,**->« >V I V*N^ f r, Surgeon General's Office JitA & Q^^aOOOQCQ^QO'C /, Q" i.)$ if)M r MEPOST ON THE Epidemic Small Pox and Chicken Pox, WHICH PREVAILED IN NEW-YORK DURING THE LAST AUTUMN AND WINTER, EXPLANATORY OF THE CAUSES OF SUPPOSED FAILURES OF THE VACCINE DISEASE. ORDERED BY THE MEDICAL SOCIETY OF THE CITY AND COUNTY OF NEW-YORK, AT THEIR QUARTERLY MEETING, JANUARY, 1816. i,!t , ,:■.,-... NEW-Y6RK. PRINTED BY G, FORMAN, NO. 60 PARTITION-STREET- 1U16. / AT a quarterly meeting of the Medical Society of the city and coun- ty of New-York, held on Monday the 1st inst. the following Report having been read and approved, it was Pesolved, That it be published, and that a Committee of two be ap- pointed to superintend the publica- tion and distribution of the same. Whereupon Dr. Pascal is and Dr. .Watts were appointed for that purpose. Extract from the Minutes, GERARDUS A. COOPER, M. D. Sec'ry. April 1, 1816. TO THE MEDICAL SOCIETY OF THE CITY AND COUNTY OF NEW-YORK- The Committee appointed to exam- ine into the progress of the Small Pox for the year past in this city: to ascertain the origin of reports which have arisen unfriendly to the Vaccine Inoculation, and to en- quire into any supposed failure of the Kine Pock, RESPECTFULLY REPORT: THAT they have diligently endeavoured to ascertain the origin of the Small Pox. The first fa- tal case of that disease was found reported at the In- spector's Office on the 15th May, 1815. It occur- red in the person of a soldier of the name of Asa Tanner, who had been for a long time in a Military Hospital on account of frosted feet, from which he had not recovered when he arrived in this city, in a coasting vessel from Boston. He lodged in a com- mon boarding-house in the lower end of Front-street, and was taken sick immediately after his arrival: it was a case of confluent Small Pox, which terminat- ed his life in five days. No person was discovered i —4— to have taken the Small Pox from this man except- ing another soldier and fellow-lodger in the same house, who, it is believed, died in the Military Hospital at New-Utrecht, on Long-Island. It has been stated to your Committee, that a wo- man presented a coloured infant to a Physician of this city for advice, some time in July, on account of an eruption, which he pronounced to be Small Pox : the woman mentioned that she had just arrived from Boston. No other fatal case of this disease is found record- ed until the 28th of August. Another death occur- red on the 30th of the same month, more than three months after the first recorded death by the Small Pox. The subjects of these cases were two children of Peter Weeks, a cartman, residing in Attorney- street, near Delancey-street, in the suburbs of the city. The origin of the disease, in these instances, could not be traced. Mr. Weeks however states, that he had been much occupied in carting baggage and wearing apparel belonging to sailors, from their respective vessels, to their several lodging-houses.— The cases above mentioned appear to have propagat- ed the disease to one person only, and that in the neighbourhood, and in the same block of houses. About this time a few cases of Small Pox occur- red in Market-street, which however the Committee have not been able to substantiate minutely ; because the law which makes it obligatory on Physicians to report to the Board of Health the occurrence of ma- lignant contagious diseases, is not extended to the Small Pox. It is however credibly stated, that two persons having recovered from this disease, the con- tents of their beds were thrown into the street; and that a boy of Mr. Park, in Harman-street, received the infection therefrom, and communicated it to an infant sister, both of whom died of the Small Pox ; the one on the 13th, and the other on the 20th Sep- tember, 1815. The sixth fatal case of this disease is recorded in the Inspector's Office, as having happened at No. 15 Water-street, in the person of William Powell, a soldier lately discharged from the service, whose wife and children had recently recovered from the Small Pox. Your Committee are informed by A. Smith, another soldier, a comrade of Powell, and residing in the same house with him, that the Small Pox ex- isted on Governor's Island in February, 1815. He particularly mentioned a girl of the name of Munson, the daughter of a soldier, who had the Small Pox about that time. She was attended in the Hospital by the Military Surgeon, and recovered. There was an intimacy between this girl and the wife of Powell. The family with whom Smith and Powell boarded, remarked that at the period of Powell's sickness, there were a number of cases of Small Pox in that neighbourhood. Of the correctness of these facts, your Committee have ample evidence. In the early part of October, the Small Pox ap- peared in various parts of the city, and further en- quiry into succeeding cases of it, was deemed un- necessary. Your Committee not having been able to pro- cure any public or private records of the cases of Small Pox, except of those which were fatal, regret that it has not been in their power to trace more ex- —6— plicitly the introduction of that disease into our city. Your Committee, however, are inclined to think, that it was introduced from some distant place by means of trading or coasting vessels : this opinion is derived from the consideration of the two first re- corded deaths, and of the second case of the dis- ease ; or, that it has been conveyed into the cit}~ through the Military, with which our intercourse has been more extended and multiplied during the con- tinuance of the late Avar, than any other district of the Union. The early appearance of the Small Pox in the Military Hospital of Governor's Island, and the fatal termination of the complaint in three sol- diers at the commencement of the epidemic, have already been mentioned. The mortality from the Small Pox having been very great during the month of October, and still more so during the four succeeding months, among that portion of the community who had not passed through the Small Pox or the Kine Pock, your Com- mittee beg leave to state the causes to which it ap- pears reasonable to ascribe the rapid and alarming progress of the disease during the autumn and winter. It was observed that the violent south-east storm of the 24th September last, which ravaged such an extensive range of the North American coast, was followed by an uncommonly prevalent and severe epidemic catarrh, somewhat similar to the influenza of former years, and which extended to almost every part of the United States. It would perhaps be a novel doctrine to assert that the epidemic catarrh which prevailed so generally at that time, had some connexion with an exanthematous fever: as a matter of fact, however, it has been observed by your Com- mittee, that a number of the most violent cases of that catarrh, proved to be malignant and exanthema- tous ; and that the particular state of the atmosphere, or some other cause, contributed in an uncommon degree even among adults, to the appearance of va- rious anomalous, pustular, and exantheruatous dis- eases, and especially that of Varicella, or Chicken Pox, of which some account is hereafter to be given, as immediately connected with the object of this re- port. In conformity with numerous historical facts, both of ancient and modern record, your Committee would advert to the peculiar character of the last au- tumnal period, as having been influential in propa- gating the contagion of Small Pox, and predispos- ing the human body to its action. The violent effects of a similar storm were greatly extended over the Atlantic Ocean, and experienced nearly about the same time in many parts of conti- nental Europe, which was followed by an unusual prevalence of diseases. In the course of the month of November, the United States frigate Guerriere ar- rived in this port from the Mediterranean, with many of the crew labouring under the Small Pox ; seven- teen cases of that disease were carried to the Hos- pital at the Wallabout. Another circumstance which is in the power of all to avoid, and which might be suppressed, has also, in the opinion of your Committee, contributed great- ly to the spreading of the Small Pox ; viz : the ino- culation of individuals for that disease who had not been vaccinated. A dangerous practice has pre- vailed to a great extent, of taking variolous mat- ter from patients under the Small Pox, for the pur- pose of testing some who were said, and others who were erroneously supposed to have been vacci- nated. Many of these necessarily took the Small Pox, and thereby multiplied the sources of conta- gion, thus adding to the general alarm, and dimin- ishing the confidence of the community in the effi- cacy or preservative power of the Kine Pock. Your Committee regret to state, that the matter of Small Pox has been sought for and obtained from the first victims of that disease, by several Physicians re- siding in opposite parts of the city, and doubtless for one or other of the purposes just mentioned. To judge of the danger resulting from a single case of inoculated Small Pox, it is merely necessary to recol- lect, that one diseased person only, or some infected articles of clothing, may have caused the alarming and fatal epidemic which is not yet extinguished in our city. Your Committee, however, indulge the belief, that inoculating for the Small Pox has not been extended and encouraged as much by a sys- tematic opposition on the part of Physicians to the practice of vaccination, as by the numerous failures of the Kine Pock that were reported and industri- ously circulated throughout our city, by persons who were not qualified to judge of its preventive powers, and who induced parents to solicit and even require their Physicians to inoculate children with the Small Pox. Your Committee have to offer a few remarks in relation to the character and mortality of the Small Pox, as it has appeared in our city. As an epidemic. —9— generally speaking, it has been so virulent in its na- ture, as to attack almost every individual in whom the susceptibility to its action had not been destroyed by inoculation or vaccination. The duration of the disease was generally short, the progress of it very rapid, and the treatment, comparatively speaking, but rarely successful. In the majority of instances it was confluent: adults appear to have been as sub- ject to it as children. It prevailed most among the poorer classes of the community, and more in the eastern and upper part of the city, than near the North river, and in the larger streets on the west side of Broadway. The proportion of deaths from this confluent Small Pox, has been greater in the opinion of your Committee, than has ever been observed in London, or on the continent of Europe. The num- ber of deaths recorded in the Inspector's Office, amounts to 254 ; and 39 deaths are reported to have occurred at the Lazaretto. This number, in the opinion of your Committee, is somewhat more than one third of the aggregate cases of the confluent Small Pox that have occurred in the city. But sup- posing the aggregate of such cases of the Small Pox to be only 800; and admitting an addition of one third of this number to have taken the Small Pox in a mild way, or of the distinct kind, it will give a total of nearly 1100 cases of the Small Pox that have occurred in this city and its suburbs from the period of the first reported death, to the 1st of April instant; exclusive of a very large proportion of per- sons that have received the disease by inoculation, and of whom no precise or definite estimate can be made, for the want of the necessary records, — 10— It has not been remarked or ascertained, that either the distinct or confluent Small Pox was at- tended with scarlatina, rubeola, or any other erup- tive complaint. Your Committee cannot forbear to call the atten- tion of the Medical Society to the prompt, liberal, and humane measures adopted by the Common Council, Board of Health, and the Trustees of the City Dispensary, to arrest the progress of this in- creasing and alarming evil, and to ascribe the abate- ment of a public calamity in part to the influence and successful operation of those measures. The Varicella, or Chicken Pox, another eruptive and febrile disease, appeared about the same time with the Small Pox, and prevailed generally through- out the city and its suburbs. It was marked by se- vere and unusual symptoms, and presented the ap- pearances in particular cases, that have been said to belong to Swine Pock, or Water Pock, authorising the conclusion of there being varieties of the same disease.* It has been observed, that " medical assistance being seldom necessary in the Chicken Pox, Practi- tioners are less acquainted with this than most other eruptive fevers, "f The Committee here advert to the opinion of such high authority on this subject, for the purpose of explaining the instances of Chick- en Pox, that have been mistaken for the Small Pox ; and also to account for the differences in the histories of this disease, as furnished by European writers; and who have not described it agreeably to the ap- * Thomas's Modern Practice. f Wilson on Febrile Diseases. —11— pearances and severity it has exhibited during the late epidemic. The Committee agree with the European writers in the opinion, that no danger ever attends the Chicken Pox ; that its pustules form much sooner; are irregular in their shape, more transparent, and seldom contain well-formed pus. They agree also, that by the fifth day they are generally drying or dis- appearing, and that from this period all the symptoms continue to decline, leaving no marks on the skin, excepting in a few instances, or from accident. Authors have generally remarked, that this disease arises from a specific poison ; but it should also have been added, that this poison must necessarily be ephe- meral and extremely mild in comparison with Small Pox, since it is admitted that danger never attends the former ; that its largest pustules disappear with- out the least injury to the system ; while the epidemic Small Pox is generally followed by a secondary fever, as a part of a much more protracted disease, the vio- lence of which is in proportion, it is supposed, to the quantity of matter absorbed, and oftentimes places the life of the patient in the most imminent danger.— It may also be noticed, that the vesicles of the Chicken Pox present large and irregular, or only partial scabs, situated on their apices, and do not leave the discolouration of the skin, which frequent- ly continues a very long time after the Small Pox ; that at the period of desquamation, there are very perceptible prominences in the skin, very easy to distinguish from the even or indented surface left by the Small Pox ; the pustules of which are converted into scabs, or their contents are discharged on trie skin. 3 —12— Authors have stated, that Varicella is preceded by a short slight fever, or by a fever of uncertain dura- tion, and that it is not attended by severe symptoms. Your Committee, however, have seen it assuming a degree of violence equal to some of the forms of Small Pox, producing convulsions and great gen- eral derangement of the system. They have remark- ed also what they find to have been noticed by Pinel, Willan, and others, that the Chicken Pox may be confluent to a great degree, and they believe that it may be protracted to a longer period even than Small Pox, owing to the partial eruption of pustules, and the successive formation of others for many weeks ; that the eruption may be more abundant on the face and head, than on the back and breast, and that it may even occasion a swelling of the face. It has been further represented, that the Chicken Pox depends upon a specific contagion ; that it affects a person but once in his life, has a great resemblance to the Small Pox, and is communicable by inocula- tion with the lymph of the vesicles.* Your Committee deem it important to advert to these facts, and to avail themselves of the opinion of the most popular and practical medical author of the age, who is particular in stating the necessity of attending to the distinctive marks of Small Pox and Chicken Pox, " because there is great reason to suppose the Chicken Pox has not only been some- times mistaken for Small Pox, but that its matter * Baferaan on cutaneous diseases. Note. The eruption of Varicella is sometimes preceded by a general rash oa the i-kin, similar to what is observed in Small —13— has been used for that of Small Pox in inoculation, to which may be ascribed many of the supposed cases of the Small Pox having appeared a second time in the same person."* And again, " most of the systematic writers, down to the latter part of the eighteenth century, seem to have looked upon it (Varicella) as a variety of Small Pox. Dr. Heber- den, in the year 1767, pointed out the distinction with his accustomed perspicuity."! Whether the aggravated form of Chicken Pox that has been observed during the last autumn and winter was owing to any peculiar atmospheric constitution, or other cause, and whether it is to be considered a special variety of Chicken Pox to be added to the form most commonly described, your Committee will not venture to decide. They can however affirm from observation and conviction, that numerous in- stances of the prevailing form of this complaint, be- ing slightly noticed, and occasionally mistaken, have contributed greatly to multiply reports of the failure of vaccination. They have been repeatedly called to witness such instances of the failure of vaccination, and of pretended or imaginary cases of the Small Pox, which would be erased much sooner from the skin, than erroneous impressions could be removed from the minds of the uninformed and inexperienced. In addition to these highly aggravated and misappre- hended cases of Varicella, a variety of circumstances have occurred to diminish public confidence in the Vaccine Disease, which were the effects of alarm, * Thomas's Modern Practice of Physic. f Bateman on cutaneous diseases?. —14— and precipitation in endeavouring to arrest the pro- gress of Small Pox among persons not yet secured against its attack. Many persons were vaccinated in private practice, and at the Dispensary, who were already infected with the Small Pox. A still more fruitful cause of alarm unfortunately arose from the Small Pox occur- ring both in children and adults, who had merely been subjected to the operation, or who were errone- ously supposed to have passed through the stages of the Vaccine Disease. It must appear obvious from the mild and delicate nature of the complaint, that many instances of vaccination have passed entirely unnoticed; that many of them may have been in- complete, and that others have been left altogether to the judgment of the ignorant and unskilful.— Even professional Vaccinators, amidst their nume- rous avocations, have sometimes transferred the responsibility of the operation, and trusted it to the young and inexperienced, without watching the pro- gress and several periods of the complaint, and have consequently been unable to pronounce a correct opinion on the efficiency of the process. The pe- culiarity and novelty of the disease will also authorise the supposition, that many persons have assumed the practice of vaccinating, previous to their becoming acquainted with its specific characters. " This," Dr. Thompson observes, " was unavoidable at first. During the years 1799 and 1800, inoculation was practised by ten or twelve thousand persons, who had never seen the Cow Pox ; persons in the medical profession and out of it. In their zeal they did a world of mischief. Thousands and tens of thousands —15— were inoculated, but never seen again. Whether they had the Cow Pox or not, cannot be known. It was only known that they were inoculated, but the inoculation for the Cow Pox, and the Cow Pox it- self, are very different things : the one, the means of producing the disease ; the other, the disease itself: the one, merely a slight cut in the arm ; the other, a regular disease of two or three weeks length; and yet they have been confounded. Many who were inoculated for it, but did not take it, were thought as safe as those who went regularly through it. The number of these instances are without end.'1* Your Committee regret to have seen a proposition in a late memorial to Congress, for the extension of this last source of disappointment and calamity : they cannot believe that the facility and simplicity of vac- cination will warrant the practice of it by " every in- telligent citizen." Mr. Bryce has stated it to be " an opinion too commonly adopted, that the conducting of inoculation for Cow Pox is of so trifling a nature, as scarcely to deserve the attention of medical men." " From this circumstance, persons little acquainted with the affection, have engaged to conduct the ino- culation of Cow Pox, and have brought disappoint- ment and misery to J\ concerned." " I have lately been informed," he observes, " that the greater part of the children in two parishes in Scotland were ino- culated in this way; the result was, that the Small Pox came among them soon afterwards, and every one thus inoculated became affected with that dread- ful disease; while those few who had been inoculated "' Thompson's Tract on the Cow Pox. —16— by persons acquainted with the appearance in Cow Pox, entirely escaped." Neither will your Com- mittee admit that the want of " genuine matter is the only serious difficulty to contend with ;"* and that all the mischief and disappointment that is complained of, is to be ascribed to the use of spurious matter ; a mode of expression that shall be adverted to again in a subsequent part of this report, contenting them- selves for the present with recalling the attention of the Society, to what they deem a more correct and philosophical position; viz : " that the chief difficul- ty is in distinguishing the local affection, from that which is constitutional," discarding the term « spuri- ous Cow Pox' as erroneous, unfounded in fact or analogy, and productive of many of the evils they have been called to investigate. Your Committee consider it superfluous to enu- merate various other sources of error among Vacci- nators. They think it sufficient to remark, and they do it with great regret, that in many alleged cases of failure, they have often observed that the patient had been visited but once after the operation, or perhaps not at all; and that at other times the essential marks, or satisfactory evidences of the disease were abso- lutely wanting, and that not a single instance has been offered clearly demonstrative of the inefficiency of the Vaccine Disease. From the foregoing statement of the origin and progress of the late epidemic, and of the causes of reports unfriendly to the Vaccine Disease, your Com- * Vide a late Memorial to Congress on the subject of Vacci- nation. —17— mittee may be allowed to suggest that more effectual means should be devised to guard against any future occurrence of the Small Pox ; to promote a more general adoption of the practice of Kine Pock inocu- lation among the poorer classes of the community, and to introduce such improvements as are best cal- culated to obviate the evils that may arise from the failure of vaccination hereafter. On all these im- portant topics, the Committee have to offer what they believe to be conclusive and practical remarks : they would premise, however, some observations respect- ing the " improved mode" of vaccinating lately pro- posed by the London Vaccine Institution. It ap- pears that «the Board'* attributes many failures to vaccinating by a single puncture, and afterwards opening the vesicle, and taking a portion of the lymph for the purpose of propagating the infec- tion. Should the doctrine thus officially promulgat- ed by that Institution be true, your Committee must necessarily infer, and deeply lament, that vast num- bers of persons in this and in other countries, re- main only delusively protected by vaccination, since the practice thus reprobated has been very general- ly approved, and has as generally prevailed through- out Europe and America. The " Board of the London Vaccine Institution*' have not been at the pains to state the period of the disease at which the puncture or rupture of the vesi- cle may interfere with its operation on the system; but inasmuch as the effect of the disease generally takes place on the seventh or eighth day, it may be * Medical Repository, No. 2, vol. III. N. S.p. 261. —18— inferred that the Board "apprehend that danger may arise from puncturing the vesicle at any time during the existence of lymph in it. With all deference and respect to such high authority, your Committee owe it to themselves, to the Medical Society of which they are members, to the laws of the animal eco- nomy, to the laws of contagion in general, which they consult, and to the tranquillity of the public mind, which they wish to establish,—explicitly to de- clare their dissent from the doctrine promulgated by that Board, and which is founded upon the principle, that by diminishing the quantity of the vaccine virus, or lymph, after it is formed in the part, the operation of the disease on the system is in danger of being de- stroyed or enfeebled, notwithstanding the lymph is secreted in the part, and possesses all the charac- teristics of the vaccine virus.—Admitting, for the sake of argument, that it is experimentally proved that a Small Pox pustule, and a Kine Pock vesicle, ean be locally excited, and can respectively furnish genuine virus, in persons who have already had those diseases; yet it is believed to be utterly unknown, that a true and genuine pustule of Small Pox, or ve- sicle of Kine Pock, can take place without infecting the system, if susceptible of either of those diseases at the time.—No contagious disease, after being com- municated by the inoculation of its specific virus, is known to have been arrested: this can only be done by the immediate destruction or removal of the poi- son, or of the part to which it has been applied, before absorption has taken place.—Absorption of the in- serted virus is absolutely requisite to excite its spe- cific disease, in a person in whom the susceptibility —19— to it exists, or has not been destroyed, and it must have had a complete evolution in the system, or have exercised its peculiar property in producing an ap- propriate disease, when the pustule exhibits, among other characteristics, the presence of lymph, or mat- ter capable of reproducing the same. If the bursting or puncturing of the vaccine vesi- cle could endanger or subvert the efficient operation of the disease on the system, the genuine character of the vesicle should be completely destroyed, which has not been observed in any of the numerous in- stances that have occurred; for, whatever injury the vesicle may have sustained, the peculiar scab, more or less expressive of the disease, is reproduced, and its peculiar mark, more or less enlarged, is left on the skin. Your Committee are not acquainted with any thing that can possibly interrupt or prevent the constitutional operation of the Kine Pock in a suscep- tible subject, excepting a morbid state or action of the system, which may preclude every character of the disease, or a constitutional excitement inimical to Cow Pock, and giving rise to many of those irre- gularities " observed in the progress of the affection at the part inoculated."* It is well known that Mr. Bryce, of Edinburgh, several years ago recommended a process as demon- strating the constitutional operation of the Vaccine Disease* and which consisted in performing a second vaccination about the end of the fifth, or beginning of the sixth day after the first. If a constitutional af- fection be produced by the first, the progress of die * l>rrce on Cow P™**; —20— second vaccination is so much accelerated, that by the eighth or tenth day from the period of the first vacci- nation, both vesicles are equally far advanced, the se- cond vesicle being a miniature likeness of the first. Against the truth of this fact, or the conclusion which it furnishes, no possible objection can be made ; it implies that additional vesicles, so far from imparting more power or energy to the virus previously insert- ed, are altogether under the control of the first. It is of little importance how many vesicles there may be, or at whatever time they may be excited, since one alone fully imparts the constitutional action of the disease. Experience also offers another fact to prove the inutility of additional vesicles to secure or com- plete the action of the disease on the system. If ad- ditional vesicles impart strength or preventive power to the process, how is it that spontaneous vesicles do not occur in the most active cases of that disease ? There are various degrees of activity in diseases aris- ing from specific contagions. Thus the vaccine sometimes excites high fever; produces an uncom- monly large vesicle, attended with an unusual de- gree of inflammation, and secondary suppuration; but it hardly ever creates an additional vesicle; at least so very rarely, that the oldest Vaccinators have not perhaps witnessed it more than once or twice. Your Committee conclude, that the mode recom- mended by the London Vaccine Establishment, of exciting two vesicles instead of one, is never abso- lutely necessary, and that the utility of it can only be urgedas an additional security to the introduction of the virus, by multiplying the chances of success. —21— A very extensive and dangerous source of error arises out of the idea of a certain spurious vaccine disease, and a certain spurious vaccine matter. It may be traced to the written and oral opinions of the earliest Vaccinators, who did not discriminate between an imperfect and defective operation of the system, and a supposed specific matter, which has since been thought capable of producing a specific spurious disease. Great stress has been laid on this subject without offering the least direct or convincing proof of the reality or existence of such an article as a spu- rious Cow Pock matter. From whence does it pro- ceed, and where shall we search for it ? Does it ori- ginate in the Cow, and is it thence perpetuated by inoculating the human body, or is it spontaneously generated in man ? Is it durable, ephemeral, or vari- able ? By what regular characters can k be detected* judged of, and described? And why, if it be a spe- cific contagion, does it occasionally arise from the use of genuine Cow Pock matter? It appears some- what remarkable, that many of these points have hi- therto been only carelessly adverted to, by persons who have endeavoured to engage the sanction of the public in instituting a vaccine establishment, sound- ing the alarm and danger of a spurious matter, and ascribing the want of success in vaccinating, to the use of it. Having alluded to the deficiency of proof respect- ing the existence of a specific spurious vaccine virus, your Committee would not be at a loss to substitute opinions and inferences on this subject, apparently more consistent with facts and practical observation, to account for the irregularities or deviations, which __22__ have been construed into marks of a spurious disease They however do not think it proper, at present, to enter into the consideration of that subject, but leave it for a future and more particular investiga- tion. Professional men should feel it indispensably ne- cessary, to conduct the process of vaccination with the greatest possible attention, through all its stages, and until its complete operation on the system has taken place ; and that they should ever be ready to repeat the process, if any irregularity or deficiency in the first shall have been noticed. It may be suggested for the proper discharge of this important duty, left entirely to the responsibility of the Physician, that a regular period of attendance should be observed throughout the whole course of the disease; that attention should be especially given on the fifth, seventh, ninth, and twelfth days, or at least three times during the first ten or twelve days of the disease ; and lastly, that the unerring test, pro- posed by Mr. Bryce, should be resorted to whenever it is practicable. The importance of attending to persons who have been vaccinated, is the more sensi- bly felt by your Committee, because in the many in- stances of suspected or reported failure of vaccina- tion, they have scarcely been enabled to collect any satisfactory medical testimony in relation to the na- ture and progress of the previous disease. Your Committee have been at great pains to exa- mine into the history of some of the cases in which Small Pox is said to have succeeded to the Kine Pock. They are compelled to state, that in several instances^ no other evidence of vaccination could be —23— obtained than the oral and insufficient testimony of the patient or his friends, and that not even the least mark of a Kine Pock vesicle could be discovered. That in other instances, when a mark in the skin was triumphantly proclaimed as an evidence of previous vaccination, the person's arm had been treated by salves, poultices, and other applications, ordinarily re- sorted to for the healing of common sores ; that in others, the arm had become excessively inflamed, the swelling had extended from the elbow to the shoulder, and the sore had continued to discharge profusely for many weeks ; and finally, that in other instances, their attention has been directed to marks on different parts of the body, the consequence of sores, which were supposed to furnish the strongest evidence of the con- stitutional effect of the vaccine disease, an opinion that is fraught with danger, and is in opposition to the writings of Jenner, and the best authors on this sub- ject, all of whom affirm, that no cutaneous eruption whatever, belongs to the Kine Pock Disease. Neither is the Kine Pock a preventive of Small Pox for a limited time only, nor does it produce new and dangerous diseases, as has been affirmed by its opponents. Already has it proved a security against the Small Pox for the space of near sixty years; per- sons having accidentally taken the disease from milk- ing cows in Gloucestershire, in England, where it has been believed, time immemorial, to protect them against the Small Pox. On the subject of cutaneous diseases, no authority ever stood higher than that of Dr. Willan, who has said, after the most careful examination, that no new disorders have appeared since the discovery of tire —24— Kine Pock ; that he has investigated many cases that were attributed to the Kine Pock, but found dis- eases well known and described a thousand years ago,—common diseases of the skin, having no con- nexion whatever with the Kine Pock. The number of diseases of the skin, instead of increasing, have diminished since the introduction of this preventive, in proof of which, facts were adduced by Dr. Willan and others, who also assert, that the Kine Pock has a decided advantage over the Small Pox, Measles, and Scarlet Fever, in not exciting any other disease.* In a Report of the Royal College of Surgeons of Edin- burgh, in 1807, it is said, " The members of the Royal College have met with no occurrence in their practice of Cow Pock inoculation, which could ope- rate in their minds to its disadvantage ; and they beg leave particularly to notice, that they have seen no in- stance of obstinate eruptions, or of new and danger- ous diseases, which they could attribute to the intro- duction among mankind of this mild preventive of the Small Pox." And in a Report of the College of Physicians of London it will be found that " the tes- timonies before the College of Physicians are very decided in declaring that vaccination does less mis- chief to the constitution, and less frequently gives rise to other diseases than the Small Pox, either na- tural or inoculated." To encourage the practice of vaccination among the poor classes of the community, is an indispensa- ble precaution to avert the dreadful effects of future epidemics of the Small Pox. Your Committee have * Willan on Vaccination. —25— already adverted to the prompt and humane measures taken by the Common Council, Board of Health, and City Dispensary, in December last, for this pur* pose; but they would earnestly recommend still more efficient regulations than those which are insti- tuted by Philanthropy, and in consequence of the im- mediate pressure of a public calamity. Your Committee are informed, that most of the continental nations of Europe have successfully con- tended against the Small Pox, by providing for the vaccination of the poor, and at the same time mak- ing it a penal offence to inoculate for the Small Pox. It is a lamentable fact evinced by experience, that nothing short of compulsory measures is sufficient to oppose the effects of ignorance and prejudice.— To guard against the introduction of the Small Pox into this populous and commercial city, is an object of great moment, and well worthy attention in re- vising the Health Laws. Would it not be advis- able to reconsider the propriety of excepting the dis- ease of Small Pox from among those which are the objects of Quarantine Laws ? Ought not every ves- sel infected with the Small Pox to be interdicted from approaching this large population? And ought not every case of the Small Pox, occurring in our city, to be immediately reported to the Board of Health, to apprise the citizens of the danger of ap- proaching it f Previous to the discovery of the Kine Pock, it was computed that forty thousand persons died annu- ally from the Small Pox in Great Britain and Ireland ; that in twenty-five years, Europe had lost fifteen millions of inhabitants by that disease, and that in —26— America the natural Small Pox had proved propor- tionably still more destructive. Every inoculation therefore, for the Small Pox, tends to destroy life, and to perpetuate that loadisome disease ; whilst eve- ry vaccination tends to preserve life, and to extinguish the Small Pox. In concluding this report, your Committee must advert to the general testimony of the oldest and most skilful professional Vaccinators, whose opinions and writings they have been able to consult, and whose discerning minds have not laboured under the acri- mony of controversy, or been influenced by preju- dice or misapprehension. Their testimony is found to be uniform and unequivocal in favour of the ef#. ficiency of the Vaccine Disease. It must, however, be stated with regret, that there are a few Physicians who seem still to entertain some doubts on the sub- ject, and who, by cherishing the popular distrust of it, have, in the opinion of your Committee, hazard- ed their reputation and the public good; but who invariably proclaim, that the Small Pox is rendered extremely mild in every instance after vaccination.* If a few facts of this kind, and leading to the same conclusion were admitted for the sake of argument, they would necessarily lose their weight, when arti- ficially or otherwise produced during the prevalence of pustular and anomalous eruptive diseases; some of which are often observed to resemble not only the Small Pox, but even the Itch, the Measles, and v A second attack of Small Pox, which is admitted to have happened frequently, has either proved very violent, or termi- nated fatally. —27— Scarlet Fever. An analogous fact has lately occurred in this city, in the appearance of a phlegmonous dis- ease of the glands of the throat, that was frequently mistaken for the mumps. Some idea of the perfect efficiency of the Kine Pock may, in the opinion of your Committee, be conveyed to the public mind by the relation of a fact that has been recently observed. In a former. part of this report, it was noticed that the Small Pox had appeared on board the United States frigate Guerriere: an enquiry was instituted by the Sur- geon to ascertain whether any of those infected with that disease, had ever had the Kine Pock-—not one of them had had it! It was found however that there were one hundred and seventy-one who had been vaccinated in various parts of the United States and in Europe, not a single one of whom took the Small Pox, though constantly exposed to it in a croudec^ ship. The society for the propagation of vaccination in France reported that nearly four hundred thousand per- sons were vaccinated in the year 1801, in the French dominions. Many of them were inoculated for the Small Pox, and others were exposed to it during the prevalence of a severe epidemic Small Pox, yet all of them resisted its influence ; and since that period it is stated in a report to the Imperial Institute of France, that only seven persons took the Small Pox, out of two millions six hundred and seventy-one thousand six hundred and sixty-two persons that were vaccinated, clearly demonstrating the advantage of the Kine Pock in increasing population, and the welfare of mankind. By a report from Sir Alexan- —28— der Chrichton, Superintendor of vaccination through- out the Russian Empire, it appears that during the years 1811, 12, 13, nine hundred and sixty-two thou- sand four hundred and three persons were vaccinated in Russia. In Spain the knowledge of vaccination was received with avidity, and was taken under the protection of the government at an early period. It would be superfluous to adduce other evidence of the Kine Pock as a preventive of the Small Pox. Your Committee beg leave to call the attention of the Society to one other circumstance only : had the same number of susceptible individuals existed in this populous metropolis as would perhaps have existed in it, had not the Kine Pock been discover- ed, we should, during the last six months, in all human probability, have had to mourn over an im- mense destruction of its inhabitants; the fate, alas I that has already been often deplored in many coun- tries, and in many populous cities. (Signed) WRIGHT POST, M. D. WILLIAM HAMERSLEY, M. D. JOHN NEILSON, M. D. FELIX PASCALIS, M. D. JOHN WATTS, Jvs. M. D. \t\io CA fiiU1- &