SK?*WT*V:. IF Surgeon General's 0ffic3 5 ANflEX -y^- (}/ C/ec'ten, S ? ' No./*/*>? QgQOQO^Cr^OvaCXj. L^'TK"*'*^*"^*'4 ;■-: > y*. $^#' 4 ■< • " PHILADELPHIA: '-J '" J^¥ PRINTED FOR JOSEPH OXOFfi NO. 7/, SOUTH' SECONB STREET; BY JOHN BIOREN. 1801. RECO MMENDATIONS. THE following work by Mr. Aiken con- tains an epitome of all that has been published, or that is necessary to be known upon Vac- cine Inoculation to render the practice of it easy and successful. The subscriber consi- ders it as the most useful discovery of the -eighteenth century, and anticipates from it, in a few years, the extinction of the Small- pox. He hopes it will be immediately adopt- ed in every part of the United States. BENJAMIN RUSH, m. d. Philadelphia^ Professor of Medicine in the December 3, > University of Pennsylvania. iladelphia,~\ xember 3, > 1801. ] AFTER the united testimony of the most celebrated medical characters of Europe, respecting the great importance of Vacci- nation in preventing the Small-pox, I can only say, any further opposition to its ge- neral introduction, must be viewed as aris- ing from a total ignorance of the subject. I think it impossible for a person to read the following treatise without a full convic- tion of the important truths it establishes ; and I most earnestly recommend its seri- ous perusal to every one who feels interested in the endeavour to extirpate that most destructive disease the Small-pox; which ii o» sure calculation, is said to prove fatal t© forty 'millions of souls in every century ! Every parent—every legislator ; every friend to humanity, is called upon to exert his in- fluence in behalf of the most surprising and most important discovery which has ever been made! As far as my experience, in between twenty and thirty cases, enables me to form an opinion ; I may safely assert, that this disease is of the mildest kind ; that it is not contagious ; and that, in the only experiment yet completed, the variolous mat- ter by Inoculation has certainly failed, after the system had been guarded by Vac- cination. One portion of the Vaccine matter, which has fortunately proved effective in this city ; I procured through the polite attention of Mr. Jefferson, to whom it was forwarded by Dr. Waterhouse of Cambridge. This gentleman first introduced it into America from England; and as it still continues to retain all its characteristic properties; we may safely conclude that no danger of its degeneration is to be apprehended, (as many have imagined,) by successively passing through the human system. JOHN REDMAN COXE, m. b. Walnut-Street, Dee. 4, 1801. PREFACE. The general intereft which every no- velty in the fcience of medicine excites in this country, whilst it affords a temporary fuccefs to impoftures of every kind, pro- duces this great advantage, however, that no very material improvement in the healing art, when once fairly brought before the bar of the public, is likely to fink into neglect, fo long as it poffeffes fuch intrinfic value as really to merit the patronage of the candid and liberal part of the community. It is to the credit of the inoculation of the cow-pox, that it has been introduced by no illiberal arts or imp irical pretenfions : on C vi 5 this little work to notice. The reader who is fond of thefe intereftingpurfuits will find feveral valuable hints in the excellent works that have afforded the materials for thfs compilation ; fothat both a confiderableim- mediate benefit to the health of mankind which the vaccine inoculation promifes, and the light which may be thrown by its means upon the fubject of contagion in general, render it highly worthy of the public atten- tion. Broad-Street Buildings. CONTENTS. CHAPTER I. QF THE NATURAL CR CASUAL COW-POX. I. OF THE Cow-Pox as affecting Cows, - 14 Pujluhs en the udder ariftng from fsveral eaufes, as ftnging of flies, &c. The genuine co-w-pox a difllnil difeafe from the a- hove; itsfymptoms andprogrefs in the co-w; parti of the kingdom in -which it hat been found ; its origin from the greafe ofhorfis as maintained by Dr. fenner, II. OF THE Cafual Cow-Pox as affecting the Human Species, - 33 Symptoms and progrefs of the di/order in perfons -who milk difeafei eo-ws—enumeration of the moft important points relative to this difeafe which are already fully eftablifhed—circumflances in -which the (ovi'pox refcmbles tbefmall-pott, and tboft vibartin it differs. vin CONTENTS. CHAPTER II. OF THE INOCULATED COW-POX. 51 The co-w-pox is rendered milder by inoculation—but equally pre- fervss ctgainjl -uatiolous contagion—^differences bet~'-'?en the cafual and. inoculated cozv -pox. The following ciroumjlances in conduilliig the vaccine inoculation confidered. -viz. ^elei5J:ioH of Matter—Proper Subje&g and Seafons for Inoculation—Method of performing this Operation—Progrefs of the Difeafe—varieties that occur, fuch as rajh, fubfequent ulceration of the arm, and a truly puf- tular eruption—eaufes of this latter fymptom. Medical treat- ment, -wh.it required for the general fever, and local fore—Me- thod of taking and preserving Matter for future Inocu- lation— Comparifon bet-ween the fmall-pox and co-wpox puftult in appearance and contents—eaufes of failure in vaccine inocu- lation and difinguifhing marks. CHAPTER III. GENERAL OBSERVATIONS CONCERNING VACCINE INOCULATION 109 Whether the coiv-pox is the parent difeafe to thefmall-pox—effeils of each difeafein exciting fcropbula—peculiar -value of the vaccine inoculation in not expofmg life to hazard—in luhat inflance the trariMus inoculation h preferable—conclufian\ A VIEW OF THE INOCULATION FOR THE COW-POX. CHAPTER J. OF THE NATURAL OR CASUAL COW-POX.- In feveral parts of this king- dom where cows are kept for the purpofes of the dairy, a peculiar erup- tive difeafe has been occafionally ob- ferved among the herd, affecting the udder and teats of thefe animals, which has pretty generally obtained the name of the coiv-pox. L 10 ; Till within thefe laft two years, the knowledge of this diftemper'has been chiefly confined to the perfons im- mediately employed in the dairies, and to farriers and cow-doctors prac- tifing in the neighborhood ; but, by the latter, it appears to have been obferved with considerable accuracy, and judicious means to have been employed for its removal. Wherever it has been known, how- ever, the circumftances which now render it an inquiry of the moft in- tereiling kind have likewife been re- marked : they are that the diforder is communicated, by actual contact, to the milkers who handle the teats of the difeafed cows, and from them again is often fpread through a nu- (") merous herd ; that, when affecting the human fpecies, it is not merely confined to the local difeafe of the hands and arms, but alfo occafions a general indifpofition, often fevere, but never fatal, which runs a regu- lar courfe ; and that the perfon who has once undergone it, is ever after fecure againft the infection of the fmall-pox, either in the natural way by contagion, or by inoculation. Thefe circumftances, efpecially the latter, appear to have been known, time out of mind, to the inhabitants of the particular diftricts where the difeafe has from time to time appear- ed, and only to thefe; a fact wor- thy of note in the hiftory of the fpread of human knowledge, and C 12 ; which might perhaps appear impro- bable, if we were not affured that the fuppofed Oriental method of Inocu- lation for the fmall-pox, foon after its introduction into England as a foreign invention, was difcovered to have exifted from time immemorial in a corner of South Wales not very obfcure or unfrequented.* The above mentioned facts relat- ing to the cow-pox have at different times been cafually communicated as curious circumftances in the hiftory of difeafe, to fome men eminent for their refearches into phyfiology. However, they failed to excite that * See Dr. Woodville's History of th$ Inocu- < lation of the Small-Pox, a work replete with cu- . rious and valuable matter. ( >3 ) high attention which they deferved ; till, in 1798, Dr. Jenner, of Berk- ley in Gloucefterfhire (a diftrict cele- brated for the extent and excellence of its daires) publifhed feveral high- ly curious and interefting particulars concerning this difeafe,* which have fully prefented it to general notice, and will not fail to place his name on the honorable lift of public bene- factors. The fubject having been fince il- luftrated by further remarks and ex- * See Dr. Jenner's Inquiry into the Causes and Effects of the Variola Vaccina , Sec. Lon- don, 1798 ; which interefting work is unne- cessary here to refer to continually, as a great part of its contents have been incor- porated in the following pages. A 3 ( 14) periments, both by the fame author,* and by other medical practitioners of acknowledged abilities, it may fairly be regarded as no longer in its infancy, and may claim from the public the attention due to every thing in which the general welfare is decidedly interefted. I. OF THE I COW-POX AS AFFLCTINO COWS. The cow, though in general a healthy animal, isfubject tofome pe- culnr dileafes, many of which foe probably owes to her domeiiication * See Further Observations on l,'a Vaiirfe , Varcvia, 1799, by Dr. Jenner ; and A Con- tinuation of Facts and observation? relative to the Variola Vaccina 1800, b" *>e same. ( *5 ) and intimate connection with man. Some of them have their feat in the udder, efpecially whilft it is perform- ing the important office of the fecre- tion of milk ; and thefe it is now become of peculiar confequence to attend to, and to difcriminate with accuracy. From the obfervations of thofe who are the moft converfant with this animal, it appears that there are feveral eaufes which may produce fores upon the udder and teats, efpe- cially fuch as excite any irritation upon thofe organs during the feafon when the fecretion of milk goes on with th** greateft vigour. The Hing- ing of flies, rough handling during milking, and other external irrita- tions of this kind, will often occafion fmall white blifters on the parts, which, however, never extend more than £kin-deep, and generally are very eafy of cure. Another, and a more ferious difor- der in thefe parts, is fometimes pro- duced by fuffering a cow, while in full milking, to remain for a day or two unmilked in* order to diftend the udder when naturally fmall. This is a common artifice practifed at fairs and cattle markets, in order to increafe the price of the cow, as a large udder is reckoned an important point in the value of the animal. By this cruel and unworthy fraud, the veffels that fupply this organ are kept for an unufual length of time in a ( 17 ) ftate of high diftention, and this fre- quently terminates in violent inflam- mation of thefe parts, fucceeded by large eruptions over the teats and udder, which fometimes leaves deep and troublefome fores. The matter difcharged from thefe ulcers will communicate a fimilar puftular difor- der to the hands of the milkers, when the fkin is broken in any part; and often effects them with foul and extenfive ulcers that fometimes occa- fion puftules on the arms and fhoul- ders, and prove tedious and difficult of cure. A fuppreffion of the milk in puerperal women often affords a parallel inftance of the formation of abfcefs, though in them the progrefs A 4 ( ,i8 ) and form of the local difeafe is fome- what different. But the genuine cow-pox is a dif- tinct difeafe from thofe which have been hitherto mentioned. It general- ly makes its appearance in the fpring, and fhows itfelf in irregular puftules on the teats or nipples of the udder. They are at firft of a palifJh blue, or rather a livid color, and contain a thin watery acrid fluid. The fur- rounding parts are fwelled, harden- ed, and inflamed. Thefe puftules are very apt, unlefs timely remedies be applied, to degenerate into deep erod- ing ulcers, which eat into the flejh, as the cow-doctors very properly term it, and conftantly difcharge a matter which commonly grows thicker as C *9 ) the difeafe lafts, and hardens into a fcab. Now and then the cow be- comes generally indifpofed, loff s her appetite, and gives lefs milk than ufu- al ; but it often happens that the diforder, though very fevere, is en- tirely local. W ith regard to the cir- cumftance of yielding lefs milk, it may be obferved, that this may per- haps be partly owing to the pain giv- en in drawing the nipples ; for the cow feems to have fome voluntary command over the yield of milk. It is a well known fact in dairies, that a perfon- who has a foft hand in milk- ing will draw more from the udder than one who handles it roughly. The £Olrt|#ors Senerauy fucceed in checkin^fciis diforder in its earlier ( 20 ) ftages, by applying to the fore fome ftrong and rather corrofive metallic ; folution, fuch as that of white or blue vitriol. The cow-pox never proves fatal to cows, nor is it infectious in the ufual manner of contagious dif- tempers, but can only be communi- cated to them, or to men, by actual contact with the fpecific matter from the fores. Hence it is, that cows which are not in milk efcape the dif- eafe entirely, though eonftantly in the fame field with thofe that are highly infected ; and, as far as oblervations have hitherto been made, it is only from the circumftance of the milker .. handling the teats of the found cows immediately after toucjiing thofe of the difeafed cattle, arid receiving 21 thereby on his fingers fome of the matter difcharged from the fores in their udders, that the cow-pox ever fpreads among the herd. This will explain another obfervation which has been made, which is, that the in- fection will often keep long confined to the cattle of a fingle farm, in the midft of other herds, and only fepa- rated by a hedge, fince particular milkers are employed in each. Both cows and men may fuffer under this diforder repeatedly, but, after the firft time of infection, the fucceeding attacks are generally much lefs viru- lent (to the human fpecies at leaft) and much eafier of cure. The cow-pox is more particularly diftinguifhed from the flighter fores ( ** ) of the udder by having a great ten- dency to produce a deep hollow fore; and differs from the other ulceration! of this organ, by a livid bluenefs which conftantly attends it, and per- haps by a peculiar characteristic ap-i pearance which is only to be learnt by actual obfervation. ■ This difeafe, in its natural ftate* is only partially known throughout the country, but is pretty widely dif- fufed; and, wherever it has been traced, the opinion of its being a prefervative againft the fmall-pox, when extended to the human fubject, feems to be equally prevalent. The cow-pox is familiar to the inhabi- tants of that highly valuable and ce- lebrated dairy country, the Hundred ( s3 ) of Berkley in Gloucefterfhire, where, fortunately for the public, it attracted the attention of Dr. Jenner. It has likewile been difcovered in various parts of the counties of Wilts, Somer- fet, Buckingham, Devon, and Hants; in a few places in Suffolk and Nor- folk, where it is fometimes called the Pap-pox * and in Leicefterfhire and Staffordlhire. It is not unfrequent in the very large milk farms contiguous to this metropolis, on the Middlefex fide. It is here obferved generally to at- * See An Incuiry concerning the Histiry of the Coiv-pox, by Dr. Pearfon, whofe early attenti- on to this fubjea, and zeal in the profecuti- on of it, have much contributed to the intereft whiclrtt has generally excited. ( 24 ) tack firft fome cow newly introduced into the herd, and is fuppofed to ori- ginate in a fudden change from a poor to a very rich and partly unnatural diet, which it is the practice to ufe in, order to bring the yield of milk to its higheft point. The cow-pox has likewife been known in Ireland, from time immemorial, and in the neighbourhoodof Cork, is called Sbin~ agh, a term which belongs to the ancient language of the country, and appears to have been applied to this difeafe, as far back as oral teftimony can be carried.* It has not yet been traced to the extenfive dairies of Chefhire, or to any of the northern * See the Medical and Physical Journal, \ vol. iii. p. 503, and vol. iv, p. 425. C 25 ) counties. Probably, however, it will be frequently detected in a much greater number of places than have hitherto been found ; for thofe that have been juft mentioned include a confiderable variety of country, and the difeafe has in general been rather Concealed by the fervants, and milk- ers, as throwing fome imputation on the neatnefs and good order of their dairies. Befides, as it is not a native of towns and does not naturally fall under the eye of the more obferving part of the community, and as its powers of contagion are very limited, and little calculated to excite alarm or general attention, the induftrious inquirer has a fair field open to him * 5 ( 26 ) for collecting much new and valuable information. The hiftory of the cow-pox would be imperfect, without mentioning the following very lingular origin which has been attributed to it by Dr. Jen- ner. The horfe is well known to be fubject to an inflammation and fuell- ing in the heel called the greafe, from which iffues a very acrid matter capa- ble of exciting irritation and ulcera- tion in any other body, to the fur- face of which it may be applied. This matter is fuppofed to be conveyed to the cow by the men fervants of the farm, who, in feveral of the dairy counties, affift in milking. One of thefe, having dreffed the horfe, goes immediately to bear his part in milk- ( =7 ) ing; and, having fome particles of the difcharge from the greafe upon his hands, he thus applies it to the udder of the cows; where, if the animal be in a proper ftate for receiving the infection, it produces that fpecific change upon thefe parts, which gives rife to the difeafe of the cow-pox. The origin here afcribed to this diforder is principally founded on the.circumftance that, wherever the cow-pox appears, the greafe is gene- rally found to have preceded it; and the opinion of the propagation of the dileafe from the horfe to the cow is likewife as commonly current in fome of the dairy countries, as thofe other oblervations concerning the difeafe which have been confirmed by accu- ( *r) rate examination. Still, however; we muft as yet confider this as one of the moft dubious of all the facts that have been advanced on the fub- ject; and nothing but pofitive ex- periment can give much affiftance in an inquiry purmed in a path fo little trodden, as that of the particular modifications which a difeafe affumes, by pafling through animals of a differ- ent fpecies. Among the collateral advantages to be derived from this- fubject, though not immediately con- nected with the adoption of the cow^ pox in medical practice, we may ex- pect with fome confidence to receive fome new ideas upon feveral momen- tous queftions which regard confca- (-v 1«* 29 ) gion in general ; a fubject highly in- terefting to the phifiologift. It may be mentioned, that, as foon as this opinion concerning the origin of cow-pox was ftarted by Dr. Jenner, attempts were repeat- edly made, to introduce the difeafe in the nipple of the cow by direct in- oculation of the recent matter of grease from the horfe's heel. The confequence, (when any) which fol- lowed this operation, was a flight in- flammation and the production of a fmall pimple or puftule, the common effect of a wound made with any poifoned inftrument, but which dis- appeared in a few days, without ex- citing the fpecific difeafe of the cow- A6 (3°) pox The failure of thefe firft experi- ments, however, could by no means overthrow the opinion which, if fuc- cefsful, they were meant to eftablifh ; fince it feems to be fully afcertained that a certain predifpofition in the conftitutioh of the-cow to receive the difeafe is alfo requifite for its produc- tion ; and hence it firft appears in farms only at certain feafons, chiefly the fpring, though, when once it has got footing in the heard, it will pro- bably be communicated by contagion at any time.* * Later experiments have decided this " point, for Mr. Tanner of the Veterinary- College has actually succeeded in produ- cing the disease on the nipple of the cow by inoculation with limpid matter, from the \ grease of a horse's heel, and the vaccine pus- tule thus produced was proved to be genuine, by infecting again both human subjects and cwttle. ( 3i ) We may add, that the matter dif- charged from the fores in the horfe's heel is like wife found to occafion, at times, very troublefome ulcers on the hands of the men that drefs it, attend- ed with a very confiderable degree of indifpofition; both of v/hich appear to be full as fevere as in the genuine cow-pox, and in many points to re- femble this latter dilorder. However, the perfon who has been infected by the horfe, is not rendered thereby entirely fecure from afterwards re- ceiving the fmall-pox; though it is certain that his liability to receive this contagion is much leffened.* On the whole, therefore, though we cannot reafonably doubt that the * See Jenner, parts 1ft. and 2d. { 32 y matter of greafe may often be the parent Of cow-pox, yet it ftill remains to determine, whether this is al- ways the cafe. The frequent ap- pearance of cow-pox, apparently in a fpontaneous manner, in fituationsi and circumftances very remote from any connection with the difeafed horfe, have been often urged with great force and unanfwerable weight againft admitting, as an univerfal truth, the origin afcribed to the cow- pox by Dr. Jenner. II. OF THE CASUAL COW-POX AS AFFECTING THE HUMAN SPECIES. , Thofe puftular fores on the udder and teats of the cow, which confti- ( 33 ) tute the genuine cow-pox, (whatever be the way in which they are pro- duced) are found, by undoubted ex- perience, to poffefs the power of infecting the human fubject, when any part of the body, where the fkin is broken or naturally thin, comes into actual contact with the maiter which they difcharge. Hence it is that, with the milkers, the hands are the parts that acquire this diforder accidentally, and it here exhibits the following appearances : Inflamed fpots begin to appear on the hands, wrifts, and efpecially the joints and tips of the fingers; and thefe fpots at firft refemble the fmall blifter of a burn, but quickly run on to fuppuration. The puftule is quite circular, de- (34) preffed in the middle, and of a blueifn color, and is furrounded with a confiderable rednefs. The blue color which the puftule almoft invariably affumes, when the difer- der is communicated /directly from the cow, is one of the moil characv teriftic marks whereby the genuine cow-pox may be diftinguifhed from fome other difeafes which the milkers are likewife liable to receive from- the cow. The matter of the puftule is at firft thin and colorlefs; but, as the diforder advances, it becomes browner and more purulent. In a few days from the firft eruption, a tendernefs and fwelling of the glands in the arm pit come on, and foon after, the whole constitution becomes X IT ) difordered, the pulfe is increafed in quicknefs, and to this fucced fhiver- ings, a fenfe of wearinefs, and aching pains about the loins, vomiting, head- ach, / and fometimes even a flight de- gree of delirium. Thefe fymptoms continue with more or lefs violence from one day to three or four, and, when they fubfide, they leave ulcerated fores about the hands, which are very apt to become ill-conditioned and heal very flowly ; refembling, in this re- fpect, the ulcers on the nipple of the cow, from which they originate. It is to be obferved, that the cow- pox eruption, though very fevere on the hands, and though occafioning much general ilinefs, never produces ( 3« ) a fpontaneous crop of puftules over diftant parts of the body, as the fmall-pox does. It does, indeed, often happen, that puftules are fornH; ed in various places which accident- ally come in contact with the difeafed hands, as on the noftrils, lips, and other parts of the face, where the fkin is thin j or fometimes on the forehead, when the milker leans with that part upon the udder of an infected cow. From this account, it appears that the cow-pox, as it affects the milkers, or what may be termed the cafualt cow-pox in the human fpecies, is often a fevere diforder, fometimes confining the patient to his bed during the period of fever, and gen* C 37 ) erally leaving troublefome fores; but it has never been known to prove fatal; nor are thefe fores, if properly attended to, followed with any lafting injury of the affected parts, though they fometimes leave fears for life. The very accurate inveftigation which this diforder has lately under- gone, has eftablifhed fome very im- portant points relative to its peculiar nature, which require to be particu- larly noticed, as upon them is found- ed the profpect of invaluable benefit which may arife to the public at large from fubftituting the inoculation of this difeafe to that of the fmall-pox. B ( 38 ) The following facts may be con- fidered as fully afcertained by the faireft experiments and moft accurate obfervations: Firft. The cow-pox in its natural ftate, or, when propagated immedi- ately from an infected cow to the hands of the milkers, is capable of affecting the human fpecies repeated- ly to an indefinite number of times; but, after the firft attack, it is gene-< rally much milder in its fymptoms, and efpecially it is much lefs liable to produce the fever and general indif- pofition which always attend the firft infection. There are inftances, how- ever where the fecond, and even the third attack has been as fevere in every refpect as the firft; but thefe are very rare._______________________ ( 39 ) Secondly. The fmall-pox in a con- fiderable degree fecures a perfon from the infection of the cow-pox, and in this refpect appears to act in a man- ner very fimilar to a previous attack of the latter difeafe ; that is, to con- fine its operation to the formation of local puftules, but unattended with general fever. Hence it is, that where all the fervants of the dairy take the infection from the cows, thofe of them, who have previoufly undergone the fmall-pox are often the only perfons among them able to go through the ufual work. Thirdly. The cow-pox, in its genu- ine ftate, when it has been accom- panied with general fever, and has ( 40 ) run its regular courfe, ever after pre- ferves the perfon who has been in- fected with it from receiving the fmall-pox in any manner in which this diftemper can be communicated. This moft important fact, which has been the fubject of popular obferva- tion in feveral parts of the kingdom, long before the introduction of the cow-pox in medical practife was thought of, and therefore has the ftamp of unhiajfed evidence, may be now afferted with that confidence, which is given by the uniform refult of the moft candid examination, con- ducted with fcrupulous care carried to a confiderable extent, and authen. ticated by teftimony of many years ( 4i )'" ftanding.* This affertion is however to be taken with exactly the fame limitations as that of one infection with the fmall pox preventing a fe- cond attack of the fame difeafe. No previous infection will entirely coun- teract the local effect on the arm, produced by the infertion of vario- * See Jenner, Woodville, Pearson, and every other writer on the subject, for numer- ous cases to this point. These from the dai- ry countries of persons who took the cow- pox when young, by milking infected cows, and afterwards were frequently exposed to the variolous contagion in every possible way, are among the most striking and deci- sive examples. In several cases related by Dr. Jenner, the distance of time between the first infection and the subsequent attempts to infect, has been twenty, thirty, and even fifty years. B .2 ( 42 r lous matter in common inoculation; this may in a few cafes even go fo far as to induce a degree of general re- ver, flight indeed, but perhaps equal to that of the mildeft indifpofition caufed by a firft infection with this diforder. By the inoculation of ei- ther difeafe, however, the fmall-pox is equally and completely difarmed of its virulence againft any fubfe- quent attack; which, in fact, is the circumftance which renders this oper- ation fo peculiarly defirable. Fourthly. A comparifon of the two difeafes as to the mildnefs of their fymptoms, and the hazard to life which they may occafion, will fhow a very decided advantage in favor of the cow-pox.. Compared ( 43 ) with the natural fmall-pox, the na- tural or cafual cow-pox is both mild- er, and beyond all comparifon fafer; as no fatal inftance of the cow-pox as it affects the perfons employed in dairies, has ever been recorded. When both difeafes are introduced by artificial inoculation, they are each rendered much lefs fevere, and here too the cow-pox preferves the fame fuperiority as a fafer and milder difeafe. Fifthly. The cow-pox even in its moft virulent ftate, is not communi- cable by the air, the breath, by efflu- via, or in fhort, by any thing which conftitutes contagion in the general eftimation of this term; but can t 44 ; only be propagated by the actual con- tact of matter from a cow-pox puf- tule, with fome part of the body of the perfon who receives it. We can- not exactly determine whether in all cafes an inferiion of the fpecific virus under the fkin be neceffary; at leaft we know that when the infect- ing matter is in its moft active ftate, as it is when formed in the cow's udder, the vafcular fkin which covers the lips and noftrils readily takes the ■, infection without being broken. In this refpecT therefore the cow-pox virus feems to equal that of the fmall-pox in activity, for the latter will readily produce the difeafe when merely introduced .within the not ( 45 ; tril ;* but the ftriking difference be- tween the two difeafes in the non-con- contagious nature of the cow-pox is a fact that is fully and fatisfactorily afcertained. In the idairy farms, in- fected fervants fleep with the unin- fected : infants at the breaft have re- mained with their mothers whilft on- ly one of the two have had the dif- order upon them,-|- and in no in- ftance has the difeafe of the one been communicated by contagion to the other. * This is the method of inoculating in some of the eastern nations. t Mr. Henry Jenner gives his testimony to this fact from experiments made by him for this express purpose. ( 46 ) A review of the facts that have been advanced will fhow a number of points in which the fmall-pox re- fembles the cow-pox in a very ftri- king manner ; but it will at the fame time mark a very decided difference in others. Both the difeafes are puf- tular, that is, they produce inflam- mations of a fmall extent, which gradually increafe, and naturally and fpontaneoufly terminate in the for- mation of matter : they both agree moft ftrikingly in occafioning general fever, which comes on whilft the puftules are advancing towards a ftate of fuppuration; and they fhow a confiderable fimilarity of nature by c 47 ; the change which each makes upon the conftitution, fo as in one cafe en- tirely, in another, to a confiderable degree,,to prevent the body from re- ceiving the fame or the other difeafe a fecond time. Another point of re- femblance is that, each diforder is rendered much milder by inocula- tion, which likewife obferves in each nearly the fame period in its various changes ; alfo that fome and the fame perfons refift entirely each infec- tion from fome peculiarity in the con- ftitution which cannot be explain- ed ' ;* and laftly, that a certain pro- * Dr. Woodville, whose experience on this subject carries the highest authority, estimates the number of those that resist ( 48 ; greflive advance of the local affection, together with the regular acceflion of the febrile fymptoms at a ftated time, is requifite in each, in order to pro- duce that change upon the animal frame which tends to prevent a re- currence at any period of life. With regard to the points in which'.i the two difeafes differ, fome are only> in degree ; as, that the fmall-pox^ entirely prevents its own recurrence^ (one or two rare cafes excepted) but i only partially renders the conftitution! unable to receive the cow-pox : and : vice verfa, that the cow-pox : com- < common inoculation for the small-pox to be ' about one in sixty, and these also resist the i reception of the cow-pox. Observations en the Cow-Pox. C 49 ) pletely preierves the body from the infection of the fmall-pox, and makes it only lefs fu.fceptible of a repetition of the fame difeafe. But the moft Itriking point of difference, and that which renders the cow-pox fo pecu- liarly valuable as a fubftitute for the other, is, its not being communicable fry effluvia, or by any other method than by actual inoculation or contact iwivh the fpecific puftular matter. It is this circumftance which gives it its i^reat importance, confidered in an enlarged and extenfive view; fince, iby adopting this difeafe to fupply the place of the fmall-pox, all the dread ind all the mifchief that is occafioned 6y the unfeen agency of an active and B3 ( So ) formidable contagion is entirely re- moved ; no anxious precautions are required in order to avoid and infu- late an infected perfon, whofe breath can fpread difeafe on every fide; and thus too the time of communicating, the infection, which is ever after to afford complete fecurity againft the variolous contagion, may be felected fo as at all times to fecure the mojf favorable condition of the body. ( 5« ) CHAPTER II. ON THE INOCULATED COW-POX. JcLvery one is acquainted with the important diftinction which exifts between the fmall-pox as propagated by contagious effluvia, and that com- municated by artificial infertion of matter beneath the fkin ; and the decifive advantages which the inocu- lated difeafe poffeffes over the natural areuniverfally acknowledged, though the precife caufe of the fuperior mild- nefs of the former is as yet but im- perfectly known. ( 5* ) The comparifon between this dif- eafe and the cow-pox entirely fails in the circumftance of contagion ; for,J as has been before obferved, the lat- ter has never been obferved to be communicated in this method; and therefore, too, the term natural cow- pox cannot be employed in the fame diftinctive fenfe, as when applied to the variolous infection. d It is a curious and important fa£t,i however, that the operation of in-1 oculating with the cow-pox virus, performed in the fame method as is ufually practifed with that of the' fmall-pox, appears to produce a very * fimilar change with regard to render- ing the difeafe more uniformly mild C 53 ; and favorable ; though it cannot, like the other, fhorten the period between the firft moment of infection and the time of affecting the conftitu- tion in general, fince the cow-pox in its moft natural ftate, as it affects the milkers of difeafed cattle, is really re- ceived by a kind of inoculation, [though accidental. Therefore, as fome very character- (iftical differences in the form of the jdiforder depend on the mode in which the cow-pox is introduced into the humanfyftem, we maybe allowed to tmark that diftinaion by employing the term natural, or rather cafual, cow-pox in the human fpecies, to exprefs that difeafe which is contract - B 4 ( 54~> ed by thofe who, in milking, handle the teats of an infected cow ; and ufing the phrafe inoculated cow-pox, to imply that diforder which is excited,; by the artificial introduction beneath the fkin of fome of the fpecific mat- ter fecreted by a cow-pox puftule, ei- ther in the cow, or more commonly \ in another human fubject. As it is this form of the cow-pox with which the public are, and will be, the moft concerned, and which will probably* be adopted to aflume a confpicuous place in medical nofology, there will be no great impropriety in confining to this form the term vaccine difeafe,, which will exprefs its origin from the cow, though probably it may never be T sT ) # again neceffary to return to the pa- rent ftock in this animal. In treating of this difeafe as com- municated by inoculation, it is firft neceffary to fhow that, in this form of the diforder, all the advantages are infured which attend the cafual cow- pox ; and it is not difficult to prove that the difeafe is as much the lame in thefe two forms, as that the natural fmall-pox is the fame diftemper as the inoculated. In the cow-pox, the courfe that is run by each is very fimilar ; they each produce a general fever at a certain period, and the puftules in each equally fecrete the fpecific virus which alone can commu- nicate the difeafe to others by fubfe- ( 56 ) quent inoculation. What is very re- markable, and unparalleled in the hiftory of difeafe, is, that the cow-pox virus, after having paffed through fe- veral perfons, may be again commu- nicated to the cow by direct inocula- tion in the nipples ; and this again i will return to the ftate of cafual cow- pox, in the milkers who handle the udder of the animal thus difeafed,{; which abundantly proves that the na- '• ture of the infection continues the fame under thefe varieties.* Hence we fhould expect that the fecurity which the inoculated cow-pox af- fords againft the contagion of the fmall-pox, (which conftitutes its chief * See Woodville's Reports, hfc. of Inocula- tions for the Coiv-pox, page 62. ( 57 ) value") would be equal to that which the cafual cow-pox infures, and ac- cordingly this is confirmed by the moft authentic and unequivocal tefti- mony.* From the comparatively re- cent date of the experiments made with the inoculated cow-pox, the au- thority of forty or fifty years (which the other form of the difeafe poffeffes in the dairy countries) is wanting. But as the very end of all thefe trials * To quote particular authorities for this fact, would be to refer to almost every ac- count which has been given of every inocu- lation made in different parts of the king- dom with vaccine matter ; as in fact they would be all quite futile without the experi- mentum crucis of resisting variolous contagion, ( 5» ) has been to prove the vaccine inocula tion to be a complete prefervativc; from the variolous contagion, and as they have been attended with entire fuccefs, there is no reason to fuppofe that any number of years will pro- duce fuch an alteration in the confti* tution, as to renew the hazard of variolous contagion in any habit where it has been once completely extinguilhed. The uniform expert ence of inoculation for the fmall-poX| which may be recurred to by fair analogy, would contradict fuch a fuppofition. Like this latter difeafe,i too, certain precautions are to be taken, and obfervations made, in order to diftinguifh the cafe of a fpu- ( 59 ) rious and incomplete cow-pox, from that which is perfect and genuine. The chief differences which exift between the cafual and the inocu- lated cow-pox are in the degree in which each affects the body. As much of the feverity of the difeafe depends on the extent of topical ulceration, the former, by producing larger and deeper puftules, generally occafions a much fever er difeafe ; and thefe likewife are more liable to leave deep and extenfive fores, long after the eruptive fever is fubfided, which are difficult to heal. Another differ- ence between the two forms of this difeafe is in the appearance of the puftules. Thofe which are formed ( 60 ) by immediate infection from the cow are more prominent, and have a blueifh caft, which is very charac- teriftic. This particularly happens in the cafual difeafe, though it is alfo retained in the firft inoculation from^ the cow,* but is undiftinguifhably loft after it has paffed through one generation (if it may be fo called) in the human fubject. There are feveral important cir- cumftances belonging to vacine in- j oculation, which deferve the atten* * Woodville. ( 61 ) tion of the medical practioner, and which require to be given in detail with that minute and circumftantial defcription which alone is able to give afiiftance in directing real prac- tice. Thefe will be conveniently ar- ranged under a few diftinct heads. Of the Seleclion of Matter. Dr. Jenner has laid down with great precifion thofe fources of the fpurious or imperfect cow-pox, that idepend on the ftate and nature of the infecting matter employed for inoculation ; and fubfequent obfer- vationhas proved more than ever the neceflity of attending to this part of the fubject. They are ; B S ( 62 ) Firft. When the puftule that af. fords, the matter is not the genuinl fpecific cow-pox. This it is of greal importance to be aware of, botM when the difeafe is to be introduced immediately from the cow, and froiq the human fubject. As we often find that almoft any acrid matter from any kind of puftule, when applied by inoculation to a found furface, wil there excite inflammation and a pui tule fore, a miftake as to the naturi of the virus thus introduced migh eafily happen, and would lead to much error andfalfe fecurity with re- gard to variolous contagion. Thii diftinguifhing marks of the true dif- order in the cow, have been alread ( 63 ) mentioned. Thofe which character- ife the genuine diforder in the human fubject, will be afterwards enume- rated. Secondly. When the matter is ge- nuine, and would be perfectly unex- ceptionable if employed on the fpot, but by being kept in a manner favor- able to fpontaneous alteration, or pre- ferved in a carelefs way, it has loft its , fpecific properties. This will apply ,to infecting virus procured either from the cow or the human puftule; and from the frequent failure of mat- ter to produce the difeafe, when it has been kept for a certain length of time, though with care, it feems to be probable that the vaccine virus is ( 04 ; more liable to lofe its peculiar pro. perties than the variolous and requires * greater precautions to be preferved in fufficient activity. This" circunv fiance, however, (that is where good and proper matter has loft by keep- ing, its power of giving the genuine infection ) is much more commonly a fouice of total failure to produce any effect from inoculation, than of ex-j citing a fpurious puftule, provide J the matter had been taken at a pro- per period of the diforder, and in the moft unexceptionable manner. Thirdly. When the matter has been' taken from a true cow-pox puftule, but has been furnifhed, not by the clear limpid fluid, which forms the (65) contents of the puftule in its earlier ftages, but by the purulent matter * *vhich is to be found under the fcab 'at that advanced ftage of the difor- der, when all the firft fluid is dried up, and the puftule has either degen- ierated into a fimple ulcer, or has loft hits infecting properties. This par- ticularly applies to the difeafe of the human fubject, but both in man and fein cow, it is not very eafy to fix the iiexact limits, when the local affection teeafes to have any thing fpecific in its nature, and confequently to have Kthe power of communicating the dif- ieafe. b 6 t: [ (66) Thefe three circumftances (in any of which a partial and therefore high- ly deceitful difeafe may be excited by fpurious inoculation) will direct the practitioner in the choice of the mat- ter which he employs. The uniform mildnefs of the ino- culated vaccine difeafe has hitherto1 afforded no grounds for any fuch diftinction as good or bad, a healthy, or unhealthy fort of matter, whicffl obtains (perhaps without foundation)! in the fmall pox; and no perceptible! difference of quality has been afcer- tained, between matter procured from the inoculated puftule as foon as it begins to afford any fluid, and that which is taken juft at the time ( 67 ) when it is receding, and the fcabbing procefs commences. We may add, that hitherto no fuc- ceflive inoculations from one human fubject to another have made iny alteration, either in the nature of the diforder, or the appearance of the puftule after the firft time, of infertion from the animal; when, as has been mentioned, it retains fome of the character of the cafual cow-pox. Therefore, as long as the fupply of vaccine virus is kept up by propagat- ing the genuine difeafe through fuc- ceflive inoculations, there will be no occafion to return to the cow for a new parent ftock. ( 68 ) Of the proper fubjecls and feafons for Inoculation.' i The vaccine difeafe, when proper- ly introduced by inoculation, appears to have almoft as great a fuperiority in point of mildnefs and fecurity over the variolous inoculation, as this has over the natural fmall-pox: fo that the fame precautions which would I be highly requifite in communicat- ing the latter, (where the time can be chofen) become lefs fo where the diforder is to be introduced by ino- culation; andftill lefs where the vac- cine is fubftituted for the variolous difeafe. The experience which the ( 69 ; inoculated cow-pox already affords, feems to fhow that it may be prac- tifed with great fafety at any age, even from the earlieft infancy.* In general we may fay that fimilar pre cautions are to be ufed here, as with variolous inoculation, fo that even the vaccine dileafe fhould be avoided during the time of teething, or any particularly unfavourable ftate of bo- dy ; but we may afiert with confi- dence that at any time it is preferable * Mr. H. Jenner inoculated with the cow pox an infant a few hours old. The chile! went through the disease with the usual ap- pearances in the pustule on the arm, but without any perceptible fever. It after- wards, however, resisted the small-pox com- pletely. ( 7°) to running any confiderable rifle of the fmall-pox contagion. Of the method of performing the Inocula* tion. The object to be fulfilled in per- forming this operation is to fecure' the infertion of the infectious matter, with as little injury to the parts as is compatible with the end propofedJ Uniform experience fhows that in inoculating either with this or vario-, lous matter, the method of making j the incifion is not a matter of indif- ference ; for, on the form and depth of the wound will in fome meafure depend the degree of violence in the C 7' ) fubfequent inflammation. In mak- ing the puncture in the arm, we can- not follow a better method than that recommended by Dr. Woodville,* who advifes " that the lancet fhould be held nearly at a right angle with the fkin, in order that the infectious fluid may gravitate to the point of the inftrument ; which in this direc- tion fhould be made to fcratch the cuticle repeatedly, until it reach the true fkin, and become tinged with blood.,, The moft certain method of fe- curing the infection is to inoculate whilft the matter is fluid, and frefh * Observations on the Cow-Pox, 1800. ( 7* ) iom the puftule} but as this is of. : :n impracticable, it is advifable to hold the infected lancet for fome time over the fleam of boiling water, ro foften and diffolve the hardened; .latter. Where the virus has been, procured upon thread, the famt r.eans are to be purfued as when inoculating with variolous matter; at is, to make a fmall longitudinal ■ ifion upon the arm, to apply to •t the infected thread, and detain it 1 :'.ere by adhefive plafter, till the dif-i c-fe is communicated. This method^ is found to be more apt to fail than' cken the matter is received upon a i .cet. provided it be fluid from the iftule ; but dried matter will fel- * dom lonar Dreferve its efficacy, except ( 73 ) it be taken and kept with particular precautions. Thefe will be men- tioned in a fubiequent fection. Progrefs of the Difeafe. The progrefs of the vaccine inocu- lation, from the time of infertion to tthat of the drying up of the puftule, is commonly very uniform, the dif- ferent ftages of the local and general affection well marked, and the fuc- jxeflive changes occur for the moft j part at regular periods. The fol- lowing therefore may be confidered ^as the hiftory of this diforder which ( 74 ) will reprefent the moft ufual progrefs, of the vaccine inoculation. The firft indication of the fuccefi; of the operation, is a fmall inflamed,' fpot at the part where the puncture has been made, which is very dif- tinguifhable about the third day; this continues to increafe in fize,^ becomes hard, and a fmall circular tumor is formed, rifing a little a- bove the level of the fkin. About. the fixth day, the centre of the tu- mor fhews a difcolored fpeck, owing to the formation of a fmall quan- tity of fluid, and this continues ( 75 ) to increafe and the puftule to fill, and become diftended, till about the tenth day. At this time it fhews in perfection the characteriftic features which all along diftinguifh it from the variolous puftule. Its fnape is circular, or fometimes a little oval, but the margin is always well defin- ed, and never rough and jagged; the edges rife above the level of the fkin, but the centre is depreffed, and has not that plumpnefs which marks the fmall-pox puftule. As foon as the puftule contains any fluid, it may be opened for future inoculation, and about two days before and after the eighth day affords a period of four ( 76 ) days, when the matter is found to be in its greateft activity. After the eighth day, when the puftule is fully formed, the effects; on the conftitution begin to mew themlelves, the general indifpofi- tion is commonly preceded by pain it the puftule and*in the armpit, fol- lowed by head-ach, fome fhivering., lofs of appetite, pain in the limbs, and a feverifh increafe of pulfe. Thefe continue with more or lefs violence for one or two days, and- always fubfide fpontaneoufly without leaving any unpleafant confequence. During the general indifpofition, the I puftule in the arm, which had been ( IT ) , advancing to maturation in a regular uniform manner, becomes furround-' I ed with a circular inflamed margin, , about an inch or an inch and a half broad, and this blufh is an indication that the whole fyftem is ' affected; for the general indifpofi- tion (if it occurs at all) always ap- pears on, or before, the time when the efflorefcence becomes vifible. Af- ter this period, the fluid in the puf- tule gradually dries up, the furround- ing blufli becomes fainter, and in a day or two dies away imperceptibly; fo that it is feldom to be diftinguifh- ed after the thirteenth day from in- oculation. The puftule now no longer T W J increafes in extent, but on its furJ face a hard thick fcab of a brown or j mahogany color is formed, which,! if not pulled off, remains for nearly ( a fortnight, till it fpontaneoufly! falls, leaving the fkin beneath per-1 fectly found and uninjured. 1 The above is the uniform progrefs j of the difeafe in the greater numbed of cafes, with onr£ the variation of a day or two in the periods of the dif-i ferent changes. The fucceflive alter- ations that appear in the local affection appear to be more conftant, and more ; neceffary to the fuccefs of the inocu- lation, than the general indifpofition. ' ( "^ ) With regard to this latter, the de- gree is very various; very young infants often pafs through the whole Idileafe without any perceptible ill- nefs;* with children it is extremely Jpioderate; but with adults it is fometimes pretty fevere for a few hours, though never in any degree ►dangerous. F. ___________________________________________________________ 't Among the occasional circumftan- ces and varieties which now and then [occur, and which the practitioner 'mould be aware of, though they do r * See note, p. 69. (~8 a perfect refemblance to the diftinct [puftules which are formed in the fmafl-pox in its moft favorable ftate. . , * In the Rev. Mr. Holt's inoculation, (Me- [dical Journal, No. \0) three cases out of • three hundred proved to be pustular: but , in a subsequent inoculation of eight children with the matter taken from these pustules, no such appearance was produced,^ but the dis- \ ease assumed the mildest form. See also note, p. 69, and Dr. Woodville's Observations. ( 88 ) Medical Treatment. It is a particular recommendation of '• this difeafe, that, though much atten- j tion and difcrimination be neceffary in felecting the matter for inoculation, and performing this flight operation in fuch a manner as to infure fuccefs and (as we fliall prefently mention) in afcertaining, in fome doubtful cafes whether or not the infection has fully taken, very little medical care is necef- fary in order to conduct the patient through it with perfect fafety. Much of the hazard incurred in the fmall pox is owing to a larger eruption upon the fkin than the conftitution can fup- port; and the degree of rifk to life is T"89 ) ; in a great meafure proportioned to , the quantity of eruption : whereas, in the cow-pox, this fymptom may [for the moft part be avoided, by guarding againft fome of the eaufes "which produce it, and is feldom fo fe- vere as to give any ground for alarm. The inoculated vaccine difeafe, iwith infants and children, is uni- formly mild during the whole courfe trom the firft infertion to the fcab- bing procefs : and even in moft cafes is attended with fo little fever as fcarcely to be detected even by an (attentive eye, and requires no medi- cal treatment. Indeed, as the great .object is to produce the difeafe in a form fo perfect as to leave no do ubt ( 90 ) about its appearance, and abfolutely to fecure the patient from any fubfe, quent contagion of fmall-pox, it feems hardly advifable to take any meafun to check the approach of fever about the eighth day, any otherwife than bj preferving ftrictly that ftate of tem- perance, which well regulated chil-J dren are generally kept to during the earlier part of life. Therefore, the; preparing medicines which ufualr] make a part of the remedial procel during inoculation with the fmalLi pox, are fcarcely requifite here, efpej cially when children are the patients; except in thole habits that fuffer con- fiderable at all times from any febrile' attack. When the fymptoms of fever ( 9< ) *are manifeft, and threaten to become at all fevere, a brifk purgative, fuch &as a dofe of falts, generally produces |yery fpeedy relief. This is particu- larly ufeful when the ' patients are ^adults. V In the fmall-pox, after the eruptive \ fever has fubfided, the puftule formed ; by inoculation is apt to degenerate tinto a tedious fore, and even abfceffes *form in the arm, which, in infants, ^have fometimes been followed by the [ moft ferious confequences. The fame i caufe of complaint exifts in the ino- sculated cow-pox, but the inflamma- tion may generally be checked with- \ out difficulty, before it proceeds to any great height. ( 9* ) When the efflorefcence comes on around the puftule about the tenthij day, and the fever has fubfided, we J may confider the conftitution as having done with the difeafe fori every purpofe of future fecurity;, and therefore the local affection of ^ the arm may be put an end to, as foon as it can be done conveniently, j In by far the greater number of cafes, j the fcabbing or cicatrization fucceeds the puftular procefs with perfect re- 4 gularity. Where this happens, no application of any kind to the parts fhould be employed; but, when the inflammation increafes, when ' the inoculated puftule becomes pain- (" 93 T [fill, and the arm ftiff, the mifchief i that is then threatened, may, if ne- glected, give more trouble and indif- pofition than all the preceding part of the difeafe. To prevent this, feveral local ap- plications to the puftule may be em- ployed, all of which for the moft part check the inflammation very readily ^and induce the healing procefs. Mercurial applications, from analo- jgy with their known good effects in the local ulcers of the fmall-pox, have toeen tried, and with great fuccefs. The part affected fliould be daily adreffed with common mercurial oint- ment, or, what is a more active preparation, the Red Precipitate (94 ) of Mefcury, f Hydrafgyrus FfitratuA Ruber) in the form of an ointment.1 In two or three days after ufing thin remedy the fore generally puts on a better appearance, and becomes diM pOfed to heal, after which a fimpld drefling may be employed. J In many cafes, however, nothing! more is neceffary to check the threat-^ ening inflammation, than to keep the part conftantly moiftened with vine- gar and water, or Goulard's extrael and water, till the poftule is dried up* and only a hard fcab left. In order to put a fpeedy period to the local diforder when no longed neceffary, it has been recommended,*1 by Dr. Jenner and others, to apply T — ■ ( 95 ) for a very fhort time fome very active and corrofive folution, which may haft en the procefs of cicatrization, and prevent any trouble that might arife from frefh ulceration at the puf- tule. A drop of ftrong vitriolic acid taken upon the head of a probe and thus applied to the puft Je for a few feconds, and afterwards walhed off; or the undiluted Goulard's extract CAq. Lithargyri Acetatt) will anfwer Ihis purpofe, and fhorten the cure of [the local diforder. It is to be ob- fferved, however, that it is only very 'rarely, and in unufual inflammation protracted beyond the eighth or tenth day, that we fhould employ any of thefe remedies: and we fhould alfo ( 96 ) be aware that, as they will any timej induce a premature fcabbing, theyl would in all probability, if ufed too»j early, entirely extinguish the difeafe before it had rendered the conftitul tion fecure againft the variolous con-H tagion, and thereby the end of the; vaccine inoculation would be de^ feated. Method of taking and preferring Matter^ for future inoculation. ! There are few practitioners of the • vaccine inoculation, who have not ex-tf perienced repeated difappoinlments i in attempting to introduce this in-i fection, from the circumftance of the ( 97 ) virus lofing its efficacy in a very fhort time after having been taken from the puftule. This certainly depends in many inftances on a want of ac- tivity in the matter itfelf,for frequent, failures have happened, even where every poffible precaution has been obferved, and where no great dif- tance of time has occurred between the time of taking the matter and the attempt to inoculate the difeafe. And yet it has alfo happened, that the inoculation has fucceeded, with mat- ter preferved with no unufual care, and even after having been carried eacrofs the Atlantic. A few obfer- ivations may therefore be made with regard to the method of taking and ( 98 ) preferving the infecting matter. Where the virus is to be ufed directly after being taken from the puftule, nothing is fo convenient for receiving it as the lancet with which the fubfe^ quent inoculation is to be performed^ and it has frequently happened that this method of inoculating has fucceeded,, both with variolous and vaccine mat- ter, after repeated failures from every other method. As, however, this mode cannot always be conveniently ufed, the matter muft be allowed to dry on the fubftance on which it is received, and afterwards diluted with water, that it may be fufficiently li- > quid for infertion. A lancet will J very commonly anfwer the purpofel ( 99 ; '« in this cafe alfo, if ufed within a fvery few days after the matter has I been taken ; but it feems to be well l^ftablilhed by repeated obfervation, 1 that this method is very precarious 'for conveying infection to any con- .liderable diftance, or for fome length : of time before it is to be ufed. It I becomes then much fafer, either to Kmoiften a piece of cotten thread in ' the matter frefli from the puftule, or [ to receive it upon a fmall plate of glafs, over which, when the matter is dry, another piece of equal fize fhould be laid. In all cafes the li- quid virus fhould be fuffered to dry gradually and thoroughly in a warm temperature, and then fhould be ( 10© ) fecured from the accefs of air by cementing together with fealing wax,, or fome fimilar fubftance, the plates of glafs, or by well clofing the phial into which the thread is put. Preij vious to inoculating from the glaffifl plate, the matter muft firft be diluted . with a very minute drop of warm water, well mixed by the point of a lancet, which laft fhould then be made to take up as much as will be neceffary for inoculation, and held wiih the point downwards, till the fluid which is upon it has acquired rather a thicker confiftence. After which, the puncture may be made in the manner already mentioned. It may be obferved, that though we i "icil 7 fhould avoid doing fuch violence to the puftule which furnifhes the matter, as to make it bleed, yet the virus itfelf does not feem to lofe any of its infecting power, by being accidentally mixed with a drop of blood.* * As the circumstance of the vaccine vi- rus becoming very hard and not easily a- gain soluble when once dry, has been consi- dered by some, as a principal cause of the 1 frequent failure in this inoculation ; an in- genious friend of mine has suggested, and in one instance attempted, a method of pre- serving the matter in its fluid state, by re- ceiving it in a very minute hole, not bigger than a pin's head, drilled in glass, and care- fully cementing the hole again, to prevent the inclosed matter from drying by evapo- X" "f\SfaT There is only one way of tranfinit- ting this infection from one country to another, which is ftill more fecure than either of the above, and this is,- to keep up a conftant fucceffion oil puftules by inoculation of different: perfons (on board of fhip for inftance) which may be done at all times with- out the leaft rilk of any general in- fection, and with very flight trouble ■ and inconvenience to the perfons fo] inoculated. As a perfect puftule 1 may commonly be formed, by inocu- lating perfons who have already had ration. From some imperfection in this'] minute apparatus, the first experiment fail- ed, but the idea merits attention. the fmall-pox, though they are un- fufceptible of any general vaccine diforder, the feries of infection may be kept up, though proper fubjects for the difeafe be wanting. To conclude the comparifon be- tween the variolous and the vaccine difeafe, we may obferve that there are two points in which they differ very fenfibly ; in the form, and con- tents of the puftule. That which is formed by vaccine virus, in by far the greater number of inftances, con- tinues perfectly circular during its whole progrefs j at all times the ( io4 ) edges are elevated, and the furface. flat, and it does not fhew that promi-j nence in the centre which arifes from being quite diftended with its- contained fluid. The fmall-pox pu& tule at the place of infertion, whilef advancing to maturation, generally becomes jagged at its edges, and the i outline is rendered irregular by cluf-j ters of fmall puftules. Thefe, in the end, often become confluent, and leave a fore of a much greater extent than that of any fingle puftule, the fubfequent progrefs of which, as has been mentioned, is frequently the caufc of much trouble, and fometimes! of danger, to infants. The inoculated cow-pox puftule,! ( i°5 > on the contrary, continues well de- fined through every ftage ; and this perhaps is the reafon why it much lefs frequently leaves arty open fore at the time when the fcabbing pro- cefs fhould come on. The contents of the refpectivc puftules alfo differ. The fluid which the vaccine puftule fecretes does not progreffively change from a watery 'tip a thick purulent matter, as in the fmall-pox, but continues thin and almoft limpid, till it entirely difap- pears. It is alfo fucceeded by a hard brown fhining fcab, which latter is harder, fmoother, and of a darker (color than that which attends the variolous puftule. ( 106 ) Where the vaccine inoculation is followed by no local diforder, or only! a flight rednefs at the punctured part] for a day or two, we can have noj doubt that the operation has failedj| but cafes fometimes happen where1 the failure is equally certain, bu! which require much more difcrimi nation to be diftinguifhed from thofe in which the diforder is complete and genuine. The regularity with which the lo- cal difeafe at the place of inoculation runs through its feveral ftages, feems to be the principal point to be at tended to; for the acceflion of fevd is certainly not neceffary to conftfc tute the dileafe, fince the greatel ( io7 ) • number of infants have no apparent „ indifpofition. Therefore, when the i puftule advances in a very hafty and ^irregular progrefs,* when the inocu- lated puncture on the fecond or third , day after infertion fwells confider- . ably, and is furrounded with an ex- tenfive rednefs, this premature in- i/flammation very certainly indicates a failure in the operation. Even when the inoculation has advanced .for the firft few days in a regular manner, but when, about the fixth day, iriftead of exhibiting a well ^formed puftule and veficle of fluid, * See the excellent practical obsLwa'.ions in the latter part of Dr. Woodville's Obser- vations onAhe Cow-Pox. ( 108 ) the part runs into an irregular fetter- ing fore, the purpofe of inoculation: is equally defeated ; and thefe varie-' ties require to be watched with an attentive and experienced eye, fince? they might readily lead to a falfe, • and perhaps fatal idea of fecurity' againft any fubfequent expofure to a variolous contagion. "■■'1 ( io9 ) c *•.*;■- -«i 11 < GENERAL OBSERVATIONS CONCERN- ING THE VACCINE INOCULATION. A question of confiderable importance has been fuggefted, ariff ing directly from a review of the foregoing fubject: namely, whether the cow-pox is not originally the parent difeafe to the fmall-pox, whilft the obferved differences only depend on the length of time in which the latter diforder has paffed through various conftitutions in the human race. D ( il3 ( 122 ) every part of the world that is con- ftantly experiencing the ravages* of the fmall-pox; and the extirpation; of this formidable malady from every civilized country will no longer be a very impracticable undertaking, That the vaccine inoculation is peculiarly calculated to bring abou^ this moft defirable end, appears from a review of its leading features^ Were even the advantages which it offers much lefs perfect than we find them to be, were it only to fecure from variolous contagion the greatej part of thofe inoculated with it, or] only to exercife its prefervative powv ers for a certain number of .years. ( I23* ) the mere circumftance of not being itfelf communicable by contagion might ftill render it worthy of notice in any general and national plan for extirpating the fmall-pox, though it would then no longer recommend itfelf to individuals. But, fince it poffeffes all the fecu-' rity of the infected perfon which the inoculated fmall-pox affords, it may be an additional motive of preference with many, that, whilft the welfare of the individual is eminently confulted by employing the vaccine infection, no contagion is fpread abroad of a difeafe, which, when acquired by contagion, is one of the moft diftrefs- ( I24 ) ing in its fymptoms, formidable in its appearance, and doubtful in eventj of any to which the greater part of mankind are expofed. ( "5" > THE following collection of written testimonials, will at once show the degree of credit which the ^ Kine-Pox disease has gained and the progress .. of the Inoculation, since the first publication up- on the Subject, by Dr. Edward Jenner, in June 1798; and therefore it may be of use to annex it to the foregoing work. Dr. john ring, London, July 6, 1799. " THE fuccefs of the practice has, on the rhole, been fuch as to gratify every reafonable xpectation ; efpecially if allowance be made or the error of taking the matter from an im- iroper puftule ; an error eafy to be avoided in uture." Again, " I am happy in being able 3 add my teftimony to that of Drs. Jenner, *earson and Woodville, in conformation of the fficacy of the new practice" Dr. Ward, of Manchester, July 12, 1799. " May I not indulge a hope that the era is >robably not far diftant, when we fhall be able o congratulate mankind at large on their hav- ig a fair prospect of being exempted, at no ery remote period, from that moft deftruc- ive malady"—Small-Pox. London, July 19, 1799. " Many unfounded reports have been cir- ulated, which have a tendency to prejudice he mind of the public againft the inoculation s 4 I2fT~) of the cow-pox, we, the underfigned phyficiaj and furgeohs, think it our duty to declare oj opinion, that thofe perfons who have had the cow-pox are perfectly fecure from the infe " tion of the fmall-pox.' We alfo declare, the inoculated cow-pox is a much milder and fafer difeafe than the inoculated fmall-poj&J " William Saunders, M. d. Matthew Baillk x. D. Henry Vaughn, M. D. Maxwell Gartshc _ M. v. J. C. Lettsome, M. D. James Sims, m.'d. John Sims, M. D. William Lister, m. d. Robe Willan, M. d. Thomas Bradley, m. d. Thou ' Denman, m. d. John Squire, M. d. Richard Crof M. D. R. J. Thorton, M. d. John Abernetl William Bktir, S. Chilver, Henry Cline, Astlt Cooper, Edward Ford, J. M. Good, James Ho. ford, Joseph Hurlock, Francis Knight, Jai JLeighton, James Moore, Thomas Paytht Thomas Pole, J. W. Phipps, John Ring, Jamti Simpson, H. L. Thomas, Jonathan Wathei^ Thomas Whatcly. ' ■* Dr. Thornton, London, August A, 1799. " The cow-pox is an era in the annals til medicine, and muft redound eternally to the honor of Dr. Jenner, who was fent to deteft1 and generally apply this noble difcovery." 't C i«7 ) September, 1799. Dr. Kelson of Severn Oaks, Dr. Mitchill 0f Chatham, Dr. Harrison of Horncastle, had each inoculated nearly 100 patients, and afterwards with matter of Small-Pox ; but none took the difeafe. September, 1799 Dr. Pearson made a communication to the public, of the progrefs of the new inoculation ; at which time nearly two thoufand had been innoculated in England. His paper concludes »wtth the following intelligence : *' The fenfation excited on the Continent by the vaccine inoculation, has been much more confiderable than even in our own ifland, as I 'learned, firft from Dr. Marcet, and fince, by a ,letter from Dr. Peschier. At Vienna, Dr. ,Farro inoculated two of his own children with vaccine matter, which 1 transmitted ; and next Dr. De Carro inoculated two of his own chil- dren. An accurate journal of thefe two laft ca- fes was kept by Dr. De Carro, which he has had the complaifance to communicate to me .'through the hands of Dr. Peschier. The above ^patients had the vaccine difeafe in the ufual mild way that they have had in England, and were inoculated fubfequently for the fmall-pox, but without taking the difeafe. ( i28^) " It is expected that Dr. Frank will adopt5 the new inoculation, as it is likely to be gener- ^ ally done at Vienna. " I expect reports from Portugal, and other t parts of the continent. 1 " In Scotland the new inoculation has not been lefs fuccefsful. Dr. Anderson, of LeithM informs me he has inoculated above eighty* perfons ; that Dr. Duncan, and others, have j begun the practice at Edinburgh; and that it. has been introduced in Dundee, Paifley, and Dalkeith. " If the vaccine inoculation proceeds witK equal, mildnefs as it has done the laft four months, doubtlefs the variolous incifion mufL in no remote period, be fufpended. And if fuch an event fhould take place, pofterity willi behold with amazement, the prejudices and,, inattention of their predeceflbrs to the applica- tion of a fa61: in practice, by which a formida-j ble and loathfome difeafe was extinguifhed—a fact well known, time immemorial, to almoft every farmer in half a dozen counties of Eng- land, but neglected till Jenner had the courage, to indicate the advantage of it to focie'ty." September 11, 1799. J Dr. Evans of Ketley, in Shropshire, says^k " In confequence of the experiments I have 1 ( I29 ')" ■made, and the confidence I have in the " re- ports" of the extenfive experience of my inge- nious friend, Dr. Woodville, on the fubject, i am ^decidedly of opinion, that the cow-pox is a certain preventative againft the fmall pox." At this time he had inoculated above fixty perfons for the coW-pox, and a confiderable portion of thefe fubfequently for the fmall-pox. December 2, 1799. " The inftitution for the inoculation of the Vaccine-pox, was founded, at which time it is ftated in the official addrefs to the public, that *' above 6000 persons had had. the inoculated cow-pox difeafe. Not a fingle well attefted in- stance has been produced, among more than ,2000 of the above perfons, known to have had me inoculated vaccinc-pox, and who were fub- fequently inoculated for the fmull-pox, of this difeafe being fubfequently taken, although 'many of them were alfo expofed to the infec- tious effluvia of the natural fmall-pox. And, traditionally, this fact has been eftablifhed, time immemorial, with regard to the cafual «ow-pox." Dr. A.Huggan,Plymouth. December3l, 1799. " The introduction of the cow-pox into prac- tice, as a fubftitute for the fmall-pox, having keen found to be expedient, in the moft exten- ( i3° ) $ve fenfe of the word, the difcuffion of the, fubject will, of courfe, be confidered as clof&l This is a circumftance truly honorable to Drf Jenner, by whom this beneficial improvement doubtlefs one of the moft important in Medl cine, has been firft made known to the world.*! * * * " As I am perfectly fatisfied' from thd proof already b'efore the public, of a perfol who has had the vaccine, being thereby reM dered unfufceptible of variolous infection^ have not thought it neceffary to inoculate ana of my patients with the poifon of the latter difi eafe, having feen feveral of Mr. Stewart's on whom the experiment was made, and with ilj almoft needlefs to add, the ufual effect." J Dr. Richard Dunning. % " From the mafs of evidence already befoii the medical world, and from what has fallel under my own obfervation, I am entirely difpofl ed to give credit to the prefent advantages fail to be derived from the new inoculation; and to thofe much greater confequences which, promife to refult from it to pofterity. [experi- enced the greateft fatisfaction on finding a man of Dr- Denman's great and juftly acquired ceJ lebrity exprefling himfelf fo difpafhonately oa the important fubject of cow-pox. His letter will undoubtedly give a weighty fupport to the" intereft of the vaccine inoculation." ( '3' ) from a communication by Dr. Tromas Denmax, London, March, 1800. • " Entertaining no doubt of the advantages which will refult to fociety, when Dr. Jenner's propofal for inoculating with the cow-pox fhall be generally adopted, I have thought that fome good might be produced by an attempt to remove prejudices ; for it appears to me, that none of the facts or obfervations mentioned by Pr. Jenner have been difproved or refuted." Sec. J. H. Grose, ofWinslow, March 15, 1800. : " A more valuable difcovery cannot be made For the public than this, as it may be the means under providence, if not of banifhing, at leaft .diminifhing, the fatal influence of a diforder which has fo long defolated mankind; and I am happy to add that the practice is daily ex- .tending.'' Dr. T. Trotter, May 6, 180©., " The Jennerian inoculation has been intro- duced into this neighbourhood by Dr. Huggan, "and earneftly fupported by allthefcientific part lof the medical profeffion. Like the early pro- pagation of Chriftianity, by its divine leader, it Was firft ''preached to the poor." The chil- !s dren of poor fokliers and poor fifhermen, firft jt>«,rtook of its bleflings : publicans and finners Jiave fince embraced it; and the purity of its ( J32 ) doctrine and practice is making profelytes to the very land's end in Cornwall." Dr. Marshall of Eastington, Gloucestershire to Dr. Jenner. " Dear Sir, " Since the date of my former letter, (A.1 pril 26, 1799) I have continued to inoculate with the cow-pox virus. Including the cafe! before enumerated, the number now amount! to four hundred and twenty-three." " I have* already fubjected two hundred and eleven of. my patients to the action of variolous matter' hut every one resisted it." " The refult of mr" experiments (which were made with everp requifite caution) has fully convinced me tha£ the true cow-pox is a fafe and infallible preven« tative from the fmall-pox ;" and, " if the mar important advantages which muft refult fror the new practice are duly confidered, we raa^ reafonably infer that public benefit, the fure teft of the real merit of difcoveries, will ren-' der it generally extenfive." Dr. Kelson, Severn Oaks, May 19, 1800. " The facts I can ftate to be clearly demon-J ftrated by my extenfive inoculation, (between; 3 and 400 patients) are thefe: That the dif- eafe is ^thousand times rr.ore trifling than fmall- pox, fcarcely having had a patient fufncientlj ill to prevent amufement or labor :—.That it is Hot an infectious disease ; to determine which, I felected about 40 people in our work-houfe, and inoculated half of them, fome in both arms, and fixed them to fleep with thofe who had not had it; but in no inftance was it com- municated to the others. 1 broke the puftules, and frequently made them fmell the parts, but to no effect. After giving the difeafe to the re- mainder, I, beyond cavil, afcertained it to be ^Perfect security against the small-pox, for I im- mediately inoculated the whole party with the moft virulent variolous matter I could procure; but nothing enfued, except local fuperficial in- flammation for the firft fix or feven days. I then introduced a wretched family, juft recov- ered from very bad fmall-pox,their dirty clothes unchanged, and divided them in different beds among them, but to no purpofe. I then inocu- lated with cow-pox an infant, and as foon as I was fatisfied it had taken, I put it, and kept it in the bed with its filler who had the moft dreadful confluent fmall-pox, but no inconve- nience enfued. Moft of the work-houfe chil- dren, I have this fpring inoculated again, both irith variolous and vaccine matter, but nothing happens : this fhews the vaccine effect to be a lasting fecurity againft itself, as well as the malt-pos. Befides the cafes above noticed, D2 ( '34 ) moft of the others whom I have inoculated, have had variolous matter inferted afterwards, for the fatisfaction of themfelves or friends." To Dr. Bradliy, from Dr. Charles Cooke, Gloucester, May 29, 1800. " If I had waited for the prefent increafmg numbers of impartial teftimonies and indubita- ble facts in favor of vaccine inoculation, I need not have troubled you to infert this letter in your ufeful publication ; but as, in the outfet, I did (with more zeal than prudence) oppofe/ what I then confidered an innovation in prac^ tice, (by confounding the uncertain effects of the advantages evidently arifing from this dif- eafe when inoculated) I now think it right, in juftiee to Dr. Jenner and the medical public, to declare, that, in the courfe of my practice, I had occafion to make trial, and do approve of vaccine inoculation ; yet, I think it fhould. be conducted by practitioners, who have taken proper care to afcertain the genuine difeafe. Dr. Andrew Duncan, Professor of the Insti' tutes of Medicine in the University of Eden' burgh, in a letter to Dr. Miller of Nea- Tork, dated October 2, 1800. States, that " vaccine inoculation is making great progrefs at Edenburgh, and promifes fair to render the fmall-pox much milder than vari*1 ( »3J ) olous inoculation. The medical practitioners here have given the lead : the children of Dr. Gregory, Dr. Spens, Mr. Bennet, &x. having been inoculated with vaccine matter. Though many hundreds have now been inoculated at Edenburgh with vaccine matter, yet, among all thefe, not one cafe has occurred where the patient was ever in the fmalleft dan- ger, or had a fymptom in any degree alarming. Not one inftance has occurred, where the child, after vaccine inoculation, has taken the fmall- pox ; though repeatedly inoculated with vari- olous matter, and intentionally expofed to natu- ral contagion." [Medical Repository."] From Dr. Lettsom of London, to Dr. Barton of Philadelphia. " Vaccine inoculation is becoming more and more general in England; and on the Europe- an continent about 16,000 have had the dif- eafe, if difeafe it can be termed, without any cafe of fatality ; and about 3000 have been in- oculated again with the common fmall-pox without conveying any difeafe; fo that, pro- bablyj foon, no other than the cow-pox will be adopted here. I imagine a fatal cafe will ne- ver occur, as there is rarely more than one puftule." »36 ) Dr. Robert Cappee, York, September 6, 1800. " Dr. Woodville had, feveral months ago, in- oculated 1000 people with the fmall-pox, who had previoufly had the inoculated cow-pox ; not one of them received the infection. Many el- derly people, who had received the cow-pcoH cafually, were inoculated for the fmall-pox af- ter many years, one at the diftance of 5 3 years, but did not receive the infection. From Dr. Jenner's firft pamphlet, and a letter lately pub- lifhed, addreffed to him by William Fermor,\ Efq. I have made the following lift of per- fons, who had had the cow-pox many years be-; fore and did not receive the fmall-pox on ino- culation. Many were often expofed to them, in their own families when epidemic." " Interval of years between the infection of co-w pox, ani ^inoculation of fmall-pox. " From Dr. Jenner. " Jofeph Merret, 25 " Sarah Portlook, 27 " John Philips, 53 " Mary Barge, 31 " Elizabeth Wynne,38 " Wm. Struchcomb, 10 " Hefter Walkley, 26 " We have reafon to be infinitely thankful to providence for the means now put into our " From Mr. FermoR. " William Tredwell, 3 " Albin Collinbridge,4 " Mr. Stephens, 4 "Thomas Stales, 6 "Mr.Collinbridge, 10: ( J37 ) power, of immediately checking the ravages of one of the moft fatal plagues ;* and for the cheering hope of entirely exterminating the fcourge from the face of the earth. With thefe fentiments I feel it not lefs than a duty to lend my aid in fpreading around the know- ledge of the advantages which the vaccine in- oculation offers." [Address to the Inhabitants.] N. B. The above extracts are principally from communications in the Medical Phyfical Jour- • More than 2,000 perfons in the city of London die annually of the fmall pox ; but the malignity of the difeafe is incalculable, whenever it becomes epidemic, as it fometimes does, owing to fome peculiar tempera- *■ ture of the feafon and climate afFe&ing the human con- ftitution with an influence of fuch kind and degree as to favor its cafual fpread : then, indeed, its ravages become truly alarming, and, under thefe circumftantis, it often affumes all the deftru&ive qualities of the moft deadly plague: at fuch time even inoculation will 1101 materially leflcn the mortality, as appears from, the (0%. lowing: ; . "We learn from Halifax (Nova Scotiajsthat>a ge- neral inoculation for the fmall-pox has been- lately ad. mitted there; (laft autumn, 1800) and that the mor- tality has been very confiderable, particularly among. children. One letter mentions 800 deaths, infants and adults, and that one family had loft feveR per- fons." f^Nathnat IntMigenur.} nal, publifhed monthly in London: a work po- pular and extenfively circulated upon the con- tinent of Europe and in America. Thus fpontaneous, refpectable and unequi. vocal are the teftimonials which have from time to time appeared before the European public, favoring the Jennerian doctrine; and fo forcible and abundant are the evidences in confirmation of the moft favorable reports of the kine-pox inoculation as has feemingly pre. eluded doubt and bid defiance to fcepticifm: even prejudice ftands abafhed, and determin- ed oppofition has foftened into, what is term'' ed, prudential caution. What more can be done or faid than has been, to produce a ge- neral conviction of the utility of the kine-pox inoculation; in that it is a perfect securm against any after infection from the small-poxM and when once this fact is acceeded to as in-1 difputable, what reafonable being will hefitaid a moment in giving it the preference to th| inoculated fmall-pox as a fecurity againft j cafual infection ? Its comparative advantage^ are certainly very great and ftriking : , , [From Dr. Henry Jenner's address to thepublicn C39) Small-Pox, Very frequently calls la- tent difeafes into adtion; ihtliefe are included the various fpecies of fcro- phula. Is contagious and com- municable by effluvia. Cannot be communicat- ed with fafety to children when cutting teeth. In fickening with the ''fmall pox, children are frequently afflicted with a- larming fits; and when their conftitutions are de- licate, they fuffer materi- ally in their health during life. Is often fatal. Is attended with erup- tions and very often dif- figurei the countenance. Cow-Pox, We may fafely conclude, from a long and careful ob- servation of this difeafe, as communicated from the Cow, and from no limited experi- ence in its inoculation, that it excites no difpofition to other complaints. Numerous experiments tef- tify, that this never hap- pens in the cow-pox. This circumftance forms no objection to inoculate with vaccine matter—nu- merous experiments juftify the afiertion. Nothing of this kind has ever appeared in this dif- eafe ; and the conftitutions of children have been im- proved by its communica- tion. No inftance of the kind has ever happened. In this difeafe (even in the natural way) I never ob- ferved any puftules C H° ) ' Perfons afflicted with This objection does not this difeafe cannot mingle ap^ly to the cow-pox, as with thofe, who have ne- it is neither contagious,^ ver been afflicted by it.] nor communicable by et, fluvia. ■i Medicines are neceffary Here no medicines are re*i to be adminiftered. quired. Notwithftanding the Little anxiety can be felt, prefent impro/ed ftate of in this difeafe, as it is ne- inoculation, parents and vcr attended with the 1 eaft friends muft feel a confi- danger. derable degree of anxiety for the faety of relatives, &c. -j Requires a Nurfe. This difeafe does not. The above comparifon of the advantages which are to be derived from the fubftitution oL the vaccine difeafe for the fmall-pox, is found- ed upon principles which experience has proved to be fixed upon the folid bafis of truth., I am certainly entitled to fpeak with confi-1 dence on the fubject; as, in conjunction with:1 -my uncle Dr. Jenner (who with indefatigable induftry, has completely inveftigated the na-< ture of cow-pox) I have had a very extenfive acquaintance in this part of medical prac- tice," &c " Since my former publications on the vac-, cine inoculations, (fays Dr. Jenner in his third ( 141 ) treatife upon this fubject) I have had the fatis- faction of feeing it extended very widely. Not only in this country is the fubjefil purfued with ardor, but from my correfpondence with many refpectable medical gentlemen on the conti- nent (among whom are Dr. De*Carro of Vien- na, and Dr. Ballhorn of Hanover) 1 find it is ,as warmly adopted abroad, where it has afford- ed the greateft fatisfaction. I have the pleafure too of feeing the feeble efforts of a few indi- viduals to depreciate the new practice, are Finking faft into contempt beneath the im- menfe mafs of evidence which has arifen up in fupport of it.** F " Upwards of 6,000 perfons have now been inoculated with the virus of cow-pox, and the %r greater part of them have fince been inocu- lated with that of fmall-pox and expofed to its "infection in every rational way that could be (ievifed, without effect." * The kine-pox inoculation, ere this, no doubt, jwould have been functioned by the united tef- timony of American Physicians could they have had the privilege and means of collecting fuch data from their own experiments as fhould be thought neceffary for an accurate and juft Aecifion upon fo important a fubject. In other Countries and with communities in general, the fmall-pox has become a domefticated dif_ ( 142 ) eafe propagated and continued by fucceflive inoculations, at the pleafure and confent of parties ; while here, in New-England, private inoculation for the fmall-pox is recognized as a crime to which a fevere penalty is annexed | a circumftance operating as a complete bafl to any thorough inveftigation of the nature of the difeafe in queftion, and thus fubjecting' gentlemen of the faculty to the necefiity of re- maining either in a ftate of fufpended judg- ment, or of founding their belief upon tntK teftimony and experience of others : and it flf happens that there are fome if not many off the faculty who are unwilling to come to anfc; pofitive decifion in a cafe like the prefent, un til from their own experiments they fhall hav/ afcertained thofe facts, and poffeffed the " felves of fuch evidence) as guided the decifio of others. On an occafion like the prefent, it is trul unfortunate that there fhould be any unnecei fary obftructions in the high road to improve ment; inveftigation fhould be free and unem barraffed, nay, encouraged by every legiti mate aid. Ought not the authority of law, i found to oppofe, to be foftened into kind in dulgence ? and is it unreafonable to expefi that the public voice will cheerfully acquiefo and concur in fuch purfuits as bid fair to ter minate in the general good ? ( «43 ) With fuch accommodation of law, and fuch encouraging difpofition of the public mind, Phyficians will be without excufe if they do not harmonize among themfelves, and begin ihe work of inveftigation with fuch liberal and peneficent views as fhall evince that their concern for the public welfare is not mere pretence, but genuine and sincere. Actuated by thefe' motives of benevolence >and under a determination to conduct and jjrofecute the inquiry with all the attentive ^diligence and perfeverance which every im- portant inveftigation demands, whatever may |>e the refult, all will be ready to beftow their .willing acknowledgment of well done ; and fuch honeft endeavors muft ever meet the Jincere thanks of the wife and good. s r APPENDIX TO THE PHILADELPHIA EDITION. EDWARD JENNER'* HISTORY OF THE ORIGIN Of VACCINE INOCULATION. 1 AM inducoi to give the following concife «* Hi/lory of the origin of Vaccine Inoculation ;" from my frequently ob- ferving that thole who only conGder the fubject curfori- ly, confound the cafual Cow-pox with the difeafe when excited by Inoculation. JVLy inquiry into the nature of the Cow-pox commenced upwards of twenty-five years ago. My attention to this fingular difeafe was firft excited by obferving, that among thofe whom in the country I was frequently called upon to inoculate, many refilled every effort to give ( 146 ) them the Small-Pow. Thefe patients I foum had undergone a difeafe they called the Cow. Pox, contracted by milking Cows affected with a peculiar eruption on their teats. On enquiry, it appeared that it had been known amongthe dairies time immemorial, and that a vagti/ opinion prevailed that it was a preventative the Small-Pox. This opinion I found wai comparatively new among them ; for all the old farmers declared they had no fuch ideaj: in their early days—a circumftance that feem, ed eafily to be accounted for, from my knowi that the common people were very rarely in" oculated for the Small-Pox, until that praClio was rendered general by the improved methot introduced by the^uttons; fo that the work- ing people in the dairies were feldom put to the teft of the preventative powers of theCowi Pox. In the courfe of the inveftigation of this fubject, which, like all others of a complex, and intricate nature, prefented many difficult ties, I found that fome of thofe who feemed to have undergone the Cow-Pox, neverthelefs, on inoculation with the Small-Pox, felt its in» fluence juft the fame as if no difeafe had been communicated to them by the Cow. This occurrence led me to enquire among the me-; dical practitioners in the country around me,] wh© all agreed in this fentiment, that the ( H7 ) Cow-Pox was not to be relied upon as a certain preventative of the Small-Pox. This for a while damped, but did not extinguifhmy ardor; for, as 1 proceeded, I had the fatisfac- tion to learn that tjae Cow was fubject to fome varieties of fpontaneous eruptions upon her teats ; that they were all capable of com- municating fores to the hands of the milkers ; and that whatever fore was derived from the animal, was called in the dairy the Cow-Pox. Thus I furmounted a great obftacle, and, in confequence, was led to form a diftinction be- tween thefe difeafes, one of which only I have denominated the true, and the others the spu- rious, Cow-pox, as they poffefs no fpecific power over the conftitution. This impedi- ment to my progrefs was not long removed, jbefore another, of far greater magnitude in its appearances, ftarted up. There was not wanting inilances to prove, that when the true Cow-pox broke out among the cattre in ^a dairy, a perfon who had milked an infected 'animal, and had thereby apparently gone thro' the difeafe in common with others, was liable 'to receive the Small-pox afterwards. This, like the former obftacle, gave a painful check, to my fond and afpiring hopes: but reflecting that the operations of nature are generally. uniform, and that it was not probable the hu- 'man conftitution (having undergone the Cow-, { 148 ^ pox) fhould in fome inftances be perfectly! fhielded from the Small-pox, and in many others remain unprotected, I refumed my la- bours with redoubled ardor. The refult wai- fortunate; for I now difcovered that the virus of Cow-pox was liable to undergo progreffive I changes, from the fame eaufes precifely as \ that of the Small-pox; and that when it was' applied to the human fkin in its degenerated ftate, it would produce the ulcerative effects in as great a degree as when it was not decom- pofedj and fometimes far greater ; but having loft its specific properties, it was incapable of producing that change upon the human frame, which is requifite to render it unfufceptible of the variolous contagion ; fo that it became evident a perfon might milk a Cow one day, and having caught the diiieafe, be forever fe- cure ; while another perfon, milking the fame Cow the next day, might feel the influence of the virus in fuch a way, as to produce a fore or fores, and in confequence of this might ex- perience an indifpofition to a confiderable ex- tent, yet, as has been obferved, the fpecific quality being loft, the conftitution would re- ceive no peculiar impreffion. Here the clofe analogy between the virtu of Small-pox, and of Cow-pox becomes re- markably confpicuous ; fince the former, when taken from a recent puftule, and immediately ( 149 ) ufed, gives the perfect Small-pox to the per- fon on whom it is inoculated; but when in a far advanced ftage of difeafe, or when (although taken early) previously to its infertion, it be expofed to fuch agents as, according to the c ftablifhed laws ef nature, caufe its decompofi- tlon, it can no longer be relied on as effectual. This obfervation will fully explain the fource of thofe errors which have been committed by many inoculators of the Cow-pox. Con- ceiving the whole procefs to be fo extremely fimple as not to admit of miftake, they have been heedle'fs about the ftate of the Vaccine • virus ; and finding it limpid, as part of it will be, even in an advanced ftage of the puftule, ■■ when the greater portion has been converted into a fcab, they have felt an improper confi- ■ dence, and fometimes miftaken a fpurious : puftule, which the Vaccine fluid in this ftate is capable of exciting, for that which poffeffe•* ( the perfect character. ■'' During the inveftigation of cafual Cow-pox, I was ftruck with the idea that it might be : practicable to propagate the difeafe by Inocu- lation, after the manner of the Small-pox, firft from the Cow, and finally from one hu- s man being to another. I anxioufly waited fome time°for an opportunity of putting this theory to the teft. At length the period !_orrivp&__The firft experiment was made upon ( '5° ) a lad of the name of Phipps, in whofe arm a little Vaccine virus was inferted, taken from the hand of a young woman who had been ac- cidentally infected by a Cow. Notwithftanding: the refemblance which the puftule, thus excited ! on the boy's arm, bore to variolous inoculation, yet as the indifpofition attending it was barely perceptible, 1 could fcarcely perfuade myfelf the patient was fecure from the Small-pox^ However, on his being inoculated fome months afterwards', it proved that he was fecure.*' This cafe infpired me with confidence, and as foon as I could again furnilh myfelf with the virus from the Cow, I made an arrangement for a feries of inoculations.—A number of children were inoculated in fucceffion, ore from the other; and after feveral months had elapfed, they were expofed to the infection of the Small-pox; fome by inocuktion, others by eftiuvia, and fome in both ways ; but they all refilled it. The refuit of thtfe trials gra-' dually led me into a wider field of experiment, which 1 went over not only with great atten- tion, but with painful foiicitude. This became univerfally known through a treatife publifh- * This boy was inoculated nearly at the expiration of five year^ a?'tf rwa-ds with variolous matui, but no ocher enect was produced beyond a local inflammation around the punctured part upon the arm. ( 15' ) ed in June, 1798. The refult of my further experience was alfo brought forward in fub- fequent publications in the two fucceeding years, 1799 and 1800—The diitruft and fcepticifm which naturally arofe in the minds of medical men, on my firft announcing fo un- expected adifcovery, has now nearly riifappear- ed. Many hundreds of them, from actual expe- rience, have given their attellations that the inoculated Cow-pox proves a perfect fecurity asairft the Small-pox ; and 1 fhall probably be within compafs, if I fay, thoufands are ready to follow their example ; for the fcope that this inoculation has now taken, is immenfe. An hundred thoufand perfons, upon the fmalleft computation, have been inoculated in thefe realms. The numbers who have partaken of its benefit* throughout Europe and ocher parts of the globe are incalculable ; and it no* becomes toomanifeft to admit of controverfy, that the annihilation of the Small-pox, the moft dreadful fcourge of the human fpecies, muft be the final refult of this practice. ( 152 ) TESTIMONY, EXTRACTED FROM DOCTOR J. C LETTSOM's OB- SERVATIONS ON THE COW-POCK. London Mo. 1801. •' DOCTOR LETTSGM calls it, defervedly, the " Jenncric.il Discovery," and " The greatest discovery in ancient or modern hr;t ,;y." page 11. " In London and its environs there are a- bout one million of inhabitants, of whom, three th-oufand elk- annuaily by the natural fmall-poxy or about thuty fix thoufand in Great Britain- and Irela'n.!. The population that might re- fult, from their preservation by the Cow-pock,"1 would piohubiy re-people thefe kingdoms every century, or p-ive exiftence to twelve millions of human bcinqs ! What a glorious reflect tion to my friend Doctor Jenner, who has been the mens of premving more lives than ; ever felltotlie lot of any other human being!" page 31. || " The fatal victims of the pcftilential moff tality of t'.e fmali-pox, I am bold to frggefty amount to two hundred and ten thoufand an* nualiy in i'urope alone:" page 12. Doctor Je;.ner in a communication to Doc- tor Lettforn, pa e 31, obferves, " We have th- means in cur power (by the vaccine Ino- sculation) or Hopping the calamity (of the ( 153 ) fmall-pox); Why not employ them ? We bar" the door againft foreign plagues by our laws of quarantine, whilft the greatest domestic plague that ever infested us is fuffered to advance with- out controul." Doctor Woodville ; December 1800, in the Medical and Phyiical Journal, pages 35 and 36, has, among others, the following judici- ous and interetting remarks. " It appears from my laft publication on this fubject, written about fix months ago, thr^t the number of perfons who had then re- ceived the vaccine inoculation, at the Lon- don Small-pox Inoculation Hofpital, exceeded two thoufand five hundred ; fince then, up- wards of fifteen hundred have been inoculated for the cow-pock, at the fame place, and of thefe 1 have a report to prefent, fimilar to that ftated by me in July lalt, viz. "With none of the patients did the infeclion occafion a fevere diforder, or excite one alarming fymp- tom." AS INSTITUTION FOR THE INOCULATION Of THE VACCINE-POCK, WAS ESTABLISHED AT LON- DON, December the 2d. 1799. THE founders, in their addrefs to the public, ftrongly contrail the advantages of the vaccine over the fmall-pox inoculation, and declare, that " not a fingle well attefted inftance has ( 154 ) been produced, among more than two thou-. find perfons known to have had the inoculated vaccine-pock, and who were fubfequently in- oculated for the fmail-pox, of this latter dif- eafe beiny fabf-quently taken ; although many of thc-fi; were alfo expofed to the infectious efiluvia of th^ natural fmall-pox. This "fact , has been traditionally cftabliihed, time imme-' morial, with regard to Uie cafual cow-pock." They gi.e a detailed plan of the inftitution, * and particular directions for the vaccine inocu- <■ lation. A phyiician and a furgeon, attend every Tuefday and Friday at one o' clock, to examine, inoculate, and prefcribe for the pa- tients ; and when neceffary, attend them at their houfes. Iji MANCHESTER, GREAT BRITAIN, VACC1NI INOCULATION KA3 BEEN ZEALOUSLY INTRO-'; DUCED INTO TH£ HOSPITALS AND DISPENSA- RIES. THE medical gentlemen ofthese inftitutions, have publifhed an interefting addrefs to the . poor; (hewing the wonderful advantages of the vaccine inoculation. Towards the clofe of it, they obferve, " The prejudices of the poor againft inoculation for the fmall-pox, by which thcufands of lives have been annually faved, have b-.en often lamented ; but if they fuffer unjuft prejudices to prevent their lay- ( >ss ) ing hold of the advantages now offered to them by the inoculation for the cow-pock, they will neglect the performance of a duty they owe to theml'elves, to their families, and to fociety at large : for furely it is little lefs than criminal, to expofe their helplefs children to the attack of fo terrible and fatal a mala ly as the fmall-pox, when it may be readily avoid- ed by the inoculation of fo mild, limple and fafe a difeafe as the cow-pock." N. 13. All poor perfons, whofe affection for their families leads them to embrace this favorable opportunity, may have their children inoculated for the cow-pock, at the hofpitala and difpenfaries from 12 to 1 o* clock in the afternoon, every day in the week (Sundays ex- «epied) throughout the year- PUBLIC DISPENSARY, CAREY STREET LON- DON. June 9, 1801. Resolved unanimously, That the Phyficians and Surgeon of this charity do inoculate for the cow-pock, all fuch perfons as fhall be re- commended by the Governors (i. e. contribu- tors) for that purpofe, and that they be re- quefted to make this regulation known, as well to the Governors, as amongft the poor within the limits of this difpenfary, with fuch oblervations thereon as they lhall think pra- per. ( 15^ ) The Phyficians and Surgeon, after having ftated their obfervations, as directed, conclude thus ; " We therefore advife all thofe who regard| the health and life of their children, the fafety \ of their friends and neighbours, or the goo! of the community at large, to avail themfelves ] of the opportunity now offered to them of pre-t venting, by eafy and certain means, one of the moft loathfome and fatal dift-afes to whicli the human body is fubject. ROBERT WILLAN,? n, . . > Physicians. T. A. MURRAY. } J john pearson, Surgeon. VACCINE INSTITUTION AT PARIS. La Rochefoucault Liancourt, who is well known in the United States, publifhed a prof- pectus propofing fuch an eftablifhment. Doc- tor Woodville obtained permiffion to vifit the metropolis of France, and there introduced the vaccine inoculation. Doctor Colon's only child was the firft inoculated, and other me- dical men to teftify their confidence in it, fol- lowed the example. An account of this is inferted in the National Inftitate. A Society was immediately eftablifhed at Paris, and a large medical committee appoint- ed to inveftigate and fpread the knowledge ©f ( '57 ) the Jennerian Discovery. The committee in- ferted in the Moniteur of 11 Ventofe, 1801, a letter addreffed by it to the refpective Mayors of the twelve diftricts of Paris, in which it is obferved ; " That they had already inoculated with ■ the Vaccine Virus more than one thouiand perfons, without one being confined to their -bed a ling'e day. That the vaccinated have been inceffantly expofed to the contagion of the Small-pox, even by-fleeping in the fame bed, and eating and drinking out of the fame veffels without any effect. Moreover, seventy- two have been inoculated for the Small-poxr yet none have taken the infection. " The committee have thus, by numerous experiments, verified the obfervations of the Englifh Phyficians, and is convinced of the truth of the three principal ftatements. " 1. That the Vaccine is a very flight difeafe. " 2. That it is not contagious. " 3. That it is an effectual prefervative againft the Small-pox. " The committee is preparing a report in which it will demonftrate thefe great truths, and eftablifh the public opinion with refpect to the most brilliant, and the most important dis- F — — ^w ( 158 ) tevery of the Eighteenth Century to which Trance, Europe, and the whole world will be indebted jot the annihilation of that moft deftructive fcourgc which has ravaged and defolated it for fo many centuries." The latter was figned by the Medical Com- mittee, viz. Parfait, De la Roche, Thouret, Guillotin, Salmade, J. J. Le Roux Husson, Doussik-Dubriuil, Mariw, MoNGBNVT. ft ■.• ;'--' • . .'\fv-*$#SK}W:i.fcc. . :,■ : fC" lit ".■-■..vfe-;J^*j -■rltr$M&