formerly have been in the hands of women only, which I believe is the case now in some other dairy countries, and consequently that the cows might not in former times have been exposed to the contagious matter brought by the men-servants from the heels of horses. Indeed, a knowledge of the source of the infection is new in the minds of the of most of the farmers in this neighbourhood, but has at length produced good consequences, and it seems probable from the precautions they are now disposed to adopt, that the appearance of the cowpox here may be either entirely extinguished or become extremely rare.
Should it be asked whether this investigation be a matter of mere curiosity, or whether it tend to any beneficial purpose, I should answer that, notwithstanding the happy effects of inoculation, with all the improvements which the practice has received since its first introduction into this country, it not very unfrequently produces deformity of the skin, and sometimes, under the best management, proves fatal. These circumstances must naturally create in every instance some degree of painful solicitude for its consequences. But as I have never known, fatal effects arise from the cow-pox, even when impressed in the most unfavorable manner, producing extensive inflammations and fupurations on the hands, And as it clearly appears that this difeafe leaves the constitution in a state of perfect fecurity from the infection of the small pox, may we not infer that a mode of inoculation may be introduced preferable to that at prefent adopted, especially among those families which, from previous circumstances, we may judge to be predifpofed to have the difeafe unfavourably.
It is an excefs in the number of puftules which we chiefly dread in the small pox but in the cow pox no puftules appear nor does it feem poffible for the contagious matter to produce the difeafe from effluvia or by any other means than contact and that probably not fimply between the virus and the cuticle so that a fingle individual in a family might at any time receive it without the rifk of infecting the reft or of spreading a distemper that fills a country with terror. Several instances have come under my observation, which justify the assertion that the disease cannot be propagated by effluvia. The first boy whom I inoculated with the matter of cowpox slept in a bed while the experiment was going forward with two children who never had gone through either that disease or the smallpox without infecting either of them.
A young woman who had the cow-pox to a great extent, several sores which maturated having appeared on the hands and wrifts, slept in the fame bed with a fellow dairymaid who never had been infected with either the cow-pox or the small-pox, but no indifpofition followed. Another instance has occurred of a young woman on whofe hands were feveral large fuppurations from the cow-box who was at the fame time a daily nurfe to an infant but the complaint was not communicated to the child in fome other points of view the inoculation of this difeafe appears preferable to the variolous inoculation in conflituions predifpofed to fcrofula how frequently we fee the inoculated small-pox rouse into activity that diftreffful malady This circumftance does not feem to depend on the manner in which the diftemper has fown itfelf for it has as frequently happened among thofe who have had it mildly as when it has appeared in the contrary way there are many who from some peculiarity in the habit resist the common effects of variolous matter inserted into the skin, and who are in consequence haunted through life with the distressing idea of being insecure from subsequent infection.
A ready mode of dissipating anxiety originating from such a cause must now appear obvious. and as we have feen that the conflitution may at any time be made to feel the febril attack of cow pox might it not in many chronic difeafes be introduced into the fyftem with the probability of affording relief upon well-known physiologic principles footnote inoculation in a common way upon the arm will feldom produce this effect. When the difeafe takes place among the dairy people, the virus comes in contact with pre-existing sores, which does not fail to produce an irritation that affects the system generally.
Although I fay the fyltem may at any time be made to feel the febril attack of cow pox, yet I have a fingle infiance before me where the virus acted locally only, but it is not in the leafl probable that the fame perfon would refift the action both of the cow pox virus and the baryolus. Elizabeth Sarzenet lived as a dairymaid at New Park Farm in this Parifh. All the cows and the servants employed in milking had the cow-pox, but this woman, though she had several Fores upon her fingers, felt no tumours in the axillae, nor any general indifpofition. On being afterwards cafually expofed to variolous infection, she had the small-pox in a mild way. This will be more satisfactorily explained in the sequel.
Hannah Pick. Another of the dairymaids, who was a fellow-fervant with Elizabeth Sarsnett, when the distemper broke out at the farm, was at the same time infected, but this young woman had not only saws upon her hands, but felt herself also much indisposed for a day or two. After this I made several attempts to give her the smallpox by inoculation, but they all proved fruitless. From the former case, then, we see that the animal economy is subject to the same laws in one disease as the other. The following case, which has very lately occurred, renders it highly probable that not only the heels of the horse, but other parts of the body of that animal are capable of generating the virus which produces the cowpox.
An extensive inflammation of the erycipelatus kind appeared without any apparent cause. upon the upper part of the thigh of a fuccing colt, the property of Mr. Millett, a farmer at Rockhampton, a village near Berkley. The inflammation continued several weeks, and at length terminated in the formation of three or four small abffffes. The inflamed parts were fermented, and drefings were applied by some of the fame perfons who were employed in milking the cows. The number of cows milked was twenty-four, and the whole of them had the cow pox. The milkers, consisting of the farmer's wife, A man and a maid-fervant were infedded by the cows. The man-fervant had previously gone through the small-pox, and felt but little of the cow-pox.
The servant-maid had some years before been infedded with the cow-pox, and she also felt it now in a slight degree. But the farmer's wife, who never had gone through either of these diseases, felt its effects very severely. That the difeafe produced upon the cows by the colt and from thence conveyed to thofe who milked them was the true and not the fpurious cow pox there can be fcarcely any room for fufpicion yet it would have been more completely satisfactorj had the effects of variolous matter been ascertained on the farmer's wife but there was a peculiarity in her fituation which prevented my making the experiment Thus far I have proceeded in an enquiry founded, as it muft appear, on the bafis of experiment, in which, however, conjecture has been occasionally admitted, in order to prefent to perfons well-fituated for such discussions, Objects for a more minute investigation.
In the meantime, I shall myself continue to prosecute this inquiry, encouraged by the pleasing hope of its becoming essentially beneficial to mankind.
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2 02 - Further Observations on the Variolae Vaccinae, Part 1 40:13
Publication Two. Further Observations on the Varielly Vaccini. Part One. Advertisement. The foregoing pages contain the whole of my first treatise on the Verioli Vaccini, published in June 1798. The importance of the inquiry to the whole human race naturally excited universal attention. Ingenuity and Induftry were fet in motion, but as physiological difcuffions are ever liable to error from the complicated nature of their character, I foon clearly perceived that this theory, fo beneficial to mankind, was liable to fall into difrefpute, and to be wholly difcredited by the force of hafty conclusions unfounded on experiment. To guard the public mind from prejudice, and to enforce the necessity of a scrupulous precaution in the conduct of inoculation with vaccine matter, I was induced to offer the world further observations on the disease, which were published in the beginning of the year 1799.
These treatises I have here combined, together with some additions, which the continuance of the inquiry has enabled me to submit to the public. Further observations, etc., etc. Although it has not been in my power to extend the inquiry into the causes and effects of the Verioli Vaccini much beyond its original limits, yet, perceiving that it is beginning to excite a general spirit of investigation, I think it of importance, without delay, to communicate such facts as have since occurred, and to point out the fallacious sources from whence a disease resembling the true Verioli Vaccini might arise. with the view of preventing those who may inoculate from producing a fpurious disease, and further to enforce the precaution suggested in the former treatise on the subject of fubduing the inoculated pustule as foon as it has fufficiently produced its influence on the constitution.
From a want of due discrimination of the real existence of the disease, either in the brute or in the human subject, and also of that stage of it in which it is capable of producing the change in the animal economy which renders it unsusceptible of the contagion of the smallpox, unpleasant consequences might ensue, the source of which, perhaps, might not be suspected by one inexperienced in conducting such experiments. My late publication contains a relation of most of the facts which had come under my own inspection at the time it was written. Interferfed with some conjectural observations. Since then, Dr. G. Pearson has established an inquiry into the validity of my principal assertion, the result of which cannot but be highly flattering to my feelings.
It contains not a single case which I think can be called an exception to the fact I was so firmly impressed with, that the cowpox protects the human body from the smallpox. I have myfelf received some further confirmations which shall be fubjoined. I have lately also been favoured with a letter from a gentleman of great refpecability, Dr. Ingenhuis, Informing me that, on making an inquiry into the subject in the county of Wiltshire, he discovered that a farmer near Caen had been infected with the smallpox after having had the cowpox, and that the disease in each instance was so strongly characterized as to render the facts incontrovertible. The cow-pox, it seems, from the doctor's information, was communicated to the farmer from his cows at the time that they gave out an offensive stench from their udders.
Some other instances have likewise been represented to me of the appearance of the difeafe, apparently marked with its characteriftic fymptoms, and yet that the patients have afterwards had the smallpox. On these cases I shall, for the present, suspend any particular remarks, but I hope that the general observations I have to offer in the sequel will prove of sufficient weight to render the idea of their ever having had existence, but as cases of spurious cow-pox, extremely doubtful. Ere I proceed, let me be permitted to obferve that truth, in this and every other physiological inquiry that has occupied my attention, has ever been the object of my pursuit, and should it appear in the prefent infiance that I have been led into error, fond as I may appear of the offspring of my labours, I had rather see it perish at once, than exist and do a public injury.
I shall proceed to enumerate the sources, or what appear to me as such, of a fpurious cow-pox. First, that arising from pustules on the nipples or udder of the cow, which pustules contain no specific virus. Second, from matter, although originally possessing the specific virus, which has suffered a decomposition, either from putrefaction, or from any other cause less obvious to the senses. Thirdly, from matter taken from an ulcer in an advanced stage, which ulcer arose from a true cow-pock. Fourthly, from matter produced on the human skin from contact with some peculiar morbid matter generated by a horse. On these subjects I shall offer some comments. First, To what length puftulous diseases of the udder and nipples of the cow may extend, it is not in my power to determine, but certain it is that these parts of the animal are fubject to fome variety of maladies of this nature, and as many of these eruptions, probably all of them, are capable of giving a difeafe to the human body, Would it not be discrete for those engaged in this investigation to suspend controversy and cavil until they can ascertain with precision what is and what is not the genuine cowpox?
For example, A farmer who is not converfant with any of these maladies, but who may have heard of the cow-pox in general terms, may acquaint a neighbouring furgeon that the diftemper appears at his farm. The furgeon, eager to make an experiment, takes away matter, inoculates, produces a sore, uneafiness in the axilla, and perhaps some affection of the system. This is a way in which a fallacious idea of fecurity both in the mind of the inoculator and the patient may arife, for a difeafe may thus have been propagated from a fimple irruption only. One of the firft objects then of this purfuit as i have obferved fhould be to learn how to diftinguifh with accuracy between that peculiar puftule which is the true cow-pock and that which is fpurious Until experience has determined this, we view our object through a mift.
Let us for instance fuppose that the small-pox and the chicken-pox were at the fame time to fpread among the inhabitants of a country which had never been vifited by either of thefe diftempers, and where they were quite unknown before. What confufion would arife? The resemblance between the fymptoms of the eruptive fever and between the pustules in either case would be fo striking that a patient who had gone through the chicken pox to any extent would feel equally eafy with regards to his future fecurity from the small pox as the perfon who had actually passed through that difeafe time and future obfervation would draw the line of diftinction So I presume it will be with the cow-pox, until it is more generally understood.
All cavilling, therefore, on the mere report of those who tell us they have had this distemper, and are afterwards found to be susceptible of the small-pox, should be fufpended. To illustrate this, I beg leave to give the following history. Sarah Merlin, of the Parifh of Eaftington in this county, when about thirteen or fourteen years of age, lived as a servant with farmer Clark, who kept a dairy, consisting of about eighteen cows, at Stonehouse, a neighbouring village. The nipples and udders of three of the cows were extensively affected with large white blisters, These cows the girl milked daily, and at the same time she assisted with two others in milking the rest of the herds. It soon appeared that the disease was communicated to the girl.
The rest of the cows escaped the infection, although they were milked several days after the three above specified had these eruptions on the nipples and udders, and even after the girl's hand became sore. The two others who were engaged in milking, although they milked the cows indifcriminately, received no injury. On the fingers of each of the girls hands there appeared several large white blisters. She fuppofes about three or four on each finger. The hands and arms inflamed and fwelled, but no conftitutional indifpofition followed. The sores were anointed with fome domestic ointment, and got well without ulcerating. As this malady was called the cow-pox, and recorded as fuch in the mind of the patient, she became regardlefs of the small-pox, but on being expofed to it fome years afterwards, she was infedted and had a full burthen.
Now, had any one conversant with the habits of the disease heard this history, they would have had no hesitation in pronouncing it a case of spurious cow-pox, considering its deviation in the numerous blisters which appeared on the girls' hands. their termination without ulceration, its not proving more generally contagious at the farm, either among the cattle or thofe employed in milking, and considering alfo that the patient felt no general indifpofition, although there were fo great a number of veficles. This is perhaps the most deceptious form in which an eruptive disease can be communicated from the cow, and it certainly requires some attention in discriminating it. The most perfect criterion by which the judgment may be guided is perhaps that adopted by those who attend infected cattle.
These white blisters on the nipples, they say, never eat into the flefhy parts like those which are commonly of a bluish cast, and which constitute the true cow-pox, but that they affect the skin only quickly end in fcabs and are not nearly fo infectious. That which appeared to me as one cause of fpurious eruptions, I have already remarked in the former treatise, namely the transition that the cow makes in the spring from a poor to a nutritious diet, and from the udders becoming at this time more vascular than usual for the supply of milk. but there is another fauce of inflammation and puftules which i believe is not uncommon in all the dairy counties in the weft of england a cow intended to be expofed for sale Having naturally a small udder, is previously for a day or two neither milked artificially nor is her calf suffered to have access to her.
Thus the milk is preternaturally accumulated, and the udder and nipples become greatly distended. The consequences frequently are inflammation and eruptions, which maturate. Whether a difeafe generated in this way has the power of affecting the constitution in any peculiar manner, I cannot presume positively to determine. It has been conjectured to have been a cause of the true cow-pox, though my enquiries have not led me to adopt this supposition in any one instance. On the contrary, I have known the milkers affected by it, but always found that an affection thus induced left the system as susceptible of the small-pox as before. What is advanced in my second position I consider also of very great importance, and I could wish to be strongly impressed on the minds of all who may be difpofed to conclude haftily on my observations, whether engaged in their investigation by experiments or not, To place this in its cleareft point of view, as the familiarity between the action of the small-pox and the cow-pox matter is fo obvious, it will be neceffary to confider what we fometimes obferve to take place in inoculation for the small-pox when imperfect variolous matter is made ufe of.
The concise history on this subject that was brought forward respecting what I had observed in this neighbourhood, I perceive by a reference since made to the memoirs of the Medical Society of London, may be considered as no more than a corroboration of the facts very clearly detailed by Mr. Footnote. See an account of some anomalous appearances consequent to the inoculation of the smallpox by Charles Kite, surgeon, of Gravesend, in the Memoirs of the Medical Society of London, Volume 4, Page 114. To this copious evidence I have to add still more in the following communications from Mr. Earle, Surgeon, of Frampton-upon-Severn, in this county, which I deem the more valuable, as he has with much candour permitted me to make them publick.
I have read with satisfaction your late publication on the Varielli Vaccini, and being, among many other curious circumstances, particularly struck with that relating to the inefficiency of smallpox matter in a particular state, I think it proper to lay before you the following facts which came with my own knowledge, and which certainly tend to strengthen the opinions advanced in pages fifty-one and fifty-two of your treatise. In March 1784, a general inoculation took place at Arlingham in this county. I inoculated several patients with active Varialismata, all of whom had the disease in a favorable way, But my matter being all uf'd, and not being able to procure any more in the state I wif'd, I was under the neceffity of taking it from a puftule which, experience has fince proved, was advanced too far to answer the purpose I intended.
Of five perfons inoculated with this laft matter, four took the small pox afterwards 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 difeafe through life. He died of another diforder about two years ago. Although one of thefe cafes ended unfortunate, yet I cannot fuppof that any medical man will think me carelefs or inattentive in their management, for I conceive the appearances were fuch as might have induced any one to fuppof that the perfons were perfectly fafe from future infection. Inflammation in every cafe took place in the arm, and fever came on with a confiderable degree of pain in the axilla.
In fome of their arms the inflammation and fupuration were more violent than is commonly obferved when perfect matter is made ufe of. In one there was an ulcer which caft off several large fluffs. About the ninth day eruptions appeared, which died away earlier than common without maturation. From these circumstances I should suppose that no medical practitioner would scarcely have entertained a doubt, but that these patients had been infected with a true smallpox. Yet I must confess that some small degree of doubt presented itself to me at the speedy disappearance of the eruptions, and in order, as far as I could, to ascertain their safety, I sent one of them to a much older practitioner than myself.
This gentleman, on hearing the circumstance of the case, pronounced the patient perfectly secure from future infection. The following facts are also a striking proof of the truth of your observations on this subject. In the year 1789, I inoculated three children of Mr. Coley, of Hurst Farm in this county. The arms inflamed properly. Fever and pain in the axilla came on precisely the same as in the former cases, and in ten days eruptions appeared, which disappeared in the course of two days. I must observe that the matter here made use of 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 Arlingham five years before, I was somewhat alarmed for their safety and desired to inoculate them again, which being permitted, I was particularly careful to procure matter in its most perfect state.
All the children took the smallpox from this second inoculation, and all had a very full burthen. Thiefe facts, I conceive, strikingly corroborate your opinion relative to the different states of matter, for in both the instances that I have mentioned it was capable of producing something strongly resembling the true smallpox, although it afterwards proved not to be so. As I think the communication of these cases is a duty I owe to the public, you are at liberty to make what use you please of this letter. I remain, etc., John Earl. Frampton, upon Seven, Gloucestershire, November 10th, 1798. P. S. I think it neceffary to obferve that I can pronounce with the greateft certainty that the matter with which the Arlingham patients were inoculated was taken from a true small-pox pustule.
I took it myfelf from a fubject that had a very full burthen."
Certain then it is that variolous matter may undergo such a change from the putrefactive process, as well as from some of the more obscure and latent processes of nature, as will render it incapable of giving the smallpox 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 incised skin, frequently indeed more violent than when it produces its effects perfectly, swelling of the axillary glands, general indifpofition and eruptions. So strongly persuaded was the gentleman, whose practice I have mentioned in page fifty one of the late treatise, that he could produce a mild small-pox by his mode of managing the matter, that he spoke of it as a useful discovery, until convinced of his error by the fatal consequence which ensued.
after this ought we to be in the smallest degree furprifed to find among a great number of individuals who, by living in dairies, have been cafually expoed to the cow-pox virus when in a state analogous to that of the small-pox above defrived, some who may have had the difease fo imperfectly as not to render them fecure from variolous attacks For the matter, when burft from the pustules on the nipples of the cow, By being expofed, from its lodgment there, to the heat of an inflamed furface, and from being, at the fame time, in a fituation to be occasionally moistened with milk, is often likely to be in a fate conductive to putrefaction, and thus under fome modification of decomposition it muft of courfe fometimes find access to the hand of the milker in fuch a way as to infect him.
What confufion fhould we have? Were there no other mode of inoculating the small-pox than fuch as would happen from handling the difeafed fkin of a perfon labouring under that diftemper in fome of its advanced and loathfome stages? It muft be obferved that every cafe of the cow-pox in the human species, whether communicated by design or otherwise, is to be confidered as a cafe of inoculation, and here i may be allowed to make an observation on the cafe of the farmer communicated to me by dr. Ingenhoofs. That he was expofed to the matter when it had undergone the putrefactive change is highly probable from the doctors observing that the fick cows at the farm gave out an offentive ftench from their udders However, I muft remark that it is unusual for cattle to fuffer to fuch an extent, when difordered with the cow pox, as to make a by-fander fensible of any ill fmell.
I have often ftood among a herd which had the diftemper without being confiouf of its prefence from any particular effluvia. Indeed, in this neighbourhood it commonly receives an early check from efcorotic applications of the cow leech. It has been conceived to be contagiof among cows without contact, but this idea cannot be well founded, because the cattle in one meadow do not infect thofe in another, although there may be no other partition than a hedge, unless they be handled or milked by thofe who bring the infectious matter with them, and of course the fmalleft particle imaginable, when applied to a part fufceptible of its influence, may produce the effect. Among the human species it appears to be very clear that the difeafe is produced by contact only.
All my attempts, at leaft, to communicate it by effluvia have hitherto proved ineffectual. As well as the perfect change from that state in which variolous matter is capable of producing full and decisive effects on the Constitution, to that wherein its specific properties are entirely loft, it may reasonably be fuppofed that it is capable of undergoing a variety of immediate changes. The following singular occurrence in ten cases of inoculation obligingly communicated to me by Mr. Trye, senior surgeon to the infirmary at Gloucestershire, seemed to indicate that the varialous matter, previously to its being taken from the patient for the intended purpose, was beginning to part with some of its original properties, or, in other words, that it had suffered a partial decomposition.
Mr. Trye says, I inoculated ten children with matter taken at one time and from the fame fubjeft. I obferved no peculiarity in any of them previously to their inoculation, nor did anything remarkable appear in the arms till after the decline of the difeafe. Two infants of three months old had eryfipelas about the incifions, in one of them extending from the shoulders to the fingers' ends. Another infant had abffaffes in the cellular substance in the neighbourhood of the incifions, and five or six of the rest had axillary abfaffes. The matter was taken from the distinct smallpox late in its progress, and when some pustules had been dried. It was received upon glass, and slowly dried by the fire.
All the children had pustules which maturated, so that I fuppofed them all fecure from future infection, at leaft as fecure as any others whom I have ever inoculated. My practice never afforded a sore arm before."
In regard to my former observation on the improper and dangerous mode of preserving variolous matter, I shall here remark that it seems not to have been clearly understood. Finding that it has been confounded with the more eligible modes of preservation, I will explain myfelf further. When the matter is taken from a fit puftule and properly prepared for preservation, it may certainly be kept without losing its specific properties a great length of time. For instance, when it is previously dried in the open air on fome compact body as a quill or a piece of glafs, and afterwards fecured in a fmall vial.
Thus prepared, the cow-pox virus was found perfectly active and possessing all its specific properties at the end of three months.
But when kept several days in a state of moiffture, and during that time expofed to a warm temperature, I do not think it can be relied upon as capable of giving a perfect difeafe, although, as I have before obferved, the progrefs of the fymptoms arising from the action of the imperfect matter bear fo ftrong a refemblance to the small pox when excited completely. Thirdly, That the first formed virus, or what constitutes the true cow-pock pustule, invariably possesses the power I have afcribed to it, namely, that of affecting the constitution with a specific difeafe, is a truth that no subsequent occurrence has yet led me to doubt. But as I am now endeavouring to guard the public as much as possible against erroneous conclusions, I shall observe, that when this puftule has degenerated into an ulcer, to which date it is fometimes difpofed to pass, unless timely checked, I fufpec that matter possessing very different properties may fooner or later be produced, and although it may have paft that stage wherein the specific properties of the matter fecreted are no longer prefent in it, yet when applied to a saw, As in the cafual way, it might difpofe that faw to ulcerate, and from its irritation the fiftem would probably become affected, and thus by affuming fome of its ftrongeft characters it would imitate the genuine cow-pox.
From the preceding observations on the matter of small-pox when decomposed, it muft, I conceive, be admitted, that cow-pox matter in the state now described may produce a difeafe, the effects of which may be felt both locally and generally, yet that the difeafe thus induced may not be effectual in obviating the future effects of variolous contagion. In the case of Mary Miller, related by Mr. Kite in the volume above alluded to, it appears that the inflammation and fupuration of the inoculated arm were more than usually fevere, although the Fyflem underwent no specific change from the action of the virus, which appears from the patient's fickening seven weeks afterwards with the natural smallpox, which went through its course.
Fome of the cafes communicated by Mr. Earle tend further to confirm this fact, as the matter there manifestly produced ulceration on the inoculated part to a considerable extent. Fourthly, whether the cow-pox is a spontaneous difeafe in the cow or is to be attributed to matter conveyed to the animal, as I have conceived from the horfe, is a question, which, though I fhall not attempt now fully to difcuf, yet I fhall digrefs fo far as to adduce fome farther observations, and to give my reafons more at large for taking up an opinion that to fome has appeared fanciful. The aggregate of these observations, though not amounting to positive proof, forms presumptive evidence of so forcible a kind, that I imagine it might on any other perfon have made the fame impression it did on me, without fixing the imputation of credulity.
First, I conceived this was its fource from observing that where the cow pox had appeared among the dairies here, unless it could be traced to the introduction of an infected cow or servant, it had been preceded at the farm by a horfe difeafed in the manner already defcribed which horfe had been attended by fome of the milkers. Secondly, from its being a popular opinion throughout this great dairy country, and from its being insisted on by those who here attend sick cattle. Thirdly, from the total absence of the disease in those countries where the men servants are not employed in the dairies.
This information was communicated to me from the First Authorities.
Fourthly, from having obferved that morbid matter generated by the horfe frequently communicates in a cafual way a difeafe to the human fubject fo like the cow-pox that in many cafes it would be diflficult to make the diflinclion between one and the other.
The found skin does not appear to be fucceptible of this virus when inserted into it, but when previously difeafed from little accidents, its effects are often confpicuous. See plate number two.
Fifthly, from being induced to fuppose from experiments that fome of thofe who had been thus affected from the horse refiited the small pox. Sixthly, From the progress and general appearance of the pustule on the arm of the boy whom I inoculated with matter taken from the hand of a man infected by a horse, and from the similarity to the cow-pox of the general constitutional symptoms which followed.
This case On which I laid no inconsiderable stress in my late treatise, as presumptive evidence of the fact adduced, seems to have been either mistaken or overlooked by those who have commented upon the subject. See Case 18, Page 33. The boy unfortunately died of a fever at a parish workhouse before I had an opportunity of observing what effects would have been produced by the matter of smallpox. The experiments published by Mr. Simmons of Manchester and others on the subject, with the view of refuting this theory, appear to have but little weight, as even the cow-pox virus itself, when repeatedly introduced into the found nipples of cows by means of a lancet, was found to produce no effect.
I fear it would be trefpafing too far to adduce the general testimony of our farmers in support of this opinion, yet I beg leave to introduce an extract of a letter on this subject from the Reverend Mr. Moore of Chalford Hill in this county.
In the month of November 1797 my horfe had difeafed heels, which was certainly what is termed the grease, and at a fhort fubfequent period my cow was alfo affected with what a neighbouring farmer who was converfant with the complaints of cattle pronounced to be the cow-pox, which he at the fame time obferved my fervant would be infected with, and this proved to be the cafe, for he had eruptions on his hands, face, and many parts of the body, the puftules appearing large and not much unlike the small pox, for which he had been inoculated a year and a half before, and had then a very heavy burthen. The pustules on the face might arise from contact with his hands, as he had a habit of rubbing his forehead where the sores were the largeft and thickeft.
The boy affociated with the farmer's sons during the continuance of the difeafe, neither of whom had had the smallpox, but they felt no ill-affects whatever. He was not much indifpofed, as the difeafe did not prevent him from following his occupations as ufual. No other perfons attended the horfe or milked the cow, but the lad above mentioned. I am firmly of the opinion that the difeafe in the heels of the horfe, which was of virulent grease, was the origin of the fervants and the cow's malady."
But to return to the more immediate object of this proposition. From the similarity of the symptoms, both constitutional and local, Between the cow pox and the difeafe received from morbid matter generated by a horfe, the common people in this neighbourhood when infected with this difeafe through a strange perverfion of terms frequently called the cow pox. Let us fuppof then fuch a malady to appear among fome of the fervants at a farm, and at the fame time that the cow pox were to break out among the cattle. and let us fuppofe too that fome of the fervants were infefted in this way and that others received the infeftion from the cows it would be recorded at the farm and among the fervants themfelves wherever they might afterwards be difperfed that they had all had the cow-box but it is clear that an individual thus infected from the horfe would neither be for a certainty fecure himfelf nor would he impart fecurity to others were they inoculated by virus thus generated he flill would be in danger of taking the small pox yet were this to happen before the nature of the cow pox be more maturely confidered by the publick my evidence on the fubject might be depreciated unjuftly For an exemplification of what is here advanced relative to the nature of the infection when received directly from the horse, see inquiry into the causes and effects of the Variellae Vaccine.
Pages Twenty Five, Twenty Six, Twenty Seven, Twenty Eight, and Page Thirty Three. And by way of further example, I beg leave to fubjoin the following intelligence received from Mr. Fuster, Furgent of Thornbury in this county, a gentleman perfectly well acquainted with the appearance of the cow-pox on the human fubject.
William Morris, aged thirty-two, Fervant to Mr. Cox of Almondsbury, in this county, applied to me the Second of April, 1798. He told me that four days before he found a Ftiffnefs and Fwelling in both his hands, which were fo painful it was with difficulty he continued his work, that he had been Feized with pain in his head, small of the back, and limbs, and with frequent chilly fits, fucceeded by fever. On examination I found him still affected with these symptoms, and that there was a great profthration of strength. Many parts of his hands on the infide were chapped, and on the middle joint of the thumb of the right hand there was a small phagodenic ulcer, about the fife of a large pea, discharging with an icarous fluid.
On the middle finger of the fame hand there was another ulcer of a similar kind. Thefe Fores were of a circular form, and he defcribed their firft appearance as being fomewhat like blisters arising from a burn. He complained of excessive pain which extended up his arm into the axilla. Thefe fymptoms and appearances of the Fores were fo exactly like the cow-pox that I pronounced he had taken the diftemper from milking cows. He affured me he had not milked a cow for more than half a year, and that his mafters cows had nothing the matter with them. I then afked him if his mafter had a greafy horse, which he answered in the affirmative, and further faid that he had conflantly dreffed him twice a day for the laft three weeks or more, and remarked that the fmell of his hands was much like that of the horse's heels.
On the fifth of april I again saw him, and found him still complaining of pain in both his hands, nor were his febre symptoms at all relieved. The ulcers had now spread to the size of a seven-shilling gold coin, and another ulcer, which I had not noticed before, appeared on the first joint of the forefinger of the left hand, Equally painful with that on the right. I ordered him to bathe his hands in warm bran and water, applied Escarotix to the ulcers, and wrapped his hands up in a soft cataplafm. The next day he was much relieved, and in something more than a fortnight he got well. He lost his nails from the thumb and fingers that were ulcerated."
The Fudden difappearance of the Fymptoms in this cafe, after the application of the Fcarrotics to the Fores, is worthy of observation. It feems to Fow that they were kept up by the Irritation of the Ulfers.
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3 03 - Further Observations on the Variolae Vaccinae, Part 2 53:20
Publication Two. Further Observations on the Varioli Vaccini. Part Two. The general fymptoms which i have already defrived of the cow pox when communicated in a cafual way to any great extent will i am convinced from the many cafes i have feen be found accurate But from the very slight indifpofition which enfues in cafes of inoculation, where the pustule, after affecting the constitution, quickly runs into a fcab spontaneously, or is artificially fuppreft by fome proper application, I am induced to believe that the violence of the fymptoms may be afcribed to the inflammation and irritation of the ulcers, when ulceration takes place to any extent, as in the caful cow-box. and that the constitutional fymptoms which appear during the prefence of the fore while it aflumes the character of a puftule only are felt but in a very trifling degree This mild affection of the fyflem happens when the difeafe makes but a flight local impression on thofe who have been accidentally infected by cows and as far as i have feen it has uniformly happened among thofe who have been inoculated when a puftule only and no great degree of inflammation or any ulceration has taken place from the inoculation the following cafes will ftrengthen this opinion The cow-pox first appeared at a farm in the village of Stonehouse in this county, about Michaelmas-last, and continued gradually to paf from one cow to another till the end of November.
On the twenty-fifth of that month, fome icorous matter was taken from a cow and dried upon a quill. On the second of december, fome of it was inferted into a fcratch made fo fuperficial that no blood appeared on the arm of Fusan Phipps, a child seven years old. The common inflammatory appearances took place in confequence and advanfed till the fifth day, when they had fo much fubfided that I did not conceive any thing further would infue. Sixth appearances stationary. Seventh. The inflammation began to advance. Eighth. A vefication perceptible on the edges, forming, as in the inoculated smallpox, an appearance not unlike a grain of wheat, with the cleft or indention in the centre. Ninth. Pain in the axilla.
Tenth. A little headache. Pulse 110. Tongue not difcoloured. Countenance in health. Eleventh and twelve no perceptible illness pulse about a hundred. Thirteenth, the pufule was now furrounded by an efflorefcence interfurfed with very minute confluent puflules to the extent of about an inch, Some of these pustules advanced in size and maturated. So exact was the resemblance of the arm at this stage to the general appearance of the inoculated smallpox, that Mr. D, a neighbouring furgeon, who took some matter from it, and who had never seen the cowpox before, declared he could not perceive any difference.
That the cow-pox was a fuppofed guardian of the constitution from the action of the small-pox has been a prevalent idea for a long time paft, But the similarity in the constitutional effects between one disease and the other could never have been so accurately observed had not the inoculation of the cow pox placed it in a new and stronger point of view. This practice too has shown us what before lay concealed, the rise and progress of the pustule formed by the insertion of the virus, which places in a most confpicuous light its striking resemblance to the pustule Formed from the inoculated smallpox.
The child's arm now showed a difpofition to Fcab, and remained nearly stationary for two or three days when it began to run into an ulcerous state, and then commenced a febrile in difpofition, accompanied with an increase of axillary tumour. The ulcer continued spreading near a week, during which time the child continued ill when it increased to a fize nearly as large as a shilling. It began now to discharge pus, granulation frung up, and it healed. This child had before been of a remarkably fickly constitution, but is now in very high health. Mary Hearn Twelve years of age, was inoculated with matter taken from the arm of Susan Phipps. Sixth day. A pustule began to appear, slight pain in the axilla.
Seventh. A distinct vesicle formed. Eighth. The vesicle increasing, edges very red, no deviation in its appearance at this time from the inoculated smallpox. Ninth. No indifpofition. Pufule advancing. Tenth, the patient felt this evening a slight febrile attack. Eleventh, free from indifpofition. Twelfth and thirteenth, the fame. Fourteenth, an efflorefcence of a faint red colour, extending several inches round the arm, the puftule beginning to fhow a difpofition to fpread, Was dreffed with an ointment compofed of Hydrogyrum Nitratum Rubrum and Unguentum Ceri. The efflorefcence itself was covered with a plafter of Unguentum Hydrogyri Fortius. In fix hours it was examined when it was found that the efflorefcence had totally difappeared.
The application of the ointment with the Hydrogyrum Nitratum Rubrum was made ufe of for three days when the state of the pustule remaining stationery it was exchanged for the unguentum Hydrogyry Nitratis. This appeared to have a more active effect than the former, and in two or three days the virus seemed to be fubdued, when a fimple dreffing was made ufe of. But the Faw again fhewing a difpofition to inflame, the unguentum hydrogry nitratis was again applied, and Foon anfwered the intended Purpofe effectually. The girl after the tenth day when, as has been obferved, she became a little ill, fhewed not the leaft fymptom of indifpofition. She was afterwards expofed to the action of variolous matter and completely refifted it.
Susan Phipps also went through a similar trial. Conceiving these cases to be important, I have given them in detail. First, to urge the precaution of using such means as may stop the progress of the Pustule, and secondly, to point out, what appears to be the fact, that the most material indifpofition or at leaft that which is felt moft fenfibly does not arife primarily from the firft action of the virus on the conflitution but that it often comes on if the puftule is left to chance as a fecondary difeafe this leads me to conjecture what experiment muft finally determine that they who have had the small pox are not afterwards fufceptible of the primary action of the cow pox virus Forefeing that the fimple virus itfelf when it has not paft beyond the boundary of a veficle excites in the fytem fo little commotion is it not probable the trifling illness thus induced may be loft in that which fo quickly and oftentimes fo feverely follows in the cafual cow pox from the prefence of corroding ulcers This confideration induces me to fuppose that I may have been mistaken in my former observation on this subject.
In this refpecct, as well as many others, a parallel may be drawn between this difeafe and the smallpox. In the latter, the patient first feels the effect of what is called the Abforption, of the virus. The symptoms then often nearly retire when a fresh attack commences different from the first, and the illness keeps pace with the progress of the pustules through their different stages of maturation, ulceration, etc. although the application i have mentioned in the cafe of mary hearn proved fufficient to check the progrefs of ulceration and prevent any secondary fymptoms yet after the puftule has duly exerted its influence i fhould prefer the deftroying it quickly and effeclally to any other mode.
The term cauflc to a tender ear, and I conceive none will feel more interested in this inquiry than the anxiof guardians of a nursery, may found harf and unpleafing, but every folifitude that may arife on this account will no longer exift, when it is underftood that the puftule in a ftate fit to be acted upon is then quite fuperficial, and that it does not occupy the fpace of a filver penny.
I mention efcorotics for stopping the progress of the pustule, because I am acquainted with their efficacy. Probably more simple means might answer the purpose quite as well, such as might be found among the mineral and vegetable aftringents.
As a proof of the efficacy of this practice, Even before the virus had fully exerted itfelf on the Fyftem, I FALL LAY BEFORE MY READER the following Hiftory. By a reference to the treatise on the varioli vaccini, it will be feen that in the month of april seventeen ninety eight four children were inoculated with the matter of cow pox, and that in two of thefe cafes the virus on the arm was defroyed foon after it had produced a perceptible fickening. Mary James, Aged seven years, one of the children alluded to, was inoculated in the month of December following with fresh varialus matter, and at the fame time was expoed to the effluvia of a patient affected with the smallpox. The appearance and progress of the infected arm was, in every refpec, similar to that which we generally observe when varialus matter has been inserted into the skin of a perfon who has not previously undergone either the cowpox or the smallpox.
On the eighth day, conceiving there was infection in it, she was removed from her refidence among thofe who had not had the small pox. I was now anxiously waiting the refult, conceiving from the ftate of the girl's arm she would fall fick about this time. On vifiting her on the evening of the following day, the ninth, all I could learn from the woman who attended her was that she felt fomewhat hotter than ufual during the night, but was not reftlefs, and that in the morning there was a faint appearance of a rafh about her wrifts. This went off in a few hours, and was not at all perceptible to me on my visit in the evening. Not a single eruption appeared, the skin having been repeatedly and carefully examined.
The inoculated arm continued to make the usual progress to the end, through all the stages of inflammation, maturation, and fcabbing. On the eighth day matter was taken from the arm of this girl, Mary James, and inserted into the arms of her mother and brother, neither of whom had had either the small pox or the cow pox, the former about fifty years of age, the latter six. On the eighth day after the insertion the boy felt indifpofed, and continued unwell two days when a meafles-like rafh appeared on his hands and riffts and was thinly fcattered over his arms the day following his body was marbled over with an appearance fomewhat fimilar but he did not complain nor did he appear indifpofed a few puftules now appeared the greater part of which went away without maturating on the ninth day the mother began to complain she was a little chilly and had had a headache for two days, but no pustule appeared on the skin, nor had she any appearance of a rafh.
The family was attended by an elderly woman as a nurse, who in her infancy had been expofed to the contagion of the smallpox, but had refisted it. This woman was now infected, but had the difeafe in the flghtef manner, a very few eruptions appearing, two or three of which only maturated. From a folitary infiance like that adduced of Mary James, whofe constitution appears to have refifted the action of the varialus virus, after the influence of the cow-pox virus had been fo foon arrefted in its progrefs, no positive conclusion can be fairly drawn, nor from the history of the three other patients who were fubfquently infected, but nevertheless the facts collectively may be deemed interesting. That one mild variety of the small-pox has appeared I have already plainly fown, and by the means now mentioned we probably may have it in our power to produce at will another.
At the time when the puftule was defroyed in the arm of mary-james, I was informed she had been indifpofed about twelve hours, but I am now afured by thofe who were with her that the fpace of time was much lefs. Be that as it may, in cafes of cow-pox inoculation, I would not recommend any application to fubdue the action of the pufule until convincing proofs have appeared of the patient's having felt its effects at leaft twelve hours. No harm, indeed, could enfue were a longer period to elapse before the application was made ufe of. In flort, it fhould be fuffered to have as full an effect as it could, confifently with the fate of the arm. As the cafes of inoculation multiply, I am more and more convinced of the extreme mildnefs of the fymptoms arising merely from the primary action of the virus on the constitution, and that thofe fymptoms which, as in the accidental cow-pox, affect the patient with feverity, are entirely fecondary, excited by the irritating processes of inflammation and ulceration, and it appears to me that this singular virus possesses an irritating quality of a peculiar kind, but as a single cow-pox puftule is all that is necessary to render the varialous virus ineffectual, and as we possess the means of allaying the irritation, should any arise, it becomes of little or no It appears then, as far as an inference can be drawn from the present progress of cowpox inoculation, that it is an accidental circumstance only which can render this a violent disease, and a circumstance of that nature, which fortunately it is in the power of almost everyone to avoid.
I allude to the communication of the disease from cows. In this case, should the hands of the milker be affected with little accidental fores to any extent, every for would become the nidus of infection, and feel the influence of the virus, and the degree of violence in the constitutional fymptoms would be in proportion to the number and to the state of thefe local affections. Hence it follows that a perfon, either by accident or design, might be so filled with these wounds from contact with the virus that the constitution might fink under the pressure. seeing that we poffef the means of rendering the action of the fores mild which when left to chance are capable of producing violent effects and feeing too that thefe fores bear a refemblance to the small pox especially the confluent fhould it not encourage the hope that fome topical application might be ufed with advantage to counteract the fatal tendency of that difeafe when it appears in this terrific form At what stage or stages of the difeafe this may be done with the moft promifing expectation of fuccefs i will not pretend now to determine i can only throw out this idea as the bafis of further refonning and experiments i have often been foiled in my endeavours to communicate the cow pox by inoculation An inflammation will fometimes fucceed the fcratch or puncture, and in a few days difappear without producing any further effect.
Fometimes it will even produce an icorous fluid, and yet the fyflem will not be affected.
At this point of the inquiry, I had not difcovered the importance of inoculating with virus newly formed in the pustule. The reader will find this explained as he proceeds.
The same thing we know happens with the small-pox virus. Four or five fervants were inoculated at a farm contiguous to this place, last Fummer, with matter just taken from an infected cow. A little inflammation appeared on all their arms, but died away without producing a puftule. Yet all thefe fervants caught the difeafe within a month afterwards from milking the infected cows and fome of them had it feverely. At prefent no other mode than that commonly practifed for inoculating the small pox has been ufed for giving the cow pox but it is probable this might be varied with advantage. We Fould imitate the CaFual Communication more clearly, were we Fift by making the Smalllef Fuperficial Incifion or Puncture on the Fkin to produce a little Fcab, and then removing it to touch the Abraided part with the Virus.
A Small Portion of a thread imbrued with the Virus as in the old method of inoculating the small-pox, and laid upon the slightly incised skin, might probably prove a fucceffful way of giving the difeafe, or the cutis might be expofed in a minute point by an atom of blistering plafter, and the virus brought into contact with it. In the cafes juft alluded to, where I did not fucceed in giving the difeafe constitutionally, the experiment was made with matter taken in a purulent fte from the puftule of the nipple of a cow.
The cause of these difappointments will be explained.
Is pure pufs, though contained in a small pox puftule, ever capable of producing the small pox perfectly? I fufpec it is not. Let us confider that it is always preceded by the limpid fluid, which, in constitution fucceptible to variolous contagion, is always infectiof, and though on opening a puftule its contents may appear perfectly purulent, yet a given quantity of the limpid fluid may at the fame time be blended with it, though it would be imperceptible to the only teft of our fences, the eye. The prefence then of this fluid, or its mechanical diffufion through puf, may at all times render active what is apparently mere puf, while its total abfence, as in ftaile puftules, may be attended with the imperfect effects we have feen.
It would be digreffing too wildly to go far into the doctrine of fecretion, but as it will not be quite extraneous, I shall juft obferve that I confider both the puf and the limpid fluid of the puftule as fecretions, but that the organs eftablished by nature to perform the office of fecreting these fluids may differ effentially in their mechanical structure. What but a difference in the organization of glandular bodies conflites the difference in the qualities of the fluid fecreted? From fome peculiar derangement in the structure, or in other words, fome deviation in the natural action of a gland deftined to fecrete a mild innoxious fluid, a poifon of the moft deadly nature may be created. For example, That gland, which in its found-fate fecretes pure saliva, may, from being thrown into difeafed action, produce a poifon of the moft defructive quality.
Nature appears to have no more difficulty in forming minute glands among the vascular parts of the body than she has in forming blood-vefels, and millions of these can be called into existence when inflammation is excited in a few hours. footnote, Mr. Holm, in his excellent dissertation on Pus and Mucus, justifies this assertion.
In the Prefent Early Stage of the Enquiry, For early it certainly muft be deemed, before we know for an abfolute certainty how foon the virus of the cow pox may fuffer a change in its specific properties. After it has quitted the limpid fte it poffeft when forming a puftule, it would be prudent for thofe who have been inoculated with it to fubmit to variolous inoculation. No injury or inconvenience can accrue from this, and were the fame method practifed among those who, from inoculation, have felt the smallpox in an unfatisfactory manner at any period of their lives, it might appear that I had not been too officious in offering a cautionary hint in recommending a second inoculation with matter in its moft perfect ftate.
And here, let me fuppose, for argument's sake, not from conviction, that one perfon in a hundred after having had the cow pox fhould be found fucceptible of the small pox would this invalidate the utility of the practice for waiving all other confiderations Who will deny that the inoculated smallpox, though abstractly it may be considered as harmless, does not involve in itfelf something that in numberless instances proves baneful to the human frame? That in delicate constitutions it fometimes excites scrofula is a fact that must generally be fubscribed to, as it is fo obvious to common observation. This confideration is important. As the effedts of the small-pox inoculation on thofe who have had the cow-pox will be watched with the moft fcrupulous eye by thofe who profecute this inquiry, it may be proper to bring to their recollection fome facts relative to the small-pox which i muft confider here as of confequence but which hitherto feem not to have made a due impreffion It fhould be remembered that the constitution cannot by previous infection be rendered totally unfufceptible of the variolous poifon.
Neither the cafual nor the inoculated smallpox, whether it produces the difeafe in a mild or in a violent way, can perfectly extinguish the fufceptibility. The Fkin, we know, is ever ready to exhibit, though often in a very limited degree, the effect of the Poifon when inserted there, and how frequently do we see among nurses, when much expofed to the contagion, irruptions, and these fometimes preceded by Fensible Illnefs. Yet, should anything like an eruption appear, or the smallest degree of indifpofition, upon the infertion of the variolest matter on thofe who have gone through the cow pox, my affertions refpecting the peculiarities of the difeafe might be unjustly difcredited. I know a gentleman who many years ago was inoculated for the smallpox, but having no pustules or scarcely any constitutional affection that was perceptible, he was dissatisfied, and since has been repeatedly inoculated.
Her vesicle has always been produced in the arm in consequence, with axillary swelling and a slight indifpofition. This is by no means a rare occurrence. It is probable that the fluid thus excited upon the skin would always produce the smallpox. On the arm of a perfon who had gone through the cowpox many years before, I once produced a vefication by the infertion of variolous matter. And with a little of the fluid inoculated a young woman, who had a mild but very efficacious small-pox in confequence, although no constitutional effect was produced on the patient from whom the matter was taken. The following communication from Mr. Fuster affords a still clearer elucidation of this fact. Mr. Fuster says, On the third of april, 1797, I inoculated master H, aged fourteen months, for the small-pox.
At the ufual time he fickened, had a plentiful eruption, particularly on his face, and got well. His nurfe-maid, Aged twenty-four had many years before gone through the small-pox in the natural way, which was evident from her being much pitied with it. She had ufed the child to fleep on her left arm, with her left cheek in contact with his face, and during his inoculation he had mostly slept in that manner. About a week after the child got well, she, the nurse, desired me to look at her face, which she faid was very painful. There was a plentiful iruption on the left cheek, but not on any other part of the body, which went on to maturation. On inquiry I found that three days before the appearance of the iruption, she was taken with slight chilly fits, pain in her head and limbs, and fome fever.
On the appearance of the eruptions, thefe pains went off, and now, the fecond day of the eruption, she complains of a little,fore throat. Whether the above fymptoms are the effects of the small pox or of a recent cold, I do not know. On the fifth day of the eruption, I charged a lancet from two of the puftules, and on the next day I inoculated two children, one two years, the other four months old. with the matter. At the fame time, I inoculated the mother and eldeft fifter with variolous matter taken from mafter h. On the fifth day of their inoculation, all their arms were inflamed alike, and on the eighth day the eldeft of thofe inoculated from the nurse fickened, and the youngest on the eleventh.
They had both a plentiful irruption from which I inoculated several others who had the difeafe very favourably. The mother and the other child fickened about the fame time, and likewise had a plentiful irruption. Foon after a man in the village fickened with the small-pox, and had a confluent kind. To be convinced that the children had had the difeafe effectually, I took them to his house and inoculated them in both arms with matter taken from him, but without effect."
These are not brought forward as uncommon occurrences, but as exemplifications of the human system's susceptibility of the variolous contagion, although it has been previously sensible of its action. Happy is it for mankind that the appearance of the smallpox a fecond time on the fame perfon beyond a trivial extent is fo extremely rare that it is looked upon as a phenomenon. Indeed, since the publication of Dr. Heberden's paper on the varicelli or chickenpox, the idea of fuch an occurrence in deference to authority fo truly refpecable has been generally relinquished. This, I conceive, has been without juft reafon, for after we have feen, among many other things, fo ftrong a cafe as that recorded by Mr.
Edward Withers, surgeon of Newbury, Berkshire, in the fourth volume of the Memoirs of the Medical Society of London, from which I take the following extracts, no one, I think, will again doubt the fact.
Mr. Richard Langford, a farmer of West Shefford in this county, Berkshire, about five years of age, when about a month old, had the small-pox at a time when three others of the family had the fame difeafe, one of whom, a servant man, died of it. Mr. Langford's countenance was strongly indicative of the malignity of the diftemper. His face being so remarkably pitied and feemed, as to attract the notice of all who saw him, so that no one could entertain a doubt of his having had that difeafe in a moft inveterate manner.
Mr. Withers proceeds to fte that Mr. Langford was feized a fecond time, had a bad confluent small pox, and died on the twenty-first day from the feizure, and that four of the family, as also a fiifter of the patients to whom the difeafe was conveyed by her fons vifitting his uncle falling down with the small pox fully fatisfied the country with regard to the nature of the difeafe which nothing flort of this would have done the fifter died this case was thought fo extraordinary a one as to induce the rector of the parif to record the particulars in the parifh register It is singular that in moft cafes of this kind the difeafe in the firft inftance has been confluent fo that the extent of the ulceration of the fkin as in the cow pox is not the procefs in nature which affords fecurity to the constitution As the subject of the smallpox is so interwoven with that which is the more immediate object of my present concern, it must plead my excuse for so often introducing it.
At present it must be considered as a distemper not well understood. The inquiry I have instituted into the nature of the cowpox will probably promote its more perfect investigation. The inquiry of Dr. Pearson into the history of the cow pox, having produced so great a number of attestations in favour of my afferfion that it proves a protection to the human body from the small pox, I have not been affiduous in seeking for more, but as some of my friends have been so good as to communicate the following, I shall conclude these observations with their infertion. Extract of a letter from Mr. Drake, Surgeon, at Stroud in this county, and late Surgeon to the North Gloucester Regiment of Militia. Quote, In the spring of the year 1796, I inoculated men, women and children to the amount of about 70.
Many of the men did not receive the infection, Although inoculated at leaft three times, and kept in the fame room with thofe who actually underwent the difeafe during the whole time occupied by them in pafling through it. Being anxiof they fhould in future be fecure against it, I was very particular in my inquiries to find out whether they ever had previously had it, or at any time been in the neighbourhood of people labouring under it. But, after all, the only satisfactorie information I could obtain was that they had had the cow pox. As I was then ignorant of such a difeafe affecting the human subject, I flattered my-felf what they imagined to be the cow pox was in reality the small pox in a very slight degree.
I mentioned the circumftance in the prefence of several of the officers at the fame time expreffing my doubts if it were not smallpox, and was not a little furprifed when I was told by the colonel that he had frequently heard you mention the cowpox as a difeafe endymial to Gloucester-shire, and that if a person were ever affected by it, you fupposed him afterwards secure from the small-pox. This excited my curiosity, and when I visited Gloucester-shire, I was very inquisitive concerning the subject, and from the information I have since received, both from your publication and from conversation with medical men of the greatest accuracy in their observations, I am fully convinced that what the men supposed to be the cowpox was actually so, and I can safely affirm that they effectually resisted the smallpox."
Mr. Fry, Surgeon at Dursley in this county favours me with the following communication. During the spring of the year 1797, I inoculated 1475 patients of all ages, from a fortnight old to 70 years. Amongft whom there were many who had previously gone through the cow pox. The exact number I cannot state, but if I say there were near thirty I am certain with the number. There was not a single infiance of the variolous matter producing any constitutional effect on these people, nor any greater degree of local inflammation than it would have done in the arm of a perfon who had before gone through the small-pox. Notwithstanding, it was invariably inferted four, five, and sometimes six different times to fatisfy the minds of the patients.
In the common course of inoculation previous to the general one, a year paft without my meeting with one or two instances of perfons who had gone through the cow pox refifting the actions of the variolous contagion. I may fairly say that the number of people I have seen inoculated with the small pox who at former periods had gone through the cow pox are not lefs than forty. footnote the greater part of thefe people muft of course have had the cow pox many years before this trial was made upon them with the matter of small pox and in no one infiance have i known a patient received the small pox notwithfanding they invariably continued to aflociate with other inoculated patients during the progrefs of the difeafe and many of them purpofefully expofe themselves to the contagion of the natural small pox whence i am fully convinced that a perfon who had fairly had the cow pox is no longer capable of being acted upon by the variolous matter I alfo inoculated a very confiderable number of thofe who had had the difeafe which ran through the neighbourhood a few years ago and was called by the common people the swine pox not one of whom received the small pox this was that mild variety of the small pox which i have noticed in the late treatise on the cow pox page forty nine and a footnote There were about half a dozen instances of people who never had either the cow or swine pox, yet did not receive the small pox.
The fyflem not being in the leafl deranged, or the arms inflamed, although they were repeatedly inoculated, and aftociated with others who were labouring under the difeafe, one of them was the son of a farrier.
Mr. Tierney, Affinant-Furgeon of the South Gloucester Regiment of Militia, has obliged me with the following information, that in the summer of the year 1798 he inoculated a great number of men belonging to the regiment, and that among them he found eleven who, from having lived in dairies, had gone through the cow-pox, that all of them refisted the small-pox except one, but that, on making the moft rigid and fcrupulous inquiry at the farm in gloucterfhire, where the man faid he lived when he had the difeafe, and among thofe with whom at the fame time he declared he had afociated, and particularly of a perfon in the parif whom he faid had dreft his fingers, it moft clearly appeared that he aimed at an impofition, and that he never had been affected with the cow pox.
The public cannot be too much on their guard, respecting perfons of this defcretion.
Mr. Tierney remarks that the arms of many who were inoculated, after having had the cow-pox, inflamed very quickly, and that in several a little acerous fluid was formed.
Mr. Klein, who in July last was so obliging at my requeft as to try the efficacy of the cow-pox virus, was kind enough to give me a letter on the result of it, from which the following is an extract. My dear sir, the cow-pox experiment has fucceeded admirably. The child fickened on the seventh day, and the fever, which was moderate, fubfided on the eleventh. The inflammation arising from the infertion of the virus extended to about four inches in diameter and then gradually fubfided, without having been attended with pain or other inconvenience. There were no eruptions. I have fince inoculated him with small-pox matter in three places, which were slightly inflamed on the third day and then fubfided.
Dr. Lister, Who was formerly physician to the smallpox hospital, attended the child with me, and he is convinced that it is not possible to give him the smallpox. I think the substituting the cowpox poison for the smallpox promises to be one of the greatest improvements that has ever been made in medicine, and the more I think on the subject, the more I am impressed with its importance. With great esteem, I am, etc., Henry Klein." Lincoln's Inn Fields, August 2nd, 1798. From communications with which I have been favoured, from Dr. Pearson, who has occasionally reported to me the result of his private practice with the vaccine virus in London, and from Dr. Woodville, who has also favoured me with an account of his more extensive inoculation with the fame virus at the small-pox hospital, it appears that many of their patients have been affected with eruptions, and that thefe eruptions have maturated in a manner very fimilar to the variolus.
The matter they made ufe of was taken, in the firft inftance, from a cow belonging to one of the great milk farms in london. Having never seen maturated pustules produced either in my own practice among those who were carefully infected by cows, or those to whom the difeafe had been communicated by inoculation, I was defirous of seeing the effect of the matter generated in London on subjects living in the country. A thread imbrued in fome of this matter was fed to me, and with it two children were inoculated, whofe cafes i fhall transfcribe from my notes. Stephen Jenner, three years and a half old. Third day. The arm fhowed a proper and decisive inflammation. Sixth, a veficle arising. Seventh, the pustule of a cherry colour.
Eighth, Increasing in elevation, a few spots now appear on each arm near the infertion of the inferior tendons of the biceps muscles. They are very small and of a vivid red colour, the pulse natural, the tongue of its natural hue, no lofs of appetite or any symptoms of indifpofition.
The inoculated puftule on the arm this evening began to inflame and gave the child uneafinefs. He cried and pointed to the feet of it, and was immediately afterwards affected with febril fymptoms. At the expiration of two hours after the seizure, a plafter of unguentum hydrogry fortius was applied, and its effect was very quickly perceptible. For in ten minutes he resumed his usual looks and playfulness. On examining the arm about three hours after the application of the plaster, its effects in subduing the inflammation were very manifest. Tenth. The spots on the arms have disappeared, but there are three visible in the face. Eleventh. Two spots on the face are gone, the other barely perceptible.
Thirteenth. The pustule delineated in the second plate in the treatise on the Varielli vaccini is a correct representation of that on the child's arm, as it appears at this time. Fourteenth. Two fresh spots appear on the face. The pustule on the arm nearly converted into a scab. As long as any fluid remained in it, it was limpid. James Hill, four years old, was inoculated on the same day. and with part of the fame matter which infected stephen jenner. It did not appear to have taken effect till the fifth day. Seventh, a perceptible veficle. This evening the patient became a little chilly, no pain or tumor difcoverable in the axilla. Eighth, perfectly well. Ninth, the fame. The Veficle more elevated than I have been accuflomed to fee it, and Affuming more perfectly the variolest character than is common with the cow-pox at this stage.
Furrounded by an inflammatory rednefs about the fife of a shilling, ftudded over with minute veficles, the pustule contained a limpid fluid till the fourteenth day, after which it was encrufted over in the ufual manner, but this encruftation or fcab being accidentally rubbed off, it was flow in healing. These children were afterwards fully expoed to the small-pox contagion without effect. Having been requested by my friend, Mr. Henry Hicks, of Eaftington, in this county, to inoculate two of his children, and at the fame time, fome of his fervants, and the people employed in his manufactory, matter was taken from the arm of this boy for the purpofe. The numbers inoculated were eighteen. They all took the infection, and either on the fifth or sixth day, a veficle was perceptible on the punctured part.
Fome of them began to feel a little unwell on the eighth day, but the greater number on the ninth. Their Illnefs, as in the former cafes, defcribed, was of FHort Duration, and not Fufficient to Interrupt, but at very FHort intervals, the children from their Amufements, or the Fervants and Manufacturers from following their ordinary Builnefs. Three of the children, whose employment in the manufactory was in some degree laborious, had an inflammation on their arms beyond the common boundary about the Eleventh or Twelfth day, when the feverish symptoms, which before were nearly gone off, again returned, accompanied with an increase of axillary tumor. In these cases, Clearly perceiving the fymptoms were governed by the fate of the arms, I applied on the inoculated pustules, and renewed the application three or four times within an hour, a pledget of lint, previously soaked in aqua lithargery acetate, and covered the hot efflorefcent furrounding them with cloths dipped in cold water.
The next day, I found that this fimple mode of treatment had fucceeded perfectly. The inflammation was nearly gone off, and with it the fymptoms which it had produced. Fome of thefe patients have fince been inoculated with variolous matter without any effect beyond a little inflammation on the part where it was inserted. Why the arms of thofe inoculated with the vaccine matter in the country fhould be more difpofed to inflame than thofe inoculated in London, it may be difficult to determine. From comparing my own cafes to fome transmitted to me by dr. Pearson and dr. Woodville, this appears to be the fact. and what strikes me as still more extraordinary with refped to thofe inoculated in london is the appearance of maturating eruptions in the two inffances only which i have mentioned the one from the inoculated the other from the cafual cow pox a few red fpots appeared which quickly went off without maturating the cafe of the reverend mr moore's servant may indeed feem like a deviation from the common appearances in the country but the nature of thefe eruptions was not affertained beyond their not poffefing the property of communicating the difeafe by their effluvia Perhaps the difference we perceive in the state of the arms may be owing to some variety in the mode of action of the virus upon the skin of those who breathe the air of london and those who live in the country.
That the eryfipelas affumes a different form in london from what we see it put on in the country is a fact very generally acknowledged. In calling the inflammation that is excited by the cow-pox virus eryfipelatus, Perhaps I may not be critically exact, but it certainly approaches near to it. Now, as the difeafed action going forward in the part infected with the virus may undergo different modifications, according to the peculiarities of the constitution on which it is to produce its effect, may it not account for the variation which has been obferved? To this it may probably be objected that fome of the patients inoculated and who had pustules in confequence were newly come from the country, but i conceive that the changes wrought in the human body through the medium of the lungs may be extremely rapid.
Yet, after all, further experiments made in London with vaccine virus generated in the country ...must finally throw a light on what now certainly appears obscure and mysterious. The principal variation perceptible to me in the action of the vaccine virus generated in London from that produced in the country, was it proving more certainly infectious, and giving a less disposition in the arm to inflame. There appears also a greater elevation of the pustule above the surrounding skin. In my former cafes the puftule produced by the infertion of the virus was more like one of those which are so thickly fpread over the body in a bad cafe of confluent smallpox. This was more like a puftule of the diftinct smallpox, except that i saw no instance of puft being formed in it, the matter remaining limpid till the period of fcabbing.
Wifhing to fee the effect of the difeafe on an infant newly born, my nephew, Mr. Henry Jenner, at my requeft, inserted the vaccine virus into the arm of a child about twenty hours old. His report to me is that the child went through the difeafe without apparent illness, yet that it was found effectually to refift the action of varialous matter with which it was fubfquently inoculated. I have had an opportunity of trying the effects of the cow-pox matter on a boy who, the day preceding its insertion, fickened with the Meafles. The eruption of the Meafles, attended with cough, a little pain in the cheft, and the usual symptoms accompanying that difeafe appeared on the third day and fpread all over him.
The difeafe went through its course without any deviation from its ufual habits, and, notwithstanding this, the cow-pox virus excited its common appearances, both on the arm and on the constitution, without any fensible interruption. On the sixth day there was a vesicle. Eighth pain in the axilla, chilly and affected with headache. Ninth nearly well. Twelfth The pustule spread to the size of a large split pea, but without any surrounding efflorefcence. It foon afterwards fcabbed, and the boy recovered his general health rapidly. But it fhould be obferved that before it fcabbed, the efflorefcence, which had fuffered a temporary fufpension, advanced in the ufual manner. Here we fee a deviation from the ordinary habits of the smallpox, as it has been obferved that the prefence of the meafle fufpends the action of variolous matter.
However, the fufpension of the efflorefcence is worthy of observation. The very general investigation that is now taking place, chiefly through inoculation, and I again repeat my earnest hope that it may be conducted with that calmness and moderation which fhould ever accompany a philosophical research, must foon place the vaccine difeafe in its juft point of view. The refult of all my trials with the virus on the human fubject has been uniform. In every infiance, the patient who has felt its influence has completely loft the fufceptibility for the varialis contagion, and as thefe infances are now become numerous, I conceive that, joined to the observations in the former part of this paper, they sufficiently preclude me from the necessity of entering into controversies with those who have circulated reports adverse to my assertions, on no other evidence than what has been casually collected.
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4 04 - A Continuation of Facts and Observations relative to the Variolae Vaccinae 48:13
Publication 3. A continuation of facts and observations relative to the Varioli Vaccini, or cowpox.
Since my former publications on the vaccine inoculation, I have had the satisfaction of seeing it extend very widely. Not only in this country is the subject pursued with ardour, but from my correspondence with many respectable medical gentlemen on the continent, among whom are Dr. De Caro of Vienna, and Dr. Bullhorn of Hanover. I find it is as warmly adopted abroad where it has afforded the greatest satisfaction. I have the pleasure too of seeing that the feeble efforts of a few individuals to depreciate the new practice are sinking fast into contempt beneath the immense mass of evidence which has risen up in support of it. Upwards of six thousand perfons have now been inoculated with the virus of cow pox, and the far greater part of them have fince been inoculated with that of small pox, and expofed to its infection in every rational way that could be devifed without effect.
It was very improbable that the investigation of a difeafe fo analogous to the small-pox should go forward without engaging the attention of the physician of the small-pox hospital in London, Accordingly, Dr. Woodville, who fills that department with so much respectability, took an early opportunity of instituting an inquiry into the nature of the cow-pox. This inquiry was began in the early part of the present year, and in May Dr. Woodville published the result, which differs essentially from mine in a point of much importance. It appears that three-fifths of the patients inoculated were affected with eruptions. For the most part, Fof perfectly resembling the small pox as not to be diftinguished from them.
On this fubjec it is neceffary that i fhould make fome comments. When i confider that out of the great number of cafes of caual inoculation immediately from cows which have from time to time prefented themfelves to my obfervation and the many similar infances which have been communicated to me by medical gentlemen in this neighbourhood When I confider too that the matter with which my inoculations were conducted in the year seventeen ninety seven ninety eight and ninety nine was taken from different cows, and that in no inftance anything like a variolous pustule appeared, I cannot feel difpofed to imagine that eruptions, similar to thofe defrived by dr woodville, have ever been produced by the pure uncontaminated cow-pock virus.
On the contrary, I do fuppove that thofe which the doctor speaks of originated in the action of varialus matter, which crept into the constitution with the vaccine. And this, I presume, happened from the inoculation of a great number of the patients with varialus matter, some on the third, others on the fifth day. After the vaccine had been applied, and it fhould be obferved that the matter thus propagated became the fource of future inoculations in the hands of many medical gentlemen who appeared to have been previously unacquainted with the nature of the cow-pox. Another circumftance, strongly, in my opinion, supporting this supposition, is the following. The cow-pox has been known among our dairies time immemorial.
If Pustules then, like the Varialis, were to follow the communication of it from the cow to the milker, would not such a fact have been known and recorded at our farms? Yet neither our farmers nor the medical people of the neighbourhood have noticed such an occurrence. A few scattered pimples I have sometimes, though very rarely, seen, the greatest part of which have generally disappeared quickly, but some have remained long enough to fupurate at their apex. That local cuticular inflammation, whether springing up spontaneously or arising from the application of acrid substances, such, for instance, as cantharides, Pixburgundica, Antimonium tartarizatum, etc., will often produce cutaneous affections not only near the feet of the inflammation but on some parts of the skin far beyond its boundary, is a well known fact.
It is doubtlefs on this principle that the inoculated cow pox puftule and its concomitant efflorefcence may, in very irritable constitutions, produce this affection. The eruption I allude to has commonly appeared fome time in the third week after inoculation, but this appearance is too trivial to excite the leaft regard. The change which took place in the general appearance during the progress of the vaccine inoculation at the smallpox hospital should likewise be considered. Although at first it took on so much of the variolous character as to produce pustules in three cases out of five, yet in Dr. Woodville's last report, published in June, he faiz, Since the publication of my reports of inoculations for the cow pox, upwards of three hundred cases have been under my care, and out of this number only thirty-nine had pustules that suppurated.
Namely, out of the first hundred, nineteen had pustules, out of the second, thirteen, and out of the last hundred and ten, only seven had pustules. Thus it appears that the difeafe has become considerably milder which i am inclined to attribute to a greater caution ufed in the choice of the matter with which the infection was communicated for lately that which has been employed for this purpofe has been taken only from thofe patients in whom the cow pox proved very mild and well characterized Footnote. In a few weeks after the cowpox inoculation was introduced at the smallpox hospital, I was favoured with some virus from this stock. In the first instance, it produced a few pustules, which did not maturate, but in the subsequent cases none appeared.
End of footnote. End quote. The inference I am induced to draw from these premises is very different. The decline, and finally the total extinction nearly, of these pustules, in my opinion, are far more attributable to the cow-pox virus assimilating the varialus.
In my first publication on this subject, I expressed an opinion that the smallpox and the cowpox were the same disease under different modifications. In this opinion, Dr. Woodville has concurred, the axiom of the immortal hunter that two diseased actions cannot take place at the same time in one and the same part will not be injured by the admission of this theory. End of footnote. The former, probably being the original, The latter the same disease under a peculiar and at present an inexplicable modification. One experiment tending to elucidate the point under discussion, I had myself the opportunity of instituting. On the supposition of its being possible that the cow which ranges over the fertile meadows in the Vale of Gloucestershire might generate a virus differing in some respects in its qualities from that produced by the animal artificially pampered for the production of milk for the metropolis, I procured, during my residence there in the spring, Fomcow-pock virus from a cow at one of the London milk farms.
It was taken by Mr. Tanner, then a student at the veterinary college, from a cow at Mr. Clark's farm in Kentish Town. It was immediately conveyed into Gloucesterfhire by Dr. Marshall, who was then extensively engaged in the inoculation of the cow-pox, the general result of which, and the inoculation in particular with this matter, I shall lay before my readers in the following communication from the doctor.
Dear Sir, my neighbour, Mr. Hicks, having mentioned your wifh to be informed of the progrefs of the inoculation here for the cow-pox, and he alfo having taken the trouble to transmit to you my minutes of the cafes which have fallen under my care, I hope you will pardon the further trouble I now give you in stating the observations I have made upon the fubjeft. When firft informed of it, having two children who had not had the small pox, I determined to inoculate them for the cow pox whenever I fhould be fo fortunate as to procure matter proper for the purpofe. I was therefore particularly happy when I was informed that I could procure matter from fome of thofe whom you had inoculated. In the firft inftance I had no intention of extending the difeafe further than my own family, but the very extensive influence which the conviction of its efficacy in refifting the small pox has had upon the minds of the people in general has rendered that intention nugatory as you will perceive the continuation of my cases enclosed in this letter.
Dr. Marshall has detailed these cases with great accuracy, but their publication would be deemed superfluous.
It will appear that, since the 22nd of March, I have inoculated a hundred and seven persons, which, considering the retired situation I reified in, is a very great number. There are also other confiderations which, befides that of its influence in refting the small-pox, appear to have had their weight, namely the peculiar mildnefs of the difeafe, the known safety of it, and its not having in any infiance prevented the patient from following his ordinary bufinefs In all the cafes under my care there have only occurred two or three which required any application owing to eryfipelatous inflammation on the arm, and they immediately yielded to it. In the remainder the constitutional illness has been slight but sufficiently marked, and considerably lefs than I ever obferved in the fame number inoculated with the smallpox.
In only one or two of these cases have any other eruptions appeared than those around the spot where the matter was infected, and those near the infected parts. Neither does there appear in the cow-pox to be the leaft exciting cause to any other difeafe, which in the small-pox has been frequently obferved, the constitution remaining in as full health and vigour after the termination of the difeafe as before the infection. Another important confideration appears to be the impoffibility of the difeafe being communicated except by the actual contact of the matter of the pustule, and confequently the perfect fafty of the remaining part of the family, fuppofing only one or two fhould wifh to be inoculated at the fame time.
Upon the whole, it appears evident to me that the cow-pox is a pleasanter, shorter, and infinitely more safe difeafe than the inoculated small-pox, when conducted in the moft careful and approved manner. Neither is the local affedtion of the inoculated part, or the constitutional illness near fo violent. I fpeak with confidence on the fubjec having had an opportunity of obferving its effect upon a variety of conflutions from three months old to sixty years and to which i have paid particular attention in the cafes alluded to here you will obferve that the removal from the original fource of the matter has made no alteration or change in the nature or appearance of the difeafe and that it may be continued ad infinitum, I imagine, from one perfon to another, if care be obferved in taking the matter at a proper period, without any neceffity of recurring to the original matter of the cow.
I should be happy if any endeavours of mine could tend further to elucidate the subject, and shall be much gratified in sending you any further observations I may be enabled to make. I have the pleasure to subscribe myself. Dear Sir, etc. Joseph H. Marshall. Eastington, Gloucestershire. April 26, 1799. The gentleman who favoured me with the above account has continued to prosecute his inquiries with unremitting industry, and has communicated the result in another letter, which, at his request, I lay before the public without abbreviation. Dr. Marshall's Second Letter. Dear Sir, Since the date of my former letter, I have continued to inoculate with the Cow Pox Virus. Including the Cafes before Enumerated, the number now amounts to four hundred and twenty-three.
It would be tedious and ufeless to detail the progrefs of the difeafe in each individual. It is fufficient to obferve that I noticed no deviation in any refpect from the cafes I formerly adduced. The general appearance of the arm exactly corresponded with the account given in your firft publication. When they were difpofed to become troublfome by eryfipelatous inflammation, An application of equal parts of vinegar and water always anfwered the desired intention. I muft not omit to inform you that when the difeafe had duly acted upon the constitution, I have frequently ufed the vitriolic acids. A portion of a drop applied with the head of a probe or any convenient utensil upon the pustule, suffered to remain about forty seconds, and afterwards washed off with sponge and water, never failed to stop its progress and expedite the formation of a Fcab.
I have already subjected 211 of my patients to the action of varialis matter, but every one resisted it. The refult of my experiments, which were made with every requifite caution, has fully convinced me that the true cow pox is a safe and infallible preventive from the small pox, that in no cafe which has fallen under my obfervation has it been in any confiderable degree troublefome, much lef have i feen anything like danger, for in no inftance were the patients prevented from following their ordinary employments. In Dr. Woodville's publication on the cow pox, I noticed an extraordinary fact. He faiz that the generality of his patients had pustules. It certainly appears extremely extraordinary that in all my cafes there never was but one pustule, which appeared on a patient's elbow on the inoculated arm and maturated.
It appeared exactly like that on the incived part. The whole of my observations, founded, as it appears, on an extensive experience, leads me to these obvious conclusions. That thofe cafes which have been or may be adduced against the preventive powers of the cow-pox could not have been thofe of the true kind, since it muft appear to be abfolutely impossible that i fhould have fucceeded in fuch a number of cafes without a fingle exception, if fuch a preventive power did not exift. I cannot entertain a doubt that the inoculated cow-pox muft quickly fuperfede that of small-pox. If the many important advantages which muft refult from the new practice are duly confidered, we may reasonably infer that public benefit, the Fure Teft of the real merit of discoveries, will render it generally extensive.
To you, sir, as the discoverer of this highly beneficial practice, mankind are under the highest obligations. As a private individual, I participate in the general feeling, more particularly as you have afforded me an opportunity of noticing the effects of a singular disease, and of viewing the progress of the most curious experiment that ever was recorded in the history of physiology. I remain, dear sir, etc., Joseph H. Marshall. P.S. I fhould have obferved that of the patients I inoculated and enumerated in my letter, one hundred and twenty-seven were infedted with the matter you fent me from the London Cow. I difcovered no diffimilarity of Fymptoms in thefe cafes from thofe which I inoculated from matter procured in this county.
No puftules have occurred except in one or two cafes where a single one appeared on the inoculated arm. No difference was apparent in the local inflammation. There was no fufpension of ordinary employment among the labouring people, nor was any medicine required. I have frequently inoculated one or two in a family, and the remaining part of it some weeks afterwards. The uninfected have slept with the infected during the whole courfe of the difeafe without feeling it, so that I am fully convinced the difeafe cannot be taken, but by actual contact with the matter. A curious fact has lately fallen under my obfervation, on which I leave you to comment. I visited a patient with the confluent small-pox, and charged a lancet with fome of the matter.
Two days afterwards, I was defired to inoculate a woman and four children with the cow pox, and inadvertently took the vaccine matter on the fame lancet which was before charged with that of small pox. In three days I difcovered the miftake, and fully expected that my five patients would be infedted with small pox. But I was agreeably furprifed to find the difeafe to be the genuine cow pox which proceeded without deviating in any particular from my former cafes. I afterwards inoculated these patients with varialous matter, but all of them refifted its action. I omitted mentioning another great advantage that now occurs to me in the inoculated cow pox. I mean the safety with which pregnant women may have the difeafe communicated to them.
I have inoculated a great number of females in that fituation, and never obferved their cafes to differ in any refpect from thofe of my other patients. Indeed, the difeafe is fo mild that it feems as if it might at all times be communicated with the moft perfect fafty."
I shall here take the opportunity of thanking Dr. Marshall and thofe other gentlemen who have obligingly presented me with the results of their inoculations. But, as they all agree in the same point as that given in the above communication, namely the security of the patient from the effects of the smallpox after the cowpox, their perusal, I presume, would afford a satisfaction that has not been amply given already. Particular occurrences I shall, of course, detail. FOME of my Correspondents have mentioned the appearance of smallpox-like eruptions at the commencement of their inoculations, but in these cases the matter was derived from the original stock at the smallpox hospital. I have myfelf inoculated a very confiderable number from the matter produced by dr marshall's patients originating in the london cow without obferving puftules of any kind and have difperfed it among others who have ufed it with a familiar effed.
From this fauce, Mr. H. Jenner informs me. He is inoculated above a hundred patients without obferving eruptions. Whether the nature of the virus will undergo any change from being farther removed from its original fauce in passing fucceffully from one perfon to another, time alone can determine. That which I am now employing has been in ufe near eight months, and not the leafl change is perceptible in its mode of action either locally or constitutionally. There is therefore every reason to expect that its effects will remain unaltered, and that we shall not be under the neceffity of feeking frefh supplies from the cow. The following observations were obligingly fent to me by Mr. Tierney, Affiftec Furgent to the South Gloucester Regiment of Militia, to whom I am indebted for a former report on this fubjec.
I inoculated with the cow-pox matter, from the 11th to the latter part of April, twenty-five perfons, including women and children. Fome on the Eleventh were inoculated with the matter Mr. Shrapnel, Furgent to the Regiment, had from you, the others with matter taken from these. The progress of the puncture was accurately obferved, and its appearance feemed to differ from the smallpox in having less inflammation around its Bafis on the firft days, that is, from the third to the seventh, But after this the inflammation increased, extending on the tenth or eleventh day to a circle of an inch and a half from its centre, and threatening very FORE arms. But this, I am happy to say, was not the cafe, for by applying mercurial ointment to the inflamed part, which was repeated daily until the inflammation went off, the arm got well without any further application or trouble.
The constitutional symptoms which appeared on the eighth or ninth day after inoculation, scarcely deserved the name of disease, as they were so slight as to be barely perceptible, except that I could connect a slight headache and langer with a stiffness and rather painful Fensation in the axilla. This latter symptom was the most striking. It remained from twelve to forty-eight hours. In no cafe did I obferve the smallest puftule, or even difcoloration of the skin like an incipient puftule, except about the part where the virus had been applied. After all theefe fymptoms had fubfided, and the arms were well, I inoculated four of this number with variolous matter, taken from a patient in another regiment.
In each of thefe it was inferted several times under the cuticle, producing slight inflammation on the second or third day, and always difappearing before the fifth or sixth, except in one who had the cow pox in gloucfterfhire before he joined us, and who alfo received it at this time by inoculation. In this man the puncture inflamed, and his arm was much forer than from the infertion of the cow pox virus. But there was no pain in the axilla, nor could any constitutional affection be obferved. I have only to add that I am now fully satisfied of the efficacy of the cow pox in preventing the appearance of the small pox, and that is a moft happy and salutary substitute for it. I remain, etc. M. J.
Tierney."
Although the fufceptibility of the virus of the cow pox is for the moft part loft in thofe who have had the small pox, yet in fome constitutions it is only partially defroyed, and in others it does not appear to be in the leafl diminifed. By far the greateft number on whom trials were made refifted it entirely, Yet I have found some on whose arms the pustule, from inoculation, was formed completely, but without producing the common efflorescent blush around it, or any constitutional illness, while others have had the disease in the most perfect manner. A case of the latter kind having been presented to me by Mr. Fuster, Surgeon, of Thornbury, I shall insert it.
Three children were inoculated with the vaccine matter you obligingly fent me. On calling to look at their arms three days after, I was told that John Hodges, one of the three, had been inoculated with the small pox when a year old, and that he had a full burthen, of which his face produced plentiful marks, a circumftance I was not before made acquainted with. On the sixth day the arm of this boy appeared as if inoculated with varilous matter, but the pustule was rather more elevated. On the ninth day he complained of violent pain in his head and back, accompanied with vomiting and much fever. The next day he was very well, and went to work as usual. The punctured part began to fpread, and there was an areola around the inoculated part to a considerable extent.
As this is contrary to an assertion made in the Medical and Physical Journal, No. 8, I thought it right to give you this information, and remain, Dear Sir, etc., J. Fuster."
It appears then that the animal economy with regard to the action of this virus is under the fame laws as it is with refpect to the variolous virus, after previously feeling its influence as far as comparifons can be made between the two difeafes. Fome striking instances of the power of the cow-pox in fufpending the progrefs of the small-pox, after the patients had been several days cafually expofed to the infection, have been laid before me by Mr. Lyford, furgeon of Winchester, and my nephew, the Rev. G. C. Jenner. Mr. Lyford, After giving an account of his extensive and successful practice in the vaccine inoculation in Hampshire, writes as follows, quote, The following case occurred to me a short time since, and may probably be worth your notice.
I was fent for to a patient with the smallpox, and on inquiry found that, five days previous to my seeing him, the eruption began to appear. During the whole of this time, two children, who had not had the small pox, were constantly in the room with their father, and frequently on the bed with him. The mother consulted me on the propriety of inoculating them, but objected to my taking the matter from their father, as he was fubject to eryfipalus. I advifed her by all means to have them inoculated at that time, as I could not procure any variolous matter elfwhere. However, they were inoculated with vaccine matter, but I cannot say I flattered myself with its proving successful, as they had previously been so long, and still continued to be, expofed to the varilus infection.
Notwithstanding this, I was agreeably furprifed to find the vaccine disease advance and go through its regular course, and if I may be allowed the expression, to the total extinction of the smallpox.
Mr. Jenner's cafes were no less satisfactory. He writes as follows, A son of Thomas Stinchcombe of Woodford, near Berkley, was infected with the natural smallpox at Bristol, and came home to his father's cottage. Four days after the eruptions had appeared on the boy, the family, None of which had ever had the small pox, confifting of the father, mother, and five children, were inoculated with vaccine virus. On the arm of the mother, it failed to produce the leaft effect, and she of course had the small pox.
Under similar circumstances, I think it would be advifable to infert the matter into each arm, which would be more likely to infure the fuccefs of the matter.
But the reft of the family had the cow-pox in the ufual mild way, and were not affected with the small-pox. Although they were in the fame room, and the children slept in the fame bed with their brother, who was confined to it with the natural small-pox, and subsequently with their mother. I attended this family with my brother, Mr. H. Jenner.
The following cafes are of too singular a nature to remain unnoticed. Miss R. A young lady about five years old was feafed on the evening of the eighth day after inoculation with vaccine virus with fuch fymptoms as commonly denote the accefion of violent fever. Her throat was alfo a little fore, and there were fome uneafy fenfations about the muftles of the neck. The day following a rafh was perceptible on her face and neck, fo much refembling the efflorefcence of the scarlatina anginosa that I was induced to afk whether miss r had been expofed to the contagion of that difeafe. An anfwer in the affirmative and the rapid fpreading of the rednefs over the flin at once relieved me from much anxiety refpecting the nature of the malady, which went through its course in the ordinary way, but not without symptoms which were alarming both to myfelf and Mr.
Lyford, who attended with me. There was no apparent deviation in the ordinary progrefs of the pustule to a state of maturity, from what we fee in general, yet there was a total fufpension of the areola or florid difcolouration around it, until the scarlatina had retired from the constitution. As Foon as the patient was freed from this difeafe, this appearance advanced in the Ufual way. I witnessed a familiar fact in a cafe of Meafles. The Pufule from the Cow-Pock Virus advanced to maturity, while the Meafles Exifted in the Constitution, but no Efflurefcence appeared around it until the Meafles had Ceafed to exert its influence.
The cafe of Miss H.R. is not lefs interesting than that of her Fifter above related. She was expofed to the contagion of the Fcarlatina at the fame time, and fickened almost at the fame hour. The Fymptoms continued fevere about twelve hours when the Fcarlatine rafh showed itfelf faintly upon her face and partly upon her neck. After remaining two or three hours it FUDDENLY difappeared and she became perfectly free from every complaint. My furprife at this FUDDEN TRANFITION from extreme Ficknefs to health in great meafure feafed when i obferved that the inoculated palfule had occafioned in this cafe the common efflorefcent appearance around it and that as it approached the centre it was nearly in an eryfipelatous ftate But the moft remarkable part of this history is that on the fourth day afterwards, as foon as the efflorefcence began to die away upon the arm and the pustule to dry up, the Fcarlatina again appeared, her throat became Faw, the rafh spread all over her.
She went fairly through the difeafe, with its common fymptoms. That these were actually cases of scarlatina was rendered certain by two fervants in the family falling ill at the fame time with the diftemper, who had been expofed to the infection with the young ladies. Fome there are who fuppofed the fecurity from the small-pox obtained through the cow-pox will be of a temporary nature only. This fuppofition is refuted not only by analogy with refpect to the habits of difeafe of a familiar nature, but by incontrovertible facts, which appear in great numbers against it. To thofe already adduced in the former part of my firft treatife, many more might be added were it deemed necessary. But among the cafes i refer to one will be found of a perfon who had the cow pox fifty-three years before the effect of the small pox was tried upon him.
As he completely refifted it, the intervening period i conceive must necessarily satisfy any reasonable mind. Fould further evidence be thought neceffary, I shall obferve that among the cafes prefented to me by Mr. Fry, Mr. Dark, Mr. Tierney, Mr. H. Jenner, and others, there were many whom they inoculated ineffectually with variolous matter, who had gone through the cow-pox many years before this trial was made. It has been imagined that the cowpox is capable of being communicated from one person to another by effluvia without the intervention of inoculation. My experiments made with the design of ascertaining this important point all tend to establish my original position, that it is not infectious except by contact.
I have never hefitated to fufer thofe on whofe arms there were puftules exhaling the effluvia from affociating or even fleeping with thofe who never had experienced either the cow pox or the small pox and further i have repeatedly among children caufed the uninfected to breathe over the inoculated vaccine puftules during their whole progrefs Yet these experiments were tried without the least effect. However, to submit a matter fo important to a still further scrutiny, I defired Mr. H. Jenner to make any further experiments which might strike him as moft likely to establish or refute what has been advanced on this subject. He has fince informed me that the inoculated children at the breaft, whofe mothers had not gone through either the small pox or the cow pox, that he had inoculated mothers whofe fuccing infants had never undergone either of thefe difeafes that the effluvia from the inoculated puftules in either cafe had been inhaled from day to day during the whole progrefs of their maturation and that there was not the leaft perceptible effed from thefe expofures one woman he inoculated about a week previous to her accoufhement that her infant might be the more fully and conveniently expofed to the puftule, but as in the former instances no infedion was given, although the child frequently slept on the arm of its mother, with its noftrils and mouth expofed to the puftule in the fulleft state of maturity.
In a word, Is it not impossible for the cow pox, whofe only manifestation appears to confit in the pustules created by contact, to produce itfelf by effluvia? In the courfe of a late inoculation, I obferved an appearance which it may be proper here to relate. The punctured part on a boy's arm, who was inoculated with fresh limpid virus, on the sixth day, infted of showing a beginning veficle, which is ufual in the cow pox at that period, was encrufted over with a rugged amber-coloured fcab. The fcab continued to fpread and increase in thicknefs for fome days when at its edges a veficated ring appeared, and the difeafe went through its ordinary courfe, the boy having had fawnefs in the axilla and fome flight indifpofition.
With the fluid matter taken from the arm, Five persons were inoculated. In one it took no effect. In another it produced a perfect pustule, without any deviation from the common appearance. But in the other three the progress of the inflammation was exactly similar to the instants which afforded the virus for their inoculation. There was a creeping fcab of a loose texture, and subsequently the formation of limpid fluid at its edges. As these people were all employed in laborious exercises, it is possible that these anomalous appearances might owe their origin to the friction of the clothes on the newly inflamed part of the arm. I have not yet had an opportunity of exposing them to the small-pox.
In the early part of this inquiry, I felt far more anxiof respecting the inflammation of the inoculated arm than at prefent, yet that this affection will go on to a greater extent than could be wifhed is a circumftance fometimes to be expected. As this can be checked, or even entirely subdued by very simple means, I see no reason why the patient should feel an uneasy hour, because an application may not be absolutely necessary. About the 10th or 11th day, if the pustule has proceeded regularly, the appearance of the arm will almost to a certainty indicate whether this is to be expected or not. Fould it happen, nothing more need be done than to apply a single drop of the aqua lithargery acetate upon the puftule, and having fuffered it to remain two or three minutes to cover the efflorefcent furrounding the puftule with a piece of linen dipped in aqua lithargery compofita.
Goulard water. For further information on this subject, see the first treatise on the varioli vaccini, Dr. Marshall's letters, etc. End of footnotes. The former may be repeated twice or thrice during the day, the latter as often as it may feel agreeable to the patient. When the scab is prematurely rubbed off, a circumfance not unfrequent among children and working people, the application of a little aqua-lethargery acetate to the part immediately coagulates the furface, which fupplies its place and prevents a fore. In my former treatises on this fubject, I have remarked that the human constitution frequently retains its susceptibility of the smallpox contagion, both from effluvia and contact, after previously feeling its influence.
In further corroboration of this declaration, many facts have been communicated to me by various correspondents. I shall select one of them. Quote. Dear Sir. Society at large, muft, I think, feel much indebted to you for your enquiries and observations on the nature and effect of the Varielli, Vaccini, etc., etc., As I conceive what I am now about to communicate to be of some importance, I imagine it cannot be uninteresting to you, especially as it will serve to corroborate your assertion on the susceptibility of the human system of the varialis contagion, although it has previously been made sensible of its action. In November, 1793, I was Defired to Inoculate a Perfon with the Small-Pox. I took the variolous matter from a child under the difeafe in the natural way, who had a large burden of diftinct Pustules.
The mother of the child, being desirous of seeing my method of communicating the disease by inoculation, after having opened a pustule, I introduced the point of my lancet in the usual way on the back part of my own hand, and thought no more of it until I felt a sensation in the part, which reminded me of the transaction. This happened upon the third day. On the fourth there were all the appearances common to inoculation, at which I was not at all furprifed, nor did I feel myfelf uneafly, upon perceiving the inflammation continued to increase to the sixth and seventh day, accompanied with a very small quantity of fluid. Repeated experiments having taught me it might happen fo with perfons who had undergone the difeafe, and yet would escape any constitutional affedtion.
But I was not so fortunate, for on the eighth day I was seized with all the symptoms of the eruptive fever, but in a much more violent degree than when I was before inoculated, which was about eighteen years previous to this, when I had a considerable number of pustules. I muft confef I was now greatly alarmed, although I had been much engaged in the smallpox, having at different times inoculated not less than two thousand perfons. I was convinced that my prefent indifpofition proceeded from the infertion of the variolous matter, and therefore anxiously looked for an eruption. On the tenth day I felt a very unpleasant Felfation of Fiffnefs and heat on each Fide of my Fale near the ear, and the fever began to decline.
The Affection in my face foon terminated in three or four puftules attended with inflammation, but which did not maturate, and I was prefently well. I remain, dear sir, etc., Thomas Miles.
This inquiry is not now so much in its infancy as to reftrain me from speaking more positively than formerly on the important points of scrofula, as connected with the smallpox. Every practitioner in medicine who has extensively inoculated with the small-pox, or who has attended many of those who have had the diftemper in the natural way, muft acknowledge that he has frequently feen fcrofluous affections, in some form or another, fometimes rather quickly fhewing themfelves after the recovery of the patients. Conceiving this fact to be admitted, as I prefumed it muft be by all who have carefully attended to the fubjec, may I not afk whether it does not appear probable that the general introduction of the small-pox into europe has not been among the moft conducive means in exciting that formidable foe to health?
Having attentively watched the effects of the cow-pox in this refped I am happy in being able to declare that the difeafe does not appear to have the leaft tendency to produce this deftructive malady the fkepticifm that appeared even among the moft enlightened of medical men when my fentiments on the important fubject of the cow-pox were firft promulgated was highly laudable To have admitted the truth of a doctrine at once fo novel and fo unlike any thing that had ever appeared in the annals of medicine, without the teft of the moft rigid fcrutiny, would have bordered upon temerity. But now, when that fcrutiny has taken place, not only among ourfelves, but in the firft professional circles in europe, and when it has been uniformly found in fuch abundant inffances that the human frame when once it has felt the influence of the genuine cow pox in the way that has been defrived it is never afterwards at any period of its existence affailable by the small pox may i not with perfect confidence congratulate my country and society at large On their beholding, in the mild form of the cow-box, an antidote that is capable of extirpating from the earth a difeafe which is every hour devouring its victims, a difeafe that has ever been considered as the severest fcourge of the human race.