RESEARCHES 
UPON 
“SPURIOUS VACCINATION,” 
OR THE 
ABNORMAL PHENOMHA ACCOMPANYING AM FOLLOWING VACCINATION 
m THE 
€snit)nxuU |tip, 
DURING THE RECENT 
AMMAN CIVIL FAS, 1861-1885, 
BY 
JOSEPH JONES, M.X>., 
Professor of Physiology and Pathology in the Medical Department of the Tfni- 
versitpl’B/ Tenn. 
From the Nashville Journal 'll Medicine and Surgery. 
SWjuilU, &cmt. : 
UNIVERSITY MEDICAL PRESS—W. H. F. LIGON, PRINTER. 
1867. RESEARCHES 
Upon “Spurious Vaccination,” or the Abnormal Phenomena 
accompanying and following Vaccination in the Con- 
federate Army, during the recent American Civil War, 
1861-1865. By Joseph Jones, M.D., Professor of Physiolo- 
gy and Pathology, in the Medical Department of the Univer- 
sity of Nashville, Tenn. 
SECTION I. 
Preliminary Observations—Accidents attending Vaccina- 
tion AMONGST THE CITIZENS AND SOLDIERS OF THE CONFED- 
ERATE States—Necessity for the Investigation—Me- 
thod, Extent and Object of the Inquiry. 
During the recent civil war, untoward results followed vaccina- 
tion, and a number of deaths both amongst the troops and citizens 
were directly referable to the effects of vaccination. So great was 
the evil in the army, that it was made a special subject of inves- 
tigation, and a number of interesting reports were prepared by 
several of the medical officers, upon what was most generally 
called in the army, “spurious vaccination.” Our friend, Surgeon 
Jackson Chambliss, in charge of Div. No. 1 Camp Winder Hos- 
pital, Richmond, had examined and recorded a large number of 
cases of “spurious vaccination,” illustrated with drawings of the 
various local diseases and skin affections. As far as our informa- 
tion extends, this valuable mass of matter, relating to one of 4 
tlie most important subjects in its bearings upon the welfare of 
the human race, was destroyed during the evacuation of Rich- 
mond. If any of these reports are still in existence, we shall be 
happy to be the medium of communicating them to the profes- 
sion. 
So common had accidents become after vaccination, and so 
strong was the prejudice growing, both in the army and amongst 
citizens against its employment, that we instituted a series of ex- 
periments upon the inoculation of cows with small-pox matter, 
in order to produce, if possible, cow-pox, from whence a supply 
of fresh and reliable vaccine matter might be obtained. It was 
our design to carry out an extensive series of investigations upon 
the various secondary affections following vaccination, and to 
determine, if possible, what contagious principles could be asso- 
ciated with the lymph of the vaccine vesicle. These labors were 
brought to a sudden and unexpected close, by the disastrous ter- 
mination of the civil war. As far, however, as our labors amongst 
the Confederate troops extended, we were led to attribute the 
injurious effects of vaccination to the following causes : 
Ist.—Depressed forces, consequent upon fatigue and exposure 
and poor diet: impoverished, vitiated and scorbutic condition 
of the blood of the patients vaccinated, or yielding vaccine- 
matter. 
2d.—The employment of matter from pustules or ulcers 
ivhich had deviated from the regular and usual course of devel- 
opment of the vaccine vesicle ; such deviation or imperfection 
in the vaccine disease or pustule being due mainly to previous 
vaccination, and the existence of some eruptive disease at the 
time of vaccination. Or in other words, the employment of 
matter from patients who had been previously vaccinated, and, 
ivho were affected with some shin disease at the the time of the 
insertion of the vaccine virus. 
3d.—Dried Vaccine, Lymph or Scabs, in tuhich decomposition 
has been excited by carrying the matter about the person for a 
length of time, and thus subjecting it to a ivarm moist atmos- 
phere. 4th.—The mingling of the Vaccine Virus with that of the 
Small Pox :—matter taken from those who were vaccinated 
ichile they were laboring under the action of the 'poison of Small 
Pox, was capable of producing a modified Variola, and com- 
paratively mild disease in the inoculated, and was capable of 
communicating by effluvia Small Pox in its worst character to 
the unprotected. 
sth.—Dried Vaccine, Lymph or Scabs, from patients who 
had suffered ivith Erysipelas during the progress of the Vac- 
cine Disease, ornohose systems were in a depressed state from 
improper diet, bad ventilation, and the exhalations from Typhoid 
Fever, Erysipelas, Hospital Gangrene, Pyaemia, and offensive 
suppurating wounds. 
6th.—Fresh and dried Vaccine Lymph and Scabs, from pa- 
tients suffering from Syphilis, at the time, and during the pro- 
gress of vaccination and the vaccine diseases. 
The results of my investigations during the war, werepuhlished 
in the Southern Medical and Surgical Journal, July, 1866, pp. 
165-180, under the head of “Spurious Vaccination.” 
Since the publication of this article, we have still farther in- 
vestigated the subject, and addressed a large number of commu- 
nications relating to “Spurious Vaccination” to southern physi- 
cians formerly connected with the Confederate Army, and the re- 
plies to these inquiries will be found in the following pages ; and 
in truth, aside from the great interest and importance which 
everything relating to vaccination possesses, one of the chief ob- 
jects which we had in preparing the present article, was to col- 
lect and consolidate and preserve the labors of southern phy- 
sicians. 
The following is the general form of circular employed ; 
No. 7 North Vine Street, Nashville, Tens. 
1866. 
——M.D. 
Dear Sir 
I am at present engaged in drawing up a monograph upon “ Spurious Vaccination, 
and “Modified Inoculation.” 6 
In this paper, which will be published at an early day, I will endeavor to do full 
justice to the valuable labors of Confederate Surgeons. 
In the circumscribed and distressed condition of the Southern States, cut off from 
the surrounding world, with the necessity of Vaccinating the entire male population 
capable of bearing arms, and without any means of obtaining fresh and reliable 
matter outside of the Confederate States, the experience of the Medical Officers of 
the Confederate Army possesses a high and peculiar value. 
I shall be glad to receive from you a communication, setting forth your views at 
length upon the nature and value of Modified Inoculation, and upon the Nature 
and Causes of the Accidents resulting fromY accination (“Spurious Vaccination”) 
in the Confederate Army. 
The subject of the teansmisson of Syphilis through the medium of the Vaccine 
Virus, should be carefully discussed, and all conclusions should be supported by 
carefully recorded facts and cases. One well reported case, proving the transmission 
of Constitutional Syphilis, or any other disease, as Erysipelas, by vaccination, is worth 
large volumes of mere opinions and assertions. 
We should exercise the utmost caution in discussing the value of vaccination, and 
the causes of the accidents, which have tended of late, to bring it into disrepute with 
the public; for all conscientious physicians and lovers of mankind will agree that 
this question is interesting, not only to the physiologist and medical practitioner, 
but that it concerns every community on the earth, and comes home to every individ- 
ual of the human race. 
It has been well said, hy a writer who was not a medical man, “It is difficult to 
conceive that there should he one being who would not be affected by its decision, 
either in his own person, or by those of his nearest connexions. To the hulk of 
mankind wars and revolutions are things of infinitely less importance; and even to 
those who busy themselves in the tumult of public affairs, it may be doubted 
whether any thing can occur that will command so powerful and permanant an in- 
terest, since there are few to whom fame or freedom can he so intimately and con- 
stantly precious as personal safety and domestic affection.” 
It is important that we should carefully distinguish the accidents which result 
from carelessness in the selection of the matter, and from ignorance of the true char- 
acter and progress of the vaccine disease, 
You will oblige me by answering at an early day, and also hy forwarding the ad- 
dress of any physicians who have made this subject a special study, and who have 
recorded trustworthy observations. 
Very respectfully yours, 
JOSEPH JONES. 
This circular letter has not been as widely distributed as 
was desired ; as it has been difficult to ascertain the address of 
many of the medical officers of the Southern Army, on account 
of the sudden manner, in which the struggle terminated, and the 
utter and sudden loss of all organization and records ; and on 
account of the imperfect mail facilities of the Southern States. 7 
Therefore, all who may receive this paper, are respectfully reques- 
ted to consider themselves as addressed in person. 
The replies which have been received in response to my letters, 
will he found under the different divisions of the inquiry ; and 
we have preferred presenting each paper entire, when using it for the 
illustration of some particular branch of the subject, although it 
might contain some matter irrelevant to the subject under imme- 
diate consideration. In this manner we hoped to do entire justice 
to those contributing facts and observations ; and whilst we have 
freely expressed the results of our investigation, and given our 
judgment without reserve, we have endeavored on the other 
hand to avoid all personal criticism. The replies to these printed 
enquiries will be published from time to time as they may be re- 
ceived. 
Before proceeding to the discussion of the subjects under con- 
sideration, it is but just that I should disclaim all design of de- 
crying vaccination when properly performed. Nothing is farther 
from my intention, than even in the remotest manner, to detract 
from the value of the greatest physical boon ever bestowed by a 
mortal upon the human race. 
From authentic documents and accurate calculations, it has been 
ascertained that one in fourteen, of all that were born died of the 
small-pox, even after inoculation had been introduced; and of per- 
sons of all ages taken ill of the small-pox in the natural way, one 
in five or six died ; and in addition to this frightful mortality, 
alike observable in all the different regions of the globe, many of 
those who recovered were permanently disfigured, or deprived of 
eyesight, or left with shattered constitutions the prey to pulmo- 
nary consumption, chronic opthalmia and scrofula. 
'According to the researches of Black, Ltissmileh and Frank, 
eight or nine per cent, of the human race were carried off hy 
small-pox : and Duvillard endeavored to show that of 100 per- 
sons, only four reached the age of thirty years without having it, 
that one in seven or eight, who were affected, died ; and that of 
those who were attacked in infancy only two-thirds escaped. Be- 
fore the introduction of vaccination, small-pox was infinitely 
more destructive to human life than the plague itself: it has 8 
swept away whole tribes of savage and half civilized people, and its 
miserable victims have been abandoned by their nearest relatives 
and friends, as persons doomed by divine wrath to irrevocable 
death : it was calculated that 210,000 fell victims to it annually in 
Europe, and Bernouilli believed that not less than fifteen millions 
of human beings were destroyed by small-pox every twenty-five 
years, that is six hundred thousand annually: and this loathsome 
disease was not only universal in its ravages, but was so subtle in 
its influence and insidious in its attack, that all efforts to stay its 
violence or to prevent its approach, were utterly futile. Even 
inoculation whilst it was far less severe and fatal than the natu- 
ral small-pox and thus benefitted the indiviual, tended neverthe- 
less to increase the spread of the disease, and its extensive adop- 
tion was attended with a most marked increase of mortality of 
the disease in the human race. 
Sir Matthew Hale in a letter of advice and admonition to one of 
his grandsons, has given an excellent picture of this disease, which 
well illustrates its odious characters, and exhibits the impression 
which it makes upon the world at large, in a stronger light than 
if the description had been drawn up by a strictly professional 
hand. 
“ First, therefore, touching your late sickness (small-pox) I would have you re- 
member these particulars: Ist. The disease itself in its own nature is now become 
ordinary very mortal, especially to those of your age. Look upon even the last 
year’s general bill of mortality, you will find near two thousand dead of that disease 
the last year; and, had God not been merciful to you, you might have been one of 
that number with as great likelihood as any of them who died of that disease. 2d. It 
was a contagious disease that secluded the access of your nearest relations. 3d. Your 
sickness surprised you upon a sudden, when you seemed to be in your full strength. 
4th. Your sickness rendered you noisome to yourself and all that were about you ; 
and a spectacle full of deformity, by the excess of your disease, beyond most that 
are sick thereof. sth. It was a fierce and violent sickness: it did not only take away 
the common supplies of nature, as digestion, sleep, strength, but it took away your 
memory, your understanding and the very sense of your condition, or of what might 
be conducible to your good. All that you could do was only to [make your condi- 
tion more desperate, in case they that were about you had not prevented it and taken 
more care for you than you did or could for yourself. 6th. Your sickness was des- 
perate, in so much that your symptoms and the violence of your distemper were 
without example; and you were in the very next degree to absolute rottenness, pu- 
trefaction and death itself.” 9 
By the unaided efforts of a man, emulous not of distinction 
but desirous of advancing truth, and promoting the happiness and 
well being of his fellow creatures, and distinguished as much for 
his humility, long suffering and perservence, as for his unsur- 
passed powers of practical observation, the world has been fur- 
nished with the means of completely eradicating this terrible 
scourge, by substituting the same disease in a mild, modified form 
non-communicable by effluvia and capable of affording complete 
immunity from the natural small-pox. 
So far, therefore, from charging the accidents which we are 
about to describe, to the process of vaccination, as established and 
advocated by Edward Jenner, we are persuaded that a very large 
part, if not the whole of these distressing accidents and failures, 
are to be ascribed directly or indirectly to the ignorance, and 
inattention, of those who practice vaccination. We have no 
more sympathy with the modern opponents of vaccination, than 
we have with those English physicians who attempted to decry 
the labors and to steal the honest dues of their immortal coun- 
tryman, and who condescended to such low expedients as to 
caricature the process of vaccination, by representing the 
human visage under its effects, in the act of transformation into 
that of the lower animals, the cow and the horse. And we 
would heartily endorse any public enactment which would guard 
in a proper manner the process of vaccination ; and at the pre- 
sent time some of the older European edicts upon the subject of 
vaccination, as those of the Emperor of Russia in 1811, and of 
the King of Wirtemburgh in 1818, might be reenacted by the 
General and State Governments, with great benefit to the people. 
If the profession had uniformly adhered to the advice and the 
rules established by the illustrious founder of vaccination, we 
would have been spared the vast majority of the unfortunate ac- 
cidents which tend to bring this, the only safeguard against the 
small-pox, into disrepute. 
Dr. Jenner gave the most minute attention to every deviation 
from the correct progress of the vaccine vesicle, to the state of 
the virus to be inserted, to the condition of the skin of the per- 
son about to be vaccinated, and to the character of the vesicle 10 
itself; and so early as tire year 1799, liad ascertained by the 
clearest evidence, some of the causes of accident and failure 
which have been confirmed by later observations. 
He showed that in some cases the system was not rendered 
totally unsusceptible to the variolous contagion, either by the cow- 
pox vaccination, or the small-pox ; but that vaccination, when 
properly performed with genuine matter, afforded as complete 
protection as the small-pox itself. He proved that by inocula- 
ting a person who had gone through the cow-pox, with variolous 
matter, it was possible to excite a local vesication, the virus from 
which was capable of producing a mild but efficacious small-pox. 
He farther maintained that modifications and varieties might 
arise in the vaccine pustule, and that these varieties were such 
as to produce “ every gradation in the state of the pustule, from 
that slight deviation from perfection, which is quite immaterial, 
up to that point which affords no security at all.” He held that 
fluid taken from a spurious vaccine pustule can propagate and 
perpetuate its like, and even if it be taken from a genuine pus- 
tule in its far-advanced stages, it is capable of producing varieties 
which will be permanent if we continue to employ it. 
Jermer laid great stress upon the herpetic state of the skin, in 
inducing deviation in the normal progress of the vaccine disease ; 
but every deviation, from whatever cause it may have arisen, was 
considered by him of the greatest moment; and in all his pub- 
lished works, as well as in his private communications and let- 
ters, he never failed to urge the importance of the most scrupu- 
lous attention to the mode of propagation and to the whole pro- 
gress of the vaccine disease. 
Thus in his paper on the “Varieties and Modifications of the 
Vaccine Pustule,” he thus urges upon the profession the neces- 
sity of the most careful attention to this important subject: 
“ I shall conclude this paper hy observing that although vaccine inoculation does 
not inflict a severe disease, but, on the contrary, produces a mild affection, scarcely 
meriting the term disease, yet, nevertheless, the inoculator should he extremely care- 
ful to obtain a just and clear conception of this important branch of medical science. 
He should not only he acquainted with the laws and agencies of the vaccine virus on 
the constitution, but with those of the variolous also, as they often interfere with 
each other. 11 
“A general knowledge of the subject is not sufficient to enable us to warrant a 
person to practice vaccine inoculation: he should possess a peculiar knowledge; and 
that which I would wish strongly to inculcate, as the great foundation of the whole, 
is an intimate acquaintance with the character of the true and genuine pustule. 
The spurious pustule would then be readily detected, whatever form it might assume; 
and errors known no more.” 
Dr. Jenner, in a letter written to Sir Gilbert, near the close of 
bis life, reiterates these precautions, and observes : 
“ With regard to the mitigated disease which sometimes follows vaccination, I can 
positively say, and shall be borne out in my assertion by those who are in future days 
to follow me, that it is the offspring entirely of incaution in those who conduct the 
vaccine process. On what does the inexplicable change which guards the constitu- 
tion from the fang of the small-pox depend 1 On nothing but a correct state of the 
pustule on the arm excited by the insertion of the virus; and why are these pus- 
tules sometimes incorrect, losing their characteristic shape, and performing their 
offices partially'?”—(Life of Edward Jenner, M.E., L.L.E., etc., hy John Barm, M.E., 
Vol. 241.J 
Jenner even went so far as to maintain that the process of vac- 
cination might be rendered ineffective by mechanically disturb- 
ing the vesicle, during the collection and transmission of the 
virus, and he insisted upon the necessity of allowing one vesicle 
at least to run its course undisturbed. 
So far, therefore, from desiring to injure the cause of vaccina- 
tion by the record of distressing failures and accidents, it will be 
our endeavor, rather in the spirit of Jenner. to guard the process, 
by so exposing the cause of these accidents as to lead to their 
avoidance in future. 
“Ere I proceed, let me be permitted to observe, that truth in 
this, and every other physiological inquiry that has occupied my 
attention, has ever been the first object of my pursuit; and 
should it appear in the present instance that I have been led into 
error, fond as I may appear of the offspring of my labors, I had 
rather see it perish at once than exist and do a public injury.” 
SECTION 11. 
Modification, alteration and degeneration of the Vac- 
cine Vesicle, dependent upon depressed and deranged 12 
FORCES, RESULTING FROM FATIGUE, EXPOSURE AND POOR DIET; 
AND UPON AN IMPOVERISHED, VITIATED AND SCORBUTIC CON- 
DITION OF THE BLOOD OF THE PATIENTS VACCINATED AND 
yielding Vaccine Matter. In scorbutic patients all in- 
juries OF THE SKIN TEND TO FORM ULCERS OF AN UNHEALTHY 
CHARACTER. EFFECTS OF SCURVY UPON THE CHARACTER AND 
PROGRESS OF THE VACCINE VESICLE. INVESTIGATIONS UPON 
THE EFFECTS OF VACCINATION AMONGST THE FEDERAL PRIS- 
ONERS CONFINED IN CAMP SUMPTER, AnDERSONVILLE, GrA, 
Letter and Report on Spurious Vaccination, by Dr. S. 
E. Habersham, 
Large numbers of the Confederate soldiers manifested slight 
scorbutic symptoms, which were not sufficient to attract atten- 
tion, or to induce treatment, and as far as we could learn, no 
attention was paid to this condition either in vaccination or in 
the selection of the vaccine lymph. 
In scorbutic patients, all injuries tended to form ulcers of an 
unhealthy character, [and the vaccine vesicles even when they 
appeared at the proper time, and manifested many of the usual 
symptoms of the vaccine disease, were nevertheless larger and more 
slow in healing, and the scabs presented an enlarged, scaly, dark, 
unhealthy appearance. In many cases, a large ulcer covered with 
a thick laminated crust, from one-quarter to one inch in diameter, 
followed the introduction of the vaccine matter into scorbutic 
patients. Matter from these scabs and sores was frequently used 
in vaccination, and this decomposing pus and blood acted as an 
animal poison in some cases, and especially in constitutions de- 
bilitated by exposure, fatigue, and salt diet. 
During the prosecution of the investigations which we insti- 
tuted upon the diseases of the Federal prisoners confined at 
Andersonville, the opportunity was embraced of investigating the 
remarkable effects which followed the attempts of the Confederate 
medical officers to arrest the spread of small-pox by vaccination. 
In a number of cases, large gangrenous ulcers appeared at the 
points where the vaccine lymph had been inserted, causing ex- 
tensive destruction of tissues, exposing arteries, nerves, and 13 
bones, and necessitating amputation in more than one instance. 
These accidents led to the belief amongst some of the prisoners 
that the Surgeons had intentionally introduced poisonous matter 
into their arms during vaccination. 
After careful inquiry we were led to the conclusion that these 
accidents were, in the case of these Federal prisoners, referable 
wholly to the scorbutic condition of their blood, and to the 
crowded condition of the stockade and hospital. The smallest 
accidental injuries and abrasions of the surface, as from splinters, 
or bites of insects, were in a number of instances followed by 
such extensive gangrene as to necessitate amputation. The gan- 
grene following vaccination appeared to be due essentially to the 
same cause; and in the condition of the blood of these patients, 
would most probably have attacked any puncture made by a lan- 
cet, without any vaccine matter or any other extraneous material. 
It appeared also that the dried scab, resulting from the vaccina- 
tion of these scorbutic patients, was also capable of producing 
effects wholly different from the vaccine lymph of healthy indi- 
viduals ; and in some cases these effects were of a most potent 
and injurious character. 
The cause of Justice and Truth, demands at my hands, some- 
thing more, than this simple record, with reference to the acci- 
dents following vaccination, amongst the Federal prisoners con- 
fined in Camp Sumpter. 
In the specification of the first charge against Henry Wirz, 
formerly Commandant of the interior of the Confederate States 
Military Prison, during his Trial before a Special Military Com- 
mission, convened in accordance with Special Orders No. 453, 
War Department, Adjutant General's Office, Washington, Au- 
gust 23, 1865, the following is written : 
“And the said Wirz, still pursuing his wicked purpose, and still aiding in can-ying 
out said conspiracy, did use and cause to he used, for the pretended purpose of 
vaccination, impure and poisonous matter, which said impure and poisonous matter 
was then and there, by the direction and order of said Wirz, maliciously, cruelly, 
and wickedly deposited in the arms of many of said prisoners, by reason of which 
large numbers of them, to-wit, one hundred, lost the use of their arms, and many 
of' them, to-wit, about the number of two hundred, were so injured that they soon 
thereafter died: All of which he, the said Henry Wirz, well knew and maliciously 14 
intended, and in aid of the then existing rebellion against the United States, with 
the view to assist in weakening and impairing the armies of the United States, and 
in furtherance of the said conspiracy, and with full knowledge, consent and conni- 
vance of his co-conspirators aforesaid, he the said Wirz, then and there did.” 
Amongst the co-conspirators specified in the charges, were the 
Surgeon of the Post, Dr. White, and the Surgeon in charge of 
the Military Prison Hospital, R. R. Stevenson. As the vaccina- 
tions were made by their orders, and by the medical officers of 
the Confederate Army acting under their command, the charge 
of deliberately poisoning the Federal Prisoners with vaccine mat- 
ter, is a sweeping one, and whether intended so or not, affects every 
medical officer stationed at that post; and it appears to have been 
designed to go farther and to affect the reputation of every one 
who held a commission in the Medical Department of the Con- 
federate Army. 
The acts of those who once composed the Medical Department 
of the Confederate Army, from the efficient and laborious Sur- 
geon G-eneral to the Regimental officers, need no defence at my 
hands; time, with its unerring lines of historic truth, will em- 
balm their heroic labors in the cause of suffering humanity, and 
will acknowledge their untiring efforts to ameliorate the most 
gigantic mass of suffering, that ever fell to the lot of a beleaguered 
and distressed people. 
I desire at the present time, simply to place on record, the re- 
sults of labors which concern this country, no more than any 
other; and these results when properly received without preju- 
dice or malicious hatred, will be seen to relate to the hygiene 
and to the diseases of Prisoners, however confined, and wherever 
incarcerated, in civil or military prisons throughout the world. 
In accordance with the direction of Dr. Samuel Preston Moore, 
formerly Surgeon General C. S. A., I instituted during the months 
of August and September, 1864, a series of investigations upon 
the diseases of Federal Prisoners confined in Camp Sumpter, 
Andersonville, Georgia. 
The field was of great extent and of extraordinary importance. 
There were more than five thousand seriously sick in the hospital 
and stockade, and the deaths ranged from ninety, to one hundred 15 
and thirty, each day. From the establishment of the Prison, on 
the 24th of February, 1864, to the Ist of October, over ten 
thousand Federal prisoners died : that is, near one-third of the 
entire number perished in less than seven months. I instituted 
careful investigations into the condition of the sick and well, and 
performed numerous post-mortem examinations, and executed 
drawings of the diseased structures. The medical topography of 
Andersonville and of the surrounding country was examined, and 
the waters of the streams, springs and wells, around and within 
the stockade and hospital carefully analyzed. 
The report which I drew up for the use of the Medical De- 
partment of the Confederate Army, contained a truthful repre- 
sentation of the sufferings of these prisoners, and at the same 
time gave an equally truthful view of the difficulties, under which 
the medical officers labored, and of the distressed, and beleaguered 
and desolated condition of the Southern States. Shortly after 
the close of the civil war, this report, which had never been de- 
livered, on account of the destruction of all railroad communi- 
cation with Richmond, Virginia, was suddenly seized by the 
agents of the United States government, conducting the trial to 
which we have alluded. 
It was with extreme pain that I contemplated the diversion of 
my labors, in the cause of Medical science, from their true and 
legitimate object, and I addressed an earnest appeal, which ac- 
companied the report, to the Judge Advocate, Col. N. P. Chip- 
man, in which I used the following language : 
In justice to myself, as well as to those most nearly connected with this investi- 
gation, I would respectfully call the attention of Col. Chipman, Judge Advocate 
U. S. A., to the fact that the matter which is surrendered in obedience to the de. 
mauds of a power from which there is no appeal, was prepared solely for the con. 
sideration of the Surgeon General, C. S. A., and was designed to promote the cause 
of humanity, and to advance the interests of the Medical profession. This being 
granted, I feel assured that the Judge Advocate will appreciate the deep pain which 
the anticipation gives me that these labors may be diverted from their original mis- 
sion, and applied to the prosecution of criminal cases. The same principle which 
led me to endeavor to deal humanely and justly by these suffering prisoners, and to 
make a truthful representation of their condition to the Medical Department of the 
Confederate Army, now actuates me in recording my belief that as far as my knowl- 
edge extends, there was no deliberate or willful design on the part of the Chief 16 
Executive, Jefferson Davis, and tlie highest authorities of the Confederate Govern- 
ment to injure the health and destroy the lives of these Federal Prisoners. 
On the 21st of May, 1861, it was enacted by the “ Congress of the Confederate 
States of America,” “ That all prisoners of war taken, whether on land or at sea, 
during the pending hostilities with the United States, should he transferred by the 
captors, from time to time, as often as convenient, to the Department of War; and 
it shall be the duty of the Secretary of War, with the approval of the President, to 
issue such instructions to the Quartermaster General and his subordinates, as shall 
provide for the safe custody and sustenance of prisoners of war; and the rations 
furnished prisoners of war shall be the same in quantity and quality as those fur- 
nished enlisted men in the army of the Confederacy.” By act of February 17,1864 
the Quartermaster General was relieved of this duty, and the Commissary Genera] 
of Subsistence was ordered to provide for the sustenance of prisoners of war. 
According to General Orders No. 159, Adjutant and Inspector General’s Office, 
“hospitals for prisoners of war are placed on the same footing as other Confederate 
States hospitals, in all respects, and will be managed accordingly.” 
The Federal prisoners were removed to South-western Georgia in the early part 
of 1864, nob only to secure a place of confinement more remote than Richmond and 
other large towns, from the operations of the United States forces, hut also to secure 
a more abundant and easy supply of food. 
As far as my experience extends, no person Avho had been reared upon wheat 
bread, and Avho was held in captivity for any length of time, could retain his health 
and escape either scurvy or diarrhoea, if confined to the Confederate ration (issued 
to the soldier in the field and hospital) of unbolted corn meal and bacon. The large 
armies of the Confederacy suffered more than once from scurvy, and as the Avar 
progressed, secondary hemorrhage and hospital gangrene became fearfully prevalent 
from the deteriorated condition of the systems of the troops, dependent upon the 
prolonged use of salt meat. And but for the extra supplies received from home 
and from the various benevolent State institutions, scurvy and diarrhoea and dysen- 
tery would have been still farther prevalent.” 
It Avas believed by the citizens of the Southern States, that the Confederate au- 
thorities desired to effect a continuous, and speedy exchange of prisoners of Avar in 
their hands, on the ground that the retention of these soldiers in captivity was a 
great calamity, not only entailing heavy expenditure of the scanty means of sub- 
sistence, already insufficient to support their suffering, half-starved, half-clad and 
unpaid armies, struggling in the field Avith ovenvlielming numbers, and embarrassing 
their imperfeet and dilapidated lines of communication; but also as depriving them 
of the services of a veteran army fully equal to one-third the numbers actively en- 
gaged in the field; and the history of subsequent events have shoAvn that the reten- 
tion in captivity of the Confederate prisoners Avas one of the efficient causes of the 
final and complete overthroAV of the Confederate Government. * * * 
It is my honest belief that if the exhausted condition of the Confederate Gov- 
ernment, with its bankrupt currency, Avith its retreating and constantly diminishing 
armies, with the apparent impossibility of filling up the vacancies by death and de- 
sertion and sickness, and of gathering a guard of reserves of sufficient strength to 
allow of the proper enlargement of the Military Prison, and with a country torn and 17 
bleeding along all its borders with its starving women and children and old men 
fleeing from the desolating march of contending armies, crowding the dilapidated 
and over-burdened railroad lines, and adding to the distress and consuming the poor 
charities of those in the interior, who were harrassed by the loss of sons and brothers 
and husbands, and by the fearful visions of starvation and undefined misery, could 
be fully realized, much of the suffering of the Federal prisoners would be attributed 
to csuses connected with the distressed condition of the Southern States. 
It was clearly demonstrated in my report that diarrhoea, dys- 
entery, scurvy and hospital gangrene were the diseases which 
caused the extraordinary mortality of Andersonville. And it 
was still farther shown that this mortality was referable, in no 
appreciable degree, to either the character of the soil, or waters, 
or the conditions ol climate. 
The effects of salt meat and farinaceous food, without fresh 
vegetables, were manifest in the great prevalence of scurvyj 
The scorbutic condition thus induced, modified the course of 
every disease, poisoned every wound, however slight, and lay at 
the foundation of those obstinate and exhausting diarrhoeas and 
dysenteries, which swept off thousands of these unfortunate men. 
By a long and painful investigation of the diseases of these pris- 
oners, supported by numerous post-mortem examinations, I 
demonstrated conclusively that scurvy induced nine-tenths of the 
deaths. Not only were the deaths registered as due to unknown 
causes, to apoplexy, to anasarca, and to debility, directly 
traceable to scurvy and its effects, and not only was the 
mortality in small-pox and pneumonia and typhoid fever, and in 
all acute diseases more than doubled by the scorbutic taint, but 
even those all but universal and deadly bowel affections, arose 
from the same causes, and derived their fatal characters from the 
same conditions which produced the scurvy. 
Scurvy and hospital gangrene frequently existed in the same 
individual. In such cases, vegetable diet, with vegetable acids, 
would remove the scorbutic condition without curing the hospital 
gangrene. It has been well established by the observations of 
Blane, Trotter and others, that the scorbutic condition of the 
system, especially in crowded camps, ships, hospitals and be- 
leaguered cities, is most favorable to the origin and spread of foul 
ulcers and hospital gangrene. In many cases occurring amongst 18 
the Federal prisoners at Andersonville, it was difficult to decide 
at first whether the ulcer was a simple result of the scorbutic 
state, or of the action of the poison of hospital gangrene ; for 
there was great similarity in the appearance of scorbutic ulcers 
and genuine hospital gangrene. So commonly have these two 
diseases been combined, that the description of scorbutic ulcers 
by many authorities, evidently, includes also many of the promi- 
nent characteristics of hospital gangrene, as will he seen by a 
reference to the descriptions of Lind, Trotter, Blane, and others 
More than two hundred and fifty years ago, Pare described a 
condition of things similar to that of Andersonville : at the siege 
of Rouen, the air was so noxious that no wounds would heal5 
and the besieged finding that all their wounds became gangren- 
ous, reported that the besiegers had poisoned the balls ; the be- 
siegers also seeing none but putrid sores in the camp, believed 
that the wounds were poisoned, and both within and without the 
city such was the state of the air, and so putrid were all the 
wounds, that the surgeons could scarcely look upon the sores, or 
endure the smell ; and if they neglected them for a single days 
they found them filled with worms. 
Woodall, in his Chirurgeons Mate, or Military and Domestic 
Surgery, published in 1639, not only carefully describes scorbu- 
tic ulcers, but also lays down rules for their treatment ; and 
Gideon Harvey, twenty-four years later, in his “ Venus TJn- 
maskeH,” mentions superficial, profound, simple, inflamed, cal- 
lous, dry, sanious, purulent, phagedenick, and gangrenous 
as characteristic of scurvy. This last named author derives the 
name scurvy from u Scorbeck, and that from Scornobocca, or Fowl 
mouth, (from Scorno a Fowl or shameful thing, and bocca the 
mouth), for a stinking breath and fowl rotten gums, may still be 
termed a foul or shameful mouth ; they call it also La marcia di 
bocca, or putrefaction of the mouth.”—p. 24. 
The British seamen, in Lord Anson’s voyage, and in fact in 
all long voyages, before the mode of preventing scurvy was prac- 
ticed, suffered terribly from scorbutic ulcers. 
John Huxham in his Essay on Fevers, in the chapter in which 
he discourses on the “ disordered and putrid state of the blood,’’ 
observes that the 19 
“ Salt and half-rotten provisions of sailors in long voyages, cause such a sharpness 
and corruption of the humors that they are rendered almost unfit for the common 
uses of life, producing great weakness, languor, wandering pains and aches, stink- 
ing breath, corroded, spongy gums, black, blue and sallow spots, sordid, dark, livid 
fungous ulcers, gangrene, etc., etc. Such scorbutics frequently fall into patecheal 
fevers, bloody dysenteries, hemorrhages, etc. What is mentioned by the Rev. Mr. 
Walter in Lord Anson’s voyage, is very surprising, viz.: that the blood burst from 
the wounds of some of the scorbutics after they had been cicatrified for twenty or 
thirty years. I have known many a ship’s company set out on a cruize in high 
health, and yet in two or three months, return vastly sickly, and eaten out with the 
scurvy, a third part of them half-rotten and utterly unfit for service. About four or 
five weeks after they have been out, they begin to drop down, one after another and 
at length by dozens, till at least scarce half the compliment, can stand to their duty, 
particularly I remember some years since, from a squadron under Admiral Martin 
we had near 1200 men put on the shore sick at one time, though they went out 
very healthy and returned in about twelve or thirteen weeks.”-—p. 47. 
Dr. John Hunter, Surgeon in the English Army, in his “ Ob- 
servations on the Diseases of the Army in Jamaica/’ states that 
“ Sores and ulcers in the lower extremities were frequent at all seasons of the 
year and in all the different quarters where the soldiers were stationed. They to- 
gether with fevers and fluxes, amounted to nineteen-twentieths of the sick received 
into the hospitals, all other complaints not being more than one-twentieth, if particu- 
lar times be excepted, when the dry-belly-ache or small-pox were prevalent. The 
proportion of sores in the hospitals, though always considerable, admitted of great 
variation. At Spanish Town and Kingston they were often one-third; at Fort Au. 
gusta, one-half, and at Stony Hill, two-thirds of the whole number in hospital. 
They arise from the most trifling causes; a scratch, or hurt, or bruise in the lower 
extremities, are sufficient to produce a sore, which is always difficult to heal, and 
sometimes impossible. Old sores often break out anew, and prove equally obsti- 
nate,” 
Dr. Lind, in his valuable work on the scurvy, has recorded the 
fact that the slightest bruises and wounds of scorbutic persons 
may degenerate into offensive bloody and fungous ulcers, which 
are prone to spread with great rapidity, which are cured witn 
the greatest difficulty. The distinguishing characteristics ot 
scorbutic ulcers, as given by Dr. Lind, are as follows : 
“They do not afford a good digestion, but a thin foetid matter, mixed with blood, 
which at length has the appearance of coagulated blood, and is with great difficulty 
wiped off or separated from the parts below. The flesh underneath these sloughs 
feels to the probe soft and spongy. No irritating applications are here of any ser- 
vice : for though such sloughs be with great pains taken away, they are found again 20 
at next dressing, when the same bloody appearance always presents itself. Their 
edges are generally of a livid color and puffed up with excrescences of luxuriant 
flesh arising under the skin. When too tight a compression is made, in order to keep 
these excrescences from arising, they are apt to have a gangrenous disposition; and 
the member never fails to become swelled, painful and for the most part spotted. 
As the disease increases, they come at length to shoot out a soft bloody fungus, 
which the sailors express by the name of bullock’s liver: and indeed it has a near 
resemblance, in consistence and color, to that substance when boiled. It often rises 
in a night’s time to a monstrous size, and although destroyed by caustics, or the 
knife, (in which last case a plentiful bleeding generally ensues), is found at next 
dressing as large as ever. They continue, however, in this condition a considerable 
time without tainting the bone. The slightest bruises and wounds of scorbutic 
persons degenerate sometimes into such ulcers. Their appearances on whatever 
part of the body, is singular and uniform; and they are easily distinguished from all 
others, by being so remarkably offensive, bloody and fungous, that we cannot here 
but take notice of the impropriety of refering many inveterate and obstinate ulcers 
on the legs, with very different appearances, to scurvy; which are generally best 
cured by giving mercurial medicines ; whereas that medicine in a truly scorbutic 
ulcer is the most dangerous and pernicious that can be administered.” 
In like manner Doctor David Macbride in liis “Methodical 
Introduction to the Theory and Practice of Physic,” London, 
1772, p. 618, affirms that; 
“ The slightest wounds and bruises in scorbutic people degenerate into foul and 
untoward ulcers. And the appearance of these ulcers is so singular and uniform 
that they are easily distinguished from all others. Scorbutic ulcers afford no good 
digestion, but a thin and foetid ichor mixed with blood, which at length has the ap- 
pearance of coagulated gore lying caked on the surface of the sore, and is with 
great difficulty wiped off or separated from the parts below. The flesh underneath 
these sloughs feels to the probe soft and spongy, and is very putrid. No detergents 
nor escharotics are here of any service; for though such sloughs be with great pains 
taken away, they are found again at the next dressing, where the same sanguineus 
putrid appearance always presents itself. Their edges are generally of a livid color, 
and puffed up with excrescences of putrid flesh arising from below the skin. As the 
violence of the disease increases, the ulcers shoot out a soft bloody fungus, which often 
rises in a night’s time to a monstrous size, and although destroyed by caustics, ac- 
tual or partial, or cut away with the knife, is found at next dressing as large as 
ever. It is a good while, however, before these ulcers, bad as they are, come to 
affect the bone with rottenness.” 
Sir Gilbert Plane, in his “ Observations on the Diseases of Sea- 
men,” affirms that there is no complaint more hurtful to the 
public service, by sea and land, and none more afflicting to the 
individual than ulcers. 21 
“It is found,” says Dr. Blane in the work just referred to, “ from direful and 
multiplied experience, that not only those who are affected with actual symptoms of 
scurvy, but those who are exposed to the causes of it, and whose constitutions are 
in such a train as to fall into it, are particularly susceptible of ulcers of the most 
malignant kind, from the smallest injury which breaks the skin. This might natu- 
rally be expected, from what has been said of the great debility of the fibres, and 
deficiency of the powers of renovation and nutrition in this disease. The charac- 
teristic symptoms of such ulcers, are, a thin, fetid discharge, commonly mixed with 
blood, which sometimes coagulates on the surface. The ulcerated surface is soft and 
spongy, generally elevated above the level of the surrounding skin, particularly 
about the edges, where there are excrescences of luxuriant flesh, which in the more 
advanced state of the ulcer, shoots into a soft bloody fungus, called by the sailors 
bullock’s liver.”—Third Ed., London, 1799—P- 502. 
Dr. Blane records a number of important observations showing 
the tendency to foul gangrenous ulcers amongst seamen. On 
board the Granges, of seventy-four guns aud six hundred men, 
during the year 1798, the tendency to the complaint was such 
that the smallest sore, whether from a hurt or a pimple, fell into 
the state of an ulcer. Blistered parts were also affected in the 
same manner. Sores which seemed to be in a healing state, 
would suddenly become gangrenous. A black speck in the mid- 
dle was the constant precursor of this. In the most severe cases 
the ulcers b£gan with violent inflammation, which suddenly ter- 
minated in mortification ; destroying in a short time, the fleshy 
parts, so as to expose the bone, which soon became carious. 
The crew of the Triumph, of seventy-four guns and six hun- 
dred men, suffered severely from malignant ulcers during the 
summer and autymn of 1798. Not only wounds and blisters fell 
nto the ulcerated state, but a scratch or boils and the orifice of 
the arm after bleeding, were subject to the same accident. Sores 
which seemed to be in a healing state, would suddenly and with- 
out any visible cause, spread again, and become foul and bloody, 
extremely painful, and would resist every means of cure. 
This unfavorable change always began, as in the Ganges, with 
a black spot in the middle of the ulcer. Ulcers of the same 
kind prevailed to the most dreadful degree, in the ships serving 
at the Cape of Good Hope, and in the Naval Hospital there, in 
the years 1796 and 1797. These foul ulcers produced the most 
severe and protracted sufferings, terminating frequently in the 22 
loss of limbs or life, or both. Nor were they confined to the lower 
extremities, for the ossa-ilium, the scapula and cranium would 
sometimes become carious. It became frequently necessary to 
amputate at the hospital, and it was observed that if the patients 
who underwent the operation, remained in the wards, with the 
ulcers, few survived, owing to the gangrenous and ulcerous states 
of the stumps ; but when they were carried into a separate apart- 
ment, the large majority recovered. 
It was also observed, both in the ships and at the hospitals, 
where this species of ulcer prevailed, that the hands of those 
who dressed them, where the skin was broken, were attacked by 
the same sort of ulcer.—Observations on the Diseases of Sea- 
men, by Gilbert Blane, M.D.—pp. 506-512. 
Doctor Thomas Trotter, in his Medicina Nautica, has in like 
manner, recorded a large number of instances where malignant 
gangrenous ulcers have arisen spontaneously in various ships, and 
attacked with violence, not only external injuries ; but in a num- 
ber of cases, where neither wound, puncture, scab, or contusion 
could be said to have first taken place, a circumscribed red spot 
would be first perceived, scarcely to be felt, but in a few hours 
rising to a pimple, becoming black in the centre and inflamed 
around the edges, till it increased in size, swelled and assumed 
every characteristic symptom of malignant ulcer, with constant 
fever and subsequent ulceration, slough and fetid discharge. This 
malignant or gangrenous ulcer attacked also the flesh wounds 
made with the lancet in bleeding, for different inflammatory dis- 
eases, as catarrhs and sore-throats. Contused spots, even where 
the cuticle was not broken, were not exempted from the general 
tendency to ulceration. But parts that had been scalded or 
burnt, above all accidents, most quickly assumed the nature of 
this horrid sore, spread and inflamed more rapidly, and in the end 
put on the most formidable appearance ; deeper and larger sloughs 
were the consequence, and symptomatic fever violent in propor- 
tion. Even in the early stage, sometimes before the cuticle had 
hurst so as to expose the naked surface, buboes appeared in the 
groin and axilla, not to be touched without much pain, and al- 
ways attended with fever. These, however, seldom suppurated ; 23 
but where they did, they constantly exhibited the complexion o 
the parent sore. (Medicina Nautica, an Essay on the Dis- 
eases of Seamen, by Thomas Trotter, M.D., &c., Sec. Ed., 1804, 
vol. 2d, pp. 169-230 ; vol. 3d, pp. 467-504). 
Dr. Trotter, in the 3d volume states that in the summer of 
1799 the malignant ulcer made its appearance on board the 
Temeraire, with all the characteristic symptoms and violence 
which marked it in other ships. Every wound, abrasion of the 
cuticle, blistered part, scald or burn, passed rapidly through the 
various stages of inflammation, gangrene and sphacelus ; in a 
few days leaving the bones almost bare, from the separation of 
immense sloughs. 
The tendency of the hones to caries after inflammation in this 
disease, was more frequent than in any other species of ulcer, and 
in many cases rendered the cure very tedious and painful; and 
many cases sank under the long confinement necessary to the 
separation of the dead hones. 
Dr, George H. B. Macleod, in his “ Notes on the Surgery of 
the War in the Crimea,” states that 
“ The French suffered most dreadfully from hospital gangrene in its worst form. 
The system they pursued, of removing their wounded and operated cases from the 
camp to Constantinople at an early date, the pernicious character of the transit, the 
crowding of their ships and hospitals, all tended to produce the disease, and to ren- 
der it fatal when produced. Many of their cases commenced in camp, but the ma- 
jority arose in the hospitals on the Bosphorus, where the disease raged rampant. 
In the hospitals of the south of France it also prevailed, and, from what M. Lal- 
lour, Surgeon to the “ Euphrate” transport, tells us in his paper on the subject, it 
must have committed great ravages in their ships, from one of which, he says, sixty 
bodies were thrown over during the short passage of thirty-eight hours to the Bos- 
phorus. With them the disease was the true contagious gangrene, and attacked no 
only open wounds but cicatrixes, and almost every stump in the hospitals.” 
By the official reports of tbe medical officers of both the Eng- 
lish and French Armies, during the Crimean war, it was conclu- 
sively shown that, notwithstanding the extraordinary exertions 
of these powerful nations, holding undisputed sway of both sea 
and land, scurvy and a scorbutic condition of the blood, increased 
to a fearful degree the mortality, not only of gun-shot wounds, 
but of all diseases, and especially of pneumonia, diarrhoea and 
dysentery. 24 
We might add many other facts from various authors estab- 
lishing the spontaneous origin of malignant spreading gangren- 
ous ulcers, in many navies and armies, as the result of scurvy 
and crowding ; but the facts just recorded are sufficient to show 
that the foul scorbutic ulcers, and hospital gangrene, and the acci- 
dents from vaccination, arising at Andersonville, were by no 
means new, in the history of medicine, and that the causes which 
induced these distressing affections have been active in all wars 
and sieges, and amongst all armies and navies. 
In truth these men at Andersonville, were in the condition of 
a crew at sea, confined upon a foul ship, upon salt meat and un- 
varying food, and without fresh vegetables. Not only so, but 
these unfortunate prisoners were like men forcibly confined and 
crowded upon a ship, tossed about on a stormy ocean, without a 
rudder, without a compass, without a guiding star, and without 
any apparent boundary or end to their voyage ; and they re- 
flected in their steadily increasing miseries, the distressed condi- 
tion and waning fortunes of a devasted and bleeding country, 
which was compelled, in justice to her own unfortunate sons, to 
hold these men in this most distressing captivity. 
The Federal prisoners received the same rations in kind, equali- 
ty, and amount, issued to the Confederate soldiers in the field. 
These rations were, during the last eighteen months of the war, 
insufficient, and without that variety of fresh meat and vegeta- 
bles, which would ward off scurvy from soldiers, as well as pris- 
oners. 
As far as my experience extended, no body of troops could be 
confined exclusively to the Confederate rations of 1864 and 765 
without manifesting symptoms of the scurvy. 
The Confederate ration grew worse and worse as the war pro- 
gressed, and as portion after portion of the most fertile regions 
of the Confederate States were overrun and desolated by the 
Federal Armies. In the straightened condition of the Confed- 
erate States, the support of an army of fifty thousand prisoners, 
forced upon their hands by a relentless policy, was a great and 
distressing burden, which consumed their scant resources, bur- 
dened their rotten lines of railroad, and exhausted the over-taxed 25 
energies of the entire country, crowded with refugees from their 
desolated homes. The Confederate authorities charged with the 
exchange of prisoners, used every effort in their power consistent 
with their views of national honor and rectitude, to effect an ex- 
change of all prisoners in their hands, and to establish and main- 
tain definite rules hy which all prisoners of war might be con- 
tinuously exchanged as soon as possible after capture. 
Whatever the feelings of resentment on the-part of the Con- 
federates, may have been, against those who were invading and 
desolating their native land, which had been purchased by the 
blood of their ancestors from the Indians and English, the desire 
for the speedy exchange and return of the great army of veterans 
held captives in Northern prisons, was earnest and universal; 
and this desire for speedy and continuous exchange on the part 
of the government, as well as on the part of the people, sprang 
not merely from motives of compassion for their unfortunate 
kindred and fellow-soldiers, but also from the dictates of that 
policy, which would exchange on the part of a weak and strug- 
gling people, a large army of prisoners (consumers and non-com- 
batants, requiring an army for their safe-keeping), for an army of 
tried veterans. 
Apart from the real facts of the case, it is impossible to con- 
ceive that any government, in the distressed and struggling state 
of the Confederate States, could deliberately advocate any policy 
which would deprive it of a large army of veterans, and compel 
it to waste its scant supplies, already insufficient for the support 
of its struggling and retreating armies. 
And the result has shown that the destruction of the Confed- 
erate Government was accomplished as much by the persistent 
retention in captivity of the Confederate soldiers, as hy the 
emancipation and arming of the Southern slaves, and the em- 
ployment of European recruits. 
And still farther to show that these accidents attending vac- 
cination at Andersonville were active in Northern prisons, we 
quote the testimony of a medical officer who occupied during the 
war a distinguished position in the Medical Department of the 
United States Army, 26 
Dr. Frank Hastings Hamilton, late Lieutenant-Colonel, Medi- 
cal Inspector, U. S. A., in his “ Treatise on Military Surgery,” 
records the following facts which have an important bearing 
upon the subject under consideration : 
“ In still further confirmation of the correctness of our views, we will mention that 
in many of the regiments stationed in Kentucky and Tennessee during the summer 
of 1863, all slight wounds, such as scratches, slight burns, etc., took on an ulcerative 
action and often became ugly and intractable sores. Vaccination almost constantly 
produced the same results, and was in many cases followed by abscesses in the axil- 
lary, cervical, and other glands. 
“Upon the evacuation of Murfreesboro by the Confederate Army, on the first of 
January, 1863, 1673 sick and wounded soldiers were left in our hands ; of these 250 
were sick, and 1423 were wounded. The whole number were placed in chage of Dr. 
Avent, the intelligent Medical Director of General Bragg’s army, assisted by several 
other Confederate Surgeons, and were allowed to remain in the buildings which they 
had origin all}7 taken as hospitals, and which were the best the place afforded. On 
the 20th of May, 1863, nearly five months after the battle of Stone’s River (Murfrees- 
boro), Dr. Avent reported to us that 640 of these men had died, and 65 remained in 
the hospital, the remainder having been sent off for exchange. The ratio of deaths, 
continues Dr. Avent, allowing the same percentage for the 55 now on hand, is about 
38% per cent. I have not seperated the sick in this calculation from the wounded, 
from the fact that the hospitals were common to both; consequently I have no pos- 
itive data on which to make an estimate of the relative mortality. I am satisfied, 
however, that the mortality amongst the sick has beenmuchless than of the wounded. 
An estimate, placing the percentage of the wounded at about 40, I think would not 
be far wrong; which loss, you will discvover, is unprecedented in any previous bat- 
tle between the present belligerents. 
“ In explanation of this great mortality after wounds, Dr. Avent proceeds to offer 
several facts; namely, over-crowding of the patients in the hospital buildings, men- 
tal depression, the fact that only the most severely wounded were left behind ; but 
he gives especial prominence to the physical condition of the men, in consequence of 
a prolonged absence in their food of anti-scorbutic articles, both before and since 
their capture.” 
We have here a far heavier mortality amoDgst these Confeder- 
ate Prisoners, than amongst the Andersonville Prisoners; and 
according to the published statements of the United State Gov- 
ernment the majority of deaths during the war was largely on the 
side of the Confederate Soldiers confined in Northern Prisons. 
And after careful inquiries amongst returned Confederate prisoners, 
I am convinced that the accidents attending vaccination were 
quite as numerous and severe in Northern Prisons as in 
Southern; and the causes of death amongst prisoners in both 27 
sections were not materially different, with this exception, that 
the heat of the Southern States was balanced by the effects of 
severe cold upon feeble scorbutic men with insufficient clothing. 
We have dwelt thus long upon this subject, because we have 
considered its discussion, of paramount interest, in the history of 
vaccination, and of the Profession in America. 
In many cases occuring in the Confederate Army, the deleteri- 
ous effects of vaccination, were clearly referable to the condition 
of the forces, and the constitution of the blood of the patients, 
for it was observed in a number of instances that the same lymph 
from a healthy infant, inoculcated upon different individuals, 
produced results corresponding to the state of the system ; in 
those who were well fed and robust, producing no ill effects, 
whilst in the soldiers who had been subjected to incessant fatigue, 
exposure and poor diet, the gravest results followed. 
The history of vaccination in the Army of Virginia under Gen- 
eral Lee was of great interest, in the light which it threw upon 
these questions, and it is with deep regret that we learn that all 
the most valuable field reports were destroyed. 
The following letter from Dr. L. Guild, formerly Medical Direc- 
tor of the Army of Northern Virginia (General Lee’s Army), was 
received in reply to my request, for the experience upon this sub- 
ject, of this surgeon, who had held one of the most responsible 
and distinguished positions in the Medical Department of the 
Confederate Army. 
Mobile, Ala., 12th Dec., 1866. 
Professor Joseph Jones—Dear Sir:—Your letter of the 6th inst., has been re- 
ceived. 
It would afford me great pleasure to contribute to your contemplated mono- 
graph on “Spurious Vaccination;” but in the retreat of the Army of Northern 
Virginia from Petersburg to Appomattox Court-House, all of the retained papers, 
professional notes, reports, &c., of my office were either destroyed by the enemy or 
burned, with other baggage, by our own people for the purpose of lightening our 
trains and facilitating the movement of our retreating columns. When the boxes 
were burned their contents were, of course, unknown to those entrusted with the 
execution of the order. On account of this misfortune, I have nothing with which 
to refresh my memory accurately, in a single case, out of the vast number that came 
under my observation. 
The subject of the transmission of syphilis through the vaccine virus is a most 28 
interesting and important one to the profession—admitting great diversity of 
opinion, and, as you truthfully remark, “ one well-reported case is worth volumes 
of mere opinions and assertions.” 
I know of no one who could report such a case, but much useful information on 
the subject can be furnished by Dr. R. J. Breckinrigde—now of Houston, Texas— 
formerly of Louisville, Ky. He was one of the Medical Inspectors of the Army of 
Northern Virginia, and it was his duty, on several occasions, to collect and collate 
all interesting facts and opinions on the subject, such as the nature and character of 
the ulcers following vaccination, anterior history of patients, effects of treatment 
constitutional and local, &c., &c. 
I regret my inability to furnish something worthy of your consideration. 
Respectfully, yours, &c., L. GUILD. 
The testimony of Dr. S. E. Habersham, upon this canse-of the 
abnormal phenomena accompanying and following vaccination, 
is clear and important. 
The following Report, was placed in my hands by its author, 
and was accompanied with the following answer to my request 
and inquiries; 
Dr. Joseph Jones—Dear Sir:—The accompaning report of an anomalous disease 
or result of vaccination, was written shortly after its first appearance in the Army 
of Northern Virginia, and after a careful study of the cases especially assigned to 
the Hospital under my charge for “ treatment and report.” At the time, there was 
much discussion among the Medical Staff, both in Field and Hospital, as to the 
aetiology and pathology of the manifestation which by some, and, indeed, most of 
the observers, was attributed to impure virus, and especially syphilitica! inoculation. 
This latter opinion was ingeniously advocated by Surgeon Breckinridge, and no 
doubt many cases may have resulted from such an accident. In none of the cases, 
however, assigned to my Division of Chimborazo Hospital, could I discover a sufficient 
number of symptoms to lead me to suppose that such might have been the cause, 
either in its prodroma or development, hence I could not attribute the cause of the 
eruption to any other than that assigned in the report. This view as to its aetiology 
was subsequently very ably maintained by Surgeon Frank A. Ramsey, in a report 
referred to me by Surgeon-General Moore, and which was preserved among my pa- 
pers, but lost at the time of the evacuation of Richmond, together with the history 
of all the cases, and diagrams intended to illustrate the above report. In conse- 
quence of the loss of these papers this report is not as perfect as it should be; but 
I hope the general description and history of the disease is sufficiently clear and 
comprehensive to embrace every thing of practical importance concerning this hor- 
ribly disgusting and filthy accident, or result of vaccination, as seen in our army. 
Summerville. April 28th, 1866. 
Since the termination of the war, I have had several opportunities of conversing 
with a few intelligent Surgeons of the Federal Army, and ascertained from them 
that such a disease had appeared among their soldiers in regions of country where 
the scorbutic diathesis manifested itself among the troops, and to which the disease 29 
was generally attributed by them, though there were also Surgeons of that army 
who attributed it to syphilitic inoculation. I find the same view as advanced in the 
accompanying report held by most of the Surgeons of the Federal Army, as stated 
in Circular No. 6, Surgeon-General’s Office, U. S. Army, November 1, 1865. 
If you think my report of sufficient importance to appear upon the pages of your 
journal, or if it can in any way advance the cause of medical knowledge, you are 
at perfect liberty to make use of it for that purpose. 
With much respect, I remain, 
Yery truly, your obedient servant, 
S. E. HABERSHAM. 
Report on Spurious Vaccination in the Confederate Army By S. E. Habersham, M.D., 
Surgeon in the Provisional Army of the Confederate States. 
Chimborazo Hospital, Div. No. 2, November, 1863. 
To Surgeon W. A. Carrington, Medical Director— 
Sir ; I have the honor to inform you that, in accordance with your order of the 
29th June, 1863, I have received all the patients sent into this Division, with a “ pe- 
culiar eruptive disease,” supposed to be the consequence of vaccination, and here- 
with forward you the results of my investigation into this anomalous affection. 
In compliance with an order issued from the Surgeon-General’s Office in the month 
of November, 1862, general vaccination was practiced upon all soldiers as soon as 
they were admitted into this Division, and in order to insure the full protective in- 
fluence of vaccination (not anticipating any evil consequences therefrom), the order 
was strictly obeyed, and all the patients, even those having recent scars upon them, 
were re-vaccinated. A few days after the insertion of the virus, and, in many cases, 
within twenty-four hours, the seat of puncture became very much inflamed, with a 
deep inflammatory blush around it, which gradually implicated, in the severe cases, 
nearly the whole of the affected limb. A pustule rapidly formed, instead of a vesi- 
cle, which very soon discharged an ichorous fluid. This fluid was, in the course of 
forty-eight hours, converted into a dark, mahogany-colored, irregularly-shaped 
scab, prominent, and firmly attached at its base. A dark-red areola of several lines 
in diameter, measuring from the edge of the scab, was then developed, which, in 
turn, seemed to exude an ichorous serum. This was soon converted into a scab 
surrounding in juxtaposition the first, and presenting the appearance of a single 
scab. This process continued for several days, and there was often formed a scab, 
one inch or two and a half in diameter. “ Pari passu” with the increase of this 
scab, the erysipelatous blush on the limb diminished, and when the blush had dis- 
appeared, this scab ceased to enlarge. As this inflammatoiy process subsided, the 
discharge lost its serous character, and seemed to be converted into pus, which ex- 
uded from under the scab, loosening its firm attachment at its base, and thus ren- 
dering it liable to be removed prematurely by the patient in his sleep, or even by the 
friction of his clothing. When this occurred, a foul bleeding, irregularly shaped 
phagedenic ulcer was revealed, with everted edges, and presenting the appearance 
of a Syphilitic phagedenic ulcer, involving the subcutaneous areola tissue, exposing) 
in many cases, the muscular tissue below. The process of destruction of parts did 
not end here, for the ulcer continued to increase, and from the loosened edges an 30 
ichorous discharge continued to pour out from under the skin which seemed to de- 
stroy the edges of the ulcer, thus increasing its dimensions. Wherever the ichorous 
pus from this ulcer touched the sound skin, another pustule of a similar character 
was formed, in some cases reaching the size of the primary sore. This, 
was seldom the case, hut a smaller ulcer generally resulted, which often healed and 
cicatrized before the first. 
The Axillary Glands, when the arm was affected, and the Inguinal Glands, when 
the leg was the seat of the disease, sometimes became inflamed and discharged pus, 
presenting the microscopic character of healthy pus. This enlargement of glands, 
however, did not occur in a sufficient number of cases to make it a natural sequence 
of the disease. Attending the early stages of the formation of the ulcer, before pus 
was discharged, there was always more or less pyrexia, with furred tongue and loss 
of appetite; these symptoms disappearing as soon as ulceration was established. 
In these highly aggravated cases, successive crops of pustules made their appearance 
on the affected limb, often developing themselves also upon the lower limbs of the 
affected side, but seldom crossing the mesian line, and never developing themselves 
upon the trunk or head. 
The less malignant form of the disease resembled the first in character, but not in 
degree. For a few days after the insertion of the virus, merely a small inflamed 
spot was discerned, which seemed to be more the result of the injury done to the 
skin, by the prick of the lancet, than any inflammatory action resulting from a speci- 
fic cause. About the fifth or sixth day a minute pustule was discerned upon a 
scarcely larger inflamed base. This pustule and areola gradually increased, but the 
diameter of the areola was not as great, and there was no deep inflammatory blush 
upon the arm, merely a diffused redness of several inches in diameter. The same 
process, however, took place—an exudation of serum from the areola—which, in 
turn, became a crust, and which gradually increased in size; but it never reached 
the diameter of the more malignant type; and when it was detached by the process 
of ulceration, which occurred at an early period, the revealed ulcer was neither as 
deep nor as malignant in its appearance. The edges were not everted, and there 
was no discharge of pus from under the edges of the ulcer; it only presented the 
appearance of an ordinary ulcer, showing no tendency to increase, and but little to 
heal. Pyrexia very seldom attended this form, nor was the appetite impaired. 
The third and mildest form of the disease made its appearance as a small pimple, 
in from two to ten days after the introduction of the virus, and which gradually 
formed a pustule; a dark brown scab succeeded in from three to four days, which 
remained attached sometimes as long as two weeks, and when it become detached, 
a livid or brown spot was revealed, the size of which was equal to the scab. This 
scar, however, was very sensitive to the touch, and liable to bleed from the least 
friction of clothing, and when this occurred, it would exude serum or blood, and 
another scab would surely form. If the system became suddenly depressed from 
any cause, it would almost always assume the ulcerative process, and become a 
sloughing ulcer, which only healed with the general improvement of the system. 
As thus described, this disease has prevailed in the Army of Virginia, both in field 
and hospital. The Surgeons of the Army of the Southwest, report its prevalence 
there. It was developed, in the early part of the year, in a Cavalry Regiment in 
the mountains of Virginia, the Colonel commanding suffering severely from the dis- 31 
ease. In every case, its origin has been traced to the introduction of vaccine virus 
into the system. How far an epidemic cause may have exerted its influence in its 
early development, it is impossible even to surmise; we know, however, that it ori- 
ginated in Virginia, at a time when our Army was upon very short rations, and that 
many of the sotdiers sent from the field at that time presented a decidedly scorbu- 
tic appearance. Many had been reduced and were broken down by exposure to the 
inclemency of a cold winter, and the depressing influences of low diet, want of 
clothing, and many other prolific causes of disease, calculated to deprive the blood 
of its healthy constituents, particularly of its fatty matter. Hence this may have 
produced a predisposition. In verification of this fact, I will state, that when it was 
found how frequently the disease in consideration supervened upon Vaccination in 
this hospital in broken-down and depraved constitutions, it was deemed prudent to 
postpone the introduction of the virus until the patient was restored to a healthy 
condition by improved diet and medical treatment. At the first appearance of the 
evil consequences of Vaccination, 1 was inclined, with other Surgeons, to believe 
that the virus was impure, and, because of this suspicion, I threw away the matter 
we then had, and obtained a vaccine scab from Dr. Knox a practitioner on Church 
Hill, who assured me he had used it in several cases with a perfect result. 
The introduction of this virus into the arms of some ten patients resulted in the 
development of the disease in question in three of them, while in the remainder it 
produced apparently a true pustule. From this fact, and the immunity which 
healthy looking men enjoyed, I was led to believe that the predisposing cause ex- 
isted in a vitiated and impoverished condition of the blood, and so reported in my 
first report, and that the introduction of pure virus into the system was the exciting 
cause of a latent disease. This view, I see, is also held by Surgeon Frank A. Ram- 
sey, of the Department of East Tennessee, in a communication on file in office of 
Surgeon General. This view I have never had reason to change, though lam aware 
that many men, apparently in health, have suffered from the effects of Vaccination, 
In one case, which I here quote, the influence of a good condition of the general 
system seems to have exerted a wonderfully modifying influence. 
Case No. 29.— J. L. Turner, a private, Company G, fifth Virginia Cavalry, aged 27, 
married, parents healthy—he himself enjoying good health—never had any venereal 
disease. Entered the service, April, 1861—has been in service ever since, was vacci- 
nated about a month ago, when in Hospital at Parmville. 
This patient, Turner, was vaccinated last winter by Assistant Surgeon Yaiden, of 
this Division. It not having any effect upon his system, and feeling assured from 
this and previous Vaccinations that he was proof against the effect of it, he insisted 
upon being vaccinated by Assistant Surgeon Moses, from the effects of which lie has 
suffered since, and for which he was on the Bth September admitted to this Hospi- 
tal, presenting the following appearance: A number of pustules, resembling Impe- 
tigo, on left arm and leg, which were developed in successive crops, appearing as 
soon as ths original pustule began to heal. This was a remarkably mild form of the 
disease, and was improving on Cod Liver Oil, when he was furloughed on the 20th 
September, being a paroled prisoner. This patient was young, vigorous, and com- 
paratively healthy, when he received this Vaccine into his system. 32 
The search, for parasitic or cryptogamic vegetation, with a good microscope re- 
vealed none. The pustule was seldom developed where Parasites make their hah t 
tation, namely, in the bulbs, or at the roots of the hair. The pus presented micro- 
scopic characteristics of pus globules floating in a homogenous fluid. These glob- 
ules were not as abundant as in laudable pus, and not so distincly nucleated, and 
were irregular in outline in some of the cases examined. This appearance of glob- 
ules, however, often exists in healthy or laudable pus, when it has been exposed to 
air any length of time. In the many cases I have examined, I have yet to find a 
patient who will acknowledge that he has had and Syphilitic disease at any period of 
his life, though many of them have had Gonorrhoea. This exemption from Syphilis, 
however, is not strange, since it is a very uncommon disease in the rural parts of our 
country, the inhabitants of which comprise the very large majority of our Army. 
We also know that the tendency of the secondary form of Syphilis is to develope itself 
in the forehead, chest, back, and trunk, generally, and yet no cases, developed upon 
these parts of the body, have presented themselves to my observation. Many of 
the patients, also, have suffered long enough to have had the tertiary form of Syph- 
ilis developed nodes, etc., and yet no such symptoms have been seen by me. 
From what I can learn, the Army of the United States has so far escaped these 
evil results of Vaccination. A few cases, however, originated among the Federa, 
officers, in the Hospital of Libby Prison, who were vaccinated in the Prison by one 
of their Surgebns from his own arm, some weeks after their confinement, which pre- 
sented all the characteristics of the disease as it has appeared in our Army. I was 
assured by these officers that they had neither seen or heard of such a result of 
Vaccination in their Army. Does not this fact alone lead us to infer that its cause 
of origin may be traced to some abnormal condition of the blood, in these cases, 
induced by confinement in a vitiated atmosphere, without the means of eliminating 
the materies morbi from the system by exercise, and care to the function of the skin. 
The classification of this disease is difficult and unsatisfactory, since it commences 
as a Pustule, and assumes often the outward form of Rupia, which, by all dermatolo- 
gists is classified among the bullae. If wfe classify it among the pustulae, we find 
no diesease there describing it accurately, some cases resembling Ecthyma, others 
Impetigo. Inasmuch, however, as it oftener assumes the characteristics of Chronic 
Ecthyma, either in a mild or aggravated form, according to the healthy or unhealthy 
condition of the patient, I propose to name it Vaccine Ecthyma. Like all chronic 
cutaneous diseases, it shows a decided tendency to return whenever the system be- 
comes reduced from any cause, or when the patient is exposed to causes which pro- 
duce an undue action in the circulation of the capillary system. An undue amount 
of exercise in warm weather seems to excite its appearance. This was illustrated 
in those soldiers supposed to be thoroughly cured, and who were about to 
be ordered to their Regiments for duty, when a raid was threatened, in the month 
of July, upon the City of Richmond. These men were among the volunteers from 
the hospital to defend the city, and were marched through a hot sun some four 
miles to the lines at the extreme limits of the western end of the town. They 
returned with a new crop of pustules, which, however, healed by resolution in a 
short time. 33 
Treatment.—There is every reason to believe that the disease results from a blood 
disease, only to be eliminated from tbe system by enriching the blood and supplying 
its deficiency of fatty matter with rich nutritious food and by the judicious use of al- 
teratives. It is in vain to treat the ulcers locally, for without alterative treatment 
with nutritious diet, all the local applications which were tried seemed to aggravate 
rather than improve them; but as soon as the general condition began to improve, 
so did the ulcers. The milder cases began to improve a few weeks after admission 
without any treatment, except dietetic, in conjunction with the lodide of Potash, 
Syrup lod. Ferri, and Sarsaparilla; in others, merely applying simple dressing to 
the ulcers, was found sufficient to subdue it. Under this treatment, all the cases 
gradually but slowly improved. In the early part of August, we received a large 
supply of Cod Liver Oil, and I was thus enabled to test fully the treatment which 
the supposed cause of the disease naturally suggested. Some few of the patients 
could not digest the Oil, but those who could began rapidly to improve, and many 
wore able to return to their Regiments, whilst others were thought well enough to 
be transferred to their respective State Hospitals, in compliance with an order is- 
sued at that time. Those wrho were unable to digest the Oil, continued the Syrup 
lod. Ferri, which was thought the best alterative indicated in their cases. Their im- 
provement was scarcely perceptible. In the early part of September, however, an- 
other effort was made by them to take the Cod Liver Oil which they were enabled 
to do in a little Whisky ; their improvement soon became very evident to themselves 
and though not entirely well, the ulcers are rapidly granulating, No new pustules 
are being developed, and the patients are in a fair way to recover. I have no doub 
that the best remedy has been found in the God Liver Oil; and this, locally applied 
and internally administered, with an entire change of air and nutritious diet, will 
remove, and eventually eradicate, this obnoxious and filthy disease from the system. 
From the above mentioned facts, I am led to draw the following conclusions: That 
the disease is pustular at its first appearance ; that it resembles Ecthyma in its gen- 
eral character ; that it is but a local manifestation of a general disorder, or vitiated 
condition of the blood; that this vitiated condition resulted from improper and spare 
diet, together with inattention to cleanliness, thus impairing the eliminating functions 
of the skin; that Syphilitic virus has had no influence in producing the disease; 
that the morbid effects have in most of the cases resulted from deficiency in condi- 
tion, independent of any imperfection in the Vaccine Virus ; that the disease can 
only be removed by those means caluclated to improve the general condition and 
restore the healthy play of all the functions. 
SECTION 111. 
The employment of Matter, from Pustules or Ulcers 
WHICH HAD DEVIATED FROM THE REGULAR AND NORMAL 
COURSE OF DEVELOPMENT OF THE VACCINE VESICLE ; SUCH 
DEVIATION OR IMPERFECTION IN THE YaCCINE DISEASE AND 
Pustule, being due mainly to previous Yaccination, and 
THE EXISTENCE OF SOME ERUPTIVE DISEASE AT THE TIME OF 
Yaccination. * Or, in other words, the employment of 34 
Matter from patients who had been previously Vaccin- 
ated, AND WHO WERE PARTIALLY PROTECTED, OR WHO WERE 
AFFECTED WITH SOME SKIN DISEASE AT THE TIME OF THE 
INSERTION OF THE YaCCINE YIRUS. 
Whilst it might admit of debate, whether pure vaccine virus7 
obtained from persons never before vaccinated, and who manifested 
all the phenomena of the disease, and especially the characteristic 
febrile phenomena, ever becomes deteriorated or possessed of 
deleterious properties in its passage through numerous human 
bodies, not suffering with such a contagious disease as syphilis ; 
on the other hand, it cannot be denied that the protective power 
of vaccination has been impaired to a lamentable and almost in- 
calculable extent, by a succession of imperfect vaccinations ; 
and especially by the employment of matter from those who have 
been previously vaccinated, or who have suffered from small-pox 
previous to vaccination. 
Yaccination may be rendered imperfect by the development of 
febrile and other diseased states after the introduction of the 
virus into the system, arising from the action of cold, or some 
cause producing constitutional disturbances differing essentially 
from the febrile phenomena which mark the progress and perfec- 
tion of the vaccine disease ; as well as by its imperfect and 
altered course in those who are partially protected by previous 
vaccination. 
In the isolated condition of the Southern Confederacy, cut off 
from the surrounding world, and denied even vaccine matter, as 
“ contraband of warwith the necessity of turning out the 
entire fighting population to repel invasion, and with the necessity 
of employing all the available medical aid, good, bad, and indif- 
ferent ; and with the progressive increase of small-pox; it is not 
strange that the process of vaccination was not as carefully 
watched and tested as it should have been : and that consequently 
much imperfect material circulated as vaccine matter, which not 
only afforded little or no protection against small-pox, but also 
proved positively deleterious. 
My friend and colleague, Professor Paul P. Eve, M.D., of the 
University of Nashville, has recorded in his discussion of certain 35 
questions relative to the health of the late Southern Army, 
interesting observations upon Spurious Vaccination ; and it will 
be seen, from the following extracts, that this distinguished 
surgeon, inclines to the belief, that the abnormal manifestations 
of the vaccine disease, may be due, in a great measure, to the 
alteration of the matter in consequence of its passing through a 
long succession of human subjects, and in consequence of 
the co-existence of various diseases. 
“ The scab used in Atlanta,, which did so much mischief, was soft, porous, and 
spongy, of a yellowish brown color, resembling concrete, inspissated pus. It was 
not a small, hard, compact, translucent substance, like dried compressed glue, of 
dark mahogany color, requiring, as the genuine scab does, considerable effort to 
break it; neither did it present the clear, even, vitreous aspect when fractured, but 
was bulky, irregular and crumbling. In every instance, wherein vaccination was 
attempted with it, premature effects were developed. No proper period of incuba- 
tion, nor papular or vesicular eruption was observed, but in a few days, even as 
early as the second, inflammation had set up, and by the fourth or fifth day, sores 
were produced, covered by a thick, dirty crust, with an ichorous discharge. Soon 
an ill-constituted ulcer, with perpendicular edges, ensued, extending through the 
dermoid to the cellular and muscular tissues, and involving the neighboring 
lymphatics. The cutaneous surface suffered chiefly, presenting large, irritable 
very dark colored and scabby ulcers. Sometimes there was one, in other cases 
several, not on the extremity only into which the matter had been inserted, but on 
the others, and sometimes on the body. These cases were greatly aggravated by 
complications with erysipelas, scorbutus, syphilis, itch, etd> I believe we had no 
death from an uncomplicated case of Spurious Vaccination, though forty to fifty 
patients were treated in this hospital. * * While every deviation from the 
regular development of the vaccine disease may be considered spurious, we yet 
understand now by that term, a pretty well defined, certainly a peculiar, if not a 
specific affection, which we have already attempted to describe. * * 
Intimately connected with the nature of spurious vaccination, is involved the 
question of its being simply a local affection, or constitutional disease. To what 
are its symptoms due; to a virus, or do they arise from cachexia 1 lam free to 
confess that the investigation of this subject has caused me to reverse the opinion, 
that the effects of impure vaccination are alone to be attributed to the bad condition 
of the patient’s system, and did not depend upon anything special or specific. 
From repeated experiments, it is well ascertained that laudable pus when inserted 
into a healthy person is inocuous, and should it be used even in a decomposing or 
concrete state, will not excite certain uniform and peculiar results. Impure blood 
peculiarity of constitution, indulgencies, epidemic influence, etc., etc., will account 
I know, for many local disturbances, but not for the origin of spurious vaccination. 
In every case it is the result of vaccination with impure virus, by careless or inex- 
perienced persons. In reference to the nature of this impurity, there is good 
reason to believe that it results from a perversion or modification in the vaccine 
vesicle. We know heat destroys vaccine, as well as variolous virus, and it may be 
that excessive inflammatory action changes the genuine vaccine matter into the 36 
spurious. Or it may be this virus affected by another disease, or the bad state of 
the system, or becoming nearly effete itself, by passing through numerous systems 
produces a disease only resembling the true vaccine. The difficulty of developing 
genuine vaccination in one once impressed by the spurious, shows plainly the 
connection between the two.”—The Nashville Journal of Medicine and Surgery, New 
Series. Vol. 1. 1866. pp. 21-28, 
It will be seen from the following interesting communication., 
that Doctor Hamilton, of Chattanooga, who enjoyed ample op- 
portunities for the investigation of the accidents following vac- 
cination in the Confederate Army, attributes much of the spu- 
rious vaccination, to the careless use of matter from imperfect 
vesicles or sores. 
Chattasooga, Jan., 15, 1866. 
Prof. Joseph Jokes:' Dear Sir:—-Your note of the sth was received some 
time since. Sickness, absence from home, and professional duties have pre- 
vented an earlier reply, which I much regret, but cannot remedy. 
In regard to the subjects named, I fear I can afford but little information 
worthy of your consideration. 
Of what is termed “Spurious Vaccination,” I saw many instances during my 
service as Surgeon in the army; and while in charge of the General Hospital 
at Strawberry Plains, East Tennessee, I was directed, from the Surgeon Gen- 
eral’s Office, to make a statistical report of all cases which had come to my 
knowledge. In obedience to this order, I had collected notes of many cases, 
hut shortly after came the evacuation of East Tennessee, and my engagement 
in a different field of labor, so that the report was not made, and most of the 
notes which I had accumulated were “lost or destroyed by unavoidable acci- 
dent.” 
Prom the few notes I have on hand, and from such facts as I can recall to 
memory, I give you herewith the general results. 
All the cases, with a few exceptions, of “ Spurious Vaccination,” which came 
under ray observation during the war, were reducible to one of the three fol- 
lowing named classes; 
Ist. A single suppurating ulcer at the point of vaccination. 
2d. General eruptions, sometimes single, sometimes in patches involving a 
considerable extent of surface, appearing during the existence of the original 
ulcer, or after it had healed. 
3d. General eruptions attended by suppuration of the lymphatic glands. 
To -what extent these different forms may be regarded as seperate stages of 
the same development, I am not prepared to say, and I believe that no con- 
nection exists between them in such a sense. There certainly was no dis- 
coverable progression through the different conditions, such as is seen in some 
diseases. 
It is evident that the result of any vaccination or inoculation must depend 
upon one or both of the following causes : 
Ist. Upon the kind of virus used. 37 
If vaccine virus is not used in any particular instance the result will he use- 
less and perhaps hurtful to the patient. lam forced to the conclusion that a 
large majority of the cases of “Spurious Vaccination,” which came under my 
observation during the war, were such because of the spuriousness of the virus 
used. If, by supposed vaccination, a “ sore” was produced on the arm, the 
virus was supposed to be “ taking,” and straightway the matter was put into 
other arms, and other “sores” produced, when, on examination it would be 
found that not one of the arms gave evidence of vaccination. The pustules 
did not possess the characteristics of true vaccine, either in their progress or 
in their results. The proper scar was not left by them, nor the usual protection 
from variola afforded. A portion of liquid or encrusted pus, or of epithelium, 
was inserted in the arm, and the patient was presumed to be vaccinated. In 
some instances true vaccine virus was used on persons whose systems were 
protected by previous vaccination, and the matter from the resulting pustules 
when used with others, became a source of evil. Soldiers practiced upon them- 
selves from the arm of one of their number, whence came a long train of evil 
results. 
2d. Upon the condition of the patient. 
But there were instances where portions of the same scab, produced in some 
persons the true vaccine pustule, and in others only the spurious eruption, and 
the explanation must be found in the condition of the patient. Just what this 
peculiar condition is, or what its causes are, we know not. The questions con- 
cerning the influence of army life on the physical, mental and moral condition 
of men recently taken from the walks of civil life, are many and various, and 
as yet, I believe most of us are only “ guessing” at answers. Every medical 
officer remembers how fatal among soldiers, at times, were complaints which 
are ordinarily remediable, and that too, when, at the time of the appearance of 
the disease, the soldiers were apparently in robust health. It will also be re- 
membered how very few instances occurred of what would be regarded as 
types of any one disease, while at the same time a large number of cases would 
be found. Nearly all were more or less modified, and some so completely as 
almost to lose their identity. But this subject is too extensive for discussion at 
this time. 
In regard to the transmission of syphilitic poison through the process of 
vaccination, I can recall to mind a few instances, where I feel positively certain 
that secondary syphilitic eruptions existed, and the patients were equally posi- 
tive in their expressed belief that the symptoms came from vaccination. Such 
cases were always diagnosticated as syphilitic, and treated and relieved as such 
My experience leads me to put so little faith in the assertions of persons affected 
with any venereal disease, on this subject, that I have arrived at no reasonable 
conclusion, and I can only say with the poet—begging pardon for so unpoetic 
a connection—“Though I canna see, I guess and fear.” 
To sum up then, in a few words. First—lt is my belief that most of the 
cases of so-called spurious vaccination resulted from the fact that vaccine virus 
was not used, and therefore no vaccination, in the proper sense of the terjn 
took place. Secondly—The condition of the system, affected by atmospheric 
influence, or the kind of life led by soldiers, or by what you will, so modified 
the action the virus as to produce morbid results. 38 
I regret that circumstances prevent a more extended consideration of the 
subject touched on in this letter, such as their importance demands, and I 
rejoice to learn that you are preparing a Monograph on the same, and I shall 
look forward with much interest for its appearance in print. 
Yery truly yours, E. D. HAMILTON. 
Dr. Jenner in the beginning of his inquiries, felt the propriety 
of watchfulness ; and at an early day he distinctly announced 
that it was possible to propagate an affection by vaccination con- 
veying different degrees of security, according as that affection 
approached to, or receded from, the full and perfect standard ; 
he also clearly stated that the course of the vaccine pustule might 
be so modified as to deprive it of its efficacy, and that inoculation 
from such a source might communicate an inefficient protection, 
and that all who were thus vaccinated were more or less liable to 
subsequent small-pox. He still farther maintained that fluid 
taken from a genuine pustule in its far advanced stages, is ca- 
pable of producing varieties which will be permanent if we con- 
tinue to employ it. Dr. Jenner attached great importance to 
the condition of the skin at the time of the insertion of the virus. 
In his tract “ On the Varieties and Modifications, of the Vac- 
cine Pustule occasioned by an herpetic state of the skin,” he says, 
u I shall here just observe, that the most careful testimonies now 
lie before me supporting my opinion that the herpetic, and some 
other irritative eruptions, are capable of rendering variolous 
inoculation imperfect, as well as the vaccine.” 
One of the entries in his Journal is to the following effect; 
“ Inoculated Lady C. F. a second time. It is very evident that 
that affection of the skin called red-gum, deadens the effect 
of the vaccine virus. This infant was covered with it when in- 
oculated four days ago. The same thing happened to Mrs. D’s. 
infant.” 
In a letter to Mr. Dunning, dated Berkely, Dec. 23, 1804 
Dr. Jenner says ; 
“There may he peculiarities of constitution favorable to this 
phenomnon. My opinion still is, that the grand interference is 
from the agency of the herpes, in some form or another; for I 
have discoverd that it is very Proteus, assuming, as it thinks fit, 
the character of the greater part of the irritative eruptions that 39 
assail us. I shall have much to say on this disease one of these 
days.” 
The reported failures of vaccination, and the occurence of 
several violent variolous epidemics in different parts of the coun- 
try, induced him to endeavor to rouse the attention of profes- 
sional men to those points, in the practice of vaccination which he 
deemed essential to its sucess. With such intentions he printed 
a circular letter early in 1821, which was sent to most of the 
respectable medical men in England; in it he directed their 
observation to the three following questions ; 
“First, Whether the vaccine vesicle goes through its course 
with the same regularity when the skin is under the influence of 
any herpetic or eruptive disease, as when it is free from such 
affections ; secondly, whether the existence of such eruptive 
diseases causes any resistance to the due action of vaccine lymph, 
when inserted into the arms ; thirdly, whether cases of small- 
pox, after vaccination had occurred to the observer ; and if so, 
whether such occurrences could he ascribed to any deviation 
in the progress of the vaccine pustule, in consequence of the 
existence of herpetic, or other eruptions, at the time of vaccin- 
ation.”—The Life of Edward Jenner, M.D., LL.D., F.R.S., &c., 
by John Baron, M.D., vol. ii. p. 272. 
The answer to these inquiries, by the Rector of Leckhamstead, 
contains facts of such value in their bearing upon this portion of 
the subject, that we are induced to reproduce it entire : 
Leckhamstead, Near Buckingham, June 29th, 1820. 
Edward Jenner, M.D.; Dear Sir:—Your letter did not reach Buckingham till 
June 23rd, though dated the 12th. The object of inquiry appears to be the extent 
to which cutaneous diseases reject or modify the vaccine virus, so as to render the 
efficacy and security doubtful. 1 have looked over a number of copies of commu- 
nications to Dr. Harvey, and will with great pleasure send you the transcripts of the 
interference of variolus and vaccine infection, and the superseding power of the 
latter if applied in time, six of which took place at Old Stratford in 1816, among 
the children of one family, being the whole time under the same roof. The distress 
and alarm at that time wore extremely great, as the inhabitants were recovering 
from the measles when the small-pox broke out. The anxiety of the parents was 
such that I was induced, contrary to my own opinion, to vaccinate several where 
the fever of measles had not completely subsided: the consequence of which was 
nothing more than that the vaccine virus lay dormant in its cell till the field was 40 
clear, and came into action two or three days later; but afterwards proceeded in as 
regular and decided a manner as in constitutions which were not previously en- 
gaged. 
I discovered at a very early period that the itch was not an impediment; as to 
the shingles, I cannot speak- The grand rejecting agent in children is the tooth 
rash or, as it is here commonly called, the red gum, especially while it continues 
bright and active. Dr. William Cleaver (when Bishop of Chester) promoted an ex- 
tensive variolous inoculation in his diocese. Some years after, he asked me if I 
could account for the very frequent failure of communicating the infection to young 
children. I told him that it applied equally to the vaccine; though frequently, if 
the virus was fresh and active, it would be suspended in its career for a time only, 
but push forward with success at last. 
I beg to assure you, Sir, that nothing I have met with has, in the slightest degree, 
shaken my faith in the vaccine. I have seven children, the eldest sixteen, all vac- 
cinated by myself; and of 14,305, all within a few miles of this place, I have never 
heard of a single fatal disappointment; and of only two or three cases of modified, 
or what I should feel inclined to call superficial, or cutaneous small-pox. As to 
remote or derivative diseases, I know of no such thing fairly to be ascribed to the 
cow-pox; I have ample means of knowing if such a thing had taken place, as the 
people of my two parishes, and many in the neighborhood, are, somehow or other, 
continually coming under my consideration for medical assistance. My communica- 
tions of late years have been to Dr. Harvey according to the directions of the 
National Establishment; but I have met with no demand for inoculation since Feb- 
ruary' 1820, simply from the absence of any stimulating alarm. 
I am dear Sir, with the highest respect, 
Your most obedient tumble servant, 
T. T. A. REED, Rector of Leckhamstead. 
Mr. Eeed had, in 1806, printed and distributed a tract for the 
encouragement of those who entertained any doubt respecting 
the efficacy of vaccine inoculation ; and distinguished himself 
as an ardent and successful promoter of vaccination ; his tes- 
timony, therefore, is of great value. 
Dr. Jenner maintained to the last hour of his life, that 
any cutaneous disease, however slight in appearance, was capa- 
ble of interfering with the regular course of the cow-pox, and of 
preventing it from exercising its full protecting influence : 
and his directions for obviating any deterioration of the virus, 
regarded first, the character of the pustule itself, the time and 
quality of the lymph taken for inoculation, and all other cir- 
cumstances that might go to affect the complete progress of the 
disorder. Thus he maintained that the vaccine fluid should he 41 
talmn, for the purpose of inocculation, at an early period of the 
formation of the vesicle, and before the appearance of the 
areola ; and he insisted that the pustule, when excited, should 
be permitted to go through all its stages in an uninterrupted 
manner, and if any deviations appeared in its progress, he 
always forbade the employment of virus from such a pustule for 
further vaccinations. 
Dr. Waterhouse, in a letter to Dr. Mitchell, dated Cambridge, 
Sept. 26th, 1801, says : “ Yesterday I received a letter from Dr. 
Jenner, one paragraph of which I must transcribe, because 
it contains the golden ride of vaccination, viz.: ‘1 don’t care 
what British laws the Americans discard, so that they stick 
to this—never to take the virus from a vaccine pustule for the 
purpose of inoculation, after the effloresence is formed 
around it. I wish this effloresence to be considered as a sacred 
boundary, over which the lancet should never pass/ ”—Med. 
Repository, N. Y., vol. v., p. 236. 
Every deviation, from whatever cause it may have arisen, was 
considered by Jenner of the greatest moment ; and as has been 
fully shown by the learned author of his life, in all his pub- 
lished works, as well as in every private communication, he 
never failed to express his deep sense of the importance of the 
most scrupulous attention to that part of the subject ; and 
to the last he felt that, had his admonitions been received 
as they ought, had the phenomena connected with vaccine 
inoculation, been studied by all who conducted the practice, a 
large proportion of the failures would have been avoided. 
The following important and interesting communication, 
published about forty-five years ago, confirms, in a striking 
manner, the correctness and great value of the laws laid down 
by Jenner, with reference to the relations of the vaccine disease 
to cutaneous affections : 
Observations on the Vaccine and Varioloid Diseases. Communicated by 
James Davis, M.D., of Columbia, South Carolina. 
I offer you the following communication, not only because it seems to corroborate 
the observations of Dr. Jenner and others, that the simultaneous existence of cuta- 
neous diseases, with the vaccine pox, has a tendency to vitiate the virus of the latter disease, and render it unfit for communicating the true kine pock; but, moreover, 
because it would appear that the vaccine matter is liable, from this circumstance, to 
be converted into a virus of a totally different character. * * * 
I extract the following case from my note book: 
On the 29th of June, 1814, I vaccinated Master James D. Montgomery, ret. 18 
months, son of Dr. B. R. Montgomery, Professor of Moral Philosophy, &c., in the 
South Carolina College, together with six other healthy children. I had obtained 
the matter that I made use of from Dr. Smith of Baltimore. James D. Montgomery 
had been laboring under a cutaneous disease (the strophulus interlictus of Willan) 
for about three months. It had resisted every remedy which I had prescribed for 
it, and by this time had literally spread over the whole surface, so as to render it 
difficult to find a sound spot on the arm, large enough for making the insertion. I 
should have been deterred from vaccinating in such a case, but for a remark of Dr. 
Jenner, viz.: “ That vaccination, although not very certain to take in cases of cuta- 
neous eruption, yet, when it did take, it was curative of the cutaneous disorder.” 
Upon this information, I recommended it to Dr. Montgomery, who readily acceded 
to the experiment. The vaccine failed to take effect in every one of the cases, ex- 
cept in that of J. D. Montgomery ; and in his case, it was really gratifying and de- 
lightful to observe the effect of it on the cutaneous disease. As the vaccine pock 
advanced, the affection of the skin disappeared, and that in a very exact proportion 
to each other; so that, by the time the pock was mature, the cutaneous disorder 
had entirely gone off. From fifteen to twenty-five days after the kine-pock had 
been in its full course, he was afflicted with two abscesses, one on his back, and one 
on his breast, which discharged from half an ounce to an ounce of laudable pus ; 
since which time he has remained in sound and perfect health. 
His pock proved to be anomalous, and whether it were sufficient to protect his 
system against the small-pox has not since been tested. But from the constitutional 
symptoms which I attentively observed, I am very much inclined to believe, that as 
to himself, it was effectual. 
The virus manifested no signs of having taken effect until the eighth day, when 
the small inflamed point at the puncture first appeared. 
The areola did not progress from day to day with regularity, nor was it at any 
time sufficiently circumscribed, having some radii considerably longer than 
others. Its color was a coarse red, instead of that beautiful fine blush, which the 
genuine vaccine generally exhibits. 
The pock, although of ordinary size, and of a concave surface, was destitute of 
that cordon of head-like vesicles, which form around the corona of -the true kine- 
pock. It was peculiarly dry, insomuch that it was difficult to obtain from it as 
much lymyh as would serve for further vaccination. 
Four healthy children (white and black) of the family of Dr. E. D. Smith, 
Professor of Chemistry, &c., were vaccinated from this pustule. I had expressed 
an opinion, that although I believed the constitution of little Master Montgomery 
was secured against the Small-pox, that, nevertheless, I doubted of the efficacy of 
the matter of his pustule to communicate the true disease. As matter, however, 
was hard to be obtained, and as it was conceived no danger could result from it, the 
Doctor determined on making the trial. It failed to produce any effect whatever on 
all, except on one of the Doctor’s own children. In this case the puncture began 43 
to inflame within the first fourteen hours. The inflammation spread rapidly, accom- 
panied witli innumerable papulous eruptions over the inflamed suface, exuding a pro- 
fuse quantity of gelatinous matter. It continued to spread for about thirty hours, 
assuming in its progress rather a formidable appearance, and exciting a good deal 
of alarm, until it occupied a space longer than five or six areolas of the true pock; 
extending over the one more longitudinally than laterally. Aperients were adminis- 
tered, and the topical affection fomented with a decoction of chamomile flowers, and 
in about forty-eight hours it had totally, disappeared, having exhibited no sign what- 
ever of any thing like a pock. There was no constitution! disturbance accompanying 
the affection. The child remained in perfect health, and has undergone the kine- 
pock by a subsequent vaccination. 
This case evinces two facts in a clear and decided manner, to wit: that the vac- 
cine disease is capable of effecting the cure of certain inveterate diseases of the skin; 
and that certain diseases of the skin may exert such an influence over the vaccine 
matter, as not only to vitiate and render it unfit for communicating the true kine- 
pock, but also absolutely to change and convert it into a poison of a new and un- 
known character. Two facts of great practical importance, and which perhaps, 
deserve more investigation and scrutiny, than they have hitherto received. 
The influence of kine-pock over cutaneous disorders, is an old remark; and the 
influence of diseases of the skin in vitiating the matter of the kine pock, and ren- 
dering it unfit for communicating the true pock, is equally old. But its liability to 
be converted into a poison of a different nature, productive of singular and anoma- 
lous affections, in consequence of being blended with certain cutaneous disorders, 
is a subject which has not hitherto attracted as much attention as it merits. In this 
instance, the cutaneous disease of Master Montgomery, obviously occasioned a con- 
version of the vaccine matter into a new kind of virus, producing a new and singular 
affection. It is true, it proved to be a mere topical affection, and terminated with- 
out any serious consequences ; but, as the vaccine matter is liable to be changed by 
one form of cutaneous disease, is it not reasonable to conclude, that it may also be 
changed by others'? And although, in this particular case, it was changed into com- 
paratively an inocuous virus, have we any evidence, that in blendingwith some others 
of the multifarious affections of the skin, incident to mankind, it may not become 
converted into a virus of deleterious and destructive operation ?- 
All this however, indicates nothing against the utility and importance of genuine 
vaccination, but only shows how important it is that it should be practiced with a 
care, circumspection, and skill, with which the prevailing custom of our country at 
present is utterly incompatible; and until there shall be a reform effected in this re- 
spect, it will be in vain to look for the full extent of those beneficial results to man- 
kind, which the kine-pock is unquestionably calculated to afford. 
The attainment of these results in strict conformity with the laws of our condition 
in the attainment of every other great and important good, is beset with difficul- 
ties; nevertheless we have no reason to suppose that these difficulties are insupera- 
ble. Every year brings to light some new facts, which enable us to approach nearer 
and nearer to the attainment of the desired object. And as one principal obstacle 
to the improvement of our knowledge of this subject has been the apathy, indiffer- 
ence, and even levity with which it has been received by a great majority of the 
community; so, when, perhaps from severe afflictions and scourges, or from any 44 
other causes, this supineness and indifference shall be removed; then the marc 
of improvement will be rapidly accelerated, and great and permanent advantages 
■will be the happy result. 
Would it not be a wise precaution, and worthy of legislative provisions, to impose 
a penalty on any one who should communicate the vaccine disease from an unhealthy 
subject I—The American Medical Recorder of Original Papers and Intelligence in Medicine 
and Surgery, conducted by John Pberle, M.P., Philadelphia, and H. TV. Pucachet, M.P., 
New YorJc,vol. v., 1822—pp. 268-272. 
The power of the vaccine virus to relieve diseases of the skin, 
can only depend upon its absorption into the blood, and its ef- 
fects upon the entire system ; and facts are not wanting to show 
by actual manifestations of the local disease in other parts of 
the system not inoculated with the virus, that the entire system 
as well as the skin is brought under the action of this poison. 
Dr. Denby, reported the case of Henry Freeman, a lad of twelve 
years of age, who was vaccinated in the left arm by the usual 
mode. The vesicle was marked by the appropiate progressive 
character of successful inoculation. It happened that on the 
same day on which he was vaccinated (five hours subsequent to 
that process,) an incised wound was accidentally inflicted on 
his right knee ; which wound, for two or three days promised 
union by the first intention. On the fourth or fifth day, how- 
ever, an increase of pain was felt in the knee, with throbbing 
and heat about the edges of the wound ; and, on inspection, 
some slight papulae, to the number of ten or thirteen, were ob- 
served surrounding it. These appearances were yet referred to a 
common cause. On the eighth day, their peculiar and regular 
form imparted a conviction that they were true vaccine vesicles, 
which they proved to be by their progress and maturation,—Lon- 
don Med. Press, April, 1825. 
As far as our knowledge extends, the records of Medicine, are 
singularly barren of critical observations upon the phenomena 
manifested by man, when acted upon, by two or more diseases at 
the same time. This imperfection of knowledge results not only 
from the complexity of the phenomena, and the difficulties of 
the investigation, but also from the comparatively infrequent 
occurrence of two or more contagious diseases, at the same time, 
in the same household, and in the same individual. 45 
Every fact illustrating the relations of the vaccine disease, to 
other diieases arising simultaneously in the same individual, is of 
importance in the light which it throws upon the modifications 
of the vaccine disease, and upon the question of the possibility 
of transmitting various contagious diseases through the medium 
of the vaccine virus. 
The following facts and observations by various writers, bear- 
ing upon these questions, which we have gathered up after some 
research, are presented under this division of our subject, to 
which they naturally belong, rather for the purpose of exciting 
and aiding farther investigation, than as full and complete inves- 
tigations upon which definite and uncontrovertible principles may 
be founded, I have myself conducted extended investigations 
upon the mutual relations, of various concurrent diseases, as 
Malarial Fever, Typhoid Fever, Pneumonia, Cerebro-Spinal 
Meningitis, Hospital Gangrene and Pyasmia, the results of which 
it would be impossible to present at the present time, although 
related to the subject now under discussion ; and I shall present 
those facts which relate chiefly to the relations of Small Pox and 
the vaccine disease to several of ihe Exanthemata. 
If we accept without reserve the doctrine of John Hunter, 
that “Ho two actions can take place in the same constitution or 
in the same part, at one and the same time : no two different 
fevers can exist in the same constitution, no two local diseases in 
the same part, at the same time (Works of John Hunter, 
edited by James F, Palmer London 1837 vol. ii., Treatise on the 
venereal disease, p. 132): the question of the modification of the 
vaccine disease hy concurrent diseases, as well as of the possibili- 
ty of the transmission of contagious diseases through the med- 
ium of the vaccine virus is definitely settled in the negative. 
The unreserved assent to such a doctrine as this, is wholly in- 
compatible with the admission of the possibilty of transmitting 
such a disease as Syphilis through the medium of the matter 
produced by a distinct disease, different in its mode of origin, 
constitutional action, symptoms and progress. 
Even the renowned author of this doctrine, appears to have 
experienced difficulties, when he attempted to apply it univer- sally. The engrafting of other diseases upon the systems of 
those who were laboring under constitutional syphilis, and scur- 
vy, as well as the occasional occurence of these two diseased 
states in the same individual, presented at the outstep diffi- 
culties to the mind of John Hunter, which he attempted to re- 
move by argument. The mode, as well as the facts, by which 
Hunter supported his doctrine are worthy of full consideration, in 
this connection, as gathered from various portions of his works. 
“Of diseased Actions, as Icing incompatible with each other.—As I reckon every opera 
tion in the body an action, whether universal or partial, it appears to me beyond a 
doubt that no two actions can take place in the same constitution, nor in the same 
part, at one and the same time; the operations of the body are similar in this re- 
spect to actions or motions in common matter. It naturally results from this prin- 
ciple that no two different fevers can exist in the same constitution, nor two local 
diseases in the same part. There are many local diseases which have dispositions 
totally different, but, having very similar appearances, have been supposed by some 
to be one sort of disease, by others to be of a different kind, and by others again a 
compound of two diseases. Thus the venereal disease, when it attacks the skin, is 
very similar to those diseases which are vulgarly called scorbutic, and vice versa. 
These, therefore, are often supposed to be mixed, and to exist in the same part. 
Thus we hear of a pocky-scurvy, a pocky-itch, rheumatic-gout, &c., &c., which 
names, according to my principle imply a union that cannot possibly exist. 
“It has been considered as contradictory to this opinion that a patient might have 
scrofula, scurvy, venereal disease, small-pox, &c., at the same time. All of this is 
indeed possible; but then no two of them can exist in the same part of the body 
at the same time; but before one of them can occupy the places of another, that 
other must be first destroyed, or it may be superseded for a time, and may after- 
wards return. 
“ When a constitution is susceptible of any one disease, this does not hinder it 
from being also susceptible of others. I can conceive it possible that a man may 
be very susceptible of every disease incident to the human body, although it is not 
probable ; for 1 should believe that one susceptibility is in some degree incompati- 
ble with another, in a manner similar to the incompatibility between different actions, 
though not of so strict a kind. 
“A man may have the lues and the small-pox at the same time; that is, parts of 
his body may be contaminated by the venereal poison, the small-pox may at the 
same time take place, and both diseases may appear together, but still not in the 
same part. 
“In two eruptive diseases, when both are necessarily the consequence of fevers, 
and where both naturally appear after the fever nearly at the same distance of time, 
it would be impossible for the two to have their respective eruptions, even in differ- 
ent parts, because it is impossible that the two preceding fevers should be coexistent. 
“ From this principle I think I may fairly put the followiug queries: Do not the 
failure of inoculation, and the power of resisting many infections, arise from the 47 
existence of some other disease at that time in the body, which is therefore incapa- 
ble of another action 1 
“Does not the great difference in the time, from the application of the cause to the 
appearance of the disease, in many cases, depend upon the same principle 1 For 
instance, a person is inoculated, and the puncture does not inflame for fourteen days, 
cases of which I have seen. Is not this deviation from the natural progress of the 
disease to be attributed to another disease in the constitution at the time of inocu- 
lation 1 Does not the cure of some diseases depend upon the same principle I—as,1—as, 
e.g., the suspension or cure of- a gonorrhoea by a fever. 
“ Let me illustrate this principle still further by one of many cases which have 
come under my own observation. On Thursday, the 16th of May, 1775, I inocu- 
lated a gentleman’s child, and it was observed that I made pretty large punctures. 
On the Sunday following, viz., the 19th, he appeared to have received the infection, 
a small inflammation or redness appearing round each puncture and a small tumor. 
On the 20th and 21st, the child was feverish; but I declared that it was not the 
variolous fever, as the inflammation had not at all advanced since the 19th. On the 
22d, a considerable eruption appeared, which was evidently the measles, and the 
sores on the arms appeared to go back, becoming less inflamed. 
“On the 23d he was very full of the measles; but the punctures on the arms 
were in the same state as on the preceding day. On the 25th, the measles began 
to disappear. On the 26th and 27th the punctures began again to look a little red. 
On the 29th the inflammation increased, and there was a little matter formed. On 
the 80th he was seized with fever. The small-pox appeared at the regular time, 
went through its usual course, and terminated favorably.” (Yol. hi., Treatise on 
the Blood, Inflammation and Gunshot Wounds—pp. 3-5. 
“All diseased actions are simple.—A disposition of one kind may and shall exist in a 
part or whole, while an aciton of another kind is going on; and when the action 
ceases, the disposition, or dormant action, if we may he allowed to call it so, shall 
then come into action. * * * 
“Two children were inoculated for the small-pox. Their arms inflamed; hut 
about the third or fourth day from the inoculation symptoms of fever arose, and the 
measles appeared, and went through their progress as usual. During this time the 
inflammation in the arm was arrested; hut when the measles were completely gone, 
the small-pox took place, and went through its progress. 
“ Here a disposition for the measles had taken hold of the body, but although it 
had done that previously to the small-pox, yet it was not in such a way as stopped 
the progress of the small-pox. The small-pox matter was capable of contaminating, 
and produced inflammation, which went to a certain length, but the moment the 
measles changed their disposition into action, as the two actions could not go on 
together, the action of the small-pox was suspended till the measles had gone 
through its action, and the moment the constitution got free of this, the small-pox 
began to act again. 
“A lady of rank was inoculated by Mr. Sutton. A few days after a fever came 
on, of the languid or putrid kind, but without any eruption, except a few petechia; 
on the breast; she went through the process of a low fever, and afterwards the 
small-pox commenced; yet when the pustules matured they spread and were very 48 
large; also a different set of eruptions succeeded, so that thirty days passed before 
the skin was clear of the eruptions. 
“ These cases show that but one mode of action can take place at the same time; 
yet I could conceive that two actions might produce a third one, which might have 
been a new poison, as the last case in some measure seems to show.” (Vol. i. Prin- 
ciples of Surgery—pp. 312-313.) 
Dr. Joseph Adams, in his valuable Observations on Morbid Poi- 
sons, Chronic and Acute, (London, 2d Ed. 1807,) advocated the 
doctrine of Hunter, that “ Two actions cannot be carried on at 
the same time, or in the same constitution.” And recorded in 
his work the following observations to sustain this proposition. 
“ Though the law was entirely overlooked till Mr. Hunter’s time, yet it is now as 
well ascertained as any other in pathology. It is worth remarking, that in all the 
epidemics described by Sydenham, in which small-pox and measles raged at the 
same season, he gives no hint of there ever appearing at the same time in the same 
person. Dierembroek, indeed, mentions a solitary instance in Which the two dis- 
eases took place at the same time. His son remarks on the passage, that he never 
met with a similar instance more than twice in his own practice. Dierembroek’s 
account is somewhat confused. It should be remarked, too, that measles was at 
that period not so distinctly marked as in later times, and that with the small-pox 
and other exanthemata, an unusual efflorescence, which may be mistaken for 
measles, is not uncommon. We have, however, two cases given us by that close 
observer, Dr, Russell, (Medical and Chirurgical Transactions, vol. ii. p. 90), which from 
the reputation of the author, deserve particular notice. The series and order of 
symptoms are traced with such accuracy, as not only to place the fact beyond a 
doubt, but to enable us to make remarks without conjectures, or with only such 
as every reader Will see are admissable. 
“We shall first observe, that when in the ill-built and crowded city of Aleppo, 
small-pox and measles were at the the time epidemic for three months together, 
only two such cases occurred. In both these cases, the measles were of a formida- 
ble kind. It is now established, that if measles do not produce their full action, 
they sometimes occur a second time. (See Dr. Willan’s Diseases of London, p. 207.) 
It would be a curious enquiry, if there were any chance that it could be satisfied, 
to learn whether, on a future epidemic, these children took the measles again. 
However, those who know how few laws in pathology are without any exception, 
will only be surprised that this should so rarely occur. 
“ Dr. Settsom (Mem. of Med. Society, vol. iv., p. 288), relates the history of a 
family, consisting of the parents, eight children, and three servants, among whom 
scarlatina and measles appeared about the same time. Some had measles first, 
others scarlatina. All had the latter, and as many as had not gone through them 
before, had measles. In consequence of this succession, adds the Doctor, the dis- 
eases continued in the family for two months, which probably might have terminated 
in as many weeks; but no person had the two diseases at the same time, so far, at 
east, as could be ascertained by the symptoms !” 49 
The industrious De Haen, wishing to discover a common original cause for all the 
exanthemata, remarks that small-pox and measles usually become epidemic about 
the same time. Referring to his notes, he observes,"that in the year 1752, scarce a 
family but was visited by both diseases at the same time, yet each individual had 
the two diseases in succession—Videas successive iisdem in aedibus occupare in- 
fantes quorum alii morbillis, variolis alii laborere demum incipiant.—Tat. Med., vol. 
i., page 102. 
“ Dr. Winterbottom, in a general vaccination, describes the retardation of that 
process, by the occurrence of measles, as an event too common to excite any parti- 
cular attention. (Med. Trans., vol. xiv., p. 25.) The same retardation was remarked 
by Dr. King, from the same cause. (Med. Trans., vol. xiii.,p. 167 J. The same oc- 
curred to Mr. Wachsell, at a general inoculation in Walthamstow. 
‘ Dr. Willan observes, that it is generally found the small-pox, measles, scarlet 
fever, and hooping-cough, become epidemic about the same time, and continue 
their progress, though not with equal violence. (Diseases of London, p. 105.) Yet 
of the three former he gives no instance in which two of them appeared at the same 
time in the same person. It is evident that this was not from any inadvertency, 
because we find the same accurate writer, on another occasion, observing that 
hooping cough and small-pox had occasionally occurred in the same person and at 
the same time. On this I would remark, that after the febrile paroxysm of hooping 
cough has subsided, the disease loses its specific character, and if the lungs have 
materially suffered, the cough may be exasperated by the variolous paroxysm. 
But Dr. Willan, in another place (Diseases of London, pp. 38-39) asserts, that in some 
instances hooping cough commenced during the small-pox eruption. If this fact 
had been furnished by a less accurate observer, I should have objected, that when- 
ever hooping cough is epidemic, we have usually other severe coughs at the same 
time, which in children, are not easily distinguishable from hooping cough. But ad- 
mitting the accuracy of the statement, it only proves, as Dr. Willan observes, that 
the law, though very general, is not without any exception. We have also his own 
authority, that in some instances the hooping cough was instantly superceded by 
small-pox, and after the decline of the latter, returned with the same violence as 
before. Mr. Oakes (Medical Journal, vol. viii., p. 426) relates the case of a child whom 
he was under the necessity of inoculating with small-pox whilst under the hooping 
Cough. The consequence was that as soon as the eruption appeared, the cough 
ceased, and never returned. The same has frequently happened after vaccination, 
and, I have reason to believe, permanently, as the cough has not returned, at least, 
ten days after the process of vaccination has been completed. This is now so gen- 
erally understood, that many mothers have brought then’ children to the hospital 
for vaccination, under an expectation of curing them of hooping cough, and I do 
not recollect that any of them have been disappointed. However, I would never 
recommend it till the acute symptoms of the cough are passed, for, as till that time 
the full action of the disease is not over, it is reasonable to expect its return when 
the proccess of vaccination is completed. 
“ To those who are fond of tracing the operations of nature under disease, it will 
be curious to mark the exact regularity of the succession of these morbid poisons 
when they occur in the same subject. Mr. Hunter, (Introduction to Treatise on the 
Venereal Disease, and also to the Treatise on the Blood, &c.) found the variolous 50 
insertion in his patient interrupted on the fourth day after the puncture was made, 
till which time it had proceeded regularly. On the day following, the morhillous 
fever commenced, and on the fourth day after that, the measles appeared. Four 
days afterwards, the measles began to disappear. During these eight days, the va- 
riolous insertion had made no progress ; but on the following day it recommenced its 
process, and in five days afterwards the variolus fever commenced. Here the con- 
stitutional disposition was interrupted on the fourth day. On its recommencement, 
five days more were neccessary before the action could take place, nine days being 
the medium between the insertion of small-pox and the commencement of the va- 
riolous fever. 
“ Mr. Cruickshanks’s case (Treatise on the Absorbent Vessels, p. 126,) appears to 
have been interrupted ah initio: for he found his patient with all tne symptoms of 
morbillous fever on the ninth day after inoculation. The punctures of the arms, 
therefore, continued invisible till the constitution began to recover from the measles, 
after which time the punctures inflamed and required their full period of eight days 
for the appearance of small-pox. 
“In a general vaccination at Walthamstow, two children were seized with the 
morbillous eruption on the eighth day after vaccination. In these the areola from 
that virus was suspended for four days. In a third, on the 10th day; and here the 
interruption to the process was only three days. 
“ But a most elegant experiment, in illustration of this subject, is contained in 
Dr. Willan’s last number of Cutaneous Diseases. ‘I inoculated,’ says Dr. Willan, 
‘ about the same time, three children with the fluid contained in these (lymphatic 
or miliary vesicles in measles), but no effect was produced by the inoculation. A 
similar trial, at the inoculation hospital, proved more successful. Richard Brooks, 
aged 18, was inoculated by Mr. Waschsel, with fluid from the miliary vesicles in the 
measles, and with vaccine virus, January 6, 1800. On the 10th, there was some red- 
ness and ulceration in both the inoculated places. January 15th, the redness round 
the part, where the lymph of the measles was inserted, had disappeared, while the 
vaccine pock was vivid. January 18th, the vaccine disease was over. January 
22d, he has a severe cough, sneezing, and watery eyes, with cold shiverings and faint- 
ing. January 28th, the measles appeared; his eyes were inflamed and the lids 
swollen. January 29th, the efflorescence was diffused all over the surface of the 
body ; frequent cough and violent fever. February Ist, efflorescence disappeared; 
cough and fever much abated. From that time he gradually recovered, and was 
dismissed in health on the 12th of February.’ ” 
“ This interesting passage, besides containing an account of the successful inocu- 
lation of the measles, affords also a striking illustration of the protraction of a dis- 
ease', after the disposition of it had taken place, and its regular return to complete 
all its periods, as soon as the cause which interrupted them ceased. This subject 
was, at the same time, susceptible of the two contagions; and as long as the dis- 
eased actions were local, both went on at the same time in different parts. But as 
soon as the the constitutional disposition commenced in one (the vaccine), the local 
action from the other was suspended. When the vaccine disposition and action 
were completed, the rubeolous disposition commenced. Four days afterwards, the 
constitutional symptoms first showed themselves, with cough, sneezing, and watery 51 
eyes.* In six days more the eruptive symptoms began, and were completed on the 
following day. On the fourth day afterwards, the efflorescence disappeared, and 
the symptoms abated, making, in the whole, about twenty-seven days, a fair allow- 
ance for the two diseases. 
“The following laws, then, are to be admitted with as few exceptions "as any 
others that are received in pathology. 
“ Ist. All persons are susceptible of the impression from a morbid poison, in pro- 
portion as they are unaccustomed to it. 
“ 2nd. That susceptibility and disposition are necessary in a constitution or part 
before the action excited by a morbid poison can take place. 
“ 3d. That after the constitutional disposition has taken place from a local dis- 
eased action, the destruction of that local action will prevent the future appearance 
of the constitutional disease. 
“ 4thly. That no two actions from two different morbid poisons can be carried on 
at the same time in the same part, or in the same constitution. 
“sthly. If a constitutional disposition to one morbid poison exists, whilst the 
action of another is going on in the constitution, we ought to expect the action of 
the first to appear after the action of the second is completed, or has ceased. 
“ 6thly. Though nothing can prevent an action from following after a disposition has 
taken place, yet a disposition may be prevented by preventing a susceptibility in the 
constitution or part. 
“ Tthly. The susceptibility may be prevented by rendering the constitution familiar 
with the morbid poison, or, as long as the constitution is exposed to it, by keeping 
up a constitutional action previously excited by another morbid poison, or any other 
cause.” (Adamson Morbid Poisons, pp, 21-23.) 
Dr. Lundford, a native of Jamaica, who made Yaws the sub- 
ject of his inaugural dissertation states that “ those who are under 
the Yaws, are liable to the other exanthemata, such as measles and 
small-pox. The latter may be induced by exposure or inoculation, 
which last is better attempted when yaws is in the decline, for 
then the small pox will either entirely take away yaws, or at 
least will check it for some time ; nor will the funguses continue 
long, even if they should happen to appear again on the surface.” 
Upon this observation Mr. Adams in his work on Morbid Poi- 
sons, remarks: . 
“All this is perfectly analagous to what has been traced in other morbid poisons. 
It is probable that the irritation from small-pox and measles, being greater than 
from yaws, may interrupt the latter at any time. But the laws of that poison, re- 
quiring a certain course to be pursued, if the new irritation is induced before that 
* Dr. Willan considers the common period, after infection hy effluvia before these symptoms 
appear, to be from six to ten days. The anticipation, in this case, by inoculation, is nearly anal- 
ogous to the mean difference between inoculated aud casual smali-pox. 52 
course is completed, the disease must return as that new irritation ceases. If, on 
the contrary, that irritation has not been induced till the course of yaws is com- 
pleted, and nothing remains of it hut an habitual ulceration, the new irritation will 
not only supercede the old action, but by breaking the habit, very much expedite 
the cure.” 
<! Dr. Dancer, in confirmation of the above, gives the following quotation from Dr, 
Membhard :—‘ During the universal prevalence of the small-pox in this Island, in 
the year 1784, it was remarked, that several negroes, afflicted with yaws, who had 
the yawy pustules on the surfare of the body, and had been a considerable time under 
all the afflicting circumstances of the disease, were inoculated promiscuously among 
many other negroes. The result was that upon the decline of small-pox, and dying 
away of the pustules, the yaws also gradually disappeared; as if both might be 
considered in the light of one congenial disease.” (Adams on Morbid Poisons pp. 
212-213.) 
Dr. Belgrade, relates several cases of tlie simultaneous occur- 
rence of small-pox and measles, which ran their course together. 
A child was inoculated with the matter : on the eight day, this 
infant, after a slight indisposition, took the measles. 
“On the fifteenth, having completely recovered from the measles she became very 
feverish. Between this and the twentieth, she had several convulsions. On that 
day small-pox appeared. The infant not having been near any other child with 
that disorder, it was thus proved not only that the eruption was variolous, but that 
the fever was infectious. 
“ Still the difficulty remained of accounting for its origin, since no small-pox was 
known to prevail in the neighborhood. The parents and neighbors could give no 
clue. Soon afterwards I heard that a child had recently died of combined small-pox 
and measles. Unable to trace this report, I concluded it was merely an erroneous 
account of the present case. Calling, however, with Mr. Daniell, on a female, one 
of his dispensary patients, she informed me that the child was her own. Of this 
case I can give no accurate narrative. The mother herself was dying, and the child 
had been visited by no medical attendant. Judging from the statement, I imagine 
the two disorders occurred in succession, not simultaneously. The child was taken 
ill some days before Brookes’s and certainly died of small-pox. Yet even this was 
unsatisfactory, since the families lived at a distance from each other. No communica- 
tion of the children was known, until I discovered that they had attended the same 
school, a circumstance of which their friends were mutually unconscious.” (Medico- 
Chirurgical Transactions, of London, vol, viii., Tart I.) 
Dr. Kussell in noticing the reciprocal influence of small-pox 
and measles, states that he carefully watched above 300 cases 
in which these diseases succeeded each other, at a time when 
they were both epidemic at Aleppo (1765). He noticed that 53 
the measles rarely succeeded small-pox in less than 20 days from 
the first appearance of the eruption. Several cases occurred 
where small-pox succeeded measles before the total disappearance 
of rubeolous rash from the extremities, that is on the 11th or 12th 
day of the eruption. He adds, “so little did the quality of the 
first disease influence that of the second, that a mild distinct 
small-pox was often observed to follow the worst kind of measles, 
and vice versa.” Wilan relates the case of a young man, aged 
eighteen inoculated for measles and cow-pox on the same day ; 
the coAv-pox took the lead, measles following at the end of sixteen 
days : and Dr. Gregory has described a case very analogous, but 
there measles had the start, and after sixteen days, cow-pox had 
its turn. Dr. Gregory calls attention to the fact, that in each 
case sixteen days was the period of suspension, and ex- 
presses his belief that this was not accidental. (Lectures on the 
Eruptive Fevers.) 
Dr. Morland reported to the Boston Society for Medical Im- 
provment the following interesting case : 
On the 13th of February 1856, he vaccinated a healthy male in- 
fant, six months old. On the 17th of the same month, a faint hut 
sufficiently distinct eruption of measles was observed about the 
neck and shoulders. The usual symptoms of rubeola had declared 
themselves on the next morning after the vaccination, and the 
disease, consequently, must have commenced only a few hours pre- 
viously to that operation, if four days he adopted as the period 
elapsing between the attack and the appearance of the eruption. 
The vaccine vesicle matured very slowly for several days, and the 
ruheolous eruption continued with varying distinctness, hut al- 
ways comparatively slight, until the 19th, of February, when it 
disappeared. The vaccine vesicle then took a start, and went on 
rapidly to perfection. There seemed to he a retarding action 
reciprocally maintained for a time by the two affections, thus 
accidentally concurrent; vaccine finally prevailing. The circum- 
stantial record made at the time reads thus : 
“February 17th, vaccination apparently taking effect, measles appeared; will the 
vesicles be retarded 1 18th, Vesicles advancing very slowly, measles retrograding ; 
ordered a warm bath. 19th, Vesicles going on, but more slowly than is common ; 54 
less redness around it; eruption of measles gone ; will it recur 1 20th; Vaccine ve- 
sicle much larger ; child feverish; warm bath. 21st, at 7% o’clock in the morning, 
the child was seized with a severe general covulsion. He was seen by Dr. M. in 
about twenty minutes ; a warm bath had been used. Wine of ipecac, and enemata, 
with cold lotions to the head, were at once resorted to, and subsequently, three 
grains of calomel with five of rhubarb were given. Aspect of the little patient pale 
and confused. At 1% o’clock, P. M., he had another convulsive attack of rather 
greater severity, By previous direction, he was immediately placed in a warm bath, 
the body and limbs were well rubbed with the hands, and sinapisms were applied 
to the abdomen and to the feet; the face being colored and the scalp showing many 
turgid vessels, a large leech was applied to the left temple, and the wound was al- 
lowed to bleed for half an hour after the animal fell off. No more convulsions through 
the day. At oclock P. M., mustard was applied to the back of the neck. The 
night of 21st was passed by the patient in quiet sleep. 22d, very bright and well 
to all appearance, until o’clock, A. M., when he had another very severe convul- 
sion, lasting several minutes longer than the two previous ones. He was seen fif- 
teen minutes after the access of the fit; was found stupid, with an occasional wild 
look of the eyes; had been placed again in the warm bath. Mustard-water fric- 
tions to the extremities were continued ; the head being rather hot, cold applications 
were cautiously made to it; one drachm of castor oil was given ; discontinued the 
breast milk. Dr. Storer saw the patient at this time, and recommended calomel and 
Dovers powder, one eighth of a grain of the former to one half of a grain of the latter, 
every three hours. A continuance of the mustard water frictions were also advised. 
Dr. S. believd that another leech might be needed. Dr. James Jackson, who had 
been sent for at Dr. M.’s request, visited the child shortly after, and gave a favorable 
prognosis. It was thought best by him to restrict the child’s nursing to one minute’s 
time every two hours ; and, in the intervals, to allow sugar and water. Dr. J. 
thought that although another leech might possibly, be required, he should ‘ be slow 
to apply it.’ The remainder of the management was concurred in. The powders 
above mentioned were commenced, and the other means continued. There seemed 
a degree of amendment in the afternoon of this day, and there had been some good 
sleep. The night of the 22d was quietly passed : there was only one dejection ; a 
little colicky pain from flatulence; no convulsive action. 23d, Quite well, seeming- 
ly ; pulse 118, rather sharp (yesterday, 128 to 130); skin moist; one powder was 
taken at bedtime last evening, and another this morning. The vesicle of vaccina- 
tion has broken and partially dried into quite a large scab; it was full, yesterday. 
In the afternoon of this day the child seemed dull and stupid, possibly from fatigue ; 
the lips and tongue somewhat swollen; suspended the regular use of the powders ; 
renewed the mustard frictions, etc. He was now allowed to draw the breast during 
three minutes, not having nursed for three hours previously. Flatulence trouble- 
some; relieved by mint-water. 24th—Night quiet; had one dejection; got one 
powder about midnight; the eyes somewhat red ; no signs of returning rubeolous 
eruption; tongue white; occasional colic. 25l*h—Nearly as well as ever. 26th—• 
Same record. 27th—A cervical gland, on the left side (that of vaccination), much 
enlarged; otherwise very well and lively. Discontinued visits. From the last date 
to the present time, there has been no untoward occurrence, the child seeming bet- 
ter, even, than before his illness. 55 
“ The supervention of measles upon vaccination, by the doctrine of chances must 
be rare ; a purely accidental occurrence. The points of interest in this case are the 
evident mutually retarding influence of the two affections thus coexisting; the 
modification of the vaccine vesicle and of the eruption of rubeola by this action— 
not uncommonly witnessed under such, or similar, circumstances of complication—• 
and, especially, the convulsions, as to their cause. Dr. M. was at first inclined to 
ascribe these to the retrocession of the measles ; but it will be noted that they were 
manifested upon the eighth day after vaccination, when the vesicle should be per- 
fect and the primary febrile action is usually observed—and consequeutly they may 
be more reasonably referred to the latter. This was Dr. Jackson’s opinion. How 
much influence the conjunction of the two affections may have had, however, can 
hardly be determined. In his recently-published volume, Dr. Jackson gives an in- 
stance where convulsions took place in a child, on the eighth day after vaccination. 
Some time previous to this, the patient had had pneumonia, which was ushered in 
by convulsions, and the same had occurred, also, during dentition. Dr. J. had ap- 
prehended they might take place after the vaccination, and had forewarned the 
mother on the subject. He refers to other cases in which convulsions were observed 
in children at the commencement of bronchitis and scarlatina, but mentious only 
one after vaccination. In the case detailed above, there had not been any convul- 
sions, previously, nor any threatening of them; there wras, therefore, no reason to 
expect them. 
“In this connection, the remark of Sydenham may appropriately be referred to. 
‘ that an epileptic fit, in infants, is so sure a sign of small-pox, that if, after teething, 
they have one, you may predict variola—so much so, that a fit over night will be 
followed by the eruption next morning. This, however, will be generally mild, and 
in no wise confluent.’ (Works, Syd., Soc. edit., vol. ii., p. 252). Dr. Jackson also 
remarked 1 that he believed convulsions are not rare in children, when the symptoms, 
so-called of small-pox first appear—corresponding to the eighth day of vaccination.’ 
It would seem that the accident must be infrequent after simple vaccination.” 
(Boston Med. and Surg. Journ., June 19, 1856). 
Joler has described an epidemic of measles that took place in 
the Betzat Circle, in Bavaria, in the district where he himself 
resided. He says that the disease was much milder among the 
vaccinated than among the unvaccinated. 15 in 52 died among 
the non-vaccinated, while barely 1 in 300 died among the vacci- 
nated, showing that measels was 86 times more fatal among the 
former than the latter. 
As far as our knowledge extends there are but few facts hear- 
ing upon the question of the possibility of the transmission of 
the poison of measles along with the vaccine virus. 
The experiments of several authors have shown that measles 
may be transmitted by inoculating a sound person, either with 56 
the blood, with the fluid of the accidental vesicles which some- 
times complicate the eruption, or with the secretions of those af- 
fected with the disease. 
Dr. Home of Edinburgh in 1758, appears to have been the 
first European physician who proposed and performed the inoc- 
ulation of measles. His method of inoculation was to apply 
cotton dipped in the blood of a measly patient to a wound in 
the arm of the well patient. He describes the febrile symptoms 
as appearing on the sixth day, and of a mild character with no 
secondary complications. (Clinical Facts and Experiments 1758). 
Mr. Wachsel, of the small-pox Hospital, in the early part of 
this century, inoculated successfully a lad, with fluid taken from 
the measly vesicles. In 1822, Dr. Speranza, an Italian physi- 
cian, in the territory of Mantua, repeated the experiments of 
Dr. Home, Professor of Materia Medica in the University of Ed- 
inburgh. He inoculated six cases and afterwards himself, with 
the blood taken from a slight scratch in a vivid papula. In a 
few days the measles appeared ; and went through their course 
mildly and regularly. This encouraged him to make further 
experiments ; and he says they were all successful. 
Dr. Yon Katona of Borsoder, in Hungary, conducted an ex- 
tensive series of experiments upon the inoculation of measles in 
1842. He inoculated 1122 persons, by taking the blood and 
fluid from the vesicles, or a drop of the tears from a patient la- 
boring with the disease. The operation is said to have been 
performed in the same manner as the inoculation for small-pox ; 
the infecting blood was drawn from the surface most effloresced. 
The puncture was immediately surrounded by a red areola, 
which soon disappeared. On the seventh day, the fever set in 
with the usual premonitory symptoms of measles, as rigors and 
catarrhal symptoms ; on the ninth or tenth day the eruption ap- 
peared ; on the fourteenth desquamation commenced with decrease 
of fever and eruption ; and on the 17th day from inoculation 
(7th or sometimes Bth from eruption), the patients were in general 
convalescent and apparently well. Dr, Katona failed only in 78 
cases, out of 1112 (seven per cent.); and he affirmed that the re- 
sulting disorder was mild, contrasting favorably Avith the severi- 57 
ty of the reigning epidemic. No dbaths occurred among the in- 
oculated. The fruitless and unsatisfactory experiments, which 
have been performed at different periods for the purpose of testing 
the possibility of inoculating measles, cannot be adduced as evi- 
dence against these well established facts ; far a single successful 
inoculation is sufficient to overthrow any number of unsuccessful 
attempts. 
Dr. George Gregory in his valuable Lectures on the Eruptive 
Fevers, even goes so far as to express his belief that the child 
whose case he had detailed as having undergone cow-pox after 
measles, “ received the germ of measles and of cow-pox at the 
same time ; in other words, that unknown to me the child that 
furnished the lymph was incubating the measles, with the zuma 
or poison of which the vaccine matter had become impregnated.” 
The following is the case as recorded by Dr. Gregory : 
Eliza Finch, aged four months, residing at Pentonville, was 
vaccinated by me at the Small-pox Hospital, May, 15th, 1832. 
May 17, the child began to droop. Bilious vomiting, very severe, 
with drowsiness, succeeded. Much blood passed by stool. The 
head was very hot. Vomiting continued all that and the four 
following days. It ceased on the 22d. On the 24th the other 
febrile symptoms yielded a little. On the 25th (nine days from 
the invasion of symptoms, and eleven from the probable re- 
ception of the germ,) measles appeared and vrent through its 
course regularly.” 
Whilst the preceding facts, in the main, support the doctrine 
of Hunter, and show that where two poisons, representing two 
distinct contagious exanthematic diseases, act simultaneously upon 
the human being, the most obvious pathological phenomena 
excited by the poisons will not occur simultaneously, but in suc- 
cession, the one poison retarding the action of the other, the one 
producing its cycle of changes, whilst the other remains dormant 
as it were, during the action of the other, and immediately after 
the changes induced by tne first cease, inducing its own distinct 
effects; at the same time it must be admitted, that the character 
and course of these specific eruptive diseases, are greatly modified 58 
by such altered states of the constitution as exist in scurvy, 
scrofula, and secondary syphilis. 
In that class of diseases represented by constitutional syphilis 
and scurvy, the whole mass of blood is at fault, and the nutri- 
tion is perverted, and the course and products of diseased actions 
are comparatively modified. 
As all the nutritive processes are more or less deranged in 
scurvy and secondary syphilis, and as it is now established that 
the blood in the latter disease is capable of reproducing syphilis 
when inoculated in healthy bodies, and as we have shown that 
in scurvy the blood is so deteriorated and 'the forces so de- 
pressed, that the smallest injuries tend to degenerate into foul 
gangrenous ulcers, it is but reasonable to conclude, apart from 
well-established facts, that the vaccine lymph would partake of 
the qualities and properties of the blood from which it is formed, 
and the parts by which it is secreted. And even if the doctrine 
be maintained that the vaccine matter, as well as all other spe- 
cial morbid poisons, have an unvarying chemical and physical 
constitution, the difficulty is not removed, as in the practice of 
vaccination we are unable to separate the active agent of the 
virus, from much extraneous matter, as lymph and blood. And 
we contend that it is impossible to open a living vaccine vesicle 
and draw matter for vaccination, without injuring to a greater or 
less extent, the delicate blood-vessels, within and around the 
vesicle. 
With reference to the concurrent action of the poisons of two 
contagious Exanthemata, upon the same system, we know nothing 
whatever of the state and mode of the existence of that poison 
which lies dormant whilst the other is acting. Does it remain 
in the part where it has been inserted, or does it exist as well in 
the blood, and affect those organs and tissues which are not im- 
plicated in the action of the first P 
Until the relations and effects of e|,ch special exanthematous 
poison has been carefully studied, and its effects determined upon 
the constitution of the blood, upon the process of nutrition, 
upon the action of the nervous system, and upon the chemical 59 
and physical phenomena of the body, as manifested more especially 
in the disturbances of Circulation, Respiration and Calorification, 
and Excretion, it will be difficult if not impossible to settle such 
questions. 
SECTION IY. 
Dried Vaccine Lymph, or Scabs, in which decomposition 
HAS BEEN EXCITED BY CARRYING THE MATTER ABOUT THE PER- 
SON FOR A LENGTH OF TIME, AND THUS SUBJECTING IT TO A 
WARM MOIST ATMOSPHERE. 
The effects of such decomposing matter, resemble those of the 
putrid matter received in dissecting wounds. 
The practice of some physicians to mix a considerable portion 
of powdered vaccine scab, with water upon a glass slide, and to 
use this in a number of vaccinations, from house to house, is not 
unattended with danger, especially during warm weather. The 
danger of this filthy procedure, is three-fold. First, when the 
dried scab is used, the chances of communicating the vaccine 
disease by inoculation are lessened, and there is greater danger 
of communicating other diseases through the medium of this 
O O 
dried mass of pus, blood, lymph and cellular tissue. Second, 
when animal matter is finely divided and mixed with water, and 
subjected to a temperature of near summer heat, all the condi- 
tions are supplied for those active chemical changes, which in 
nitrogenized matters, frequently lead to the formation of poisons, 
capable of exciting rapid and destructive changes in the living 
organism. Third, in using matter from a common store, fresh 
blood is frequently conveyed from the patient vaccinated, upon 
the instrument or lancet, to the vaccine mixture. The liability 
to putrefactive change is not only increased by this mixture, but 
also the danger of communicating secondary syphilis, or any 
other disease capable of being transmitted by vaccination is aug- 
mented. When a score, or more, cases are vaccinated from the 
same supply, and with the same instrument, if the greatest pre- 
caution is not employed, more or less blood from different indi- 60 
viduals "becomes mixed with the virus. The method so common 
in America, of vaccinating with the dried scab, should he entirely 
abandoned. 
In the warm climate of the Southern States, it is especially 
difficult to preserve vaccine matter for any length of time, with- 
out more or less change and even putrefaction. The length of 
time which the vaccine virus will retain its active properties, will 
depend upon the temperature and the moisture of the climate. 
The true mode of preserving and propagating the vaccine virus, 
is that recommended by Jenner, viz.: the inoculation of the lymph 
directly from the arm at a period not later than the eighth day. 
By a succession of such vaccinations upon a number of children, 
transported for this purpose, Dr. Francis Xavier Balmis, 
Surgeon-Extraordinary to the King of Spain, imparted vaccina- 
tion to many nations during his voyage round the world (1803- 
1806) executed for the sole purpose of carrying to all the posses- 
sions of the King of Spain beyond the seas, and to those of other 
nations, the inestimable gift of vaccine inoculation. 
At an early day in the history of vaccination, Dr. Jennermade 
numerous attempts to send the vaccine virus to the most distant 
possessions of the English in the East. After the failure of the 
virus sent hy ships to India, he proposed that on hoard some 
ship going to India twenty recruits, or men of any description 
who had not had the small-pox, should he selected ; and a sur- 
geon appointed to attend the successive vaccinations. Dr. Jen- 
ner thus engaged that the vaccine disease should he carried in its 
most perfect state to any of the English Settlements. Upon the 
rejection of this proposition hy the government, he formed the 
plan of equipping and sending out a vessel to India with such ar- 
rangements and such a number of men as to ensure the continu- 
ous transmission of the vaccine virus, hy private suhscirptions, 
and put down his own name, for one thousand guineas. Before 
his design could he carried into execution, tidings arrived from the 
east, that Dr. De Carro had succeeded in forwarding vaccine mat- 
ter from Yienna to Constantinople, and from thence to Bombay, 
The manner in which Dr, De Carro, (by whose unwearied labors 
the vaccine disease was first disseminated over Germany, Venice, 61 
Lombardy and other parts of Europe,) transmitted the vaccine 
virus to India, possesses great interest at the present time, when 
so much carelessness is manifested by the profession both in the 
selection and in the preservation of the virus. Many dissappoint- 
ments having arisen from the difficulty of transmitting it in an 
active state, to distant countries, Dr. De Carro employed every 
expedient that ingenuity or experience could suggest to obviate 
them. Various methods had been tried. Impregnated lint, or 
threads enclosed between plates, or in bottles and in tubes closed 
up with wax. The practice of imbuing the points of common 
steel lancets was soon abandoned. To these succeeded lancets 
of silver, silver gilt, gold and ivory. After a series of trials, Dr. 
De Carro, gave the preference to ivory, which he considered to 
be, in all respects, the most secure vehicle for transporting the 
virus. On lancets of this material it was sent from Breslau to 
Moscow, where, under the patronage and actual inspection of the 
Eussian Empress, it completely succeeded. As that which was 
destined for Bagdad would be exposed to the accidents of a long 
journey, in a climate heated by a scorching sun, he took special 
care to protect it as much as possible from external influence. 
He sent some on lancets of silver, silver-gilt, and ivory : he also 
impregnated some English lint with the vaccine fluid, and en- 
closed it between glasses ; and when he had properly secured them 
he dipped them at a wax-chandler’s till they formed a solid ball, 
which he enclosed in a box filled with shreds of paper. In this 
state the packet was safely conveyed across the Bosphorus, and 
passed over the whole line of deserts ; and he had the satisfaction 
of hearing that, on its arrival on the banks of the Tigris, its con- 
tents were still liquid, and succeeded on the first trial. It was 
received on the 31st of March, 1802, upon the banks of the 
Tigris, and before the end of June it had reached Bombay, 
Dr. De Carro, in a letter to Dr. Jenner, dated Vienna, April 
22d, 1803, thus describes the method which he had employed for 
the preservation of the vaccine virus : 
“ I do not know whether you are well informed of the great improvement which 
M. M. Ballhorn and Stromeyer have made to the glasses invented by you. They 
have taught us a simple and easy manner to preserve the vaccine lymph fluid during 62 
an indefinite term. The Hanoverian Vaccinators take a small bit of English charpie, 
which you call, I believe, dry lint. The quantity must be, of course, equal to the 
concavity of the glass. The pustule then is punctured by a circular or half-circular 
incision with the lancet, so as to open a greater number of the cells forming the 
vaccine pustule covered with the same pellicle. The lint is applied upon the pus- 
tule on the most wooly side, so as to act better as a Syphon. It pumps in a very 
short time a sufficient quantity of vaccine fluid to saturate it as completely as if it 
had been dipped in a glass of water, particularly if the lint is now and then gently 
pressed with the point or back of the lancet. When it is quite full you take it with 
the lancet, and place it carefully in the cavity of the glass; you put a drop of oil, 
or a little mucilage upon the internal surface of the glasses; you make the flat bit of 
glass slide upon the charpie, so as to exclude the air as much as possible; you tie 
the two bits with thread, and seal the edges. To prevent the access of light, I 
commonly fold it in a black paper, and when I was desired to send it to Bagdad, I 
took the precaution of going to a wax-chandler’s, and surrounded the sealed-up 
glasses with so much wax as to make balls. With this careful manner, it arrived 
still fluid on the banks of the Tigris.” Life of Edward Jenner, vol. i., pp. 420, 430. 
The method so extensively employed in America, of preserv- 
ing the entire scab after it seperates from the arm, by enclosing 
it in wax, is not only less reliable than the method practiced by 
Drs. Jenner and De Cairo and others, but it is attended with 
greater danger, from the changes induced by heat and moisture. 
Shortly after the introduction of vaccinatoin into the United 
States, by Ur. Waterhouse, ignorant persons, in New England, 
not of the Medical Profession, who were stimulated by avarice 
to carry on a traffic in vaccine matter, obtained the shirt-sleeves 
of patients which had been stiffened by the purulent discharge 
from an ulcer consequent on vaccination. These they cut into 
strips, and sold about the country as impregnated with the true 
vaccine virus. Several hundred persons are said to have been in- 
oculated with this poison, which in some cases produced great 
constitutional disturbance. 
SECTION Y. 
The Mingling of the Vaccine Virus with that of the 
Small-Pox ; Matter taken from those who were vac- 
cinated WHILE THEY WERE LABORING UNDER THE ACTION 
of the Poison of Small-Pox, was capable of producing 
a modified Variola, and comparatively mild Disease in 63 
the Inoculated, and was capable of communicating by 
effluvia Small-Pox in its worst character to the Un- 
protected. 
In more than one instance small-pox was disseminated, by vac- 
cination with what was considered as vaccine virus. In all such 
cases the virus was obtained from patients who were 
under the action of the poison of small-pox, at the time of the 
insertion of the vaccine matter. Some cases of small-pox were 
said to have originated from the employment of small-pox scabs, 
which had been sent through the lines by the enemy as good 
genuine vaccine matter. As tar as my knowledge extends, such 
accidents did not arise from the wilful and malicious dissemina- 
tion of small-pox matter, as was charged publicly through the 
newspapers ; but they were referable to the careless employment 
of vaccine matter derived from patients in small-pox hospitals, 
or from members of households vaccinated after small-pox had 
appeared in their midst, and consequently after the introduction 
of the poison into their systems. 
Such accidents are by no means new to the profession, for 
more than half a century ago, they had well nigh proved fatal 
to the infant cause of vaccination. Many of the patients experi- 
mented upon, by Dr. Woodville at the small-pox hospital in 
London, were not only exposed to a variolous atmosphere, but 
they actually had small-pox matter inserted into their arms on 
the third and fifth days after vaccination. Dr. Jenner had posi- 
tively asserted that pustules do not belong to the cow-pox : Dr. 
Woodville, on the contrary, affirmed that three-fifths of the pa- 
tients whom he had inoculated with vaccine matter, had pustules 
not to be distinguished from variolous ones. Dr. Woodville, in 
an interview which he held with Dr. Jenner on the 23d of March, 
1799, mentioned that the cow-pox had been communicated by 
effluvia, and that the patient had it in the confluent way. Dr. 
Jenner is said to have remarked on this marvellous occurrence, 
“ Might not the disease have been the confluent small-pox com- 
municated by Dr. Woodville, as he is always full of the infec- 
tion ?” 64 
Such careless experiments as those of Dr. Woodville, con- 
ducted in a small-pox hospital! excited the strongest feelings 
of disappointment among the principal medical men of London, 
and for a season threw doubt upon the accuracy of Dr. Jenner’s 
statement. And it was only after careful investigation that Dr. 
Jenner was able to demonstrate that the London coio-pox luas 
somehoiv or other compounded with small-pox. 
This contaminated matter, from the London small-pox hos- 
pital, was distributed to different parts of the country by Dr. 
Pearson, and caused most unpleasant accidents. Some of this 
contaminated matter fell into the hands of Mr, Andre, Surgeon 
at Petworth, and fourteen persons who were inoculated with it 
had variolus eruptions and in some casQs suffered severely. Lord 
Egremont wrote a long letter on this occasion to Dr. Jenner, de- 
tailing the occurrence at Petworth. The reply of Dr. Jenner to 
this letter is worthy of careful consideration, in the light which 
it throws upon similar accidents occurring dnring the recent war. 
My Lord :—I am extremely obliged to your Lordsbip for your kindness in giving 
me so fully the accoimt of the late inoculation at Petworth; a subject which, before, 
I did uot clearly understand; and which, of course, had given me much vexation, 
I will just briefly lay before you part of the history of the cow-pox inoculation since 
my experiments were first publicly made known; which may tend in some measure 
to explain in what manner pustules may be produced. 
About a twelve-month ago Dr. Woodville, Physician to the small-pox hospital, 
procured some virus from a cow at one of the London Milk-farms, and inoculated 
with it several patients at the small-pox hospital. Fearful that the infection was 
not advancing properly in some of their arms, he inoculated them (some on the 
3d, others on the -6th day afterwards), with small-pox matter. Both inoculations 
took effect; and thus, in my opinion, a foundation was laid for much subsequent 
error and confusion; for the virus thus generated became the source of future 
inoculations, not only in the hospital, bnt in London, and many parts of the country. 
DR. JENNER TO LORD EGREMONT. 
Hearing a murmur among medical people that the cow-pox was not the simple 
disease I had described, but that in many instances it produced as many eruptions 
and was attended with as much severity as the small-pox, I went to town with the 
view of inquiring into tne cause of this deviation. Dr. Woodville at once invited 
me to the small-pox hospital, and very ingenuously told me the whole of his pro- 
ceedings. The inoculated patients were shown to me, and though some were with- 
out eruptions and exhibited the appearance of the true cow-pox, others were very 
full of them, and I could not discern any difference between them and the perfect 
small-pox. I therefore did not hesitate to tell the Doctor that it clearly appeared to 65 
me that the small-pox had crept into the constitution with the cow-pox; that I did 
not consider them as two distinct diseases, but as varieties only of the same disease; 
and therefore they might coexist in the same constitution, and that thus a mixed 
disease had been produced. I communicated also the same sentiment to Dr. Pear- 
son, who was then, and had been, busily employed not only in inoculating from 
this source, but in dispensing threads embued in the virus to various places in our 
own country, and to many parts of the continent. Foreseeing what was likely to 
ensue from these hasty measures, I remonstrated against them, but was not listened 
to. In many places where the threads were sent a disease like a mild small-pox 
frequently appeared; yet, curious to relate, the matter, after it had been used six 
or seven months, gave up the variolous character entirely, and assumed the vaccine; 
the pustules declined more and more, and at length became extinct. I made 
some experiments myself with this matter, and saw a few pustules on my first 
patients; but in my subsequent inoculations there were none. Prom what I once 
saw at the hospital, I had reason to think that some of these threads sent out were 
not only stained with small-pox matter from the contamination spoken of, but that 
they had sometimes a dip in a real small-pox arm ; as the patients were all mingled 
together at the hospital, and stood with their arms bare, ready to afford matter one 
among another. Without making any further trials with matter from the cow man- 
aged in another way, Dr. W. published a volume containing the result of his prac- 
tice, which certainly damped the spirits of many who had from my representation 
taken up a high opinion of the cow-pock inoculation. A thought now struck me 
that, if possible, it would be proper to procure matter from a London cow, and 
compare its effects with that generated in the country. 
Unwilling to determine in a hurry, I procured matter from a London cow, con- 
ceiving it possible that the animal in this situation might generate matter possessing 
qualities differing in some measure from that which is more in a state of nature in 
our meadows here: but the result convinced me that the virus was the same, as 
600 people were inoculated from this source without the appearance of any pustules. 
But this history, my lord, does not tell you by what means the pustules appeared 
at Petworth; but it informs you how errors may arise, and how they may be per- 
sisted in. There is another source which I fear will be too common, Lancets are 
often carried in the pocket of a surgeon with small-pox dried upon them, for the 
purpose of inoculation. A gentleman some time ago sent a lancet here to have it 
charged, as it is called, with cow-pox matter: perceiving it stained at the point with 
some dried fluid, it was sent back; when he immediately recollected that his lancet 
was prepared with the matter of the small-pox. What confusion might have hap- 
pened from this; and how narrowly we escaped it! For it was but an equal chance 
probably, that, had the lancet been used, a direct small-pox might have been pro- 
duced; for the chances were equal whether it produced one disease or the other. 
It may be necessary to observe, it is improbable that a mixture of the two mat- 
ters used in this way would have produced a mixed disease, as two different dis- 
eased actions cannot go forward in one and the same part at the same time, so that 
the disease would have been either the perfect cow-pox or the perfect small-pox. 
The matter which was made use of, I hear, came from Dr. Pearson; and doubt- 
less Mr. Keate will have candor, and, I hope, industry enough to trace the error to 
its source. That there was error somewhere, of which Mr. Keate became the inno- 66 
cent cause, is a fact that I think will not admit of controversy. I have sometimes 
seen, perhaps in one case in a hundred, a few scattered pimples about the body 
and sometimes rashes: but these have arisen from the inflammation and irritation of 
the arm, for it is very well known that many acrid substances applied to the skin, 
so as to produce local inflammation, will frequently occasion a similar appearance.” 
This letter, in which Dr. Jenner announces the doctrine held 
and taught by his friend John Hunter, (viz., two diseased ac- 
tions, cannot go forward in one and the same part, at the same 
time), is important not only in the demonstration which it affords 
of the transmission of both small-pox and cow-pox, at the same 
time, through the same mass of matter, but it also contains a 
strong argument for the view held by Jenner that these were not 
distinct diseases, but only 'Varieties of the same disease. 
Dr. Adams, in his work on Morbid Poisons, gives the following 
interesting and important observations, which confirm the cor- 
rectness of the views of Dr. Jenner. 
“ It is to be hoped that a very correct attention to the processes of variolation and 
vaccination will enable ns to ascertain the exact analogy which exists between two 
morbid poisons evidently distinct, yet nbt entirely separated by those laws which 
we have traced in others. The correspondence in the laws of each—the peculiari- 
ties in which they differ—the manner in which they interrupt each other’s action, 
and the manner in which they may be made to act in concert, are all equally inter- 
esting, and are the daily subjects of experiment and observation. At present the 
following may be considered as established facts: 
“Each, when inserted, requires about the same time to produce its local effects. 
“A subject, that has regularly passed through either, is insensible to the future 
constitutional effects of the variolous poison. 
“ Each will produce secondary eruptions, having the salne property of infecting 
as the primary; but the secondary eruptions appear more than ninety-nine times in 
a hundred in small-pox, and not once in three hundred, if the skin is otherwise en- 
tire in the Cow-pox. 
“In the small-pox, secondary pustules appear whilst the primary is advancing, 
and maturate two or three days after them. In cow-pox, when secondary vesicles 
appear, it is not till the primary has begun to scab. 
“ The small-pox may infect by the effluvia, the cow-pox can only he communi- 
cated by the scretion from the local infection. 
“ When these poisons are inserted at the same time in the same part of the same 
subject, by mixing the secretion of each, only one will produce its effect. 
“ When inserted separately in different parts of the same subject, each will pro- 
duce its local effect, and at the same time. 
“ If cow-pox is inserted at the same time that the subject is exposed to a vitiated 
atmosphere, the former will supersede the effects of the latter. If inserted four days 67 
later, the effect will be less certain, but as far as can be ascertained, not more un- 
certain than from the variolous insertion.” (Adams on Morbid Poisons, p. 10-16.) 
Dr. Adams gives several instances to show that the vaccine and variolous diseases 
may be confounded in certain cases, that is, that the laws peculiar to one may occa- 
sionally influence the other. (See pp. 16-20.) 
“ The invaluable Jennerian discovery has introduced us to a morbid poison, the 
properties of which are different from all others that we are acquainted with in su- 
perseding the constitutional susceptibility to another. As such a law as this is 
unknown in any other two morbid poisons, we might suspect the analogy between 
these two would be clearer than between any other twYo. We might even expect 
that the characters of the two might be altered by applying both at the same time, 
and also that the phenomena of one might imitate the phenomena of the other in 
such a manner, as to render the distinction between the two often doubtful. It is 
therefore, rather a matter of- surprise that the distinction should be so regularly 
preserved, and the laws which separate other morbid poisons so rarely infringed. 
i! The next thing I would remark, is that small-pox and cow-pox, contrary to the 
law of all morbid poisons, which are different in their action, will proceed together 
in the same person, without the smallest interruption of each other’s course. If 
inserted nearly at the same time, in the same person, each proceeds in the same 
comse as if it were in two different subjects : if inserted nearly in the same spot, 
the two form one common areola, but the vesications are distinct, and each preserves 
its own character, till that of small-pox becomes purulent from suppuration for the 
the separation of the slough. If secondary pustules follow from the small-pox, and 
they should continue coming ont till the cow-pox has completed its progress, its 
vesicle, like any other inflamed part, will become the seat of a small-pox pustule, or 
the whole vesicle will become purulent, contrary to its legitimate character. In the 
first case, you may take small-pox matter from the pustule, which, by the adhesive 
inflammation, will remain distinct from, though seated in part of the vaccine vesi- 
cle ; and from the other parts of the vesicle yon may take the vaccine matter, and 
each will perpetuate its respective morbid poison. If the whole vesicle becomes 
purulent, it is a variolous pustule, and will inoculate small-pox. 
“It was remarked by Dr. Woodville, that if a person is inoculated with small-pox 
to-day, and three or four days after is re'inoculated with the same morbid poison, 
though the last insertion may remain a smaller pustule than the first, yet both inocu- 
lations will arrive at their height at the same time. The same takes place in cow- 
pox ; and also, if a person is inoculated to-day with cow-pox, and three or four 
days after with small-pox, or to-day with small-pox, and three or four days after 
with cow-pox, the two insertions, though the last may remain smaller than the first, 
will maturate and scab at the same time. 
“By these facts it appears, first, that a marked kind of small-pox may be per- 
petuated. If, therefore, the cow-pox is a marked kind of small-pox, there can be 
no reason why it should not have been perpetuated with its true character; and 
that the cow-pox is such, appears, secondly, by its not being interrupted by, and 
not interrupting the progress of small-pox, and by both retaining their respective 
laws and characters at the same time, whether inoculated separately in different 
subjects, or the same ; or if each has been inoculated in the same subject at different 
times, the consequence is similar to the inoculation of either one, at different times. “ These experiments have been repeated so often, as to leave no question con- 
cerning the law. The same experiments have been repeatedly tried with small-pox 
and measles, and also with cow-pox and each of the others, yet these interruptions 
have always followed, which have been remarked in the early part of the work. 
“As therefore, a marked variety of small-pox is capable of preserving its distinct 
character under inoculation, there seems no reason why the cow-pox should not 
be among such varieties; and as any of the known varieties will destroy the suscep- 
tibility to the disease in all other forms, so there is no reason why cow-pox, if among 
the varieties, should not do the same; and there is the more reason to expect this, 
because, contrary to any other morbid poisons, the action of small-pox and cow-pox 
are maintained at the same time in different parts of the same constitution, subject 
respectively to similar laws, whether only one or both of them are applied in any 
variety of forms. 
“ It may be said that small-pox is an eruptive disease, whilst cow-pox, though 
affecting the constitution, is only confined in its local action to a single part. But 
small-pox is sometimes, we have seen, equally confined in its local action, and prin- 
cipally in those cases in which its appearance most resembles cow-pox. It is not 
less certain that cow-pox, on some occasions, produces secondary eruptions. Be- 
des the cases I have seen myself, the Rev. Mr. Holt (Med. and Phys. Journal) 
gives an accounl of full eruption of vesicles, which had the same properties of con- 
tagion as the inoculated part. The Rev. Mr. Fermn saw a few scattered in different 
parts.” (Adams on Morbid poisons, pp. 398-401.) 
Dr. Willan found “ that when a person was inoculated with 
vaccine and variolous matter about the same time, (that is, not 
exceeding a week,) both inoculations proved effective, for the 
vaccine vesicle proceeded to its acme in its usual number of days, 
and the maturation of the variolous pustule was attended by a 
variolous eruption on the skin.” (On Yaccine Inoculation, p. 1.) 
When cow-pox is inserted during the incubative stage of the 
casual small-pox, while the small-pox is still latent, the vaccine 
vesicle for the most part does not advance, or advances tardily 
and impetfectly. There are exceptions, however, to this rule, 
and cow-pox and casual small-pox may sometimes be seen run- 
ning their full course at the same time. In no case, however, 
does the cow-pox so inserted alter or modify the course of the 
small-pox. When the variolous and vaccine fluids are inserted 
into the arms on the same day, each disease occasionally pro- 
ceeds, preserving its original character. At other times, how- 
ever, they mutually restrain and modify eacn other. The vac- 
cine vesicle is smaller than usual, and irregular in its progress, 
while the variolous pustules which follow are of the kind de- 69 
nominated variolce verrueosae, vulgarly swine-pock, stone-pock, 
or horn-pock ( Will an on Vaccine Inoculation, p. 5); that is to 
say they are hard and shining, surrounded with little inflamma- 
tion, and they suppurate imperfectly. The small quantity of 
matter they contain is absorbed, leaving the cuticle horny and 
elevated for many days afterwards. Upon the extremities the 
eruption does not pustulate at all, but is minute and papu- 
lous, and terminates by desquamation. It will be found in 
most cases that even though the eruption be modified in its 
character, there is nevertheless considerable disturbance of the 
general system under the joint influence of the voriolous and 
vaccine poisons. 
Dr. Woodville has said that if the cowr-pox matter and the 
small-pox matter be both inserted in the same arm of a patient, 
even within an inch of each other, so that on the ninth day the 
same efflorescence becomes common to both the local affections, 
nevertheless inoculating from the cow-pox tumor the genuine 
vaccine disease will be produced (Observations on the Cow-pox, 
p. 12); but if the inoculation be performed with a mixture of 
the two matters, then the chance is equal that small-pox or cow- 
pox will be the result, or the varioloid disease. 
W hen the insertion of the vaccine lymph 'precedes that of the 
variolous by a period not exceeding four days, both diseases ad- 
vance locally. Sometimes an eruption of small-pox papulm fol- 
lows. At other times the variolas fever is slight and unaccom- 
panied by eruption. Under these circumstances, matter taken 
from the primary vesicles shall sometimes communicate cow-pox 
and small-pox respectively, but more commonly the variolous 
poison predominates, and contaminates the lymph of the vaccine 
vesicle. It was ignorance of this phenomenon, in the mutual 
action of the vaccine and variolous poisons, which occasioned Dr. 
Woodville’s mistakes at the small-pox hospital in 1799. 
Variolous matter inserted into the arm at any period not ex- 
ceeding a week from the date of vaccination will take effect and 
be followed by a pustule. After that time no effect is produced. 
When small-pox inoculation precedes by three or four days the 
insertion of vaccine lymph, the vaccination advances, but alter 70 
the tenth day the fluid in the vaccine vesicle becomes purulent; 
and in that state will communicate small-pox. (Willan on Vac- 
cine Inoculation, p. 8 ; also Dr. George Gregorie’s valuable arti- 
cle on Vaccination in the Cyclopaedia of Practical Medicine.) 
Dr. Denby, whilst admitting that the period of incubation of 
variola may be somewhat undefined, as in the case of other ani- 
mal poisons, concludes that nevertheless, from experiments, a fair 
conclusion may be formed as to the usual period of this incuba- 
tion, when vaccine prophylaxis may be induced. And from these 
Dr. Denby judged that, if on the third day, before the onset of 
erethism, rigor, and headache, perfect lymph be inserted, prophy- 
laxis is almost certain, assuming three or four days for the pre- 
monitory symptoms before the variolous point or papula appears. 
The vaccine vesicle will then be eight or nine days old, the areola 
will be becoming indurated, and erethism will exist. Dr. Denby 
considers that in this fever against fever, the essence of prophy- 
laxis really exists. If under this influence the variolous papula 
proceeds, it will resemble umbilicated varicella or horn-pock. If 
the vaccine be used two days later, especially if there be bron- 
chial or pulmonary symptoms present, it will be useless. The 
papula may be just apparent, but it will be blighted. There 
are of course exceptions to this rule. A woman was delivered, 
says Dr. Hennen, while suffering from confluent variola ; the 
infant was vaccinated a few hours after birth. The mother died 
on the 11th day; the infant had true vaccine, and lived. (Med. 
Times, Oct. 25, 1851). In an analagous case reported by Mr. T. 
C. Beatty of Durham, the child delivered from a mother in whom 
the variolous pustules made their appearance during labor, was 
not vaccinated until the morning of the fourth day after its 
birth. True vaccine was the result; and yet, on the eigth day 
after she was vaccinated, when the vesicles were fully matured, 
the little patient was very ill, and showed signs of an eruption 
under the skin, which proved to be confluent small-pox, of which 
the little creature died four days after. (London Lancet, 1852.) 
Dr. Robert Fowler of the Loughborough Dispensary, and Mr. 
Robert Tod of Gilmore Place, Edinburgh, (London Lancet, 
1852); M. M. Herard and Bousquet, (L’Union MMicale, Ros. 71 
108, 109, 110, Bulletin de Th6rapeutique, tom. xxxv., pp. 342- 
52), and others, have recorded cases proving the possibility of 
the simultaneous existence of small-pox and the vaccine disease, 
and confirming the correctness of the conclusions of J enner and 
the older observers. 
M. Bousquet goes so far as to deny that the two eruptions, 
variola and vaccinia, exert any reciprocal reaction, and the nearer 
they appear together, the more independent are they of each 
other. Suppose, for example, that they could appear at the 
same hour, then each would pursue its ordinary course, just as if 
the other were not present. But supposing the one eruption 
appears after the other, all will depend upon the space of time 
separating them. If this be only some hours, or even two or 
three days, all passes on as just stated. The case is different 
when one of these eruptions is greatly in advance of the other. 
If this is not to such an extent as to exclude, the eruptions pro- 
gress together, but not in parallel. The most advanced always 
keeps its advantage, and finishes at its ordinary epoch, without 
having undergone any change in form or duration. The other 
follows it at a distance, but after the variolous capacity of the 
subject has become exhausted by the first, the second dies away. 
In these influences, M. Bousquet considers that there is nothing 
direct, active or special, they are the consequences of the faculty 
possessed by the eruptions of supplying or substituting each 
other. The vaccinia does not arrest the variola, but it is the 
variola that stops short in the face of the vaccinia ; and, con- 
versely, variola does not cut short the course of vaccinia, but 
this last interrupts its own course in presence of the variola. It 
is the right of precedence, and the more widely the two eruptions 
are separated, the more readily do they exclude each other, while 
the nearer they are together, the more independently do they 
proceed. Considered in themselves, the vaccine and variolous 
virus are so little capable of destroying each other’s energy, that 
if they are mixed together, and inoculation performed with the 
mixture, M. Bousquet affirms that two perfectly distinct erup- 
tions may be produced. Considered as regards their effects, 72 
therefore, according to this view, it cannot be said that vaccinia 
cures variola, or even, rigorously speaking, that it prevents it. 
It takes its place, stands in its stead, and is neither more nor less 
than a substitution. Thus, so far from explaining the operation 
of vaccinia by the supposed opposition it offers to variola, we 
would rather do so by the analogy and reciprocal action of the 
two diseases. (Bulletin de Therapeutique, tom. xxxv., pp. 342- 
52 ; also The British and Foreign Medico-Chirurgical Eeview, 
April, 1849.) 
From the facts recorded in this section, we deduce the prac- 
tical conclusions : 
First—-That vaccine matter derived from the patients of 
small-pox hospitals, or from those in civil or military practice 
who have been exposed to the contagion of small-pox, should 
never be used for the propagation of the vaccine disease. 
Second—The vaccine disease is not a distinct disease from 
small-pox, but a variety or modified form of the variolous affec- 
tion. 
SECTION YI. 
Dried Vaccine Lymph or Scabs, erom Patients who had 
SUFFERED WITH ERYSIPELAS DURING THE PROGRESS OF THE 
Vaccine Disease, or whose Systems were in a depressed 
STATE FROM IMPROPER DIET, BAD VENTILATION, AND THE 
EXHALATIONS FROM TYPHOID FeVER, ERYSIPELAS, HOSPITAL 
Gangrene, Pyaemia, and offensive Suppurating Wounds. 
In several instances during the revolution death resulted from 
Phlegmonous Erysipelas, following vaccination in apparently 
healthy patients, in both civil and military practice. 
It was believed that in some cases the poison of Erysipelas 
was conveyed along with the vaccine virus. 
In one instance which came to my knowledge, the lives of sev- 
eral negro women and children were destroyed by Erysipelas 
excited by vaccine matter taken from the same scab, and a stout 73 
healthy white man who was vaccinated with the same matter, 
and by the same physician who vaccinated the negroes (on a 
neighboring plantation,) was extremely ill from the effects of the 
poisonous matter, and barely escaped with the loss of a large 
portion of the muscles of the arm. 
I was informed upon good authority that this matter caused 
the death of a pregnant negro woman, and of another negress 
and her young infant, of some week or ten days of age, at the 
time of the inoculation of the vaccine virus. 
The following observations relating to Erysipelas following 
vaccination, were placed in my hands, by Dr. Frank A. Ramsay, 
of Memphis, Tennessee: 
Communicability of Syphilis hy Vaccination. By Wit. Gerdner. M. D.; of Green 
County, Tennessee. 
I notice in the “ Medical and Surgical Monthly—June, 1866,” an article taken 
from the Richmond Medical Journal, June, 1866, by Wm. Fuqua, M. D. Appomatox 
county, Virginia, on the Communicability of Syphilis by Vaccination. 
About the same time referred to by Dr. Fuqua, I had numerous cases of vaccin- 
ation, in the district of my practice, presenting abnormal features. The people 
believed it to result from and called the exhibitions by that name. I made 
close scrutiny of the cases, occurring under my observation, and concluded that they 
were not syphilitic in origin or manifestation. I regarded them as Erysipelas, pre- 
senting the form called Phlegmonous: for which opinion I thought I had reasons. 
Many cases assumed the form of common Erysipelas, invading limited portions < f 
the arm; and in some few cases the whole surface of the vaccinated limb was 
affected. 
The proper distinction for the practical physician of Erysipelas, is Superficial 
and Deep Seated—ordinary or common Erysipelas affecting the cuticle proper— 
deep seated or phlegmonous Erysipelas involving the tissues, particularly the cellu- 
lar. At present the cause of the difference is inexplicable—why in one case serum, 
and in the other lymph is poured out, remains a Question, while the fact exists. 
Each distinct inflammation has its habits.” 
As far as my knowledge extends, the records of medicine do 
not afford any very large collection of cases of Erysipelas super- 
vening upon vaccination. The following are the most important 
cases of the apparent excitation of Erysipelas by vaccination, 
which were noted in the works and journals consulted during 
these researches ; 74 
Diffuse Cellular Inflammation following Vaccination.—The first was that of a female 
child, aged five years, who had been vaccinated by a respectable practitioner in 
Dublin. This child was brought to the physician who reports these cases, about 
three weeks after it had been inoculated. The arm was then greatly swollen, the 
swelling extending to the hand; the integuments of the upper arm were of a dusky 
leaden hue, and a large black slough occupied the situation of the usual crust of 
the vaccine vesicle. The child’s pulse was weak and slow, not exceeding 64. The 
extremities were cold, tongue dry and coated. There were extensive sloughing and 
hemorx-hage from the mucus membrane of the mouth. The integuments of the 
cheeks adjoining the commissure of the lips were of a livid hue. The respiration 
was very much hurried, but no physical sign of disease could be detected in the 
chest. 
The child’s parents stated that these formidable symptoms first presented them- 
selves, between the ninth and twelfth day from that on which it had been vaccin- 
ated. The practitioner who inoculated the child affirmed that up to that period, the 
vaccine vesicle ran a healthy course, and that he had vaccinated other children with 
the same lymph in whom the course of the vesicle was perfectly regular. This child 
was of a delicate constitution, having sufferd with attacks of scrofulous ophthal- 
mia, pneumonia, and bronchitis. Its health was said to be good, at the time it was 
inoculated. Complete recovery, though very slow, was effected in this case hy 
the use of mild tonics and stimulants. 
The second case was that of a male child, aged eighteen months, who was also 
vaccinated by a physician of Dublin. About the twelfth day from the period on 
which it was vaccinated, the arm was attacked with severe inflammation of the ery- 
sipelatous character, the vaccine vesicle having, up to that day, according to the 
statements of the parents, run a regular course. On the sixteenth day, a dark 
slough, as large as a shilling, occupied the situation of the vesicle; the entire 
extremity was immensely swollen; the integuments of the upper arm were of ery- 
sipelatous redness, and such of them as were in the immediate neighborhood of the 
slough were quite livid. The attending fever was of the inflammatory type, the 
skin being hot, tongue furred, pulse rapid and full, and the thirst great. Until the 
fever was subdued by cooling and alterative medicines, and the local inflammation 
relieved by the application of poultices and fomentations, the sloughing spread with 
the most alarming rapidity. After the sloughs had separated, and the progress of 
the gangrene arrested, a large and deep ulcer remained with undermined edges, at 
the bottom of which the muscles of the arm could be distinctly observed; so exten- 
sive was this ulcer, that it was not healed for three months, though the case pro- 
gressed most favorably in every respect.”—Dublin Journal of Medical Sciences, 1844. 
Dr. Greene reported to the Boston Society for Medical Improve- 
ment, a fatal case of erysipelas, following re-vaccination, which 
occurred in January. 1846. 
The patient, a gentleman sixty-four years of age, had been vaccinated twenty 
years before, and re-vaccinated, though without success, two or three times since. 
On Friday, the day after the re-vaccination by Dr. Greene, he was seized with chills, 75 
nausea, and a sense of general uneasiness; and, at the same time, inflammation 
commenced in the arm, attended with heat, redness, and pain. He slept none on 
the following night, and on the next night was attacked with vomiting and purging. 
The symptoms from this time did not become materially worse, however, till the 
following Wednesday, when he complained of pain just below the elbow; and on 
Thursday, a small patch of erysipelas was discovered at this point, which gradually 
extended over the arm and chest of the affected side, the infiltration of the cellular 
tissue, keeping about two inches ahead of the redness. He died at ten on Friday 
evening, a little more than eight days from the time of re-vaccination, the erysipelas 
having extended to within two inches of the sternum. In regard to the quality of 
the matter introduced, Dr. Greene remarked that it was taken on the eighth day 
from a perfectly formed vesicle, on the arm of a perfectly healthy infant, horn of 
healthy parents; that one of his own children had boen vaccinated with the same 
matter, and also another person, in both which cases, the symptoms and appearances 
were slight. 
It is said tliat in 1849 and 1850, Erysipelas so frequently followed 
vaccination in Boston, and the result was so often fatal, that many 
physicians refused to vaccinate, except when it was absolutely 
necessary, and almost entirely abandoned re-vaccination. Cases 
were reported to the Boston Society for Medical Improvement, 
by Drs. J. B. S. Jackson, Cabot, Bigelow, Homans, Putnam, and 
Channing. From the transactions of this society we select the 
following cases : 
Case Reported by Dr. Cabot.—This being a case rather of diffuse cellular inflam- 
mation than common erysipelas. The patient was a gentleman, sixty-nine years of 
. age, who having been exposed to varioloid, was re-vaccinated in two places on the 
3d of April. On the second day, two vesicles had formed about the size of a smal\ 
pin’s head, and there was pain in the axilla, with pain and soreness under the pec- 
toral muscles. In about two weeks the inflammation had extended to the hand, and 
in the course of the third week an opening was made about the elbow, from which 
a considerable quantity of sero-purulent fluid was discharged; the back of the hand 
being opened down to the fascia a few days afterwards. From the shoulder the ery- 
sipelas extended over the whole hack, down the right arm to the elbow, and some- 
what over the abdomen from each side; also across the front of the chest, nearly to 
the right shoulder. The whole duration of the erysipelas in an active form was 
about seven or eight weeks; neither the hand nor lower extremities were affected; 
the areola about the vaccine points subsided, hut subsequently this surface was 
attacked with the disease. The suppuration .about the left shoulder and down the 
upper extremity, had been very extensive; the pectoral muscle was separated from 
the parietes of the chest, and the skin of the forearm was so detached from the 
subjacent parts that fluids thrown in at the elbow would pass out at the back of the 
hand; very numerous openings have been made about the elbow and shoulder for 
the discharge of pus. For about two months the patient was confined to his bed, 76 
and convalescence was tedious. The prostration was not so great as would hav 
been expected in such a case; the pulse not rising above ninety during the active6 
stage of the inflammation; there was, however, some delirium, with chills, headache 
and pain in the back. No suppuration occurred, except in the parts above alluded 
to. 
Case Reported by I)r. J. Bigelow.—This patient was a gentleman, about thirty years 
of age, and having been exposed to the small pox, was re-vaccinated with several 
others, from the same virus. Two days afterwards, an erysipelatous spot, of the 
size of a dollar, was discovered around the point of vaccination. This spread rap- 
idly in every direction, and at the end of five days, had occupied the whole arm 
from the shoulder to the elbow. At this time, several dark spots appeared upon the 
inside of the arm, which in two days were perfectly gangrenous, so that an incision 
was made five inches in length, without pain. The slough was apparantly confined 
to the skin and cellular substance, inasmuch as the muscular power was at no time 
lost. Meanwhile the pulse was quick, and the skin hot, with prostration, headache 
and delirium. In another week, the erysipelas had extended to the whole trunk, 
halt way down the thighs, and to the wrist of the affected arm; the patient being 
much of the time delirious, or somnolent, and with a pulse of 120. During the 
third week, the symptoms were greatly aggravated, and the cerebral affection 
increased; there was also a retention of urine, and the catheter was required for a 
fortnight. During this time, however, the slough gradually separated, leaving a 
large, deep ulcer. The patient became convalescent at the end of a month, and 
slowly recovered; the ulcer requiring another month or more to cicatrize. No 
other person, Avho was vaccinated with the same virus, had any unusual symptoms; 
but a lady of the family, about seven weeks after the vaccination, was attacked with 
i nflammation of the fauces and tonsils, followed by prostration and delirium, and 
died in a week; during her sickness a livid spot, about two inches in diameter, 
appeared over the upper part of the sternum, but this disappeared before death. 
In another case reported by Dr. Bigelow ; a healthy child about five months old, 
was vaccinated, and the vesicle went on well until the ninth day, when the arm 
became erysipelatous, the inflammation rapidly spreading over the whole trunk; 
and the child died in a few days. On the eighth day of the vesicle, the day before 
the appearance of the erysipelas, matter was taken with which three others were 
vaccinated, and these patients had perfect vesicles without any anomalous symp- 
toms. 
Case Reported by Dr. Homans.—The patient was a healthy infant, about three 
weeks old. On the eighth day, the vesicle appeared well, and matter was taken wth 
which other children were vaccinated, the result being in every case, successful. On 
the tenth day, erysipelas appeared below the elbow, and extended into the axilla ; 
the swelling and redness were very defined, and the inflammation spread rather 
more' rapidly than is usual in the adult. Vomiting and diarrhoea came on, and 
lasted for some days; and the pulse was too quick to be counted. The head and 
abdomen then became affected, and on the ninth day from the invasion of the 
disease, the scrotum and penis were greatly swollen; these last were punctured with 
much relief, but a deep sloughing of Hie scrotum took place, one and a half inches 
in diameter, and nearly exposing the testicles. The extremites were next affected, 77 
but in the mean time the child began to improve, and the pulse had fallen to 120 
On the subsidan :e of the disease, abcesses formed upon the body and limbs beneath 
the surface, and about the left hip, one that was quite large and deep. This last, is 
the only one that remains open, and the child is fairly convalespent, after a sickness 
of about three months. 
Dr. Charming mentioned a case of Erysipelas, after vaccin- 
ation, in which the shoulder, axilla, and pectoral muscles were 
involved,—(The American Journal of the Medical Sciences, Oct., 
1850—pp. 318-321.) ' s 
Dr. Charles E. Buckingham, Physician to the Boston House 
of Industry, has also published an interesting case of “Consti- 
tutional Irritation following Vaccination,” from which we make 
the following abstract : 
B , a farmer, twenty-five years of age, of previous robust health, vaccin 
ated on Thursday, August 28th, 1849. 
Sept. Ist, he took an emetic, and on the 2d a cathartic dose. Both operated 
freely. Dr. Buckingham was first called to him at 9, P. M., September 3d. At! 
this time the patient presented the following condition :—Complete anorexia; great 
thirst; headache; sleeplessness; pain in back; eyes and hearing normal; urine free 
pulse 129, full and strong; decubitus dorsal. His late vaccination was not known 
at this time. Got a saline mixture, consisting principally of bicarbonate of soda 
and chlorate of potassa. 
4th. Febrile action less; has pain in calf of right leg ; no tenderness, redness, 
swelling, or heat. 
9th. Pulse 84; appetite good. No sleep last night on account of the pain in the 
calf, and in the sole of the right foot; has had a sinapism to the foot, with partial 
relief; no dejections for twenty-four hours; whole of right calf swollen ; a circum- 
scribed red spot one and a half inches below head of right fibula, covering about 
two square inches. 
10th. Patient was seen, in consultation, by Dr. H. G. Clark. Redness more 
diffused; leg much swollen, and (edematous from knee to heel; pain confined to 
the spot of yesterday, which is, for the first time, tender; no headache or thirst 
e}res and hearing normal; neither delirium nor sighing; no appetite; tongue red at 
its top, and in other parts covered with a thick creamy paste ; pharynx the same; 
pulse 88, full. 
13th, 9, A. M. Pulse 100, full and soft; no dejection. Attention was called to 
a hard, red, circumscribed swelling on the left forearm, similar to the others; in 
examining which, found the remains of an irregular vaccination, of which Dr. 
Buckingham first learned the date as given above. 
let'll. Swelling of right leg decidedly less ; that of the left leg hard, red, and 
excessively tender. The right elbow was red and swollen. The right eye red 
swollen, and painful about the orbit; no conjunctival redness; tears trickling over 
face; pulse 120, full, soft, dicrotic; respiration slow and distinct, with occasional 78 
sighing; no delirium; tongue perfectly steady, when protruded; face somewhat 
livid; no dejection for two days, except from enemata. 
18th, Had a good night; pulse 112; respiration 16 ; nose much swollen, dusky, 
red, and painful; about a dozen papules, hard, red, and shot-like, scattered over 
forehead, face, back, and legs; no glandular enlargement. 12 M., a few more 
papules on abdomen; the others are becoming pustular, and a few are umbi!icated_ 
19th, 8)4 A. M. Two dejections, with urine; tongue dry, black, and cracked; 
redness and swelling of whole upper face; papules increasing in number, and pus- 
tules in size; a few of them umbilicated; no glandular enlargement. 
20th, 10 A. M. Pulse 120, more firm, but not so full; respiration 32, laboured, 
no rales; numerous black, pasty dejections ; took oss of brandy in the night; rest- 
less, and occasionally wandering; easily roused, and speaks sensibly, but soon falls 
asleep again; pustules increasing in size and number, some of them as large as 
good-sized peas; knuckles of right hand swollen; both sides of face red, swollen, 
and oedematous; right leg of normal size, and appears well; left leg the same, with 
the exception of slight tenderness; swelling of left forearm soft and fluctuating; no 
glandular enlargement, nor mark of absorbents. 
9 P. M. Constantly delirious ; unable to drink; frequent involuntary dejections 
and urine; hands tremble, pulse 184, feeble; respiration 86, noisy and husky; 
sounds and impulse of heart normal; many of the pustules drying; scab of vac- 
cination came otF arm; erythema and oedema of scalp. 
21st, 10 A. M. Delirious all night; takes nothing; insensible; no dejections; 
pulse 134, soft, and moderately full; respiration varies from 30 to 40, occasionally 
like that in hydrophobic paroxysm; heart’s impulse strong; first sound loud, 
second sound scarcely perceptible. 
P. M. Died. The body was removed early next day. No antopsy 
allowed.” 
As far as Dr. Buckingham could learn, there had been no sick animal on his farm, 
and so far as known, the patient had had no communication with any such, nor had 
he any occasion to handle hides.—The American Journal of the Medical Sciences, July, 
1850—pp. 96-99. 
Doctor Paul F. Eve does not admit the possibility of the inocu- 
lation of erysipelas by vaccination, as will be seen from the fol- 
lowing extract from his article on the health of the Southern 
Army: 
“ Erysipelas by Vaccination. In regard to the innoculation of erysipelas by vac- 
cination, independent of a peculiar atmospheric influence, and irrespective of some 
adventitious circumstance connected with a wound, I am not prepared to admit. We 
are all familiar with the idiopathic variety of this affection attacking the cutaneous 
and mucous surfaces, at times, too, becoming epidemic, and apparently in affinity 
with puerperal peritonitis, and we know the traumatic type; but surely this disease 
does not originate from a specific virus. It is evidently infectious, but not, I believe, 
contagious. A distinguished surgical writer, admitting that it is inpculable, states 
expressly that it would be impossible for it ever to appear in a sound individual. 79 
There, then, must be a predisposition in the general system, it would seem in every 
nstahce, usually induced by malaria, before it is developed. And if this be true, 
namely, that the attack depends for its origin upon a peculiar state and condition of 
the patient’s health, is it not then unwise, not to say erroneous, to suppose that ery- 
sipelas occuring after vaccination is due to a poison escorted by vaccine matter into 
the system! Ido not, therefore, believe it inoculable by this little operation.” 
The view maintained by Hippocrates and his followers, that 
Erysipelas was a disease originating from some intestine commo- 
tion of the humors, and that the offending matter was thrown 
off or eliminated by means of the skin, has been held by a large 
number of writers, with various modifications and slight addi- 
tions up to the present time. The French writers especially ad- 
vocate this view, and as a general rule deny the contagiousness of 
Erysipelas. The English writers, on the other hand, are almost 
unanimous in considering the disease as capable of propagating 
itself by contagion under certain circumstances. Dr. Cullen ad- 
mitted a species of Erysipelas capable of throwing off contagious 
emenations. He says, “ This disease is not commonly contagious, 
but as it may arise from an acrid matter externally applied, so 
it is possible that the disease may sometimes be communicated 
from one person to another.” 
The first well-authenticated facts militating against the old 
notions, and proving the contagious nature of Erysipelas, were 
published by Dr. Wells in 1798 ; for although Sauvages, in his 
“ Nosologia Methodica,” published thirty years before, admits 
an Erysipelas contagiosum, his views are obscure and his au- 
thority doubtful, as the epidemic of Tolouse in 1715, to which 
he refers in support of his ojoinion, appears to have been Scarla- 
tina, and v not Erysipelas. The examples brought together by 
Dr. Wells, in which this complaint appeared to be unequivocally 
propagated by contagion, have been sustained by similar cases, 
described by Pitcairn, Stevenson, G-ibson, Lawrence, Gregory, 
Elliotson, Arnott, Watson, Eogers, Goodfellow, and other Eng- 
lish Physicians. 
The question of the possibility of communicating the poison 
of Erysipelas along with the virus of the vaccine disease, is inti- 
mately associated with that of the contagiousness of Erysipelas. 
There was a diversity of opinion amongst the Confederate 80 
surgeons with regard to the contagiousness of Erysipelas. This 
diversity of opinion was clearly referable in some cases to dog- 
mas embraced during education, and to a want of careful and 
extended observation, and investigation of the origin, and mode 
of propagation, of the diseases incident to camp life. The relia- 
bility and value of the testimony of men upon such questions, 
clearly depends, not merely upon the extent of the field of ob- 
servation, but also upon the mode in which, and the intelligence 
with which, the phenomena are investigated. 
Many cases occurred during the progress of the war, in which 
Erysipelas was clearly referable in its origin and spread to the 
crowding together of large numbers of sick and wounded, in ill- 
ventilated hospitals. 
The following communication from Dr. J. C. Nott, of Mobile, 
Alabama, illustrates, not only the dependence of Erysipelas upon 
crowding, but also shows that in such cases, in like manner with 
Hospital Gangrene, the disease is best eradicated by scattering 
the patients and giving them free ventilation. It would be 
surely unwise and unphilosophic to refer the origin of Erysipe- 
las in such cases to an atmospherical influence, for the disease 
was most prevalent and most fatal in the most crowded hospitals, 
and was most speedily and effectually destroyed by breaking up 
those sources of contagion. 
No light whatever.is thrown upon the subject, by declaring 
the disease infectious and not contagious in crowded hospitals. 
We can only refer the propagation of infectious diseases to the 
exhalations from the sick, or from the excretions of their bodies, 
which act upon the extended surface of the lungs and skin of 
those immersed in the infected atmosphere ; and we know that 
in the case of the two most ’contagious and infectious diseases, 
Small-pox and Measles, the diseased actions may be propagated 
in both ways by the inhalation of the exhalations of the sick, as 
well as by direct contact with the morbific matters. 
Mobile, 21st Nov., 1866. 
Dear Sir: Your letter came to hand yesterday, together with two Nos. of your 
Journal. lam sorry that I have no notes or statistics relating to Hospital Gangrene. 
My connection with the array was in the Command of Gen. Bragg, commencing 81 
about sis weeks before the battle of Shiloh. I had, it is true, been the Medical 
Director in Mobile for some time previously, but we had no wounds to deal with. 
Very soon after we got to Corinth, all sorts of camp diseases prevailed among the 
troops—diarrhoea, typhoid fever, &c., and erysipelas. The Colonel of a regiment 
came to me and begged me to visit a small brick church in the suburbs of Corinth, 
in which his men were dying at a fearful rate with Erysipelas. On visiting the 
church, I found some seventy or eighty sick and wounded men crowded together in 
a small church, and about one half of them with Erysipelas. There had been daily 
skirmishing going on, and about one fourth of the men had been wounded, The 
disease attacked those wounded, as well as others, indiscriminately. Many of them 
were dying of Erysipelas of face and scalp, who had not been wounded, and I never 
saw a more revolting scene than this hospital presented. I ordered it to be evacu- 
ated at once, and the patients to be removed to tents, at some distance off in the 
open field. The effect was immediate and salutary. The Erysipelas ceased to 
attack others, and the health of the command improved rapidly. 
At the same time above alluded to, we had some cases of Hospital Gangrene among 
the wounded in different hospitals, up to the time of the battle of Shiloh. Being 
occupied very busily in office as Director of the Post, I had no time for visiting 
hospitals, and the battle of Shiloh coining off soon, and there being very little hos- 
pital accommodation, we were compelled to send off in' every direction 10,000 
wounded and as many sick. So I saw very little of what occurred among our 
wounded. 
I afterwards went into Kentucky; was at the battle of Perryville, and other 
smaller battles; but here we had to leave our wounded behind, after every battle. 
So really my experience has not been extensive or satisfactory in Hospital Gan- 
grene. I have seen a good many scattering cases during the war, and have found 
them best treated by the application of Nitric Acid, Iron, tonics, stimulants, and 
good diet. 
On the whole, then my observations and information are too indefinite to be worth 
much, and I write more to state the simple fact that we did have cases of Hospital 
Gangrene before and after the battle of Shiloh, and I looked upon it as close akin 
to Erysipelas. 
Very Respectfully, Yours, &c., J. C. NOTT. 
Prof. Joseph Jones, Nashville. 
It will be seen from the following statistical information and 
sanitary report of the Moore Hospital, Manassas J unction, Vir- 
ginia, for the month of January, 1862, that in this hospital, 
which received the worst cases of Typhoid Fever and Pneumo- 
nia, and which was liable to sudden and unavoidable crowding 
of the sick, Erysipelas attacked almost universally the patients 
operated on, only two escaping. 
“Mooee Hospital,” Manassas Junction, Va., February 7, 1862. 
Tuos. H. Williams, Surgeon C. S. A., Medical Director Army of Potomac ; 
Sir ; I have the honor to forward the report of the “ Sick and Wounded” of the 82 
Moore Hospital, for the month of January. The face of it shows only 235 patients 
admitted, while 77 of these have died—a fearful mortality, I confess—and did it 
extend to all diseases treated, would soon decimate our army. But when it is re- 
collected that the 235 men kept here were picked out of over 2,900 that have passed 
through and were sent further hack, and that those kept are the sickest—in fact a 
number came in moribund, others dying from six to twenty-four hours after their 
arrival—the mortality does not appear so appalling. At the beginning of January, 
here were remaining 114 sick and convalescents; of these 25 died during the past 
month, making the mortality 102. The report shows 37 cases of fehris typhoides, 
with 17 deaths, which is, strictly speaking, not true, as there have been but 4 or 5 
cases of well-developed typhoid fever in the wards, and those so diagnosed are, in 
the majority of cases, simple continued fever, taking on a typhoid form but wanting 
in all the particulars of typhoid fever proper; and, I feel confident, was there an 
opportunity afforded for post-mortem examinations, they would he found wanting 
in the pathological changes peculiar to the disease. 
There were 128 cases of pneumonia treated, with a loss of 45, almost 36 per cent., 
though not large when the condition of the patients at the time of entering the hos- 
pital is taken into consideration; a large majority of the cases are sick from three 
to ten days in camp before they are brought to the hospital. Such cases presenting 
had symptoms, but still not necessarily of a fatal character, after a ride in an am- 
bulance or wagon of three or five miles over a rough road, are placed beyond 
redemption. Stimulants and carh. ammonia may revive the vital spark, and the 
man live for several days, and occasionally, I am happy to say, has elasticity 
enough about his constitution to get well. As an evidence of the fatality caused by 
surrounding disadvantages, I have simply to refer to some ten or twelve cases of 
pneumonia in my nurses where every case has recovered, each one of them showing 
the good effects of antimony in the early stages of the disease. 
Those sent from this place to general hospital, have been convalescents sent fur- 
ther back to make room for the sick. They have been South Carolinians and Mis- 
sissippians, and were sent to Charlottesville and Warrenton. 
The number of furloughs (47) is large for the number of patients; but when it 
is considered that all of the wounded—at least 60—from the battle of Drainesville, 
were here, that will be accounted for. 
I may add that the two cases of erysipelas were purely idiopathic, and in the 
ward where all of the worst wounded were, there was quite a number of other 
cases there, arising from any little operations peiformed, such as removing a bullet 
or spicula of bone, but two patients operated on escaping ; on one of those, I ligated 
the carotid artery, in the other amputation of the thigh was performed. The latter 
Operation was performed three weeks since, and the same day a bullet was extracted 
from the shoulder, which immediately took on erysipelatous inflammation, whilst 
there has never been the slightest symptoms of it about the amputation. In several 
of these cases, and especially the idiopathic, the inflammation was not confined to 
the skin, but extended to the sub-cutaneous areolar tissue, forming what Dr. 
Stone, of New Orleans, says is different from erysipelas, and what he calls, 
“subcutaneous areolar inflammation,” never running its course without suppuration, 
and occasionally to an enormous extent, invariably presenting typhoid (low) symp- 
toms. 
I am, Sir, your ob’t Serv’t, 
J. F. BELL, P. A. C. S., 
Surgeon in Charge. 83 
These examples might he multiplied, but these are believe d 
to be sufficient to illustrate the experience of many Confederate 
surgeons, upon the intimate relations of Erysipelas in its origin 
and spread to such diseases as Hospital Gangrene which were 
known to be contagious. 
On the other hand the armies were never so healthy, and the 
wounded were never so free from Erysipelas, as during the most 
active campaigns. 
The army of General T, J. Jackson, (Stonewall), during its 
active campaign in the Yalley of Virginia, was remarkably 
healthy, and the wounded, as I ascertained by an examination 
of the records of several of the largest hospitals, connected with 
the Department commanded by this distinguished soldier, were 
exempt to a great degree from both Erysipelas and Hospital Gan- 
grene. This immunity was due to several causes, but chiefly to 
the active habits and good morale of his soldiers, to the com- 
paratively abundant supplies of this rich country, and to the 
large and commodious hospitals established at Staunton and 
other eligible points in this elevated and healthy region. The 
truth of this assertion will be sustained in the following Sanitary 
Report of his Medical Director, Surgeon Hunter McGuire : 
S. P. Moose, Surgeon General, C. S. A.: 
Sir : I have the honor to forward the consolidated report of sick and wounded, 
and the return of the Medical officers, serving in the Army of the Valley of Virginia 
for the month of March, 18G2, (Maj. Gen’l Jackson’s Command). 
Though subjected to long, and sometimes forced marches, the health of this army 
was better during the month of March than during any other since its organization. 
It is a fact well known to Regimental Surgeons and Commanders, that the numbers 
reported sick during marches, even when they are long and fatiguing, provided the 
weather is clear and dry, is less than that which occurs when troops are stationary 
and subjected to the ordinary duties of camp. 
New Market, Va., April 15, 1862. 
Towards the end of the month, recruits and drafted men were added to the regi- 
ments, and the amount of sickness increased, indeed the large proportion of those 
reported sick, belong to the men recently attached to the regiments, who are not 
yet inured to the hardships of a soldier’s life. I enclose also a list of the killed and 
wounded of this army, in tire engagement near Winchester, March 23, 1863. It 
numbers sixty-one killed, and three hundred and sixty-one wounded. Some of the 
latter were mortally wounded, and have since died, which increases the number of 
dead, as far as known, to eighty-eight, and proportionally reduces the number of 
wounded. One hundred and fifty-seven of the wounded were removed from the 84 
field, the rest fell into the hands of the enemy. It is gratifying to know that our 
dead were decently buried by the citizens of Winchester, and that our wounded 
have received every attention from the physicians and ladies of that place. 
Very respectfully, your obedient servant, 
HUNTER McGUIRE, 
Medical Director, Army of Valley of Virginia. 
Whilst we do not at all deny, that Erysipelas at times prevails 
as an epidemic, and appears to he produced by some general epi- 
demic influence, and that in many cases the disease may be most 
plausibly accounted for, by sudden changes of atmospheric tem- 
perature, along with considerable moisture, together with derange- 
ment of the bowels, and the effects of particular articles of food; 
at the same time there are facts to show that this disease is at 
times, if not always contagious. 
Neither would we be understood as insinuating, that instances 
of its transmission by contagion, are common in private practice, 
for isolated cases frequently occur in private families in which no 
member of the family and no nurse contracts the disease. 
The origin and spread of Erysipelas in Hospitals; will depend 
upon the hygienic condition of the wards, and upon the state of 
the constitution of the patients. 
Many of the Confederate Surgeons appeared to be aware of 
the dangers attending the indiscriminate use of sponges, dress- 
ings, and uncleansed wash bowls, when erysipelas was present in 
their wards. When wounds were cleansed with sponges or rags 
which had been used on erysipelatous patients, it was frequently 
observed that the disease appeared ; and such propagation 
appeared to be clearly referable to the transference of the con- 
tagious matter. 
It can be shown therefore that the evidence of contagion in 
Erysipelas rests upon nearly the same grounds as in the well 
known contagious diseases, scarlet fever, measles, and Typhus 
fever. 
Many of the British Physicians and Surgeons, entertain hut 
little doubt of the connexion, if not the identity of Erysipelas 
with Puerperal fever. Without entering into an extended exam- 
ination of the facts upon which this view rests, it will be suf- 85 
ficient to recall the well known fact, that inoculation with the 
fluid of a female who had died of puerperal fever, is a most fatal 
source of diffuse cellular inflammation to the dissector. 
Dr. George Gregory in his Lectures on the Eruptive Fevers, 
says that he had heard of a case, where vaccine matter taken from 
the arm of a child laboring under erysipelas, had communicated 
both diseases. 
And finally Dr, Willan has testified, that if a person he inocu- 
lated with the fluid contained in the phlyctinae or vesicles of a 
genuine erysipelas, a red, painful, diffused swelling and inflam- 
mation analogous to erysipelas is produced. 
This experiment has not as far as we are aware been repeated; 
and with such a direct demonstration of the possibility of com- 
municating erysipelas hy inoculation, we are at a loss to know 
upon what principles of reasoning, authors who have never per- 
formed a single experiment themselves, assume the right of 
setting aside the assertion of Dr. Wiliam 
By these facts therefore, as well as hy those which occurred 
during the recent war, amongst the soldiers and citizens of the 
Confederafe States, we are justified in drawing the conclusion, 
that it is possible to communicate the poison of Erysipelas, 
through the medium of the vaccine matter. 
The practical conclusion which we draw from this discussion ? 
is that; 
As far as possible soldiers, especially during long and 
fatiguing campaigns, and when crowded in hospitals and bar- 
racks, should he vaccinated with the lymph or vaccine virus 
from young healthy children. It is best, both in Civil and in 
Military practice, not to use the vaccine virus from the arms on 
soldiers, because their mode of life is an artificial one, to a great 
extent: a stereotyped life of restraint and hardship, and of great 
sameness of diet, and consequently a life liable to great excesses 
and irregularities of habits, and to great and sudden variations 
of health, as well as to slow and imperceptible deterioration of 
the nutritive fluids. 
The quality of the .vaccine virus, will depend in great measure 
upon the manner in which the nutrition of the body is per- 86 
for med. We use the word nutrition in its largest sense. Vaccine 
matter obtained from the arms of the feeble and often scorbutic 
convalescents of crowded civil and military hospitals, is wholly 
unfit for the propagation of the vaccine disease. Of all places, 
civil and military Hospitals are the very last, to which the pro- 
fession should look for supplies of vaccine matter ; and yet 
during the recent war, it was in the crowded hospitals that vac- 
cination was most dilligently, perpetually, and indiscriminately 
performed. In these most destructive centres of contagious dis- 
eases, of Typhoid fever, Erysipelas, Hospital gangrene, and Pya3- 
mia, the so-called vaccine matter passed from soldier to soldier in 
an endless round. Is there any marvel that under such a system, 
enforced hy military law, the matter should have progres- 
sively deteriorated, and the accidents of vaccination, (Spurious 
vaccination) have become both common and serious P 
SECTION VII. 
Fresh and Dried Vaccine Lymph and Scabs from Patients 
SUFFERING WITH SECONDARY OR CONSTITUTIONAL SYPHILIS, 
AT THE TIME, AND DURING THE PROGRESS OF VACCINATION 
and the Vaccine Disease. 
We examined at different times, during the progress of the 
recent war, and also had under treatment, various skin affections? 
which presented the characters of the cutaneous diseases, char- 
acteristic of secondary Syphilis, which were directly traceable to 
impure vaccine virus. I saw several cases in which enlarged 
buboes in the axilla and groin accompanied the peculiar skin 
affection induced by impure vaccine matter. No such results 
followed vaccination as performed by myself or immediately 
under my direction during the war ; these accidents were avoided 
in my civil and military practice, by adhering rigidly to the rule 
of using the lymph from the arms of healthy children and 
infants: the opportunity therefore did not present itself of 
observing and carfully noting the disease in its first stages. The 
cases resembling constitutional Syphilis and which were said to 87 
have resulted directly from vaccination, which came under my 
observation and treatment, were as a general rule of long stand- 
ing, and had been collected from different hospitals, and from 
various regiments, serving in widely separated districts. 
In the summer of 1863, I examined a large number, and if my 
memory is correct, over two hundred cases of severe skin affec- 
tions and general constitutional derangement resulting from vac- 
cination, in the large hospitals in and around Richmond, Vir- 
ginia, In these cases, as well as in those examined in other 
parts of Virginia, South Carolina, and Georgia, great difficulty 
was experienced in tracing the impure matter to a definite source, 
that is to the point at which it became contaminated or deteri- 
orated. I do not wish to be understood as asserting or insinua- 
ting that this large number of cases presented the symptoms of 
secondary Syphilis : so far from this it appeared to me that those 
cases which presented the most complete resemblance with con- 
stitutional Syphilis were not as numerous as those which were 
clearly referable to scorbutic and other deranged conditions of the 
system induced by fatigue, exposure and bad diet. 
During the progress of the war, the subject of the relation of 
vaccination to constitutional Syphilis, engaged my most anxious 
thought, and I had determined to make it a special subject of 
investigation in the Field and General Hospitals, immediately 
upon the completion of my investigations upon Typhoid fever, 
Malarial fever, Small Pox, Hospital Gangrene, and Pyasmia, 
believing that a correct solution of this difficult and important 
question was to be obtained only by a personal examination of 
the cases as they arose in the regiments serving in the field, and 
by a careful collection and examination of the testimony of the 
regimental Surgeons and Assistant Surgeons. From experience 
gained in other investigations in the Field and General Hospitals, 
I was well aware that such labors required much time and were 
beset with many difficulties. From the terrible drain upon the 
Confederate States for men, the hospitals and convalescent camps 
were subjected to the most rigid scrutiny, and all men not abso- 
lutely disabled from every kind of duty, were at the earliest possi- 
ble moment transferred to clerical and light duty in the Quarter- 88 
master, Commissary, Medical and Purveying departments. From 
the great disparity of numbers, and from the immense extent of 
country in which the operations were conducted, the Confederate 
troops were in perpetual motion. The same soldiers, in the 
course of a few months, conducted fatiguing campaigns which 
extended over entire States, and fought bloody and desperate 
battles with superior forces in localities separated by hundreds of 
miles. Whole armies that had been victorious at some remote 
portion of the border, or of the Atlantic and Gulf coasts, were 
suddenly transported by railroad, across the entire Confederacy, 
to take their immediate part, without rest, in the bloody battled 
of the mountains of Tennessee and in the valleys of Virginia. 
These difficulties were experienced to a greater or less degree by 
every medical officer who undertook the investigation of this 
subject; and it has been rendered still more obscure, by the 
sudden manner in which the struggle terminated, and by the 
loss of the most extensive and valuable reports on file in the Sur- 
geon General’s office at Richmond. 
I have sought to remedy, in a small degree, these defects, by 
addressing inquiries to a large number of those who formerly 
occupied positions in the medical service favorable for the investi- 
gation of the causes of the accidents following vaccination. It 
must be confessed that up to the present time, the replies 
received to these inquiries, have been wanting in that full and 
accurate detail of individual cases, which is so necessary to the 
proper solution of the question, whether the lymph or scab of a 
vaccine vesicle may, beside its peculiar virus, contain another 
infectious principle, as that of Syphilis. 
The affirmative of this question was held by many, both in 
civil and military practice; and a number of the Confederate 
Surgeons, boldly took the ground that secondary Syphilis could 
be communicated along with the vaccine virus,' and especially 
when the dried scabs were employed. In the records upon this 
subject, which we examined in the Surgeon General’s office in the 
Confederate Capital, this view was clearly announced. Several 
of these reports had been prepared in accordance with a direct 
order issued by the Surgeon General, directing a careful invest!- 89 
gation into tin 3 origin and causes of spurious vaccination. The 
history, and results of a portion of the investigations ordered by 
Dr. Moore, are given in the following letter from my friend, 
Professor S. M. Bemiss, M. D., now of the Medical Depart- 
ment ot the University of Louisiana. Dr. Bemiss enjoyed 
most extended opportunities for the investigation of this subject 
not only during his connection with the Army of Northern Vir- 
ginia, but also during his efficient service as Assistant Medical 
Director of the Army of Tennessee. 
New Orleans, November 21, 1866. 
Prof. Joseph Jones, University of Nashville; 
My Dear Sir : 
Yours of the 9th instant, reached me to-day. I regret that I can furnish you no 
information likely to be of service to you iu the investigation you have undertaken. 
During the month of March, 1863, while connected with the army of Northern Vir- 
ginia, Medical Director Guild was so impressed with the importance of this affection 
that he ordered a committee of investigation into the extent of its prevalence, its 
causes and nature. I think the committee limited their inspections to those regi- 
ments only whose medical officers had reported the presence of this “ Spurious vac- 
cination.” The committee consisted of Surgeons R. J. Breckinridge, now of 
Houston, Texas, Herndon, of Fredericksburg, Virginia, and , of North Car- 
olina. I was not officially connected with the committee, but accompanied it from 
motives of professional interest. I kept many valuable notes in reference to the 
appearance of the ulcers and their history; but at the close of the war my camp 
chest was lost and with it all my MSS. My recollections are that the cases of spu_ 
rious vaccination were most numerous iu the 12th and 16th Ga. Regiments. In one 
of those regiments we found over one hundred cases of ulcerated arms and hands, 
and in many instances extending to the body and lower extremities. In one of 
these regiments the historical connection with Syphilis was most conclusive. They 
had all been vaccinated from the arm of a comrade of very dissolute habits, who 
had just returned from a leave of absence. This soldier was at this time in camp 
and presented unmistakable evidences of Syphilis. I do not think I err when I 
state that there was no chancre on the penis, but we rested our opinion of the exist- 
ence of Syphilis upon the characteristic sore throat and eruption, and his Confessions 
as to the recent existence of chancre. He had just returned from some little village 
!'n Georgia, and informed us that a physician practicing there, I think by the name 
of Russell, had taken matter from his arm and inserted it into the arms of a large 
number of young persons in his neighborhood. I regret that I cannot recall the 
names of the medical officers of these regiments, so that you might address them 
letters of enquiry. The “ vaccination ” in all these cases was done by the soldiers 
themselves and not by their medical officers, consequently, acting upon the popular 
idea that the larger the sore the more complete is the protection, they selected the 
worst sores for the propagation of the virus. I remember that the committee agreed 90 
with regard to the worst of these ulcers, that their appearance and progress were so 
analogous to syphilides that they did not hesitate to class them as such. The usual 
treatment for Syphilis did not cure or benefit these cases tvith any marked uniformity. I 
think we find a ready explanation of this observation in the condition of constitution 
and circumstances under which the treatment was instituted, poor diet, scurvy and 
camp life. During my long service in the western army I saw much of this form of 
disease, and in the majority of cases failed to connect it with Syphilis, either as it 
respects history or characteristics. I treated one case in which the manifestations 
were decidedly syphilitic, but the soldier had suffered from constitutional disease 
in bad form for some year or more previously. In brief, toward the conclusion of 
the war I abandoned my previous opinion that all such cases were true syphilides, 
and was willing to admit that some of them could not be classed with those affec- 
tions either by history, characteristics, or progress, and that we must refer them to 
the introduction of a poison differing from Syphilis, or to some peculiar constitu- 
tional crasis winch determined the character of the sores. I refer you to the follow- 
ing gentlemen: Dr. L. Guild, Mobile, Alabama; Dr. James C. Mullens, * , S. C.; 
Dr. R. P. Bateman, Memphis ; Dr. B. M. Wible, Louisville. 
Very respectfully, &c., S. M. BEMISS. 
Professor Paul F. Eve, M.D., of the Medical Department of 
the University of Nashville, as will he seen in the following quo- 
tation from his article “On the Health of the Southern" Army,” 
believes that Syphilis may be transmitted by vaccination. 
“Syphilis m Connectim ivith Vaccination.—From all I have heard and read on the 
transmissibility of Syphilis by vaccination, the question, from the evidence 
already accumulated, would appear decided in the affirmative. While I have seen 
nothing confirming this opinion, yet I do know that cases did occur in Richmond, 
Va., said to be corroborative of it, and that Medical officers in the Southern service 
were specially cautioned as to the source whence vaccine matter was derived. Since 
my return to Nashville, I find that the opinion obtains among the Surgeons of the 
United States Army, that in some instances syphilitic diseases have been definitely 
traced to the insertion of vaccine matter. My colleague, Dr. Briggs, called my 
attention recently to a case of this kind, of the source of which ho entertains no 
doubt. I failed to see it, as the patient had left for the Hot Springs of Arkansas. 
When told that he had the secondary symptoms of Syphilis, he replied that was 
impossible, as he never yet had contracied the primary, though confessing that he 
was almost daily exposed to it. Two other physicians were consulted as to the 
affection, and from this history of the case were inclined to the belief of the patient, 
but stated it looked like venereal. It was subsequently ascertained that this per- 
son had been vaccinated from a girl of the town who labored under constitutional 
Syphilis. Not only was the arm in this instance made very sore, but buboes formed 
in the axilla, followed by ulcerations in the throat, copper blotches in the skin, 
nodes, &c. 
“ The possibility of communicating Syphilis by vaccination, was agitated in Italy 
as far back as 1846: and the transmissibility of this unfortunate contamination was 91 
there definitely admitted in 1861, by a committee elected at a Medical Congress at 
Acqui in Piedmont, at which it was believed that numerous cases had occurred in 
both children and adults, who had been vaccinated. The names of Pacchiotti, 
Parola, Ponza, Tassani, of Milan, who I met there in charge of a large hospital 
after the battles of Magenta and Solferino, in 1859, De Kalt, Hubner, &c., vouch 
for the accuracy of this report. The transmission of (syphilitic) disease has also 
been maintained by Lecoq, Rollet of Lyons, and particularly by Vennois in the 
Archives Gendrales de Medicine of Paris, 1860; and on this point, the admission of 
Dr. D. P. Condie, long known to occupy the front rank in the profession, and who 
has done so much for its literature, deserves serious consideration ; and he publishes 
these words in a recent number of the American Journal of Medical Sciences: 
“ ‘ Let it be strongly impressed upon the mind of every physician, lest in his 
attempt to guard the system against one formidable malady, he inoculate with ano- 
ther, more insidious in its operations, but not less destructive.’ 
“As to the consentaneous presence of two constitutional diseases in the same 
patient, and the contagiousness ot secondary symptoms of Syphilis, it is sufficient 
for us to state that at a recent meeting of the Academy of Medicine in Paris, the 
the report from a committee, on which M. M. Velpeau and Ricord served, (than 
whom it may be safely asserted two better names for this very purpose never existed 
in the annals of the profession), decided both these questions in the affirmative.” 
Dr. O. Kratz, in the following report to the Surgeon General, 
on vaccination, originally published, in the July number of the 
Confederate States Medical and Surgical Journal, (vol. i., 1864, 
p. 104), supported the view that Secondary Syphilis could he 
communicated through the medium of the Yaccine Virus. 
On Vaccination and Variolous Diseases. By 0. Kkatz, Surgeon, P. A. C. S. 
The following remarks on Vaccination and Variolous Diseases have been sug- 
gested to me from my own experience. Spurious Vaccine and its deleterious in- 
fluence on Vaccination, seem to me worthy of further investigation, as a subject 
hitherto not sufficiently appreciated. 
11l order to define my stand-point, let me state, at the outset, that Liebig’s Theory 
of Fermentation is till now, the best to explain the phenomena of vaccination, and 
that all the anomalies occurring, may be best elucidated by this hypothesis. At the 
same time I do not feel warranted in subscribing blindly to it; but I think we have 
not any better as yet, and I simply adopt it in the same manner as I would have to 
conform to the atomic theory in treating about chemistry. 
In vaccinating a subject we introduce, then, the yeast, the virus, into the circula- 
tion, to produce the fermentation and its result, the scab. If there is a certain sub- 
stance in the system for the virus to react upon, the scab will be formed and the 
subject is vaccinated. If, on the contrary, this substance is entirely deficient or 
modified in some way or other, no scab, or an imperfect one, will be the result. 
With very few exceptions, the good vaccine matter, will produce a normal scab 
on the subject never vaccinated before. The reacting matter in the system is elimi- 92 
nated, and by this process the liability to the infection of small-pox rendered impos- 
sible or greatly diminished. Possibly, in a long interval of time, this matter may 
be re-organized in the body, but never to its original state. I say never, because such 
a subject may be attacked by varioloides, but never by variola. 
If this re-acting matter is re-organized as nearly as possible to its original state, 
the second vaccination will produce a scab also, but never a perfect one. It may be 
perfect for the protection of the individual on whom it appears, but it offers no 
guarantee for re-vaccination on other subjects. I call this a pseudo-scab. This 
scab may yet retain much of the original fermenting property, but not the same as 
the genuine. If this virus is used again for re-vaccination of an individual, its pro- 
duct will offer again less guarantees of being protective. Continuing in this man- 
ner, the scab will finally contain nothing but common suppurative matter—pus—as 
if taken from any other suppurating place in the body. The germ of the scab 
itself will be more or less modified and deviating from its normal structure. 
As I have no book of reference bn the subject, I quote the following from 
memory: 
Some years ago, the Academy of Medicine in Paris investigated yery closely the 
fact, if syphilis could be transferred by vaccination. The result obtained by re- 
peated and most direct experiments was, that it could not be communicated by 
transmission of genuine Vaccine Virus, from one individual to another, affected with 
syphilis in any of its stages. Liebig’s explanatory theory of fermentation holds 
good here. The Vaccine Virus will re-act only on certain substances in the system 
and ignore others entirely. We know, at the same time, that matter from a syphi- 
litic suppurating surface will reproduce syphilitic symptoms on another subject. 
I have had occasion to observe several well defined cases of Hupia Syphilitica pro- 
duced solely by vaccination. Other respectable Surgeons, worthy of implicit belief, 
from their scientific attainments, have noticed the same and similar facts repeatedly. 
These subjects bad never Syphilis before, otherwise the inference would be doubt- 
ful or worthless altogether. Therefore, instead of having had vaccine virus inserted, 
they have been inoculated with Syphilis. 
I have seen one case, where the product of the vaccination was Surpetigo rodeus, 
a frightful disease of, I believe, a cancerous character. Some cases had herpes 
excedens as the result of vaccination on their arm. 
The syphilitic cases had been treated for other cutaneous diseases without any 
material amelioration. The mercurial treatment removed the symptoms at once. 
I have never seen anomalous results from vaccination if the following precaution 
was strictly adhered to: The vaccine matter used was taken from a healthy infant, 
never vaccinated before. 
The indiscriminate vaccination and re-vaccination from arm to arm has been, in 
my opinion, the principal cause of the deterioration of the vaccine virus, and of 
producing cutaneous diseases from vaccination. A second cause may be found 
in the fact, that the virus used is old and too rarely regenerated by passing it 
through the cow. Cow virns will fail only lin 100 ; good common virus will fail 3 
in 100, if I remember right.—Confederate States Medical and Surgical Journal, July, 
1864. 
The testimony of Doctor Wm, F, Fuqua, of Virginia, for- 93 
merly Surgeon cf the 7th Florida Regiment, 0. S. A., is clear 
and decided. Fifty-two Confederate soldiers, who had been 
inoculated with virus from the arm of a sailor who was laboring 
under Syphilis, presented the characteristic symptoms of consti- 
tutional Syphilis, as abcesses in the axillary glands, pain in the' 
limbs and joints, sensation of dryness and ulceration in the throats, 
buboes, coppery colored spots, and loss of hair, and they were 
only relieved by syphilitic treatment. If these results of vaccin- 
ation had been due to a depressed and scorbutic state of the 
blood, the syphilitic mercurial treatment would have greatly 
aggravated the diseased condition. 
On the Communicability of ■Syphilis by Vaccination. By Wm. M. Fuqua, M.D.. Appo- 
matox County, Virginia. 
On assuming charge of the Seventh Florida Regiment, late C. S. A., as Medical 
officer, I found fifty-two men who had been recently vaccinated, suffering from 
severe ulcers on their arms, at the site of vaccination. Some of these ulcers had 
scabbed, and to all appearances seemed to promise a speedy “ return to duty!” 
There were others, varying in size from that of a quarter of a dollar to that of a 
Mexican dollar. Their edges were hard, shining, and everted; in some few cases 
they were undermined. An ashy coloured slough covered their base, which was 
from time to time cast off. This, however, was not always a genuine slough, but a 
tenacious grey and partially organized exudation. These ulcers were offensive, and 
discharged pus freely. The redness circumscribing them, was limited, the limb but 
little swollen, and the pain of a burning, stinging character. In many instances, 
the lymphatic vessels were much inflamed, and the axillary glands, in each case, 
were more or less affected. Many of these patients complained of pain in their 
limbs; there was some febrile excitement, and their appetites had been much 
impaired. Having thus briefly described these ulcers, it may not be improper to 
remark upon the hygienic condition of the regiment. 
At this time, it was doing duty at Knoxville, in the department of East Tennessee, 
and was quartered a mile from towu, upon soil which had been previously occu- 
pied by troops, who had left the encampment In no praiseworthy condition. To the 
south, southwest, and west, passed the Holston river. The general health of the 
command was bad—the sick list comprising one-seventh of the command. The pre- 
vailing diseases were the malarial fevers and acute diarrhoea. 
The first part of the treatment of these cases, consisted in their removal to a 
more cleanly and healthful locality; cleanliness of person and clothing was enjoined 
also. General directions were given as regards diet, and of maintaining their bowels 
in proper condition. The second part of the treatment was the local application of 
astringents in the milder cases, and escharotics, varying from the mildest kind to 
that of the most potential, in conjunction with the astringent lotions in the severe 
ones. Under this regimen, some few improved; none, however, recovered; by far 94 
the greater number grew worse. Abcesses now began to form in the axillary 
glands ; pain in the limbs and joints increased in severity; there was a sensation of 
dryness in the throats of many, which was speedily followed by ulceration. Our 
apprehensions were now fully awakened; each day we inquired more and more dili- 
gently for some new symptom which might be diagnostic. Coppery coloured spots 
now appeared upon two; the hair began to fall off in a third, and it was not a week 
before a syphilitic bubo, in its incipient stage, appeared in another. Heretofore, 
these cases had been denominated “ spurious vaccination.” Spurious they were, in 
one sense; but specific in another, in the strictest acceptation of the term. 
It is hardly requisite for me to state, that these cases were placed upon syphilitic 
treatment, and we had the satisfaction, in comparitively short time, of seeing the 
greater number of them returned to duty. A few were sent to the General Hospital, 
one of whom died. 
In conclusion, let me remark, that having mentioned to Dr. Frank Ramsey, then 
Medical Director of the Department, the nature of these cases, he requested 
me to make a report in detail concerning them, which was done, and in all prob- 
ability found its way to the late Surgeon General’s office. 
Upon inquiry, it was definitely ascertained, that the virus for inoculating these 
patients was obtained from a sailor, on the coast of Florida, who labored under pri- 
mary Syphilis at the time of vaccination.—Richmond Journal of Medicine and Surgery, 
June, 1866. 
The following article by Dr. Frank A. Ramsey, of Memphis, 
Tennessee, contains an argument for the possibility of the trans- 
mission of Syphilis by vaccination, although its author does not 
feel justified in supporting this opinion in “ a sirictly professional 
disquisition.” In a letter from Dr, Ramsey to myself, accompa- 
nying this paper, dated Memphis, November 15, 1866, he says : 
“ The subject has occasioned me much thought, and incidentally 
some research, being on the watch for anything, however remote, 
at all applicable to the question. But I cannot say that I have 
formed any definite views regarding the question involved.” 
Abnormalities of Vaccination. By Frank A. Ramsey, M.D., Medical Director of the 
(Quondam) C. S. A. 
It is after conference, regarded as proper for the following letter to be published. 
The subject matter of which it treats, was one of exceeding importance and inter- 
est, almost from the incipiency of the intestine strife, in the Southern States, but 
has not yet had, in the professional periodicals, any exhibition of the attention it 
elicited, or any declarations of results of observation, or of investigation. 
I do not deem it necessary to defend now, the course of thought taken in the 
letter, written under the peculiar circumstances connected with the period at which 
it bears date. It has, however, a reference to a particular opinion, which I would 95 
/ 
not at any time, or under any circumstances, support in a strictly professional dis- 
quisition ; that opinion had been hastily expressed, in the midst of official businessj 
and for the purpose of producing a particular effect, which I honestly Judged to he 
proper and best in the exigency. 
Effects very nearly resembling rupia, followed vaccination, with presumptively 
pure virus, in so many instances, as induced the Surgeon General, to appoint medical 
officers connected with the Southern army, to the dnty of tracing, if any, the con- 
nection between syphilis and vaccinia; and the prosecution of this duty gave occa- 
sion to the letter, now presented in the hope that it will lead others to record their 
observation, experiences and reflections, on the same subject; and with the inten- 
tion on the part of the writer himself, under other and more favorable conditions to 
give the subject further consideration: 
MEDICAL DIRECTOR’S OFFICE ) 
Abingdon, Virginia, March 20,1864. $ 
Doctok:—Your note, of March the eleventh, informing me, that you had been appointed 
“ chairman of a committee on the relation of vaccination to Syphilis,” and making reference to 
my “ report of last year,” and asking me for “ any further information relative to Spurious vac- 
cination,” has been received; and I take the first opportunity, offered in the performance of ofll- 
cial duties, to reply. 
I have no facts, which have occurred within the field of ray own observation, directly relating 
to the subject, as stated by you; but, with your permission, will continue writing, until I have 
given you something of the operation of my mind, occasioned by your note. 
I thank you for the honor you have clone me, in preferring the request, and in the reference you 
have made to, I presume, a letter written by me, to a Burgeon at Chattanooga, a copy of which I 
deemed proper to forward to the Surgeon General. That letter was written, as I now write to 
you, currente calamo, and though I preserved a copy, it was left at Knoxville, and has doubtless 
fallen into the possession of the enemy.- I am, therefore, prevented from making reference to it, 
as I am debarred from any ability to consult authority, or to refresh my memory, as I should, and 
would do, if differently situated. But, if I correctly remember, the letter was not of such a char- 
acter, as to convey an idea, that the observations were of cases of Spurious vaccination. Indeed, 
the basis of the letter was furnished by observations of results, or effects following the introduc. 
tion, or inoculation of vaccine virus undoubtedly pure. And though the results or exhibits were 
in their course, certainly not such as ordinarily present from vaccination, or as are usually re cog 
nized as essentially cow-pox; yet observations were not sufficiently numerous, or continued for a 
time long enough, to determine whether any, or the same degree of immunity from small-pox 
was occasioned in subjects thus affected, as in those who presented the ordinary course of the 
cow-pox disease. There were, however, practitioners of medicine, who were esteemed, in com- 
munities in which they labored, as capable observers, who affirmed that these subjects were as 
free from liability to small-pox, as those in whose economies the vaccine disease had exhibited 
nothing unusual, in deviation from its regular course If, then, the scab was undoubtedly a pure 
vaccine scab, and the effect was perfect, or relatively perfect, immunity from small-pox, notwith. 
standing there was nothing observed from the application of the virus, until the production oi 
the ultimate effect, at all like vaccine disease in progress, the disease, 1 think, cannot properly 
he termed spurious. To he spurious, the vaccine virus must not be in the scab, or the effect 
must be an absence of any protective energy having been impressed on the economy into which 
the scab had been introduced. Varioloid consists of exhibits in course, differing from varioia in 
course, yet no one, I presume, would feel himself justified in terming it spurious small-pox, 
because it is known to proceed from small-pox virus, will communicate small-pox, and leaves 
the economy it has affected, impressed with immunity from a future attack of small-pox. Vari- 
oloid is, then, not spurious small-pox, but small-pox modified in its exhibits in progress, through 
an economy previously impressed by the operation of the virus of cow.pox. Here the modify- 
ing cause is known. 
So by analogy, the cases which gave occasion to my letter of last year, were, each, an instance 96 
of modified cow-pox. The matter was obtained from Nashville, Tenn., from Atlanta, Ga., and 
from Richmond, Virginia, from Surgeons of reliability, and the same results were observed to 
follow upon the introduction of the several matters, in some instances regular vaccinia, in others 
abnormal exhibitions; indeed, in many an approximation to the regular exhibition of original 
poison from cow matter, could not be discovered. And professional men, who were not desti- 
tute of reputation for capacity, affirmed, on the strength of observations sufficient to satisfy 
them, that the economies thus affected, were impressed with immunity from small-pox, as though 
they had passed through cow-pox in its regular exhibitions. 
True, to make complete the analogy I have instituted, it remains to establish by experiment, 
that true vaccinia-in its regular exhibitions, in one instance, or more, can be produced by the 
inoculation of matter from one of these economies. Which experiment,'however, I will leave to 
some one with more curiosity and temerity than I have, feeling satisfied myself, that they were 
cases of modified cow-pox. But in these instances, the modifying cause is unknown. It must, 
however, have obtained an union with cow-pox matter, in its passage through an economy pecu- 
liarly afieoted, and, therefore, resided in the scab, not altered from its ordinary physical appear- 
ance, because, as yet, not sufficiently imbued with the acquired and modifying contagion. Or, it 
must have been a peculiar condition of the individual economies, into which the vaccine virus 
watf introduced. Or, it must have been telluric or celestial relationships sustained by the partic- 
ular persons affected; or, as Sydenham’s comprehensive term is applicable in giving expression 
to such relationships—“ the epidemic constitution.” 
In my previous letter, 1 believe, I advanced this last as sufficient to account for the abnormali- 
ties which had been observed. It is the more easily assumed, and probably the more easily sus. 
tained position. I will, however, not undertake to defend it here, for, notwithstanding my great 
respect to the “ epidemic constitution,” when I am at the bedside of a patient, I can, when 1 am 
reflecting, readily comprehend, that either one or all the positions may he defended, as the sourco 
of cause in its influence modifying cow-pox. 
Will vaccine virus become possessed of capacity acquired in its passage through an economy 
peculiarly diseased, to propagate such disease in other economies? The question thus stated, 
will, in some degree, embrace the relation of vaccination to Syphilis. 
Whether there is truth in the doctrine which has been promulgated, that two distinct contagi- 
ous diseases cannot exist at the same time, in the same economy, it is not amiss to make reference 
to it here; for if it is not true, the fact does not justify the assumption, that two poisonous 
causes cannot he introduced into an economy at the same moment, one having the office of vehi- 
cle for the other—does not justify an assumption, that two poisonous causes in the same 
economy, at the same time, can occasion no modification, each of the other, or the one of the 
Other- and if it is true, the fact or modification is at once established. More directly assertive of 
the virus acquiring a modifying capacity, even to the complete destruction of original physical 
appearances, and exhibitions of effects, is the idea suggested during the year 1800, by Richard 
Dunning, Surgeon, Plymouth-Dock, that “ the vaccine disease, united with some other virus, 
may have afforded the more active affection of variola.” Dunning’s reviewer, from whom I 
received my information, says, “ the hint deserves some attention, as a point of speculation’ 
which cannot he subjected to the test of experiment.” 
I only make reference to it as an assertion made long ago, that one virus may he modified by 
another; for Ido not regard the poisons of variola and vaccinia as being at all identical. This, I 
think, is evident, if there is truth in the following statement: Small-pox and varioloid will pro- 
duce small-pox, hut never cow-pox. Cow-pox will produce cow-pox, hut never small-pox or 
varioloid. Cow-pox will prevent the occurence of small-pox, or mitigate its severity, and lessen 
jts mortality in the human economy. Small-pox having occurred in the human economy, is not 
preventive of cow-pox, if its poison he introduced by inoculation. Cow-pox, reproduced in the 
human system, inserted into the teat of the cow, will produce cow-pox. Small-pox, similarly 
introduced into brute animals, will not produce small-pox. This last assertion is made by Wm. 
Woodville, M. D., London, 1800, and by others, perhaps before, and several limes repeated, since, 
and within the past two years medical officers in the service have attempted, at Greenville, Tenn.! 
to occasion small-pox in a cow, in one instance, and in a calf in another instance, using matter 
taken from a case of confluent smali-pox, then under treatment, and inserting it under the cuticle, 
and introducing it into the stomachs, mixed with food, and without any had effects .whatever, or 97 
any disturbance of the health of the animals. I am aware,[thatjobservations have been pub 
lished, seemingly different from this, but there is a want of explicitness in connection with their 
relation, which justifies a doubt of authenticity. But this, if you please, by way of parenthesis. 
The most insidious of contagious poisons affecting the human economy is, probably, the syph 
ilitic. It has, doubtless, occurred to almost every practitioner, to observe cases in which the 
subjects were known to have beenjtreated for Syphilis, and afterwards, to have exhibited for 
many, very many years, entire health, when occasion, known or unknown, presented, and they 
offered themselvesTfor treatment, affected with disease which the physician pronounced to be 
syphilitic, and which could not be cured, except by the administration of anti-sypilitic agents, 
The poison had remained latent, or dormant for these many years, only awaiting circumstances 
or conditions, favorable to the exercise of its capacity to affect. I had under my charge, for 
twenty years, a family, the children of which were generally healthy, whose father was treated 
for Syphilis from the age of nineteen to twenty-four; since which, he has enjoyed good health 
in every particular. His children, however, were frequently attacked with illness', 
deemed sufficient to require my professional attention. No odds, how simple the attack, even 
though, when I first called, the evidences were nothing more than those of slight catarrh, I have 
never known them yield or mitigate, until one dose, or more, of a mercurial—generally calomel— 
had been administered. This I have ascribed to the presence in their economies of the syphilitic 
poison derived from their father, and exerting au influence retarding healthy developments,[or 
preventing the disappearance of symptoms of diseased action, not in themselves syphilitic. The 
cases cited in “ Montgomery on Pregnancy,” bear well on this point. A woman married a man 
with latent constitutional Syphilis. She became infected, which was first exhibited at concep- 
tion, or in miscarriage, followed by secondary symptoms of Syphilis. A woman contracted 
Syphilis, was treated and recovered. A considerable time afterward she married. One, two, or 
three children were born, all affected with Syphilis. The husband died, and the woman married 
again, a healthy man ; and to this husband, children were born, and all died, except one, affected 
with Syphilis; the exception had mercury and recovered. One of the children communicated 
Syphilis to the woman by whom it was nursed. 
But the insidiousness of this contagion is more strongly exhibited in another case, cited by 
Montgomery. A woman, whose husband had constitutional Syphilis, gave birth to a child; 
which died with Syphilis in two months, the mother remaining wholly free from any exhibits of 
the affection. This husband died, and she married again, a healthy man. Hour years after the 
former birth, she was delivered of a child, which, in a few months, presented the same syphilitic 
apprarances manifested by the child ef the first husband. 
If these instances are, as observers affirm them to be, true, how little effort does it require for 
the mind to conceive the probability of a vaccine scab, having acquired the capacity from an 
economy, affected with Syphilis, to propagate that disease ? If a woman can remain in health, 
after sexual congress with a man affected with latent constitutional Syphilis, and yet years after- 
ward, give birth to syphilitic children, begotten by a healthy man, it is within the bounds of 
legitimate assumption, to affirm that syphilitic exhibits may be manifested in an economy, by 
the introduction of vaccine matter, taken from an economy tainted with Syphilis, even though it 
is in that system in latency, and had never been developed. 
Two of the cases which gave occasion to my letter of last year, were ladies whose husbands 
occupied prominent and responsible positions in society. Neither the husbands or wives were at 
all under suspicion of immoral taint. The wives were vaccinated, and for many months were 
affected with ulcerations, which, under other circumstances, would have been, without hesitation, 
pronounced to be syphilitic rupla. They came under the care of Act. As’t. Surgeon Meadows, 
then, as now, in charge of Small-pox Hospitals in this department. He put them on the use of 
bi-chloride of mercury, and they both recovered in ten or fifteen days. 
Permit me to summarize. Two contagions may be introduced into the human economy at the 
same moment of time, and connected with the same vehicle; or, one contagion may be the vehi- 
cle of another, and each may exert its own ultimate effects, the intermediate effects being the 
exhibitions of but one or the other of the contagions having made impression, or, the interme- 
diate effects may be the exhibitions of one poison, which, having passed their course, the inter- 
mediate effects exhibiting the presence of the other poison, supervene and pass their course. 
Syphilis and vaccine. Two contagions, may respectively modify each other. An illustration does 
not occur to me. One contagion may modify another, and while it is itself not subjected to a 98 
modifying influence, exerted "by the one it has modified, it may he modified hy another contagion. 
Cow-pox and small-pox, cow-pox and Syphilis. The inlrodnction of one contagion into an econ- 
omy, may arouse another, which has remained dormant or latent, and unsuspected. Cow pox 
and Syphilis. 
An item relative to the treatment of Small-pox;— Act. As't. Surgeon Meadows, in two cases of 
Smail-pox, occurring in children, empolyed croton oil, applying it on the third and fourth day of 
the active fever, to the breast, producing full and confluent pustulation. The immediate effect 
was, certainly unpleasant—very considerable cerebral disturbance, evidently, in its intensity; 
ascribahle to the croton oil pustulation : but lie is convinced, that the course of the disease was 
shortened two-thirds, desquamation beginning on the seventh day, instead of during the second 
week; and that the eruption was one half less than it would have been under other circum- 
stances. Ho has, also, practiced opening each pimple, just as it assumed the vesicular character) 
with the effect, he believes, of expediting the process, desquamation occuring one third the time 
sooner than usual. 
I have written, Doctor, hurriedly, but I hope that I have not been so rapid, as to have failed 
wholly of interesting you, at ieast for the moment. 
Very respectfully, your obedient servant, 
FRANK A. RAMSEY, 
Surgeon and Medical Director, P. A. C. S. 
To James Bolton, M, D., 
Chairman committee on the Relation of Vaccina, to Syphilis, Richmond, Va.—The Medical and 
Surgical Monthly—May, 1866-p. 140.147. 
Dr. Crawford, of Grreeneville, Tenn., was able to trace the im- 
pure virus which produced indurated ulcers and constitutional 
symptoms, to a single individual, and the disease thus dissemi- 
nated hy inoculation, yielded to the remedies hest adapted to the 
treatment of syphilis. 
Greenville, Tenn., Jan. 27, 1867. 
Prof. Joseph Jones, M.D. 
Dear Sir:—Having seen, in the January Number of the “Nashville Journal 
of Medicine and Surgery,” a circular letter addressed by you to the Surgeons of 
the late Confederate Army, instituting inquiries upon “Spuriotis Jraccination,” I de- 
sire to respond to your inquiries, and to communicate those facts in my possession, 
which may throw light upon this subject, which is fraught with so much interest to 
science and humanity. 
During the winter of 1862 and 1863, I was “ Surgeon in charge” of the “ Madison 
Hospital” (Confederate) at this place, during which time over one thousand patients 
came under my charge. Small-pox made its appearance in the Hospital 15th No- 
vember, 1862. In anticipation of the appearance of the disease, I had some time 
previous, procured a fresh sppply of genuine vaccine virus by vaccinating some 
healthy children. In this way I had kept a fresh supply on hand since 1856. That 
is by vaccinating some healthy child every few months. I immediately ordered all 
patients then in hospital (350) to be vaccinated, both those that had been, as well as 
those that had not previously been vaccinated. The matter took well upon all who 
had not been vaccinated, and imperfectly in some cases that had been vaccinated. 
A “ Pest-house” was established, and the infected, as soon as the nature of the dis- 
ease was manifested, removed at once to it. The disease did not extend to the pa- 
tients in hospital: but from time to time patients were admitted, many of whom 99 
proved to be suffering with'variola. But in no single instance was the disease com- 
municated to those that had been recently vaccinated or re-vaccinated, and but six 
cases of varioloid occurred out of the 350 patients, all of whom had been exposed to 
the contagion of small-pox. There was great alarm, both among citizens and sol- 
diers ; for the small-pox cases were exceedingly fatal, owing to the want of proper 
comforts and attention. Out of 90 cases, 40 proved fatal. Neither the citizen nor soldier 
was satisfied of his immunity from danger, unless he could make a “sore" of some 
sort upon his arm. Consequently vaccination was perseveringly sought from the 
ugliest and foulest looking ulcers. The idea being with the masses, that vaccination 
loses its effects after a few years, and must be renewed: if a sore was not produced 
by matter from one arm, another was sought. This stare of things continued with- 
out any mischievous effects until about the first of January, 1863, when Col. Clay- 
ton, then Commander of the Post at this place, who had been on leave of absence 
some weeks in North Carolina, returned with an ugly looking ulcer upon his right 
arm which was reported to be the genuine matter. The cry of eureka was raised, 
and it was not long until dozens, both citizens and soldiers, had this matter inserted 
into their arms. From this dates the history of “ Spurious Vaccination.” Col. 
Clayton had been successfully vaccinated some years before; but so soon as it was 
known that we were in the midst of the most loathsome of all diseases, I re-vacci- 
nated him twice with genuine virus, but without effect. What the history of the 
case was from which he received the infectious matter, I never learned, for the 
Colonel could not find out. Col. Clayton was about 21 years of age, sanguine tem- 
perament, and in excellent health at the time he received the infectious matter into 
his arm. The ulcers I regarded at the time, and still regard, as caused by inocula- 
tion with syphilitic virus. The cases ran an indefinite course of from three weeks to 
six months, and yielded only to Blue Mass, lodide Potassium, internally, and Sul. 
Cupri. externally. Some cases taken in their incipiency, yielded in a few days to 
the external treatment alone. 
It is proper to state that there was no tendency to scorbutic disease among either 
soldiers or citizens, and the infectious matter was equally as severe among the citi- 
zens as soldiers. The hospital was well provided with everything calculated to 
promote comfort and health. The patients were in good houses, had plenty of 
clothing, and rations in abundance, such as fresh meats, fruits, potatoes, cabbage, 
&c. There was no scarcity of these things in this country at that time, and wdiat 
the Government did not provide, the citizens supplied with a liberal hand. 
This “ Spurious Vaccination” yielded no protection whatever from variola. I 
have seen more than a dozen cases of variola occur where there were large ulcers 
from this spurious virus, the patients thinking they -were protected from the disease 
by such “sores' The spurious matter would take effect in all cases and all sorts of 
constitutions. 
About this time orders were issued from Surgeon General Moore to procure fresh 
vaccine virus through the cow, I tried the experiment three times without suc- 
ceeding. First on a cow seven years old, with a calf six months old. Then a young 
heifer two years old, and finally the calf. I inserted the matter in the teats, nose, 
ears and various parts of the skin, but never succeeded in getting a crust. Finally 
I fed the calf on the dried scabs mixed with its food, but it died without yielding 
me the much sought for treasure. 100 
In August, 1863, the Confederate Army evacuated East Tennessee, and in Sep- 
tember, 1863, the Federal Army took possession and held for a time. That army 
under Gen. Burnsides was composed of new recruits, made up mostly of six months 
volunteers, many of whom had not been in the service three months. This same 
disease was among them. This army was abundantly supplied with anti-scorbutics, 
and fed with a liberal hand, and had never been exposed to hardships. 
My best wishes for your success in your undertaking. 
Yours sincerely, S. P. CRAWFORD. 
If such accidents had been confined entirely to the Confederate 
Army, or to the period of the war, when the citizens were to a 
greater or less extent subjected to unusual privations, and to the 
action of the most depressing causes, the views of those who 
denied emphatically the possibility of transmitting the poison of 
constitutional syphilis by the process of vaccination, would re- 
ceive at least a show of support from the apparent dependence of 
the abnormal phenomena accompanying the vaccine disease, upon 
the depressed and deranged states of the system, induced by im- 
proper nutrition and physical causes. 
It happened, however, that a large number of cases, which 
were referred by both citizens and physicians, to the contamina - 
tion of the vaccine virus with the syphilitic poison, occurred in 
the quiet manufacturing community of Graniteville, after the 
close of the war. 
Under the kind, liberal and efficient management of the intel- 
ligent head of the Graniteville Manufacturing Company, the 
operatives enjoyed comfortable dwellings and abundant sup- 
plies of nutritious and wholesome food. This class of the popu- 
lation of South Carolina were perhaps, more favorably situated, 
as to subsistance and support, than the great majority of the citi- 
zens of South Carolina, whose dwellings and barns had been laid 
in ashes, and whose social and agricultural system, the growth of 
centuries, had been so completely overturned, as to convert, with- 
out warning, the richest into the poorest. 
The following report of Dr. W. F. Percival, of Aiken, South 
Carolina, is important, as being the most clear and intelligent 
statement, which I was able to obtain after considerable inquiry. Report on the Communication of Syphilis through the medium of Vaccine Virus, amongst 
the inhabitants of Graniteviile and vicinity—1866. By W. F. Percival, M. D., of 
Aiken, S. C. 
Aiken; Nov. 15th, 1866. 
Prefessor Joseph Jones, M. D., 
Dear Sir : 
I received your letter yesterday, and enclose a copy of my report on Spurious 
vaccination, with pleasure. I intended sending it to one of the Medical journals, 
hut have never had time to revise and prepare it for publication; the fads, however, 
are all stated. 
I. am with high esteem, yours very respectfully, 
W. F. PERCIYAL. 
Spurious Vaccination.—The Epidemiological Society of London, prepared four 
questions on the subject of vaccination, to be addressed to the most eminent Medi- 
cal men in Europe. The third was as follows : 
Have you any reason to believe, or suspect, that lymph from a true Jennerian 
vesicle, has ever been a vehicle for syphilitic or other constitutional infection I 
Among the number who responded, (over 400,) but three asserted their belief; 
twenty-seven in doubt, and nine had no experience. The rest asserted that it could 
not be done. 
In a report from the College of the Faculty of Medicine, at Prague, the following 
language is used: “ The possibility of inoculation with Syphilis by means of vac- 
cination, (although not a single completely attested fact is known in this country,) 
is not to be excluded, for the conveyance of Syphilis, by means of inoculation, has 
been placed beyond a doubt.” 
In the face of so much testimony against the possibility of such an occurrence, 
the following report will perhaps throw some light on the subject. 
About the last of April, 1866, I was requested to take charge of some cases of 
Spurious vaccination, at the manufacturing‘village of Graniteviile. One hundred 
and fifty cases were presented for examination, men, women, and children, of all 
ages, from fifty years to twelve months. The larger proportion were operatives in 
the Factory, the others engaged in out-door work. There was every variety of con- 
stitution, from the pale and attenuated girl, to the hardy and robust laborer. Of 
the one hundred and fifty cases, ninety-three had been previously vaccinated. The 
appearance of the sore was identical in every case, viz: an excavated ulcer, of cir- 
cular form, with raised and hardened edges and base. They varied in size from 
one half to two inches in diameter, covered with grey or dark sloughy matter, and 
secreting unhealthy pus. There was no appearance of granulation. In some cases 
ulcers of a similar character, appeared on the arms affected; others on the opposite 
arm, and in a few on the lower limbs. In some, abscesses formed on the inside of 
the arm, and in nearly all the axillary glands were inflamed, and many suppurated 
A thick and unhealthy crust would form, to be soon separated by the pus which 
accumulated beneath. In one case, there was a copper-colored eruption on the body 
and limbs; in two or three the hair dropped off. None of these cases were in the 102 
primary stage. The disease had existed from three to eight weeks. Most of them 
pursued their ordinary avocations, as far as possible, and complained of no cousti- 
tntional symptoms, or any loss of appetite. 
The history of these cases, as given to me by the individuals first vaccinated, was, 
that they had obtained the virus from a man whom they afterward discovered to 
have had primary Syphilis. One was vaccinated from another, and so it spread. 
None of the ulcers had evidenced any tendency to heal. One of the worst cases 
was a man who, two years previously, had small-pox. 
The usual treatment, both constitutional and local, for venerial ulcers, effected a 
cure in from three to six weeks. 
It might be supposed that the predisposing cause of the ulcers, existed in a viti- 
ated condition of the blood, dependent on local causes, but I had twelve or fifteen 
cases in other localities, some of them ten miles distant; all of these had obtained 
the virus with which they were vaccinated at Graniteville. All of these were strong 
and healthy individuals. Again, most of the cases reported had been vaccinated a 
short time previously and had progressed in the usual manner without any trouble, 
showing that no local cause had produced any derangement of their system. 
As I did not see the individual from whom the virus was first obtained, I am 
unable to say that he really had primary Syphilis. 
I cannot therefore draw positive conclusions from the above cases, and only pre- 
sent the report as information. 
On the other hand, many of the Confederate Surgeons, enter- 
tained views similar to those announced by Dr. Habersham, and 
denied that any of the cases of Spurious vaccination were syph- 
ilitic in their origin or relations. 
Thus Dr. S. F. Stout, of Pulaski, Tennessee, formerly Medi- 
cal Director of the General Hospitals attached to the Army of 
Tennessee, in his reply (dated near Pulaski, Hov. 19th, 1866,) 
to my inquiries, says : 
I am not satisfied that there occurred a well authenticated instance of the propa- 
gation of secondary Syphilis by means of the so-called Spurious vaccine matter. I 
think that the injurious effects were chiefly produced upon persons already diseased 
syphilitic, scorbutic, or while living in an atmosphere infected by the causes of gan- 
grene and erysipelas. A vast majority of these cases were those of individuals, who 
had been previously vaccinated, and in very many instances, the virus used was 
taken from the arms of re-vaccinated individuals. Thus common pus, and even 
ichor, was no doubt inoculated, which produced effects similar to those that are 
caused by? a wound, received while dissecting a dead body, modified in many 
instances, no doubt, by the condition of the patient’s health, and the morbific influ- 
ences to which he was exposed. 
Prior to my assumption of authority to take steps to stop the evil, I am satisfied 
that there were several errors m practice among our troops. First, the order requir- 
ing all soldiers to be vaccinated, whether they had been previously effectually vac- 103 
cinated or not. Tins order was literally interpreted and acted on by the superin- 
tendents of vaccination appointed by the Surgeon General. Secondly, many soldiers 
ignorant of the characteristics of genuine vaccinia, vaccinated themselves, or each 
other, without consulting a Surgeon. Thus, no doubt, common pus, and even 
ichorus matter were often inserted. Thirdly, When variola first appeared in our 
army, so great was the fear of the disease, and the consequent anxiety to vaccinate 
everybody in the army, or in its vicinity, that the temptation to the Surgeon to use 
any virus within his reach, was very great. Thus much matter was used, which 
ought to have been rejected by Surgeons. 
In my investigations I could not learn of a single well authenticated instance in 
which due care had been taken in the selection of the virus, whether in the form of 
lymph, or of the dried scab, that was accompanied by the evils of so-called Spuri- 
ous vaccination, in a perfectly healthy individual, in an atmosphere uninfected by 
erysipelas or gangrene. Believing my conclusions to be correct, when as Medical 
Director of the hospitals I undertook to relieve the army of the evil, I made provi- 
sions to supply it with virus taken only from the arms of healthy children, who had 
never before been effectually vaccinated. By the zeal and energy of medical officers 
designated at every hospital post, from supplies of virus obtained from the 
Surgeon General, S. P. Moore, and Surgeon J. C. Mullins, superintendent of 
vaccination of my department, .appointed by me, the army in the field and the hos- 
pitals in the rear were amply furnished with virus from healthy children. No 
soldier was vaccinated with matter taken from another soldier. The supply was so 
abundant, that there was not temptation to use any other part of the dried crust 
than the vitreous, mahogany-colored portion. I recommended, that no soldier who 
had been vaccinated within a few years past, and who had the characteristic mark, 
should be re-vaccinated, unless positively known to have been exposed to variolous 
contagion; and especially, if he were labouring under any form of Syphilis, was 
scorbutic, or was living in an atmosphere infected with gangrene or erysipelas. 
Under this practice, the so-called Spurious vaccination disappeared from our army; 
and before the close of the war it might be said to have ceased to exist in Georgia. 
Having thus far entered into a statement of the impressions I have, and of facts 
bearing upon the subject, it may not he amiss to say to you, that my observations 
and experience during the war lias confirmed my faith in the prophylactic powers 
of the Jennerian vhus. I use the term Jennerian to designate that vaccine virus, 
which has been propagated from that originally supplied by Jenner. The im- 
munity of so many thousands of soldiers and officers witnessed during the war, and 
the comparatively small number of the vaccinated who were attacked with variola 
or varioloid, enhance my estimate of the protective power of vaccinia, rather than 
diminishes it, as has been the case with many, whose field of observation has been 
comparatively smaller than mine. 
I have no data, by which to form an opinion, as to the relative 
frequency and nature of the foul gangrenous ulcers attendant upon 
vaccination in the United States forces. In the Second Section 
of the present inquiry, we have quoted the testimony of Dr. 
Hamilton to show that they were to a great extent, as in the 104 
Confederate Army, referable to tbe depressed and scorbutic con 
dition of the soldiers. 
Dr. Woo ward, in Circular Ho. 6, War Department, Surgeon- 
GeneraFs Office, p. 127, affirms that the accidents attendant 
upon vaccination in the United States Army, were generally re- 
garded by the Medical officers, as “the expression of scorbutic or 
other cachectic conditions of the patients, and not due to any 
poisonous admixture with the vaccine virus; and it was fre- 
quently observed that the same scab which had produced a num- 
ber of successful vaccinations, would; in other men vaccinated at 
the same time, produce the ulcers referred to.” 
It appears, however, that some of the United States Medical 
officers, held that a portion at least of these abnormal affections 
following vaccination, were due to the admixture with the syphi- 
litic poison, as will be seen by the following extracts from an ar- 
ticle on Spurious Yaccination, by Geo. H. Hubbard, M.D., late 
Brevet Lieut.-CoL, and Surgeon U. S. Yols., published in the 
Philadelphia Medical and Surgical Reporter, February 10, 1866, 
p, 103. 
On the last day of November, 1863, I reached Fort Smith, Arkansas, under an 
assignment to duty as Medical Director of the Army of the Frontier. 
My attention was immediately called to several hundred men disabled in conse- 
quence of spurious vaccination, and a board of medical officers was soon after 
organized, by command of Major General Schofield, to investigate its origin, etc. 
This Board made a detailed report, from which, from reports of other medical 
officers, and from personal observation, I was enabled to arrive at the following facts 
and conclusions. 
It was definitely ascertained that the virus which caused all these cases came from 
persons who had been vaccinated in the rebel army, or by rebel Surgeons. 
This virus was used by ignorant medical officers and by self-inoculation among 
the men, till more than five hundred were infected. 
The Board reported that—“ Soon after the operation was performed, the points 
at which the matter was inserted commenced to itch and inflame, and by the second 
or third day, pustules were formed, of a yellowish color, which rapidly increased in 
size, and in a few days burst. In some a scab formed, but in all,. open ulcers were 
formed by the tenth day, and which furnished a thin ichorous discharge. 
“At the time we examined the patients, some had well marked Hunterian chan- 
cre ; some had large excavated ulcers, with edges elevated above the raw and sur- 
rounding induration ; the centres, when not recently cauterized, were of a brownish 
hue—some, whose primary ulcers were about healed, had secondary symptoms, 105 
such as swelling and ulceration of the glands in different parts of the body; while 
others had pain and stiffening of the joints. 
“ The disease was brought to the Ist Arkansas Infantry by deserters from the 
Confederate army, and in our opinion it is Syphilis.” 
The following is from my official report to the Surgeon General:—“ I have no 
reason to believe that in any one case did this virus produce a true vaccine pustule 
or had any of the protecting power of vaccination. 
“ The ulcers all possessed, in a greater or less degree, the well established pecu, 
liarites of veneral chancre, being of a specific and progressive nature, spreading in 
some cases to the size of a dollar, but usually about half that size; commonly 
round in shape, but often irregular, and usually of the depth of the true skin. 
“ All had ragged, elevated, indurated, and overhanging edges, little sensitive to 
the touch or even to caustics; while the bottom of the ulcer, (especially under these 
indurated edges,) was excessively sensitive. 
“All discharged dark ill-conditioned pus, which in many cases caused painful 
excoriation of the surrounding skin, and when transferred to other parts of the 
body, reproduced ulcers like the original; in this way, chancres were produced on 
the penis in several cases. 
“Cases precisely similar occurred in the Indian Brigade, stationed at Fort Gibson 
in the Cherokee nation. 
“ Acting Assistant Surgeon Miller, on duty at that post, reported as follows: 
“ Besides the cases occurring among the troops, it has spread among the people 
to an alarming extent by self-inoculation. 
“In a large proportion of the cases, consecutive symptoms have appeared; sup- 
puration of the lymphatic glands in the axilla, sore throat, exanthematous eruptions, 
etc. 
“The cases occurring among the troops have received the ordinary treatment for 
Syphilis, and in most cases with excellent results. 
“ The mischief was wide spread before the true character of the disease was 
recognized, so that few cases have had prompt abortive treatment, and many are, in 
consequence, permanently disabled. 
“Nearly every case has required constitutional treatment, in addition to local 
treatment of the chancre. 
“ The milder caustic applications proving insufficient, in many cases, acid nitrate 
of mercury was used to clear away the indurated edges, when the ulcer usually 
healed rapidly under mildly stimulating applications.” 
“ Six cases of well marked small-pox occurred in men who had previously suf- 
fered severely from this venereal inoculation.—Med. and Surg. Reporter,—Feby. 19th 
1866,—p. 103. 
Up to the commencement of the recent civil war, the belief 
was almost universal that secondary syphilis could not thus he 
communicated hy vaccination. 
In the Papers relating to the History and Practice of Vaccina- 
tion, contained in the Report of the General Board of Health, 106 
presented to both Houses of Parliament, by command of Her 
Majesty—London, 1857—Mr. Simon called for the opinion of the 
profession at home and abroad on the general question. 
“ Have yon any reason to believe or suspect (a) that lymph 
from a true Jennerian vesicle has ever been a vehicle of syphi- 
litic, scrofulous or other constitutional infection to the vaccinated 
person ; (h) or that unintentional inoculation with some other 
disease, instead of the proposed vaccination, has occurred in the 
hands of a duly educated medical practitioner ?” 
In answer to this question a writer in the British and Foreign 
Medico-Chirurgical Review (October, 1857, Review iii., Small- 
pox and Vaccination), quotes the opinions of Hebra, which may 
be taken as expressing in a logical and lucid manner, the belief 
of the majority of the medical profession at that time. 
“ This widely-grasping question (says Hehra) requires several separate answers, 
because queries are made,— 
“1. Whether the lymph of a vaccine vesicle may, besides its peculiar virus, contain another 
infectious principle—e. y. that of syphilis 7 
“2. Whether constitutional non-infecting diseases, as, for instance, scrofula, may be trans- 
mitted by the inoculation of cow-posy matter 7 
“3. Whether a vaccine vesicle possesses such characters that it may easily he distinguished 
from other similar vesicles, blebs or pustules 7 
“ (I.) The transmissible infectious principles which have hitherto been recog- 
nized, by means of inoculation, are, the syphilitic virus contained in the pus of 
a chancre; and the virus contained in the cow-pox vesicle, and the small-pox pus- 
tule. The question, therefore, simply is, whether these morbid poisons have ever 
been mixed 1 Whether inoculation has ever taken place with such a mixture 1 And 
what results were obtained by such an operation 1 It is well known that compen- 
dious answers have, for some time past, been offered to these questions, chiefly the 
result of Sigmund’s experiments. These answers agree in the following respects : 
“ Inoculation with secretions of this kind—viz., containing, as it were, several 
special poisons, either produced no effect at all, or only generated a chancre, by 
inoculating a mixture of pus from the chancre and vaccine lymph; and only cow- 
pox, by inoculating a combination of vaccine lymph and blenorrhagic matter. 
Hence one morbid state only was produced, either cow-pox or syphilis; the latter 
circumstance being a proof that both poisons are not simultaneously transmissible. 
This opinion is supported by the experience of Heim, Ricord, Bousquet, Taupin. 
Landouzy, Friedenger, &c. 
“(II). It is maintained in many quarters that the blood of persons suffering 
from secondary syphilis may serve as a vehicle to the infectious principle; but were 
even this theory found correct, it would have no prejudicial effect on the practice of 
vaccination, because we know from experiments made for the purpose (Heim), and 107 
from accidental inoculation, that regardless of the quality of vaccine lymph, the 
latter may be inoculated from syphilitic upon sound individuals; and, on the other 
hand, from sound subjects upon such as are under the influence of systemic syphilis, 
without propagating syphilis along with the cow-pox. 
“ What has here been proved of syphilis, must a fortiori, hold good as regards 
other constitutional morbid states, as direct inoculations with the secretions peculiar 
to these diseases have always yielded a negative result. 
“ But although it is abundantly proved that scrofula, tubercular affections, rickets 
cancer, and other blood diseases cannot be transmitted by means of their own se- 
cretions, or along with the vaccine lymph, we should nevertheless, if possible, avoid 
vaccinating diseased persons, because experience has taught us, as regards adults 
and children, that the phenomena of vaccination may awake—s. e., render worse— 
dormant affections, and that moreover, the cow-pox vesicle easily degenerates upon 
such individuals. These latter vesicles are nevertheless adapted for further propa- 
gation even when they take an imperfect development, because a positive result, a 
regular development of the vesicle, and sufficient protection against small-pox have 
been observed in cases where vaccine lymph was transferred from weakly, scrofu- 
lous, and rickety subjects upon perfectly sound individuals. 
“ (III.) Every morbid appearance on the cutaneous envelope has its own pecu- 
liar characters, by which it may be distinguished from all other similar phenomena; 
the vaccine vesicle presents, in the like manner, sufficiently striking peculiarities as 
to form, size, number, locality, and peculiarity as regards its course, to enable the 
observer easily to establish a distinction between the same find other vesicular bul- 
lar or pustular eruptions.” 
We shall examine these doctrines and conclude these Re- 
searches on Spurious Vaccination, with an examination of the 
following questions : 
(Ist.) The possibility of communicating Tuberculosis and 
Cancer by Inoculation. 
(2d.) The possibility of communicating Secondary or Con- 
stitutional Syphilis by Inoculation. 
(3d ) The possibility of communicating the poison of Syphi- 
lis through the medium of the Vaccine Virus. 
I. True Tubercle is organized ; that is, it is composed of liv- 
ing cells, and during its growth it resembles, to a certain extent, 
fresh granulations. These soft fragile cells and nuclei, resem- 
bling the gland cells of the lymphatic glands, are to be regarded 
as the characteristic living element of tubercle. According to 
this view, Tubercle resembles malignant growths. 
M. Yillemin’s researches appear to have settled the question 
of the inoculability of Tubercle. This observer affirms that he 108 
had succeeded in reproducing tubercle by inoculation, again and 
again, in rabbits, not only when taken from the human subject, 
but also when derived from the cow ; and farther, that the tu- 
bercular matter thus produced in one rabbit, could be in like 
manner transmitted to another. (Gazette Hebdomadaire, 1866). 
Dr. Lebert, Professor at Breslau, has succeeded in introducing 
tubercle into the system by subcutaneous injection, and thus 
confirmed M. Yillemin’s experiments. Dr. Lebert’s experiments 
were made with Guinea pigs and rabbits, and both grey and 
yellow tuberculous matter were employed, as well as liquid from 
a cavity : the nape of the neck was the spot chosen for injection, 
and the amount introduced varied from fifty centigrammes to a 
gramme, diluted and triturated with distilled water. The result 
of his experiments was the finding of tubercles not only in the 
lungs, but in other organs, as the liver, spleen, plurae and peri- 
cardium. In some experiments, the tubercles were found in large 
portions of the lymphatic system. Microscopic examination re- 
vealed the identity of the tubercles thus formed in animals by 
inoculation, with those of man. 
Tubercle still farther resembles malignant growths, in that 
the original growth causes the formation of new tubercles in its 
neighborhood and thus gradually infects large tracts of living and 
previously healthy tissue. It is possible in many cases, by care- 
fully comparing the symptoms during life, with the results of 
post-mortem examination, to trace the gradual propagation, of 
tubercle from a well defined centre. 
It is not my design to discuss, at this time, the cause and mode 
of origin of tubercle, or its relations to inflammation, and to de- 
fective nutrition ; my design has been simply to show that there 
are facts and experiments proving the possibility of transmitting* 
the disease from one animal to another by inoculation. And 
whilst we are unacquainted with a single fact which illustrates 
in any manner the relations of vaccination to tuberculosis, at the 
same time it must be admitted that we need farther experi- 
ments and light upon this subject: and we know just enough to 
create a prejudice against the indiscriminate use of vaccine 
matter from scrofulous and tuberculous subjects. Dr. George 109 
Budd, of London, in liis valuable work on Diseases of the Liver, 
has recorded a large number of facts to show, not only that can- 
cer may be disseminated by inoculation, or by the mere contact 
of a sound part with a part affected with cancer, without any 
direct vascular connexion between them ; and by cancerous mat- 
ter conveyed by lymphatics and veins to other parts of the body : 
but that cancer may even be propagated by inoculation, or by 
injection of cancerous matter into veins, from one animal to an- 
other. 
The facts recorded by Dr. Bndd, illustrate in the clearest 
manner the first two modes of the dissemination of cancer, in 
the human being; and to support the third proposition he 
cites the following experiments : 
Professor Langenbeck, injected into the veins of a dog some pulp 
taken from a cancer which had just been removed from a living 
body. At the end of some weeks the dog began to waste rapidly. 
It was then killed, and several cancerous tumors were found in 
its lungs. 
Another instance to the same effect, taken from a German pe- 
riodical, is related in the Provincial Medical Journal forseptem- 
tember 23, 1843. Some cells were collected from a black liquid 
in the orbit of a mare affected with melanosis, and were inocula- 
ted into the conjunctiva and lachrymal gland of an old horse. 
These merely caused a black spot on the conjunctiva, which ex- 
tended very slowly ; but about the sixteenth week after inocula- 
tion, melanosis of the lachrymal gland was very decided ; it had 
invaded the whole organ, and pushed the globe of the eye for- 
ward. Some of the melanotic matter, taken from the same mare, 
was injected into the veins of the neck of a dog, who died suddenly 
whilst hunting, three weeks after the operation. There was 
found in the left lung a melanotic tumor, which was ruptured, 
and which contained a brown, coffee-colored fluid, abounding in 
cells. 
So many instances have occurred of cancer of the penis in men 
whose wives had cancer of the womb, that many physicians have 
been led to believe that the disease in these instances was pro- 
pagated by contagion. (On the Diseases of the Liver by George 110 
Budd, M.D., Third Edition, London, 1857, chapter iv., pp. 388- 
416). 
It would in like manner, be foreign to our purpose to enter 
into any speculations as to the cause of cancer, or into an exam- 
ination of the question, whether the germ of the disease be a 
true parasite, introduced from without; or whether cancer is 
generated within the body, or of the materials of the body, under 
the influences of certain agencies. 
We will have accomplished our purpose in recording these facts, 
if we succeed in directing the attention of the profession in this 
country, to the necessity of greater attention to the condition 
of the subjects selected for the propagation of the vaccine disease. 
We proceed now to the consideration of the second and more 
important question, which relates to the propagation of one of 
the most destructive poisons in its action upon the human race. 
11. The formal and persevering denial by eminent surgeons, 
that Secondary Syphilitic disease could be communicated by con- 
tact, and the adoption of this theory by a large and influential 
school, has inflicted much domestic misery and led to most un- 
warrantable and destructive carelessness in the process of vacci- 
nation. 
The question of the commincation, by contact and inoculation 
of Secondary Syphilis, is of vast importance in its bearing upon 
the human race, and should not be settled dogmatically—in fact 
it is not in any manner a question of belief, but of facts. 
As early as 1498, Gaspard Torella affirmed that he had often 
seen the unweaned child infected by the sore breasts of its mother, 
and then bestow upon its nurse, who fondled and kissed it, the 
same unfortunate endowments. 
Many of the older writers appear to have entertained no doubt 
with reference to, the possibility of communicating constitutional 
syphilis. The following testimony is from William Clowes, who 
wrote more than two centuries and a half ago ; 
I have also knowne divers persons infected, who have had in all other parts of the 
bodie manifest signes thereof, as dolors, tumors, ulcers, and venemous pustules, &c. 
And yet in the parts aforesaid, no paine, or any signe thereof: so that their opinion is 
not to he observed, which affirme, that this disease is ingendred onely, by the com- pany of uncleane persons: for I have knowne not many yeares past, three good and 
honest Midwives infected with this disease, called Lucs Venerea, by bringing abed 
three infected women, of three infected children, which infection was chiefly fixed 
upon the Midwives fingers and hands, &c. What should I speake of young sucking 
children, whereof divers have beene grievously vexed with this disease, and some of 
them a moneth, two, three or foure moneths old, and some of them a yeare old, 
some foure or five yeares old, and some of them sixe or seaven yeares old, amongst 
which sort, I thought it good here to note a certaine wench, the daughter of one 
Save, of twelve yeares of age, the which I cured, in the yeare of oure Lord 1567, 
who was greatly infected with this sicknesse in many parts of her body, having there- 
on painfull nodes or hard swellings and ulcers, with corruption of the bones, and 
yet no signe in the most suspected parts, neither by reason of debilitie was able to 
have committed any such act, but it is not to be doubted, but that she received the 
infection, either from the parents, the which cure of some is supposed uncertaine, 
whether, children begotten by infected parents, may bee cured or not: or else she 
was infected, as divers are, by sucking the corrupt milke of some infected nurse, of 
whom I have cured many, for such milke is engendred of infected bloud, and I may 
not here in conscience overpasse, to forewarne thee good Reader, of such lewde and 
filthie nurses: for that in the yeare 1683, it chanced that three young children, all 
borne in this citie of London, all of one parish, or very neere together, and being 
of honest parentage, were put to nurse, the one in the countrie, and the other two 
were nursed in this citie of London : but within lesse than halfe a yeare, they were 
all three brought home to their parents and friends, grievously infected with this 
great and odious disease, by their wicked and filthy nurses: Then their parents 
seeing them thus miserably spoiled and consumed by extreme pttines, and great 
breaking out upon their bodies, and being so young, sick and weake, impossible to 
be weaned, were forced, as nature doth binde, to seeke by all meanes possible to 
preserve these poore silly infants, which else had died most pitifully. To be briefe, 
ere ever those children could be cured, they had infected five sundry good and 
honest nurses; I cured one of the children, and the nurse which gave it sucke, the 
other two children and their nurses were also cured by others, but one of the 
children lived not long after, as I was given to understand. Also friendly Reader, 
I read of late in a certain history, written by Ambrose Fare, in his 2. book, intreating 
of the causes of Lues Venerea, which history indeed is worthy the rehearsall: “An 
honest Citizen saith he, granted his most chaste wife, that she should nurse the 
childe which she was lately delivered of, if she would keepe a nurse to be partaker 
of the travell and paines: the nurse that she tooke by chance, was infected with 
Lues Venerea, therefore she did presently infect the foster childe, and he the mother, 
and she the husband, and he two children which he had daily at his table and bed, 
not knowing of that poison which he did. nourish in his own body and intrals. But 
when the mother considered and perceived, that her childe did not prosper or profit 
by the nourishment, but continually cried and waxed wayward, desired me to tell 
her the cause of that disease, neither was it any hard matter to doe for his body was 
full of the small-pocks, whelkes, and venerous pustules; and the brests of the nurses 
and mother being looked on, were eroded with virulent ulcers : and the body of the 
father and his two sonnes, the one about three yeares, and the other foure yeares of 
age, were infected with the like pustules and swellings that the childe had : there- 112 
fore I shewed them that they were all infected with Lues Venerea, whose beginnings, 
and as it were provocations, were spred abroad by the nurse that was hired, by her 
maligne infection. I cured them all, and by the helpe of God, brought them to 
health, except the sacking childe, which died in the cure: and the nurse being 
called before the magistrates, was punished in prison and whipped closely, and had 
been publikely whipped through all the streets of the citie, if it had not been for 
the honors of that unfortunate family.” Thus we see children infected by filthy 
nurses, and sometimes nurses be infected by giving sucke to such infected children. 
And now to returne to my former purpose, the disease, as saith Nicholas Masa, whose 
counsell and direction in the cure of this disease I have greatly observed. The dis- 
ease because it hath a flowing matter, being once entred into any part of the body, 
proceedeth on from part to part, never resting until it hath corrupted the liver, with 
the ill disposition of this infection especially. When it toucheth any such part, as 
hath in it an apt disposition to admit such infection, as when the action or force of the 
agent is wrought and imprinted in the patient, fitly affected to receive the same 
forme, and so it disperseth itselfe through the whole bodie : likewise this sickness is 
many times bred in the mouth, by eating and drinking with infected persons, and 
sometimes onely by breathings: and Almanor a learned Physition setteth down© 
for truth, that this disease may be taken by kissing, and sometimes by 
lying in the bed with them, or by lying in the sheets after them : also it is said to 
come by sitting on the same stoole of easement; where some infected person fre- 
quenteth, and sometimes such as have been cured of this disease, fall into it againe 
by wearing their old infected apparell: all which causes of this disease I rather se*’ 
dowr.e, for would thereby admonish as many, as shall read this treatise, to be 
careful! of themselves in this behalfe, and to shun as much as may be, all such oc- 
casions. A Profitable and Necessarie Boolce of Observations for all those that are burned 
with the flame of Gun-powder, cj-c,.- By William Cloives. London; M. Dawson, 1637. pp. 
151-2-3. 
Gideon Harvey, in his “Venus Unmasked/' published two 
hundred years ago, expresses similar views ; 
4. Drobl. How many various ways doth the Pox exert its Contagion 1 No exter* 
nal part is impowered to transmit its infection immediately, except where its sus- 
cepted : so we observe the Venereal parts to be infectory immediately upon the sus- 
ception of virulency, but not through kissing, sucking of the breast, by sweat, or 
through any other parts but themselves. So the mouth that’s infected by kissing, 
or sucking a thorow pockifled whore’s tet, is capable of immediately infecting 
anothers lips by kissing, or any other part by sucking it, because the pocky Miasms 
are neer; but not by copulation, or sweat, &c., because the contagion cannot be 
crept so far. Experience verifies this dictate. Is it not an ordinary trick of 
Wenchers (as Musa relates) to suck whores tongues, and tets of their breast 
and yet those, whom they know have been pockifled many years about their 
lower parts, and for that reason though their appetites are furious, yet dare 
not be dabbling, but the other they reiterate a thousand times over without the 
least hazzard 1 An instance for the other part of the dictate, which I had from my 113 
my first master in Physick, that wonder of Physicians Prof. Job. Anfonid. vandcr 
linden, p. m. the profoundest Commentator on Hippocrates and Celsus, that ever any 
age presented, whom I heard that most famous Professor Regius Guido Patin intitu- 
late the Patch Hippocrates. He during his Incident practice at Amsterdam, had a 
Merchants Prentice in cure of an Gonorrhe, and a blistered, or cankered like mouth; 
both symptoms he contest to have started upon him at the same time. The excel- 
lent Professor being curious and admiring at the rarity of such distant symptoms 
emerging at once, extorted an ingenuous confession from his Patient, upon pretence 
that it would facilitate and abreviate the cure : the other without any longer sus- 
pense impudently told him, his tongue was as unfortunate as his tayl; a sort of 
Diabolick fatyrism, outvying Aretius fiagello de Principi, and very like a Patch inven- 
tion. What insued 1 this bastard at a BesoecJc (an invitation thats usually made to 
young folks, preliminary to all Weddings) accosted himself to two pretty Damsels, 
and being planted between them, oft flanckt to the right, and in a kiss pledged his 
right hand man, and so to the left, and performed the like duty there. But the 
tragick event may imprint a dread upon all young women. A short time after their 
lips felt hot, inflamed, grew sore and ulcered, one named it the thrush, another a sore 
mouth vulgar applications rather promoted than checkt the evil, wherein they per- 
sisted so long that accessory accidents, as sordid ulcers of the palat and tonsils, 
nocturnal pains, &c. moved a jealousie of the fowl disease. Here you may remark, 
how innocently the poor lasses pessundated their fortunes. The reflexion of this 
relation upon the latter part of the dictate I commit to your own thoughts. 
2. A Wench or Monsieur by that time they are thorow pockified, are infectious 
in any part Where ever the Pox bursts out, because the virulent seminaries are pro- 
pagated quite through the body, which exhaling at the places affected, transport 
the contagion. What the thorow-pox is expect below ; so that when the malady is 
tumefyed to so high a flood, its time for Nurses, Physicians, and all visiters to stand 
off: upon such occasions a person may, he infected by drinking out of the same 
vessel (provided the spittle adhering be warm still,) as we have heard of many; 
(Leonardos Botallus adduceth an observation of a patient of his, of a chast and 
religious converse, who was stigmatized by a peculiar pledging of his familiar, then 
under a sore affliction of a thorow-pox. His lips inflamed, afterwards ulcered, his 
jaw bone grew carious, and was miserably rackt with nocturnal arthritick pains.) 
By trying of a warm Pocky Glove; by succeeding a virulent Patient on a close 
stool; by shifting of him, or making his bed whilest the sheets continue warm ; as 
Nicol. Massa's friend and Patient, who incurred this evil, by touching the sheets, one 
lay in, that was lame of a Neapolitan ulcer in his legg; and that old woman in 
Horst’s observ. aged fifty-six'; tending a Pocky fellow in his lying in, was seized of the 
same disease in as furious a degree as her Master: and by kissing, witness Favcnti- 
nus, who knew a young man, that contracted this evil by oft kissing a fowl slut. 
The initial symptoms appeared about his mouth; his privities, which otherwise 
might have bin suspected, appearing free from all contagion. To this IT parallel 
another; one Mrs. &c. then a pocky inhabitant of the Hague, having run the gant- 
lop of several cures, Hydrotick and Mercurial, at last proved with child ; her reckon- 
ing being expired, she was brought to bed of a Monster, in all particulars resemb- 
ling a living child; saving the skin, which was abominallv (-inhered with soots and 114 
botches. This object of mercy upon us was committed to the care of a Nurse, the 
Infant aspiring to higher things, bad the world adieu. But the unhappy Nurse had 
cause to curse her late Foster-child, her breasts and head ulcered, a Caries got into 
the cranium, the Pox took possession of the poor woman’s carcase, for want of a 
purse to release her. The pocky original Mistris &c. was proclaimed barbarous by 
a whole Jury of Matrons, for refusing relief to the disastered woman. In all these 
transactions the Pater Familias stood it out vigorously with a fresh countenance, no 
sign contradicting his pancratick health. Just such another mischance Musa Brasa- 
volus, tells us, befell a nurse that suckled one Sr. Orobo's child, thorowly conspur- 
cated with the Pox. The observation hereupon infers this a thorow-pox, and conse- 
quently must prove infectious in all parts of the body. Physicians in this case run 
a great risk in feeling pulses, and approaching such Patients in their sweats.— Venus 
Unmasked, or a More Exact Discovery of the Venereal Evil, or French Disease: By 
Gideon Harvey, London; T. Grismond, 1665. pp. 94-5-6-7-8-9. 
In like manner Daniel Turner in liis work on Syphilis, pub- 
lished in 1717, maintains the contagious nature of constitutional 
Syphilis: 
And this I intend shall suffice for its Chronology or Time, the Topology or Place, 
and the Ristriography or Account of the Disease in, general; which, with some other 
Writers thereon, we shall now define, A venomous or contagious Distemper, for the most 
part contracted by impure Coition, at least some Confute) liu CcnicAcf both Sexes, or some 
other lewed and filthy Dalliance between each other that way tending. 
I said for the most part, because it is beyond Controversy, the Infection is also 
communicated by other ways, as from Pocky Parents by Inheritance; by sucking 
an infected Nurse, to the Child; suckling a diseased Child, to the Nurse; lying also 
in Bed with the Diseased, without any Carnal Familiarity ; by which, though it may 
be possible for strong and vigorous Bodies to escape, yet are the tender ones, espe- 
cially of little Infants, very likely to be contaminated, as I have more Reason to 
believe than by bare Imagination. 
There are several other more uncommon Ways of giving as well as receiving the 
Venereal Venom ; some of which I have already imparted to the World in short 
Remarks upon a Quack Libel, Printed several Years past: But the Thought of such 
vile Monsters, and their execrable Practices, is too shocking (unless to the Dregs of 
humane Nature) to bear even a Repetition of Circumstances, and lit only for a 
detestable Gonologium or Collection of Smutt and Obscenity, in which I am told, 
they have been inserted, as some of the Author’s 'own Observations. 
As for those fancied Ways of catching it by common Conversation, drinking after 
one, sitting on the same Close-stool, drawing on a Glove, wiping on the Napkin or 
Towel, after the infected Person, with a hundred the like Stories; I believe in our 
time (whatever may have happened formerly) there is no great Danger; Yet we 
find in one of our late Chronicles, that these and such like Imaginations, were so 
strongly rivetted in Men’s Minds at that time, even those of the better and more 
learned sort, that it was one of the Articles against a noted Cardinal, That he had 
breathed on the King, when he, the said Cardinal, had this Disease upon him 115 
Which you will find in Baker's Chronicle, and of which Passage Dr. Harvey has also 
taken Notice. HUdanus likewise tells us of a young Gentlewoman, who contracted 
the same, by only putting on the Apparel of a Gentleman (that it seems was pox’d) 
at a Masquerade, of wdiich, through Modesty concealing her Illness (which first of 
all had seized the Pudenda) till she was past Recovery, she deceased. The good 
Man’s Credulity, at least his Charity, might however be abus’d in this Relation, as 
the young Lady perhaps was also after the Masque, otherwise than by simply put- 
ting on the Habit. But were it so as the Case is stated, there is nothing therein 
much more admirable than what the same great Man recites of a whole Family he 
knewr infected, viz. the Wife with three Children and a fourth in the Womb, as also 
a Maid Servant, by the Husband, wdio had got the Distemper in their Absence only 
by sleeping in the same bed with his Man Servant, whom he after understood was 
broke out with this Distemper. 
The Relation of Horst, and Hornung. are yet more strange, of several People 
infected in the Bagnio, by having the same Scarificator apply’d after Cupping, as 
had been used to a Venereal Patient: Which seems a like credible with that of the 
Priest poxed at his Ear, in the time of confessing a wanton Nun; the venomous 
Breath from her Mouth defiling the holy Father: But enough of this.—Syphilis; a 
Practical Dissertation on the Venereal Disease: By Daniel Turner, London; It. Bonwitke $• 
Co., 1717. pp. 10-11-12. 
John Hunter, in his Treatise on the Venereal Disease, gives a 
number of instances of the communication of secondary Syphi- 
lis, from which we select the following ; 
A lady was delivered of a child on the 30th of September, 1776. The infant 
being weakly, and the quantity of milk in the mother’s breasts abundant, it was 
judged proper to procure the child of a person in the neighborhood to assist in 
keeping the breasts in a proper state. It is worthy of remark that the lady kept 
her own child to the right breast, the stranger to the left, In about six weeks the 
nipple of the left breast began to inflame, and the glands of the axilla to swell. A 
few days after several small ulcers were formed about the nipple, which, spreading 
raipdly, soon communicated and became one ulcer, and at last the whole nipple was 
destroyed. The tumor in the axilla subsided, and the ulcer in the breast healed in 
about three months from its first appearance. On inquiry, about this time, the child 
of the stranger was found to be short-breathed, had the thrush, and died tabid, 
with many sores on different parts of the body. The patient now complained of 
shooting pains in different parts of the body, which were succeeded by an eruption 
on the arms, legs, and thigh, many of which became ulcers. 
She was now put under a mercurial course, with a decoction of sarsaparilla. 
Mercury was tried in a variety of foims: in solution, in pills internally, and extern- 
ally in the form of ointment. It could not be continued above a few days at atime> 
as it always brought on fever or purging, with extreme pain in the bowels. In this 
state she remained till March 16th, 1779, when she was delivered of another child 
in a diseased state. The child was committed to the care of a wet nurse, and lived 
about nine weeks; the cuticle peeling off in various parts, and a scabby eruption 
covering the whole body. The child died. 116 
Soon after the death of the child, the nurse complained of headache and sore 
throat, together with ulceration of the breasts. Various remedies were given to her, 
but she determined to go into a public hospital, where she was salivated, and after 
some months she was discharged, but not cured of the disease. The bones of the 
nose and palate exfoliated, and in a few months she also died tabid. 
Of the various remedies tried by the lady herself, none succeeded so well as sea- 
bathing. About the end of May she began a course of the Lisbon diet-drink, and 
continued it with regularity about a month, dressing the sores with laudanum, by 
which treatment the sores healed up; and in September she was delivered of 
another child, free from external marks of disease, but very sickly; and it died in 
the course of the month. 
About a twelve month after, the sores broke out again, and, although mercurial 
dressings and internal medicines pvere for a twelve month, when 
they began again to heal up. ******* 
The third case was of a gentieman, where the transplanted tooth remained, with- 
out giving the least disturbance, for about a month, when the edge of the gum 
began to ulcerate, and the ulceration went on until the tooth dropped out. Some 
time after, spots appeared almost everywhere on the skin; they had not the truly 
venereal appearance, but were redder or more transparent, and more circumscribed 
He had also a tendency to a hectic fever, such as restlessness, want of sleep, loss of 
appetite, and headache. After trying several things, and not finding relief, he was 
put under a course of mercury, and all disease disappeared according to the com- 
mon course of the cure of the venereal disease, and we thought him well; but some 
time after the same appearances returned, with the addition of swelling in the bones 
of the metacarpus. He was now7 put under another course of mercury, more severe 
than the former, and in the usual time, all the symptoms again disappeared. Sev- 
eral months after the same eruption came out again, but not in so great a degree as 
before, and without any other attendant symptoms. He a third time took mercury, 
but it was only ten grains of corrosive sublimate in the whole, and he got quite wef, 
The time between his first taking mercury and his being cured was a space of three 
years.—The Works of John Hunter, with Notes, edited hy James F. Faimer. Vol. ii.,p 
475, 476; p. 484. 
In an extract from a letter to Dr, Duncan, published in the 
uMedical Commentaries for the years 1783-84-85” it is said 
that a new disease has lately been discovered in London, occa- 
sioned by the transplanting of teeth from the head of one person 
to that of another. The mortality from it is computed at nearly 
two deaths to ten diseases ; and about one in every hundred, who 
receive teeth by transplantation, are affected with the disease. 
Ulcerations of the throat and gums, and eruptions on the skin, 
are the chief marks of the disease. When death takes place it 
is from the occurrence of sphacelus. For five or six weeks after 117 
transplanting, the teeth look well, and are as firm as the others.” 
pp. 490, 491. 
In the third volume of the London Medical Transactions, Dr, 
William Watson, Yice President of the Koyal Society, recorded 
an interesting case, illustrating the terrible effects of transplant- 
ing teeth, from which we extract the following particulars : 
An unmarried lady, in the twenty-first year of her age, of a 
delicate habit, hut in other respects in perfect health, observing 
one of the incisors of her upper jaw to become black and carious, 
determined on having it replaced by a sound tooth. This was 
accordingly done by an able dentistthe tooth which was intro- 
duced, being taken from the mouth of a person apparently 
healthy in every particular. At the end of a month, her mouth, 
which had continued all that time a little tender, became very 
painful. Her upper gums were at first inflamed and enlarged ; 
afterwards they were discolored and ulcerated. This ulceration 
spread very fast, insomuch that the gums of the upper jaw were 
corroded away, and the alveoli left bare. Before another month 
was at an end, the ulceration occupied the whole space under 
the upper lip between the teeth and the nose ; it extended like- 
wise to the cheeks and throat, which were corroded by large, 
deep and fetid ulcers. Soon after this, part of the alveoli of the 
upper jaw became carious, one of her teeth dropped out; and in 
a few days a second tooth, together with the transplanted tooth, 
which hitherto had remained firm in its place. About this time 
blotches appeared on her face, neck and various parts of her 
body ; and several of these became ulcerated sores. The fetid 
discharges from her mouth and throat had for a considerable 
time deprived her of sleep ; and the soreness of the parts had 
prevented her from taking nourishment. And, in addition to 
these, the soreness from the external ulcers induced such a decree 
' O 
of fever that her death was soon expected. 
When Dr. Watson was consulted, concluding that all her 
fluids were in a most putrid and acrimonious state, he directed 
Peruvian bark combined with gum-myrrh in large doses. Ho 
benefit resulted from this plan, and the patient was placed upon 118 
alterative doses of mercury. The improvement was marked, the 
ulceration was arrested and the blotches began to disappear. 
The internal administration of mercury was abandoned, on ac- 
count of its irritant effect upon the bowels, and the impression 
was kept up by rubbing mercurial ointment into her legs and 
thighs ; this practice in like manner was attended with beneficial 
effects. In about ten or twelve days, the blotches had entirely 
disappeared and the ulcers of the mouth almost completely 
healed. The griping and purging, however, returned with such 
violence that Dr. Watson was compelled to abandon the mercury 
altogether. Small portions of the carious alveoli continued to 
exfoliate, the ulceration began again to spread, the patient la- 
bored under great weakness, with frequent returns of feverish 
heat, and was every night oppressed with colliquative sweats. 
Her strength gradually lessened, till death put an end to her 
sufferings. 
As the progress of the disease was not impeded by the most 
powerful antiseptics in liberal doses, and as it gave way to mer- 
curials even in small doses, there appeared to be good ground for 
believing that the taint was truly venereal: but Dr. Watson, 
although aware of the great subtilty of the venereal poison, was 
perplexed by the statement that the person from whom the tooth 
was taken was perfectly well, and never had any venereal taint. 
Mr. Clement Hamerton, Surgeon to the Castletown Dispensary, 
has recorded in the Dublin Journal (March, 1841) cases illus- 
trating the Introduction of Syphilis into the System, through 
other Channels than Sexual Intercourse, from which he draws 
the following conclusions ; 
A healthy child is applied to the breast of a venereal nurse ; 
in a couple of weeks syphilis shows itself in the child. A ve- 
nereal child is applied to the breast of a healthy woman ; soon 
afterwards she gets a syphilitic sore of the breast, which con- 
taminates her system. A servant girl sucks a venereal sore 
breast, she gets a venereal ulcer of the mouth, which taints her 
system. The midwife has a slight scratch on the palm of the 
hand, and in delivering a putrid venereal child, she gets a sore 
on the hand which infects her system ; and lastly the husband of 119 
the midwife is diseased at the time the ulcer exists upon his 
wife’s hand. 
Dr. Egan has recorded (Dublin Quarterly Journal, May, 1846) 
several cases illustrating the contagiousness of Secondary Syphi- 
lis. In the first case the child was horn apparently healthy; 
eight weeks afterwards syphilis appeared. An ulcer then pre- 
sented itself upon the breast of the nurse, and Secondary Syphi- 
lis occurred. In the second case the child was born apparently 
healthy ; about ten weeks afterwards a suspicious rash appeared, 
succeeded bj blisters and fissures about the mouth ; ulcers oc- 
curred on the nurse's breasts, and then a scaly eruption, and 
other secondary symptoms. Both cases were cured by anti- 
syphilitics. In the third case, the woman was a dry nurse, being 
disqualified by age from suckling. The child was unhealthy, 
and affected with sores, of a brownish color, about the nates and 
mouth, and a constant flow of saliva. A scratch appeared on 
the neck of the nurse, whether produced by a pin or torn by the 
nails of the child was uncertain ; but being in the habit of 
bringing the child’s mouth in contact with the affected part, in 
order to induce sleep, the disease was believed to be communi- 
cated through the abrasion, and the local effect was succeeded 
by an eruption, cured by anti-syphilitics. 
In a trial which took place at Cork, Dr. O’Connor and Dr_ 
Bull, gave evidence to show that a child affected with syphilitic 
eruption may convey the contagion to the nurse. (Lancet, July 
4, 1846.) 
Dr. Hector G-avin has given the history of a case, where a man 
and his wife, purporting never to have had syphilis, had a first 
child born perfectly free from any traces of the disease, subse- 
quently to which the diseased child of a woman known to have 
had syphilis, but supposed to be cured, was placed to the wife’s 
breast, the nipple being “cracked” at the time, and the disease 
was communicated.—(Lancet, July 18,1846;—Kankin’s Abstract.) 
Mr. Price of Margate has recorded the case of a woman who 
had syyhilis, which commenced in the nipple, from nursing an 
infected child. She gave birth to one child affected with the 
disease, and to another dead child. The child from whom this 120 
woman derived tire disease had a very sore mouth and smelt very 
badly, and its father was known to have secondary syphilis of an 
aggravated character. Another respectable married woman, six 
weeks afterwards applied to Mr. Price, having syphilis, with a 
large sore on one of the nipples, and it turned out that this 
woman was nursing the same child which had affected the former 
nurse. This woman’s own child also had the disease. This 
woman affected her husband. Two years and five months sub- 
sequently she gave birth to another child; this was affected with 
syphilis; twelve months subsequently another child was born 
similarly affected, and after this the mother was cured with 
iodide of potassium. Several very remarkable cases by Lalle- 
mand, Dr. King, and Dr. Meenick, will also he found in the 
twelfth volumn of the Medical Times—pp. 81, 176, 422—Ran- 
kin’s Abstract, Yol. 10, p. 336. 
According to M, Rizzi, who had an ample field for recording 
facts relating to congenital syphilis, in a large hospital under his 
charge in the city of Milan, if a woman contracts specific ulcer- 
ations on the breast by suckling an infected infant, mucous 
tubucles very frequent]y develop themselves on the vulva and 
about the anus ; and the syphilis, although secondary, is trans- 
missible by contact, so that a perfectly innocent woman may 
communicate the disease to her husband; and it behooves the 
medical attendant to he well apprised of this fact, as upon his 
knowledge of it, not only the health, but the yieace of mind and 
honor of the individuals must rest. 
Of 100 individuals with chancres on the breast from impure 
lactation, or on the mouth or throat, derived from contact with 
an infected infant, 34 have tubercles of the vulva, 19 syphilitic 
angina, 3 iritis, 14 tubercles of the vulva and angina simulta- 
neously, 5 tubercles of the vulva, and others disseminated over 
other parts of the body, of divers complicated symptoms, 6 
tubercles of the vulva, angina, tubercles on the skin, and iritis, 
and 19 no secondary symptoms. 
In nurses, as well as in men infected with them, M. Rizzi has 
remarked that tubercles are the most common form of secondary 121 
symptoms, and angina is frequently superadded. A discharge, 
vegetations, and exostoses, are very rare, and buboes, when they 
occur, consist only of swelling and tension of the sub-maxillary 
or axillary glands. 
In 53 infants, the disease manifested itself one month after 
birth in 33 ; at the expiration of two months in 11; of three 
months in 4 ; and in one only after the expiration of eight 
months. These statistics show how easily parties may he 
deceived as to the condition of infants that have been subject to 
the syphilitic poison, and how readily nurses may be exposed to 
the syphilitic poison from infants taken by them to nurse, 
without the slightest apprehension, whose parents even might 
not have a suspicion of the existence of the disease.—(Rankin’s 
Abstract, Yol, v, p. 219, from Graz. Med. di Milano, and Graz. 
Med. de Paris, Oct. 24, 1846.) 
On the 25th of October, 1858, a letter was addressed to the 
Imperial Academy of Medicine at Paris, by the Minister of Com- 
merce, Agriculture, and Public Works, requesting an authori- 
tative answer upon two questions : first, whether constitutional 
syphilis was contagious; and, secondly, whether, as regards con- 
tagion, there was a difference between constitutional syphilis as 
seen in infants at the breart and in adults. This letter led to 
the appointmant of a commission consisting of MM. Yelpeau, 
Ricord, Devergie, Depaul, and Gilbert, and these commissioners 
reported and their report was adopted by the Academy,—first 
that some of the manifestations of secondary syphilis, especially 
condylomata, are undoubtedly contagious; and, secondly, that 
there is no reason to suppose that the case is different in infants 
at the breast and in adults. 
The commissioners arrived at this conclusion after examining 
the clinical facts and experimental researches already on record, 
and after four experiments of their own, which were undertaken 
with great reluctance on their part. The persons experimented 
upon were all suffering from lupus, but free from any syphilitic 
taint, and these were chosen from the notion that the treatment 
for syphilis, if the inoculation took effect, might possibly be of 
service in remedying the lupus. 122 
The following case will serve as an example of the four experi- 
ments. 
On a man, whose face had been affected with lupus from child- 
hood, a raw surface was made on the left arm by strong ammo- 
nia, and to this was applied a piece of lint soaked in purulent 
matter obtained from a condyloma near the anus of a person who 
had had a chancre fifteen months previously. The condyloma 
was of fifteen days standing. Fourteen days afterwards there 
was slight redness at the seat of inoculation. Four days later 
still, a prominent coppery-colored papule made its appearance in 
the same part. On the twenty-second day this papule was much 
larger, and there was a slight oozing from the surface. During 
the week following the oozing, after being purulent, dried up into 
a thin scab. On the twenty-ninth day a gland in the corres- 
ponding axilla became enlarged. On the fifty-fifth day, the pap- 
ule on the arm had become a real tubercle, with some slight 
ulceration in the centre, and several blotches and coppery papu- 
les had made their appearance on the trunk. During the week 
following, these papules became multiplied on the body, and they 
spread also to the extremities ; many of them also changed into 
pustules of acne. Two or three days later the patient was put 
under the treatment for Syphilis, and in six weeks, at the date of 
the report, there was still much to be done in the way of a cure. 
In addition to asserting the contagiousness of secondary Syph- 
ilis, the commission arrived at the conclusion, that there are 
characteristic grounds of distinction between the primary and 
secondary affection, and that the period of incubation in the sec- 
ondary affection is from eighteen to twenty days, or even longer, 
and that the result is first a papule, and then a tubercle, which 
is finally converted into an ulcer covered with a crust.—(Ran- 
kin's Abstract, No. 30, p. 273, from Comptes Eendus, May 24th 
and 31st, 1849. 
We might greatly multiply such facts from various authors, 
but this appears to be unnecessary, as the experience of the 
authors just quoted covers three centuries ; and we are jus- 
tified in affirming that it is now clearly established that con- 123 
stitutional Syphilis can be transmitted by direct inoculation with 
the secretions of secondary sores. 
And recent experiments have shown that the blood of persons 
affected with constitutional Syphilis is capable when inoculated 
on healthy subjects of giving rise to syphilitic disease. 
Waller succeeded in inoculating a healthy boy fifteen years 
old, with this disease, by applying the blood of an individual 
affected with secondary Syphilis to incisions made by a scarifica- 
tor on the body of the boy. Well marked and unmistakable 
symptoms of secondary Syphilis followed this experiment. Other 
experimenters have arrived at similar results, but the best con- 
ducted experiments appear to be those performed by Professor" 
Pelizzari,* of Italy. 
As this subject is of great interest, we present the|account of 
these experiments, as it is contained in one of the most recent 
works on Yenerial Diseases : 
This physician inoculated two medical students with the hlood of a syphilitic patient with a 
negative result. On the 6th of February, 1862, he resumed his experiments, three physicians) 
Drs. Bargioni, Bosi, and Passagli submitting themselves to his investigations. The hlood of a 
female patient, aged twenty-live, affected with constitutional syphilis, and who had undergone 
no treatment, was used for the purpose. The hlood was drawn, with a new lancet, from the 
cephalic vein. The patient was at the time affected with mucous papules on the left labium, at 
the place where the chancre had existed; mucous tubercles surrounded the anus, and the in. 
guinal glands were indurated and enlarged, and there were pustules on the head. At the point 
on the arm from which the blood was drawn there was no sign of any eruption, the skin of the 
part was well washed, and the surgeon washed his own hands. The bandage was new, as was 
also the vessel in which the blood was received. As the blood escaped from the cephalic vein, 
some of it was received on a piece of lint, which was placed on the upper part of Dr. Bargioni’s 
arm where the epidermis had previously been removed, and three transverse incisions made. 
A similar operation was porformed on the other two gentlemen, hut in the case of one the blood 
was cold, and in that of the other it had coagulated. 
After twenty-four hours the dressings were removed, and nothing was observed but the crusts 
formed by the effused blood. Four days afterwards all traces of the inoculations had disappeared 
On the morning of the third of March, Dr. Bargioni informed Prof. Pelizzari that in the center 
of the inoculated surface he had noticed a slight elevation, which produced a little itching. The 
arm was examined, and at the point indicated Prof. Pelizzari found a small papule of a roundish 
form, and of a dull-red color. On the eighth day the papule had augmented to the size of a 
twenty-centime piece. On the eleventh day it was covered with a very thin adherent scale, which 
became denser, and on the second day commenced to crack in its central part. On the fourteenth 
day two axillary glands became enlarged to the size of nuts. The papule remained indolent, 
and there was no induration at its ba;e. On the twenty-first the scale was transferred into a 
true crust, and the part beneath was ulcerating. Slight induration was more evident. On the 
twenty-second the crust was detached, leaving a funnel-shaped ulcer, with elastia and resistant 
borders, forming an annular induration. There was hut a small amount of secretion from the 
* Lectures on Syphilis, by Henry Lee, 1863; p. 198. 124 
sore, and the pain was trifling. On the twenty-sixth the ulcer had become as large as a fifty- 
centime piece, and the surrounding induration was considerably increased. Up to the 4th of 
April the ulcer remained stationary, hut at that date its base appeared to be granulating. The 
axillary glands remained swollen, hard, and indolent. Slight nocturnal pains occurred in the 
head about this time, and the posterior cervical glands became somewhat enlarged. On the 12th 
of April spots of an irregular form and of rose color appeared on the surface of the body. The 
eruption extended itself, and during the succeeding days became more confluent. No constitu- 
tional disturbance, heat of skin, or pruritus accompanied it. On the twentieth the cervical 
glands had increased in size and were haraer. The chancre maintained its specific character and 
exhibited no tendency to cicatrization. On the twenty second the color of the eruption was de- 
cidedly coppery. Small lenticular papules were now perceived to be mixed with the erythema. 
The edges of the chancre had begun to granulate. Mercury was now administered. 
This case is of itself sufficient to prove the inooulability of syphilis through the blood of an 
infected person. 
111, As we have before said, in the Third Section of this 
Inquiry, the acceptance without reserve of the doctrine of John 
Hunter, expressing the impossibility of the coexistence of two 
actions, or two local diseases, or two different fevers, in the same 
part, or in the same constitution, at one and the same time, 
would necessarily lead to the denial of the possibility of trans- 
mitting Syphilis, through the medium of the matter produced by 
a distinct disease as cow-pox. 
What are called pathological laws, are nothing more, than 
expressions of the fixed modes in which the phenomena of dis- 
ease are manifested, and they conform to truth, only when they 
conform to, or formulate, the established course of nature. It is 
evident that a law may correctly express the relations of a cer- 
tain class of facts and phenomena, without necessarily embracing 
other facts and phenomena, which upon a superficial view are 
related to those undoubtedly embraced by the law. 
Whilst the law of Hunter may express the relations of the 
actions of the special poisons of the Exanthemata, (and we have 
shown in the third section, that it was from this very class of 
diseases, that the law was formulated,) it does not at all neces- 
sarily follow, that it is applicable to the actions of poisons differ- 
ing wholly in their nature, mode of origin, and pathological 
actions. 
The poison of Syphilis, after its introduction into the system, 
induces profound alterations in the blood, and in the processes of 
secretion and nutrition, and, in fact, produces derangement 
through all the solids and fluids. The economy under the action 125 
of constitutional Syphilis, is to he looked upon as entirely 
deranged. When, therefore, another disease is engrafted upon 
this state, the product of that diseased action, must partake, 
more or less, of the diseased condition of the blood and tissues. 
Does any one deny this, with reference to the products of inflam- 
mation excited in the syphilitic subject ? Do not even our nos- 
ologies express this fact ? Where is there sufficient proof to 
show, that syphilitic blood and lymph, furnishing materials for 
the elaboration of the vaccine matter, looses, altogether during 
this new process, its contagious and poisonous properties in the 
vaccine vesicle ? Is not the vaccine vesicle hut the manifesta- 
tion of a general disease affecting the entire system, just as the 
eruptive skin affection of Syphilis, is the manifestation of a dis- 
ease pervading the entire system ? In addition to the facts 
recorded in this inquiry, is it not well known that the fetus in 
utero is affected by the vaccination of the mother P And it is 
probable, though experiments are as yet wanting, that the blood 
of one suffering with the vaccine disease, may propagate the dis- 
ease by inoculation. 
If then it he possible to produce a protective vaccine pustule, 
in an individual suffering from secondary Syphilis, then it is 
established that two local and two constitutional diseases may 
exist at the same time and in the same constitution, and the law 
of Hunter falls to the ground, as far as the action of these two 
animal poisons is concerned. 
If the law of Hunter he universally applicable, we should 
have no vaccine disease produced at all, upon individuals suffer- 
ing with constitutional Syphilis. 
But even admitting that the special contagious matter of cow- 
pox, formed from the blood of one suffering with constitutional 
Syphilis, is free from the poison of Syphilis, how can we practi- 
cally, in the process of vaccination, separate this from all admix- 
ture with the diseased epithelial cells, cellular tissue, and syphi- 
litic products of the skin and blood. If the dried scab be used, 
does not this cover, and in fact has it not been formed from a 
circumscribed portion of structure which had been originally 126 
tainted with Spyhilis, and are not its borders and 
mixed up with the products of the secondary diseased skin ? 
The truth is, that we have much yet to learn about the phe- 
nomena manifested by the living organism when acted upon 
simultaneously by two or more poisons. Much of our estab- 
lished treatment, consists in the use of certain poisons to over- 
come the effects of other poisons, under which the system is 
laboring. 
In tliis inquiry we do not need pathological formula, and gen- 
eralizations, so much as well authenticated facts. 
We cannot subscribe to the doctrine, that practically all dan- 
ger may be avoided, by proper caution, as “every morbid 
appearance on the cutaneous envelope has its own peculiar char- 
acter, by which it may be distinguished from other similar phe- 
nomena, and thus the observer may easily establish a distinction 
between the vaccine vesicle and other vesicular, bullar, or pustu- 
lar eruptions.” Is it not well known that Syphilis may lurk for 
years in one individual, never occasioning so much inconvenience 
as to arouse suspicion, until it is unmasked by the unexpected 
appearance of an infected offspring ? On the other hand how 
fearfully rapid and destructive is the progress of the disease in 
others, in which from the first appearance of the chancre, symp- 
tom follows symptom, sore throat, swelled testicle, iritis, erup- 
tions, nodes, ulcerations, and caries, until the entire body has 
become apparently a mass of filth and rottenness. 
Both are examples of one disease, and examples of the action 
of the same poison; and we can only refer these differences to 
the peculiar states or conditions of different individuals. 
We are utterly and profoundly ignorant of the variations on 
the vaccine vesicle under these different states of the constitution; 
and we are utterly and profoundly ignorant of those conditions 
which are essential to the transmission of the syphilitic poison 
through the medium of the vaccine vesicle. 
But to the facts ; 
About eleven years ago a medical man was condemned to two 
years imprisonment for having vaccinated several children from a 
child exhibiting a syphilitic eruption on its face and body. The 127 
witnesses asserted that the vaccine pustules had not been pro- 
perly developed, and were followed Toy tedious ulcerations. 
Moreover, nine grown-up persons were asserted to have been re- 
infected by the children tainted through the vacine pustule. 
The judgment was commuted in consequence of the opinions 
expressed by Messrs. Heyfelder and Pauli, two distinguished 
medical men of Rhenish Bavaria, whose judgment had been sup- 
ported by that of Ricord and Cullerier, who utterly denied the 
possibility of communicating the syphilitic poison by the agency 
of vaccine lymph.—(B. & P. Med. Chirurg. Rev., Oct., 1855, 
from Bull. G6n. de Therap., July, 1855.) 
M. Yiennois* has collected many cases of the transmission of 
Syphilis by vaccination, and has summed up his conclusions from 
the data on hand. From his observations and researches it 
would appear that Syphilis cannot be communicated by vaccine 
virus taken from a subject affected with the disease unless a por- 
tion of the blood of the individual is also inoculated. Thus he 
says : 
“When the vaccine virus of a syphilitic subject, pure and 
unmixed with blood, is inoculated on a healthy individual, a 
simple vaccine pustule is obtained, without any near or remote 
syphilitic complications being produced. 
“On the contrary, if, with the vaccine virus of a syphilitic 
individual who either has or has not at the time constitutional 
accidents, a healthy person is vaccinated, and the point of the 
lancet be charged with a little blood at the same time as with 
the vaccine virus, both diseases may be transmitted by the one 
operation—the vaccine disease with the vaccine virus, and Syph- 
ilis with the syphilitic disease.” 
M. Yiennois also concludes that in such cases the vaccine vesi- 
cle is developed first, and that after undergoing its incubatory 
period the syphilitic ulcer, with all the characteristics of a true 
chancre, appears. 
The following are the conclusions of M. Yiennois. 
1. Syphilis has in many instances been observed to follow vac- 
*De la Transmission de la Syphilis par la Vaccination. Archiv. Gen.de Med., 
Juin, Juiliet, et Septembre, 1860. 128 
cination, ever since the introduction of that operation, and hy 
authors worthy of credit, French, English, G-erman, Italian, &c. 
2. When a syphilitic subject is vaccinated, in whom the dis- 
ease is in a latent state, syphilitic symptoms may he developed 
hy the vaccine influence ; these symptoms often consist in general 
eruptions of a papular, vesicular, or pustular character, hut a 
chancre never forms at the seat of puncture. 
3. On the contrary, if a healthy subject be vaccinated with 
vaccine virus taken from a syphilitic subject, and the lancet be 
charged at the same time with a little blood, as well as vaccine 
matter, the two diseases may be conveyed by the same puncture— 
the vaccine with the vaccine matter, and Syphilis withMhe syph- 
ilitic blood. 
4. In these cases, of which a number are on record, vaccina- 
tion is first developed because its period of incubation is shortest, 
and its evolution more rapid than that of Syphilis. The latter 
appears subsequently, and manifests itself by its characteristic 
lesion at the inoculated spot. 
5. The initial lesion, then, by which Syphilis, following the 
vaccinal pustule, manifests itself, is an indurated ulcer, with 
adenitis ; in a word, all the phenomena of primitive syphilitic 
chancre. The great law announced by M. Rollet, that Syphilis 
always commences by a chancre, even when it results from sec- 
ondary symptoms, or even from syphilitic blood, is thus fully 
confirmed. ' 
6. After the primary chancre is developed at the inoculated 
spot, and in the usual period, secondary Syphilis occurs, and 
runs the usual course, as if transmitted in any other way. 
7. When the mixture of virus does not take place accidentally, 
but is affected intentionally, (as practiced by MM. Spereno and 
Daumes, by mixing the vaccine matter with the pus of chancre,) 
the result is the same ; one virus does not destroy the other, but 
each runs its separate course. 
8. The vaccine matter thus acts as a simple vehicle for the 
virus contained in the syphilitic blood, which it divides and 
dilutes, as a drop of water would do, without at all modifying 
its properties or its effects. 129 
9. It is important, then, never to take the vaccine virus from 
a suspected person, or from an infant whose parents are unknown 
before the age at which hereditary Syphilis usually manifests 
itself. 
10. If circumstances make this last necessary, great care 
should be taken to collect only the vaccine matter, free from 
blood or any syphilitic humour. 
11. In no case should a healthy subject be vaccinated with 
matter taken from a syphilitic subject, for in spite of all precah- 
tions, there can be no certainty as to the purity of the vaccine 
matter. 
12. These precautions are the more important, because, with 
the matter from one syphilitic subject a number of persons may 
be vaccinated, and Syphilis conveyed to nearly all, (as seen by 
Ceriale, of Cremona.) 
13. It is sufficient to point out these precautions, to avoid new 
evils, and to remove the cavils of the enemies of vaccination; for 
in these cases, the propagation of Syphilis is not the fault of vac- 
cination, but of the vaccinator.—(Graz. Med. de Paris, Jan. 26, 
1861. American Journal of Medical Sciences, April, 1861.) 
These views of M. Yiennois have recently received the most 
ample confirmation from the tragedy which occurred at Rivalta, 
in Italy, by which forty-six children and twenty nurses had sy- 
philis communicated to them through vaccination, and of which 
several of the children died. The full details of this remarka- 
ble event are given in a memoir by Dr. Pacchiotti,* of Turin, 
and the following summary from his report is given from Dr. 
Hammond's recent work. 
On the 21st of May, 1861, Sig. Cagiola vaccinated Giovanni Chiahrera with lymph contained in 
a tube sent from Acqui. The operation was performed in the usual manner and with a perfectly 
clean lancet. The child was eleven months old, and in good health at the time. Forty-six other 
children were, ten days subsequently, vaccinated with the lymph taken from the vesicle of this 
child ; and ten days after this, seventeen children were vaccinated with lymph taken from the 
arm of Luigia Manzone, one of the forty-six first vaccinated. 
Of these sixty-three children, forty-six—thirty-nine of the first lot and seven of the last—were 
within two months attacked with Syphilis. On the 7th of October seven of them, including 
the little Manzone, were dead, three were yet in danger of dying, fourteen were recovering under 
the use of mercury and iodine, and one was well. 
* Sifilicle trasmissa per Mezzo della Vaccinazione in Rivalta, nresso Acqui. Gazetta della 
Asgociazone Med., Octobre 20,1861. ’ 1 130 
A medical commission was now appointed to inquire into all tlie circumstances connected with 
this fatal event, and they proceeded to the execution of the duty assigned them. 
Twenty-three children were examined in full; the others were not so accurately noticed, as 
their parents had neglected to avail themselves of medical aid in time. In the forty.six children 
who were affected, Syphilis appeared at periods varying from ten days to two months after vac- 
cination, the average time being twelve days. The initiatory symptoms were variable. Some- 
times just as the vaccine vesicle had healed, it became surrounded with a red, livid, and copper- 
colored areola, and ulcerated again. In other instances an ulcer would form.on the cicatrix, and 
become covered with a scab, which in a few days would fall off to make room for another, and 
so on. In others the vaccine vesicles had an unhealthy appearance from the first, and were 
accompanied by a general eruption. 
The principal symptoms observed by the commission were mucous tubercles in the vicinity 
of the anus and on the genitals, ulcerations of the mucous membrane of the lips and fauces, 
engorgement of the lymphatic glands in the groin and neck, syphilitic skin diseases, alopecia, 
deep tubercles, gummy tumors,f etc. 
In two subsequent papers, Dr. Pachiotti* continues the detail of his investigations. On the 
Bth of February, twenty of the mothers or nurses of the forty-six children had become affected 
with symptoms of Syphilis, He ascertained, too, from a revacoination of five of the children, 
that the occurrence of Syphilis had not destroyed the efficacy of the first vaccination. But he 
also discovered the source of the infection. It appeared that a year and a half previously a young 
unmarried woman had had Syphilis, and that she was syphilitic at the time Ohiabrera was vac- 
cinated. This woman was the mother of a child which had died syphilitic three months after its 
birth. After the death of the child she was in the habit of having her breasts drawn by the 
little Ohiabrera, and gave him the clothes which her own child had worn. Another child nursed 
by this woman, but who was not vaccinated, also became syphilitic, and this child infected its 
mother just as little Ohiabrera did his mother. It is therefore shown that the vaccine virus used 
on Ohiabrera was not at fault, but that all the other forty-five children were infected through 
the lymph taken from his arm. It is also shown that blood was on the lancet when several of 
the children were vaccinated. 
Dr. Pacchiotti, as the Jesuits of his investigations and those of the commission, gives the fol- 
lowing rules to be observed in vaccinating:— 
Ist. Examine the child from whom the lymph is taken. 
2d. Inquire into the state of the parent’s health. 
3d. Take the lymph in preference from those children who have passed the fourth or fifth 
month, as hereditary Byphilis appears in general before that time. 
4th. Do not use lymph taken from a vesicle which has passed its eighth day, because on the 
ninth and tenth days the lymph becomes mixed with pus, which latter may be of an infectious 
character. 
6th. In taking the lymph, avoid hemorrhage, as there is less danger with lymph free from 
blood. 
6th. Do not vaccinate too many children with the same lymph. 
In consequence of the publication of the details of the lamentable affair at II iv alt a, Dr. 
Marone concluded to relate the particulars of a similar event which occurred to him, and in 
regard to which he had thought it advisable to maintain a discreet silence. The particulars 
are given with sufficient fullness by Mr. Lee, whose excellent work I have already referred 
to several times. 
It seems that in November, 1856, Dr. Marone obtained some vaccine lymph, with which he 
vaccinated a number of children at Lnpara. The lymph was contained in glass tubes, and Dr. 
Marone noticed that it was mixed with a little blood, which affected its transparency. Of the 
number of children vaccinated with this lymph, notes were preserved in twenty-three cases. All 
these were affected with Byphilis, and the disease likewise manifested itself among the mothers, 
nurses, and even the servants who were brought in contact with them. The symptoms with 
which the children were affected consisted chiefly of eruptions of a syphilitic character, and sub 
*L’Union Medicale, Fev. Seme et Avril Seme, 1862. 131 
sequently of mucous tubercles at the angles of lips, around the anus, and on the vulva. The 
post-cervical and inguinal glands were enlarged, and there was emaciation, in degree varying 
with the severity of the syphilitic symptoms. 
Besides these cases, eleven nurses of the number who suckled these children gave the disease 
to eleven other children who were not vaccinated. 
In some of the cases the syphilitic phenomena continued till April, 1859. 
Dr. Marone draws the following conclusions horn his experience 
“ That the syphilitic virus was really transmitted in the above recorded cases by means of vac- 
cination. 
“ That the children vaccinated suffered first, and became the means of transmitting the disease 
to others. 
“ That the lymph used for the purpose of vaccination was impure, being mixed with blood, 
and that the result shows how necessary it is to abstain from using lymph of that description.’ 
—Lectures on Venereal Diseases: By Wm. A. Hammond, M. D. Philadelphia: J. B. Lippincolt & 
Co., 1864. pp. 208, 217. 
And whilst these pages are passing through the press, we read 
in the Medical News and Library that Syphilis has recently been 
extensively propagated by vaccination in France. 
In a western department of France, (Morbihan,) some villages 
have been the theatre of severe syphilitic symptoms in more than 
thirty children, who had all been vaccinated from a little girl 
with six punctures on each arm, the child herself having been 
operated upon from another who had been vaccinated from lymph 
preserved between two plates of glass obtained from the authori- 
ties. This misfortune created so much sensation, that the 
Academy of Medicine of Paris, sent down two commissioners? 
Messrs. Henry Eogu and Hepaul. These gentlemen have just 
presented their report to the Academy, and this important docu- 
ment ends with the following considerations : 
1. Several of the children whom we have examined were un- 
doubtedly suffering from secondary Syphilis. 
2. We see no way of explaining this contamination hut by 
vaccination, and we are confident that the cases we have seen 
were really Syphilis engendered by vaccination. 
3. As to the origin of the virus, it is very probable that the 
poison is traceable to the lymph, preserved between two pieces of 
glass, supplied by the authorities. 
As primary symptoms were also observed among the children 
M. Eicord begged the commissioners to insert that fact in thei 
report, which these gentlemen agreed to do. Here we unfortu- 132 
nately have again repeated the sad occurrences which took place 
at Rivalta, (Italy,) a short time ago.—(Medical News and 
Library, 1867—from London Lancet, Dec. 15, 1866.) 
The experience of the Confederate Surgeons, establishing the 
possibility of communicating constitutional Syphilis by vaccina- 
tion ; the experiments of Waller, Pelizzari and others, establish- 
ing the possibility of communicating secondary Syphilis by 
inoculation of the blood from patients suffering with the con- 
stitutional symptoms of this disease into healthy individuals : 
the cases collected by M. Yiennois illustrating the transmission 
of Syphilis by vaccination : and the unfortunate tragedy of 
Rivalta in the district of Piedmont, Italy, where Syphilis was 
previously unknown, (forty-six children of various ages being 
simultaneously attacked with well-marked Syphilis, proceeding 
in all cases which could be properly examined from the action of 
vaccine virus which produced chancre on the arms, followed by 
buboes in the axilla, and all these children had been vaccinated 
directly or indirectly from a single child, who was subsequently 
proved to have contracted Syphilis from a wet nurse, and these 
children transmitted the disease to a number of women, their 
wet nurses and mothers, and even to children who played and 
nursed with them, and the women so infected, in turn infected 
their husbands, and finally the disease yielded in all cases to the 
usual remedies for Syphilis;) these, and other similar facts, as 
the infection of the infant at the breast with secondary Syphilis j 
and the communication of Syphilis from the infant inheriting 
the disease from its mother or father, to a healthy nurse,—all 
demonstrate the possibility of transmitting constitutional Syph- 
ilis by inoculation of syphilitic blood, or vaccine virus, from 
patients poisoned with Syphilis ; and each such fact, of itself i s 
sufficient to overthrow the dogma, that “ Primary Syphilis alone 
is capable of being inoculated, and that secondary affections and 
the constitutional disease cannot be communicated from one 
individual to another, by any such means as vaccination, or the 
direct inoculation of syphilitic blood.” CONTENTS. 
Section I.—Preliminary Observations—Accidents attending Vaccination 
amongst the Citizens and Soldiers of the Confederate States 
—Necessity for the Investigation—Method, extent and ob- 
ject of the Inquiry, ------- 3-11 
The injurious effects of Vaccination referred to six causes, 4-5 
Circular Letter addressed to the Medical Officers of the late 
Confederate Army, - - - - ,- _ - - 5-6 
Facts illustrating the value of Vaccination, and the fatality of 
Small-Pox, - -- -- -- -- 7-8 
Description of Small-Pox, by Sir Matthew Hale, - - 8 
Dr. Jenner pointed out some causes of the accidents attending 
Vaccination and gave rules for their avoidance, - - 9-11 
m 
Section ll.—Modification, Alteration and Degeneration of the Vaccine Vesi- 
cle, dependent upon depressed and deranged forces, result- 
ing from fatigue, exposure and poor diet; and upon an im- 
poverished, vitiated and scorbutic condition of the Blood 
of the patients vaccinated and yielding vaccine matter, - 12-33 
In Scorbutic Patients all Injuries of the Skin tend to form ul- 
cers of an unhealthy character ; effects of Scurvy upon the 
character and progress of the Vaccine Vesicle, - - 12-13 
Investigations upon the effects of Vaccination amongst the 
Federal Prisoners confined in Camp Sumpter, Anderson- 
ville, Ga., --------- 13-27 
Examination of the charge urged by the United States Mili- 
tary Commission, that the Confederate Surgeons deliberate- 
ly poisoned or destroyed the Federal prisoners at Anderson- 
ville with poisonous Vaccine Matter, - 13-27 
Dr. Hamilton on Spurious Vaccination in the U. S. Army, - 26 
Dr. L. Guild on the Medical Records of the Army of Northern 
Virginia, -------- 27 
Report on Spurious Vaccination in the Confederate Army, by 
S. E. Habersham, M.D., of Augusta, Ga., - - - - 28 
S bction 111.—The Employment of Matter from Pustules or Ulcers which 
had deviated from the regular and normal course of 
development of the Vaccine Vessicle; such deviation or im- 
perfection in the Vaccine Disease and Pustule, being due 
mainly to previous Vaccination, and the existence of some 
Eruptive Disease at the time of Vaccination. Or, in other 
words, the employment of Matter from patients who had 
been previously Vaccinated, and were partially protected, 
or who were affected with some skin disease at the time of 
the insertion of the Vaccine Virus, - 84-59 
Prof. Paul F. Eve, M.D., on Spurious Vaccination. . . 35 
Dr. R. D. Hamilton, of Chattanooga, on Spurious Vaccination 
amongst the Confederate forces serving in East Tennessee, 36-38 
Investigations of Dr. Edward Jenner, on the Varieties and 
Modifications of the Vaccine Disease, ... - 38-41 
Answer to Dr. Jenner’s Inquiries, by the Rector of Leckham- 
stead. - - - - - 39-40 
Observations of Dr. James Davis, of Columbia, South Caroli- 
na, on the Vaccine and Varioloid Disease, - - - 41-44 134 
Examination of the Doctrine of John Hunter, on Diseased 
Actions as being incompatible with each other, - - 45-59 
Relations of the Vaccine Disease to Measles and other dis- 
eases, with the observations of numeious authors, - - 47-57 
Section IV.—Dried Vaccine Lymph, or Scabs, in which Decomposition has 
been excited by carrying the Matter about the person for a 
length of time, and thus subjecting it to a warm moist at- 
mosphere, - - - - - - - - 59-62 
Section V.—The mingling of the Vaccine Virus with that of the Small-pox; 
Matter taken from those who were vaccinated while they 
were laboring under the action of the poison of Small-pox 
was capable of producing a modified variola, and compara- 
tively mild disease in the inoculated, and was capable of 
communicating by effluvia Small-pox in its worst character 
to the unprotected, - - 63-72 
Observations of Drs. Jenner, Woodville, Adams, Willan, Grego- 
rie, Hennen, Fowler, and Bousquet, upon the relations of 
the Vaccine Disease and Small-pox, • 64-72 
Section VI.—Dried Vaccine Lymph and Scabs, from Patients who had suf- 
fered with Erysipelas during the progress of the Vaccine 
Disease, or whose systems were in a depressed state from 
improper diet, bad ventilation, and the exhalations from 
Typhoid Fever, Erysipelas, Hospital Gangrene, Pyaemia, and 
offensive suppurating Wounds, 72-86 
Dr. Wm. Gerdner, of Greene County, Tenn., on the relations 
of Erysipelas to Vaccination, - -- -- - 73 
Cases of Erysipelas following Vaccination, - 74-78 
Views of Dr. Paul F. Eve, on the possibility of Inoculating 
Erysipelas by Vaccination, - - - - - - 78 
Dr. J. C. Nott, of Mobile, Ala., on Erysipelas, - 80 
Report of Dr. J. F. Bell, of Virginia, ----- 81 
Report of Surgeon Hunter McGuire of Virginia, - - 83 
Section VII.—Fresh and Dried Vaccine Lymph and Scabs from Patients 
suffering with Secondary or Constitutional Syphilis at the 
time and during the process of Vaccination and the Vac- 
cine Disease, - -- -- -- -- 86-121 
Prof. S. M. Bemiss, M.D., of New Orleans, on the relations of 
Syphilis to Spurious Vaccination, ----- 89 
Prof. Eve, Drs. Kratz, Fuqua, Ramsey, Crawford, Percival, 
Stout, Woodward and Hubbard, on the relations of Syphi- 
lis to Spurious Vaccination, ------ 90-105 
• Discussion of the relations of Secondary or Constitutional 
Syphilis to Vaccination, ------ 105-132 
The possibility of communicating Tuberculosis and Cancer 
by Inoculation, - -- -- -- - 107-109 
The possibility of communicating Secondary or Constitutional 
Syphilis by Inoculation, ------ 110-124 
Testimony of Torella, 1498, William Clowes, 1637, Gideon 
Harvey, 1665, Daniel Turner, 1717, John Hunter, 1776, and 
of Drs. Duncan, Watson, Harnerton, Egan, Price, Rizzi, Wal- 
ler and others, on the contagiousness of Secondary Syphi- 
lis, ---------- 110-124 
The possibility of communicating Constitutional Syphilis 
through the medium of the Vaccine Virus, - 124-221 
Testimony of M. Viennois, Drs. Paccbiotti, Marone, Pogue 
and Depaul, --------- 127-131