3/ Q •* •> ,: • »«* .». ..»/><* # PRACTICAL OBSERVATIONS SJamnatiott: INOCULATION COW-POCK. BY JOHN REDMAN COXE, M.D. MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, AND ONE; OF THE PHYSICIANS TO THE PENNSYLVANIA HOSPITAL. Embellished with A COLOURED ENGRAVING, Representing a comparative View of the various Stage* of the Vaccine and Small-Pox. PHILADELPHIA: PRINTED AND SOLD BY JAMES HUMPHREYS, At the Corner of Walnut and Dock-streets. 1802. [Copy-Right fecured according to Law;] INTRODUCTION. THE important advantages of Vaccination, or Inoculation for the Cow-Pock, appear to be so thoroughly established, and so ma- ny valuable treatises have been written on it, that any further attempt may be deemed a work of su- pererogation: But when it is considered, that this di- sease is comparatively new in the extensive regions of America -, and that those treatises have hitherto been chiefly confined to Europe -, when it is consi- dered likewise, that numbers are yet unsatisfied, or unacquainted with, the facts upon which the intro- duction of this invaluable disease is founded ; it may not perhaps be improper to add, the additional testi- mony in its favor which has accrued here, to the immense mass which is now contained throughout a great part of the civilized globe. VI A work on this subject will not I trust, be deemed cither uninteresting or useless to the Practitioners of America, many of whom from their diftant situati- ons, cannot so readily acquire information on this new and valuable addition to Medical Science.* When we reflect that the lives of thousands, are per- haps dependent on the speedy extension of this in^ valuable blessing, I hope I shall be exempted from any charge, but that of a desire to awaken the minds of parents and physicians, to the superiority of this disease over the small-pox. Having fortunately been instrumental, in introdu- cing this disease into Philadelphia and the adjoining country , I candidly confess, I feel a pleasure in the reflection which nothing should tempt me to forego : Nor are my feelings less agreeable, in considering myself as the very first person in this city, who actu- ally had it by inoculation here. I have proved in my own person the mildness of the Vaccine, and the perfect confidence I placed in the accounts of its im- mortal discoverer. It is proper here to observe, that the prophylactic power of the Vaccine had been long known. This is not the discovery to which Dr. Jenner lays claim. * One of the principal reasons which influenced the publication of the present treatise, arose from the numerous applications for informa- tion on the subject, which it was impossible to comply with in every instance. I request those gentlemen, whom I have thus apparently neglected, to pardon me, as my silence was altogether accidental. Vll He first experimentally proved, that the virus did not lose its specific property, by being transferred from one human subject to another by inoculation j and to him therefore is mankind indebted for the happy prospect it unfolds, of completely annihilating a dis- ease, whose name alone must ever be remembered with horror. It is not among the least remarkable circumstances of this discovery, that the fact of its preservative ef- fect against the small-pox should have been so long known, v/ithout any practical use being made of it! Like Columbus' egg, the induction now appears so simple, that we are lost in astonishment, it was not sooner verified ! It was reserved for the illustri- ous Jenner; and evinces the truly philosophic mind that readily combines important truths, which others overlook.- — This truly important experiment, was made on the 14th day of May 1796: a day ever memorable in the records of humanity, by opening to view a perfect security against the most ferocious and destructive disease, which was suffered to escape from the box of Pandora ! When the important advantages of Vaccination over Inoculation,* are generally known and proper- ly estimated, we may safely conclude the celebrated * I use the term Vaccination, in opposition to Inoculation, which certainly should now be appropriated solely to the Small-pox. Inde- pendently of the propriety of the measure, it prevents the unnecessa- ry addition of the name of the disease employed. vni author of the discovery will receive that universal homage he so richly deserves. The philanthropy he has evinced, in communicating it immediately to the public, in place of converting it to his own pri- vate emolument,* is worthy of the liberal profession, to which he is so bright an ornament; and, whilst it raises him in the eftimation of a grateful world, must certainly prove the ftxongeft reproach to thofe, who by an opposite conduct, hope to serve themselves at the expence of suffering humanity. Although I have met with a large proportion of the facts laid down by writers on this disease, and have never neglected for a single day to note every occurrence to which I had previously been a ftranger; yet I am very far from viewing the prefent perform- ance, as giving that complete view of every variety in the disease, which is only to be known by time and longer experience. Enough is said however, I trust, to point out the necessity of strict attention, in order to prevent our being imposed upon by the spurious for the genuine disease; an error, which by the false con- fidence impressed, has unfortunately been productive of consequences fatal to the patient, and of injury to the extension of this most valuable blessing. That this is not a false dread, must be very evident to the inhabitants of such places, into which the spurious * This truly deserving character, has, I have good grounds to idsert, spent upwards of £.6000 sterling, or full 25,000 dollars, in his various researches and experiments, relative to this disease. IX disease has been unfortunately communicated -, even here, where the knowledge of the disease has been more extended, and more easily acquired, it has been insufficient to prevent the occasional appearance of this insidious enemy, which has not failed to check the favourable impression of the disease, which many had previously entertained. To guard in some mea- sure against this evil, I have added an engraving re- presenting the various stages of this disease, which will give Practitioners a pretty good idea of its true character, until experience shall have more fully made them acquainted with it : It is taken from one of Dr. Jenner/s, which is excelled only by Nature her- self. To this I have taken the liberty to add the profile of the pustule on the respective days, as given by Messrs. Ballhorn and Stromeyer, and which I consider an interesting and useful addition, by exhi- biting more clearly a striking difference in the Vaccine and Small-pox. To those who are in possession of Dr. Jenner's invaluable engraving, it will appear, that I have in the view of the disease on the twelfth day, given that beautiful variety of the recession of the Areola, which is represented in the third plate of his treatise on the cc Variolas Vaccinae," and also in the treatise of Messrs. Ballhorn and Stromeyer; in place of the more usual appearance, which is repre* sented in the plate from which this is copied. I 2 ] PRACTICAL OBSERVATIONS, &c. Be BEFORE we enter upon the consideration of this highly important disease, it may not be improper to take a view of its origin ; which I shall be pardoned for presenting to the reader, in the words of Dr. Jenner him- self. (See his Enquiry, &c. p. 2 to 6.) " There is a disease, to which the horse, from his state of domestication, is frequently subject. The farriers have termed it the Grease. It is an inflammation and swelling in the heel, accompanied at its commencement with small cracks or fissures, from which issues a limpid fluid, pos- sessing properties of a very peculiar kind. This fluid seems capable of generating a disease in the human body (after it has undergone the modification I shall presently speak of) which bears so strong a resemblance to the small-pox, that I think it highly probable it may be the source of that disease.* " In this dairy-country a great number of cows are kept, and the office of milking is performed indiscriminately by men and maid-servants. One of the former having been appointed to apply dressings to the heels of a horse affect- ed with the malady I have mentioned, and not paying due attention to cleanliness, incautiously bears his part in milk- ing the cows, with some particles of the infectious matter * This Treatise it must be remembered, was written in 1798. 12 adhering to his fingers. When this is the case, it frequent- ly happens, that a disease is communicated to the cows, and from the cows to the dairy-maids, which spreads through the farm until most of the cattle and domestics feel its un- pleasant consequences. This disease has obtained the name of Cow-pox. It appears on the nipples of the cows in the form of irregular pustules. At their first appearance they are commonly of a palish blue, or rather of a colour some- what approaching to livid, and are surrounded by an in- flammation. These pustules, unless a timely remedy be ap- plied, frequently degenerate into phagedenic ulcers, which prove extremely troublesome. The animals become indis- posed, and the secretion of milk is much lessened. In- flamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and sometimes on the wrists, which run on to suppuration, first assuming the appearance of the small vesications produced by a burn. Most commonly they appear about the joints of the fingers, and at their extremities; but whatever parts are affected, if the situation will admit, these superficial suppurations put on a circular form, with their edges more elevated than their centre, and of a colour distinctly approaching to blue. Absorption takes place, and tumours appear in each axilla. The system becomes affected, the pulse is quickened ; shi- verings, succeeded by heat, general lassitude, and pains a- bout the loins and limbs, with vomiting, come on. The head is painful, and the patient is now and then even affect- ed with delirium.* These symptoms, varying in their de- grees of violence, generally continue from one day to three or four, leaving ulcerated sores about the hands, which, from the sensibility of the parts, are very troublesome, and commonly heal slowly, frequently becoming phagedenic, like those from whence they sprung. During the progress * «.« It w : ll appear in the sequel that these symptoms arise princi- pally from the irritation of the sores, and not from the primary action of the Vaccine virus upon the constitution." Note of Dr, J, 13 of the disease, the lips, nostrils, eye-lids, and other parts of the body, are sometimes affected with sores ; but these evidently arise from their being heedlessly rubbed or scratch- ed with the patients' infected fingers. No eruptions on the skin have followed the decline of the feverish symptoms in any instance that has come under my inspection, one only excepted, and in this case a very few appeared on the 4 arms ; they were very minute, of a vivid red colour, and soon died away without advancing to maturation ; so that I cannot determine whether they had any connection with the prece- ding symptoms. " Thus the disease makes its progress from the horse (as I conceive) to the nipple of the cow, and from the cow to the human subject," It was for a considerable time supposed, that this idea of the "origin of the extraordinary disease in question was ill founded, because several attempts had ineffectually been made to excite the disease in the cow, by immediate ino- culation with the matter of grease ;* but it would seem from more fortunate experiments, that its real origin is here deve- loped. In Ring's Treatise, p. 14, &c. a veterinary surgeon is said to have actually succeeded in " producing the disease artificially in a cow, by removing a scab from the teat, and applying the recent blackish matter of grease to the absorb- ing surface of the sore." * This idea is opposed by the justly celebrated Dr. Woodville, whose experiments to elucidate this interesting point, entitle him to the greatest praise. — A knowledge however of the success of the experiment in other hands, which so often proved abortive with Dr. W. may be of service in guarding against the mode of drawing general conclusions, from negative experiments. We here see, all reasoning drawn from them, however plausible, at once falls to the ground by this single positive fact. In the same hasty manner, con- elusions have been drawn, that persons who have previously had the Small-pox, are exempt from the Vaccine $ which although it may be J 14 Mr. Ring at page 15, has given a very interesting letter from a Mr. Rankin, relating a case of disease accidentally produced on the face and hands of a farmer, by the fluid oozing from the heels of a horse labouring under the scratches, which spirted upon him when dressing him. The pustules induced, bore the strongest resemblance to the casual Cow-pox, and were attended with considera- ble fever, full quick pulse, violent head-ach, foul tongue, thirst, &c. At page 693, Mr. Ring says, " I am informed by Dr. Jenner, that in the case where the Cow-pox could be tra- ced by Mr. H. J. jenner from the grease, a boy, having drawn a string backwards and forwards over the heels of the horse, drew it repeatedly across his fingers, till he had caused an abrasion of the cuticle. Thus the subjacent parts were inoculated with the virus of the horse; and the disease re- sembled the Cow-pox ; the lymphatics exhibiting beauti- ful tints of red, in consequence of that affection. " Dr. Jenner has favored us with a remarkable case which came under his notice, of the system remaining unsuscep- tible of the variolous contagion, after having been affected by the matter issuing from the heels of horses. The in- disposition produced had been pretty severe. Six years af- terwards, the Doctor inoculated the person repeatedly, and exposed him also to the contagion of the small-pox, but without producing any effect. To this case is annexed a note, stating as a remarkable fact well known to many, the frequent failure of attempts to communicate the small-pox by inoculation to blacksmiths, who in the country are far- generally the case, is not so in every instance, as I shall hereafter no- tice ; hence patience is a great desideratum in experimenting. — Cows undoubtedly, as well as men, are not always in a state to receive the impression of this disease : — Hence the frequent failure by inoculation in one person with the very same matter, and with similar precautU ons, which produces it in ethers. *5 tiers ; and asking if it may not now be accounted for, on rational principles.* Another instance is adduced by Dr. Jenner to prove the obscure appearance of small-pox, after the disease produced by the grease, at least occasionally. In the next case how- ever he attempts to shew, that this cannot be entirely re- lied on, " until a disease has been generated by the morbid matter from the horse on the nipple of the cow, and passed through that medium to the human subject;" — for the per- son who is the subject of this case, took the small-pox up- wards of twenty years afterwards. (See cases 13, 14, 15.) Though these cases do not completely prove the Vaccine to originate from the Grease; yet the two first must be al- lowed to render the idea extremely provable. Three men were affected from the heels of a mare with sores in their hands, followed by inflamed lymphatic glands in the arms and axillae, shivering succeeded by heat, lassitude, and general pains in the limbs. Two of them had passed through the small-pox, and described their feelings as very si- milar in both diseases. One of these was daily employed as a milker at the farm ; and in about ten days after washing the mares' heels, the disease began to appear among the cows. This fact certainly goes far in demonstrating the ori- gin of the disease; and the probability is increased by the subsequent information, that " a child of five years old was inoculated with matter taken from a pustule on the hand of one of these men : He became ill on the sixth day with symptoms similar to those excited by Cow-pox matter." Dr. Jenner was prevented ascertaining, whether the matter thus passing from the horse through the human constitu- tion, will produce a similar effect, as after passing through the cow, in consequence of this child dying before any trial was made with variolous matter. § * It would be satisfactory to have this fact further established by those medical gentlemen, whose situation in the country gives them greater opportunities of attending to it. § This child's arm is the subject of Dr. Jenner's second plate* i6 It appears to me, the foregoing facts are sufficient in the* mind of an unbiassed person, to establish the truth of Dn Jenner's important opinion of the origin of this disease. If more are deemed necessary, they may be found in Dr. Jen-- ner's invaluable treatise, to which I must refer, particularly to his interesting observations at p. 90 &: seq* Before I conclude this part of the subject ir may not be amiss to mention Dr. Jenner's opinion, of the probabU lity that other parts of the horse as well as the heels, are capable of generating the virus which produces the Cow- pox. " An extensive inflammation of the erysipelatous kind appeared without any apparent cause upon the upper part of the thigh of a sucking colt, the property of Mr. Millet, a farmer at Rockhampton, a village near Berkeley. The in- flammation continued several weeks, and at length terminal ted in the formation of three or four small abcesses. The inflamed parts were fomented, and dressings were applied by some of the same persons who were employed in milking the cows. The number of cows milked was twenty-four, and the whole of them had the Cow-pox. The milkers, consisting of the farmer's wife, a man and a maid-servant, were infected by the cows. The man-servant had previous- ly gone through the Small-pox, and felt but little of the Cow-pox. The servant maid had some years before been infected with the Cow-pox, and she also felt it now in a slight degree. But the farmer's wife, who never had gone through either of these diseases, felt its effects very severe- ly." See p. 62. As it is of great importance to determine with precision, the origin of this disease, I have been more full, than other- wise to many might seem necessary; but as this question involves in it the possibility of producing the disease amongst us, whenever we unfortunately may lose the infection, I * I shall in a future part give some interesting communications re- specting the domestic origin of the disease among our own cows. 17 have stated what will I think suffice to call the attention of those persons to it, whose time and opportunities may ena- ble them to do justice to the subject. * As I entertain but little doubt from what is above stated, that the origin of this disease has been satisfactorily traced by the illustrious Jenner, I may be permitted to add, that amidst our veneration for the cow, we should not forget our grateful tribute to the horse, for doubly proving, thus, a source of health and pleasure. Experiments must de- termine, whether the teat and udder of the cow by inocu- lation with the grease, are alone capable of elaborating this infection; or whether other animals may not be employ- ed so to modify it, that it may serve the same good pur- pose. It is an important fact deserving of notice, by those who may be disposed to pursue experiments on the sub- ject of this disease, that when it broke out among the cows of Grey's inn lane, (Woodville, p. 10.) of two hun- dred cows, four-fifths were eventually infected; the rest, which were not in milk, escaped the disease. This proves its non-contagious nature; but the object I have in view in mentioning it, is to ascertain if the cow in this state, is less liable to receive the infection by inoculation; for having vaccinated a cow in this situation twice, ineffectually, by five punctures in all, and with fresh matter, I am rather suspicious it may be the case. Having never seen the casual Cow-pox as it has been termed, that is, the disease communicated immediately from the cow to the human subject, I shall refer to Dr. Jenner's account, observing only, that it is to be viewed in the light * Great accuracy is requisite in conducting such experiments, that we may know every circumstance tending to render them successful, when it is necessary to recur to them for a supply of infection. They must chiefly be made in the country, from the greater facility of pro- curing the matter of grease, &c. than in town. [ 3 ] of an inoculated disease, although not effected with the point of a lancet, nor even perhaps through the medium of an abraded cuticle, though probably this is the case in most instances. It is said to be generally a more violent disease, which may partly arise from the greater number and mag- nitude of the pustules, than when communicated by art, in consequence of the greater extent of surface exposed to the infection in milking the cow. In order that it may be understood what clay precisely of the disease is spoken of in the following pages, I must re- mark, that the first day commences from the moment of the insertion of the virus, and is compleated at the same hour of the succeeding day; so that, when mention is made of any particular day, as the sixth, it is to be understood of the whole twenty-four hours, immediately following the completion of the fifth day. It may be thought unnecessa- ry to mention this; but some persons I believe, are not in the habit of counting the day of inoculation as the first, which becomes a source of error and confusion, from a wane of uniformity in a circumstance apparently trifling. This disease as communicated by inoculation, in its com- mencement much resembles the small-pox : Towards the middle or close of the second day when the operation takes effect, (that is thirtv-six to forty-eight hours from the period of inserting the virus), a light speck of inflammation may ge- nerally be perceived: This becomes much more conspicuous in the course of the third day, and in most instances bv the commencement of the fourth, a minute pimple may be felt rising above the skin, and surrounded by a circular inflam- mation at its base. It now gradually increases in size, and by the close of the fifth day begins to assume, (especially if viewed with a magnifying glass), that appearance which so much distinguishes it from the small-pox. This consists in the perfect regularity, and beautifully circumscribed form of the pock, which has a surface flattened, with a depressed *9 centre, of a darker colour,* so as to give an appearance of ' elevated edges. In the small-pox on the contrary, by the sixth day, the inoculated part begins to assume an irregular, or angulated appearance, and its surface is not so flattened in proportion to its diameter. This circumscribed appear- ance is retained by the Vaccine during its whole progress* even during the process of scabbing, whilst the small-pox becomes daily more irregular, in consequence cf the conflu- ence of the adjoining pustules. (See the plate. )f About the fifth day, the pock begins to change from the red pimple to a vesicle containing a fluid, which through the cuticle somewhat resembles the colour of whey. This fluid is at its first formation in its most active state, and probably will be less liable to fail, if taken at this early period, than if delayed to a later day. From the sixth day to the tenth is mentioned as the proper period for collecting it; I shall how*- ever notice some exceptions to this hereafter. During this interval the pock augments considerably ; the flattened appear- ance becoming more conspicuous in proportion to its size; so that sometimes in a pock of nearly half an inch diameter, its elevation above the surrounding skin will scarcely, ;f at all, exceed the one tenth, or the one twelfth of an inch, evinc- ing at the same time, the total absence of the plump rotun- dity of the variolous pustule. About the eighth or ninth day, the pock having arrived to maturity, the constitution- al symptoms begin to shew themselves; the general indis- * This dark coloured speck in the centre, Mr. Addington says, " represents the cuticle still adhering in that spot to the skin under- neath." p. 16. f It is this peculiar appearance of the Vaccine disease, which is to be particularly attended to, in forming our opinion of its genuine cha- racter. The more it recedes from this standard, the greater is the pro- bability of its being a spurious disease which is excited. It may be proper to observe, when the Vaccination is performed with an infected thread, the subsequent pustule is sometimes of an oblong or oval fi- gure, though still retaining its regular circumscribed form. io position being preceded by swelling and pain of the pustule shooting up towards the axilla, (and shoulder occasionally), the glands of which now become swelled and painful, es- pecially on moving the arm, whilst the system sympathises, as evinced by languor, drowsiness, paleness, chilliness, and flushes of heat, head-ach, pain and fulness of the eyes, pain of the limbs and of the back, loss of appetite, nausea, and sometimes vomiting, an increased frequency of pulse, thirst, and white tongue. It is not to be supposed that these all occur in every patient ; on the contrary, it is difficult in many instances to detect the presence of any one of them • some or other of them however for the most part occur, and continue with greater or less violence, (seldom so as to confine the patient) from one hour, to two, three or more days, when they subside spontaneously, without any disagreeable consequence. The slight marginal inflamma- tion which has accompanied it from its first appearance, about the eighth or ninth day begins to augment very mo- derately, increasing more rapidly about the tenth or ele- venth days, so as to extend to one, two, three, or more inches in diameter, forming a most beautiful efflorescence or areola, which has been regarded as a proof that the ge- neral affection of the system had taken place : As however the areola does not always exist, and yet the prophylactic property of the disease is perfect ; we must not lay too great a stress upon it, nor be alarmed at its non-appearance, un- der an idea of the disease being merely local.* The centre of the pustule which always is depressed, now begins to assume a darker appearance ; this gradually * That the areola, even though it does occur, is not to be consi- dered as an absolute proof of the existence of the constitutional af- fection, may be inferred from its presence in a spurious disease, (see case i) in which not the slightest indisposition existed : Whereas in most instances the constitutional effects are more violent in the spu- rious disease. 21 extends to the circumference, and in three, four, or five days, the scab is generally complete, so that by the four- teenth day it is of a brown colour, darkest in the centre, and assuming a polished hue. This dark brown, or maho- gany appearance,* daily grows more intense as the fluid be- neath is absorbed ; at length it begins to detach itself at the circumference from the edge of the surrounding skin, still adhering at the centre beneath, till eventually, it falls off at different periods of time, generally from three to four weeks from Vaccination, leaving the skin sound, but most- ly with a slight depression or pit. About the eleventh day, the areola is mostly at its height, when it exhibits the appearance of a pink, or damask rose, accompanied with tumefaction and hardness of the limb, to the extent which it occupies. || Its appearance is sometimes alarming to those, who from not having before seen the varieties of the disease are not prepared for such a sudden alteration. It however subsides in a few days, and frequent- ly retires from the centre first ; leaving as it were, an inter- val of uninflamed surface, surrounded by a ring of efflo- rescence. A light blush however mostly remains till the cofapletion of the scab ; § the tumefaction generally de- clines with the efflorescence. This may be considered as a tolerably accurate account of the progress of the disease, as it has occurred to me. Some * This colour has been more properly compared I think by Mr. Addington to the colour of a dried tamarind stone. I may notice here that in the African, it rather seems to be influenced by the co- lour of the rete mucosum, as it generally I think approaches to a black. Since writing the above note, I am happy to add the opinion of Dr. Spense of Dumfries (Virg : nia), who says it precisely resem- bles " a piece of rough black sealing wax." U There is considerable variety in the actual grade of the colour of the areola, from a light p'nk to a deep crimson. § It may be rather said to exhibit a dusky hue, attended with a desquamation of the cuticle to the extent of the tumour produced. 22 varieties remain to be considered, most of which I have likewise seen, and which I shall treat of in the same order. The success of the operation must depend in a great degree, upon the disposition of the system to receive the impression of the disease, when w r e are perfectly assured of the goodness of the infection. J say in a great degree, because even w T ith such a disposition existing, the best mat- ter may fail by an injudicious mode of Vaccination, so as to produce great local irritation, which effectually prevents absorption. This w r e also find is often the case in the variolous inoculation. In perhaps a majority of cases, the first attempt succeeds. As far as my experiments go, I have excited the disease in about three-fifths by the first attempt, or rather more than one-half. § Whether the ca- ges of failure would have equally opposed the variolous con- tagion is perhaps impossible to say; I rather apprehend it would have proved to be the case.* Mr. Ring, p. 508, re- lates the case of the brother of Dr. E. Bancroft, who " was inoculated for the small-pox eleven times, and once taken to a patient labouring under the disease, and inoculated in both arms with a large quantity of recent matter, but to no purpose; yet he afterwards caught the small-pox in the na- tural w r ay." Mr. Ring mentions three instances of five at- tempts, and one of sir, before infection took place, in his practice, and ascribes it to the constitution of the patient, since it was chiefly in children of a weak habit, that this difficulty occurred. t It is not however probable, that this § By a reference to the tables I have drawn out of the first fifty cases which came in order under my care, it will be seen, that many attempts were made with old infection, in order to afcertain how long it might be preserved. I have therefore I believe, failed more fre- quently than others who have invariably employed recent matter. Set the last note of the tables. * Dr. Rollo mentions a child having been vaccinated ineffectually, who ten days before had also been inoculated for the Small -pox with- out success. Ring, p. 124. f See ccses 9 and 30 of the tables, far exceeding those nient ; cned bv Mr. Rin£. 23 weakly constitution should alone be the cause , as indepen- dently of my having succeeded frequently in the first attempt on weakly children, many of my patients in whom it failed, were by no means to be classed in this description. Although we cannot account for it, the fact remains certain, that one person more readily receives this disease (as well as other diseases), than another; and that this disposition varies in the same person at different times. The appearance of the speck of inflammation indicating the success of the operation is also very various. In gene- ral we may very accurately perceive it about the commence- ment of the third day. In several cases 1 have however ob- served it evidently early on the second day, or between twenty-four and thirty hours from Vaccination. I speak here only of such cases which actually succeed, for some- times a considerable inflammation takes place in a few hours, with great itching, and even an elevation of the cuticle as if a pustule was commencing. Where this occurs, we may almost invariably, perhaps always, predict the failure of the attempt. This is likewise generally the case in the small- pox, when the svstem is disposed to reject it. This species of local irritation I have experienced repeatedly, in the at- tempts I have made to produce the Vaccine a second time in myself; but which have hitherto failed; the inflammati- on disappearing about the fourth day.* It sometimes happens that the disease instead of becoming perceptible at this early period, does not shew itself till a ve- ry late date. In the Medical Review for April 1800, Mr. Taynton gives the case of an infant, in which no appear- ance of success took place till the twelfth day ; from which time it ran its course very rapidly. In the Medical Journal for May 1800, the Rev'd. Mr. Finch gives an instance of the pustule not appearing till the eighth day; and in another not till the jifieenth. * Since writing the above, I have succeeded in exciting a apurio** pustule. See the tables - % case i. 24 Doctor Cappe says, cases have occurred, in which there has been no appearance of a vesicle till the ninth day; and Mr. Ring has known two instances in which it did not ap- pear till the fifteenth day; and one, not till the sixteenth. " It is however certain (says Mr. Ring, p, 339) that in many cases the disorder makes a greater progress by the se- venth day, than it does in others by the twentieth."* The I\tedical Committee of Rheims mention the delay of the appearance of success in Vaccination as far as the twenty -second day. See Husson's Becherches, p. 29. By referring to case 6, in the tables, an instance will there be seen of this dormant state of the Vaccine virus for eighteen days. The Rev'd. Mr. Holt in the Medical Jour- nal for 1799, mentions a curious fact somewhat analogous. " I inoculated, says he, near thirty, twice or thrice, appa- rently without effect, allowing an interval of five or six days ; but though they sickened from the last incision, a pustule regularly appeared wherever I had formerly inoculated them, as if the dormant matter had been roused by the activity of that last inserted." I may add to this, that I have since met with three or four cases in which the previous Vaccination came on, after a weeks interval, upon the successful progress of a second attempt. The same variety exists in the Small-pox as in the Vac- cine before success is apparent. Dr. Odier of Geneva men- tions seventeen days; and Mr. Ring (p. 383) asserts that cases have occurred, where the symptoms of inflammation have not appeared till twenty-nine or thirty days after the operation. As the appearance of inflammation, indicating the infec- tion having succeeded, varies so considerably, so also does the advance of the pustule, now commencing its progress. In most cases a fluid cannot be distinctly perceived till about * Where the pustule does not appear as early as usual, its progress is generally more rapid. 2J the fifth day. I have however had one instance in which I not only perceived, but actually obtained matter on the ninety-third hour from the period of Vaccination. As I obtained it without any difficulty, I concluded I might have discovered its existence six or eight hours previously, or three days and a half from inserting the infection.* From what has been previously stated of the great variety e progress of this disease, it may be readily concluded, t no absolute number of days from Vaccination can be fixed on, for taking the matter for future practice. I have taken it in one case from the eighth to the fifteenth day inclusive; from another, a patient of Dr. Hewson's, I pro- cured matter on the eighteenth day, with which I produced a most perfect disease. I must however mention, that the progress of the Vaccine in the case of Dr. Hewson's above alluded to, had been suspended by the measles. As this case is considerably interesting, I have Dr. Hewson's per- mission to make the letter public which contains the detail. " Dear Sir, " On Friday the 17th of December last, I ob- tained on the point of a lancet, some of the Vaccine virus from Mr. M 's child, and having previously moistened the same with a small particle of water, I inoculated Sarah Wattles aged ten months, and Maria Wattles aged twelve years. This was the order of the inoculation, which I have thought worth noticing, as in Sarah Wattles it did not succeed, but in Maria Wattles, where I was obliged still further to dilute the matter, the inoculation took effect. " On Thursday the 23d, (the seventh day) examining Maria Wattles' arm, I discovered a small limpid vesicle at the place of inoculation ; the skin immediately surround- * In this case the pustule did not advance more rapidly than usual to its termination. On the contrary I obtained matter till the tenth day inclusive, when the areola began its career. Case 43. [4 3 i6 ing this vesicle was of a fine vcrmillion colour, and hard to the touch. The mother informed me, that she had ob- served some signs of inflammation the day before, when I had omitted to visit the child. The vesicle gradually in- creased till Wednesday the 29th, (thirteenth day) when I perceived a small scab in the centre, i immediately inocu- lated with the matter taken from this child, the children of Mrs. Levis, Maria, Sophia, and David, occupying the up- per story of the same house These children were brought down stairs for the purpose. " Upon repeated inquiries I never could learn, that the child suffered any general indisposition until the evening of Tuesday the 28th, (the twelfth day) when she was seized with sickness at her stomach and frequent vomiting. These symptoms continued the next day, when I found the skin hot and dry, and pulse frequent ; I could not ascertain the number of strokes in a minute, the child being very restless. I ordered some antimonial wine as an emetic to be given in the evening, and requested the mother to give her the infu- sion of senna the following morning as a cathartic. " Tuesday the 30th, (fourteenth day) the medicines have- operated freely ; the child still continues fretful, and has con- siderable fever. The scab is nearly formed. I directed ten drops oi antimonial wine to be given four times a day, mild diluting liquids to be drank freely, and the child to be kept moderately warm. On Sunday the 19th of December, (third dav of Maria W's. inoculation) Alexander Wattles about eight years old, had brought the measles to the house. Delia Wattles had taken them on Saturday the 2.5th; and #. Wattles lay at this time in the cradle with all the symp- toms of the measles. These circumstances led me to sup- pose Maria's indisposition to be the same disease ; and this opinion was strengthened by the appearance of an efflores- cence on Friday the 31st, (fifteenth day). It was not till Sunday the 2d of January, that any pustules appeared. They were confluent and left no doubt of the disease being the small-pox. The pustules began to dry on Tuesday the 27 4th of January, (nineteenth clay of Vaccination) and the child went regularly through the disease. " I have already mentioned that I attempted to inoculate Sarah Wattles with the Vaccine virus. On the third day from inoculation I observed a small purulent pustule which disappeared on the fifth. She took the measles as related above. She had but just recovered of this disease, when, to wit, on Thursday the 6th of January, she was covered with a scarlet eruption, which I apprehended to be the small- pox. This though of the distinct kind, never filled proper- ly, and at last proved fatal, carrying her off on the seventh day. Two of Mrs. Levis's children, Sophia and David, took the Vaccine infection from the first inoculation. On Tues- day the 4th of January, (seventh day) I found them setting with Mrs. Wattles' children, the mother wishing them to take the measles. My anxiety was very great lest they might take the small-pox. On Tuesday the 1 Jth of Janua- ry being the fourteenth day after inoculation, Sophia Levis had a slight eruption on the face and breast, a dry husky cough, and a considerable flow of tears ; the disease was very light. In this child the areola which usually accom- panies the Vaccine disease did not appear till the nine- teenth day after inoculation. It was on the eighteenth day that you took some matter from the pustule, and you will recollect that there was then no appearance of an areola. Upon inquiry I learnt, that you succeeded with this matter in giving the Vaccine disease, " With great respect and esteem, M Yours, Jpril 30th 9 1802, " Thos. T. Hewson." I believe the testimony of most Practitioners, is in favor of obtaining the matter as early as possible to insure success, as it is then supposed to be in its most active state. At what point we must stop, seems as yet to be undetermined. J)v f Odier, of Geneva, has considered it as most proper to 28 be taken when the efflorescence is complete ; whilst the il- lustrious author of this important discovery, considers this efflorescence as a " sacred boundary beyond which the lancet should not pass.'* Again, Dr. Cappe, and others, consider the matter as proper for Vaccination as long as it continues limpid ; and by others we are recommended to take the matter on the eighth day, or eight times twenty- four hours from the period of Vaccination : 1 have as above- mentioned, taken matter, in a case of the most perfect ap- pearance and regularity, on the fifteenth day,* when the areola had nearly declined; this I have done in several in- stances-, from one I took it on the twelfth day, when the areola extended perhaps full three inches from the pustule, which was beginning to decline. (Case 22.) These may suffice to shew its safety, where the matter continues lim- pid, and the scab has not too far advanced. Dr. Cappe says, Dr. Woodwille informed him " he had twice inocu- lated on the thirteenth day from patients, in whom the di- sease was so far advanced, that he could only obtain a little moisture from the margin of the scab; yet he was success- ful." Were we to consider the presence of the areola, as the point beyond which we should never infringe, we should in frequent instances be unable to decide: How are we to judge when this "sacred boundary" does not exist, or how can we properly estimate its appearance in the dark skin of an African ? As a general rule I think it may proper- ly be retained; but we shall all, probably, in our practice, find exceptions to it. I should rather be disposed to adopt as a rule in taking the matter, that idea which restricts it to the eighth day. I speak of those cases which advance with due regularity ; because this day embraces usually the most tardy, and most rapid cases. It will also for the most part be in unison with the former; but to this we shall like- wise find exceptions, as the areola sometimes commences * -See p. 15. 2 9 on the fifth, sixth, and seventh days.* Although I would prefer taking matter at an early period of the disease; yet my opinion, formed from the few experiments I have made on this point, leads me to conjecture, that when the pustule has exhibited the character of the real Vaccine, no danger is to be apprehended from using the matter, even although the areola be formed, provided the fluid continues limpid, and the scab has not too far advanced : I should never hesi- tate to employ such matter, especially if none other offer- ed.§ * If the pustule runs its regular course, though quick, it is a per- fect preservative. And why should not this be the case as well as when its progress is preternaturally slow ? Husson, p. 29, mentions the areola on the eighth day. If the areola always existed, and if its actual presence could be always detected, I think that it would be the most accurate criterion ; but as this is not the case, so neitherjftiall we find the disease on the eighth day in many successful cases, suffi- ciently advanced to procure infection, see p. 23, 24. of cases not ad- vancing even as late as the twenty-second day: Hence the difficulty of fixing on any point of time, which shall be exempt from any ir- regularity. § In the Medical Repository, Vol. V. p. 348, in answer to an in- quiry on the necessity of establishing a point of time for taking the Vaccine infection, Dr. Waterhouse considers the limpid state of the matter as a fallacious criterion j giving as a reason that " in the rising of a vesicle from almost any cause, the scarf-skin separates from the true, and a portion of the superfluous water of the blood, and some- times of the coagulable lymph, is found under it." He adds, " I have known this limpid fluid exude in considerable quantity from the Vac- cine pustule that has been too much irritated by pricking, and exhaust* ed of its virus. It gives a mining, glazy appearance to the thread.'" I cannot however acquiesce in this reason, because I cannot suppose any other vesicle is likely to be taken for the Vaccine ; at least when it is more generally known. I do not think it probable that any per- son acquainted with the Vaccine would be liable to err on this point. And I must confess I do not feel satisfied with the idea that the lim- pid fluid exuding from the Vaccine pustule, which has been too much 3 o In the quantity of matter to be obtained from a patient in this disease, great variety exists. In a disease consisting for the most part of a solitary pustule, it may be concluded, that in general, it does not amount to any large propor- tion §. In several instances, where from the beautiful ap- pearance of the pustule I had anticipated the procuring a considerable quantity of matter ; I have scarcely obtained sufficient to moisten the point of my lancet. This was the case with one of the most perfect pustules 1 have seen, al- though previously to its scabbing, I think it was upwards of one third of an inch diameter (See Case 38). In other cases however, a pock of less diameter than a small pea [| has yielded much more matter than it appeared to me to be ca- irrltated by pricking, has been exhausted of its virus. How are we to determine the point at which we should cease to irritate the pustule by pricking it ? I have not hitherto found the effect alluded to, nor do I apprehend much danger from it. If the matter is taken away incautiously, and unnecessary irritation is employed, lean suppose a change in the properties of the secreted fluid. I have mentioned a case in which I obtained matter daily from the seventh to the fifteenth day, or above a week ; in which the areola had nearly subsided be- fore my last attempt j yet, with perhaps forty or fifty punctures, the matter continued good to the last, as I proved by its efficacy, thirteen days after having been taken, in producing a disease which effectually guarded against the small-pox. A thread when fully impregnated with the Vaccine infection, has always to me had a shining glazy appearance. A moderate solution of gum arabic will give an accurate idea of the Vaccine infection, on glass, on a lancet, and on thread. {See its Analysis, p. 32.) Although I thus differ on this point from Dr. Waterhouse, I am satisfied of the propriety of establishing eight times twenty-four hours as the point of time for taking infection. § Although in most cases only a single pock appears, yet now and then one or more besides, occur. See case 11. 34. 42. || Dr. Husson says he has seen a Vaccine peck not larger than a pin's head j but which produced in another a pock of the usual size. The quantity of infection is by no means dependant on the size of the pock. pable of containing at one time ; which satisfies me of the propriety of die opinion of Dr. Cappe, that it is partly supplied by secretion. It will often continue to exude for a considerable time from the small punctures made in the vesicle. One case I met with, in which the pustule, with- out being of uncommon magnitude, yielded sufficient mat- ter to coat over a piece of glass, equal to about a square inch, three or four times amply, and to imbue completely a thread of more than a foot in length. Upon a moderate computation I should suppose it yielded enough to have vac- cinated two hundred persons (See case 25).* In some few cases I have obtained matter five or six days successively ; and in the one above mentioned, eight days ; whilst others have yielded it only one, or at most two days. It is there*- fore of the highest importance to pay great attention to se- cure the matter at the proper time, and never to suffer an, opportunity of taking it to pass. From inattention to this point, I have heard Physicians asking for Vaccine infection, who but a week before, had said they had under their care several cases in the finest state for taking it. Their mode was simply to depend on the quantity they obtained on the point of a lancet, for a succeeding Vaccination. This is not the method to secure so perishable an article. Phy- sicians will without great attention, have to lament its loss when they most desire to employ it. I shall in a future part endeavour to point out the best mode of preservation. I cannot perhaps in any part more properly than here, introduce a chemical analysis of the Vaccine matter made by citizens Husson and Deputren, and given to us in Dr. Moreau's " Historical and Practical Treatise on Vaccine Inoculation." (See Ring p. 790.) This Analysis although ingenious, does not seem likely to be of any practical ad- vantage. * I supplied upwards of twenty Physicians with matter from this case alone.-— I might have procured much more from it, if leisure had permitted. 32 " When exposed to the air, it readily dries, without losing its transparency. It acquires the hardness of glass ; and forming a scale, adheres like a varnish to the surface upon whkh it is applied. It oxydates iron. If left to dry in the Vaccine vesicle, it forms itself into small and hard globules. When liquid, it readily dissolves in water ; and when solid it enjoys the same property. " When exposed to heat, it presently becomes turbid ; exhales a slight odour of carbonate of ammonia ; and is soon converted into a light cellular charcoal. It produces no alteration in the colour of syrup of violets ; nor in that of tincture of turnsol. " When tried with alkohol, nitrate of mercury, nitrate of silver, or nitric acid, it affords a white precipitate; which will neither dissolve in potash, nor in the muriate of Am- monia. The concentrated sulphuric acid, oxalic acid, the vapour of oxygenated muriatic acid, potash, barytes, and muriate of ammonia, neither produce the least action upon it ; nor alter in any manner, its external qualities. It seems t® consist of water and albumen ; of which the proportions are not known.' ' To this I may add, that it does not appear to me to pos- sess any taste ; though it seems to have the glutinous sen- sation of a gummy solution, leaving a slight degree of that asperity on the«tongue, which is produced by unripe fruit. With respect to the constitutional effects in this disease, there is considerable difference in time and degree. In in- fants as far as I have seen they have been almost invariably light. Indeed in several instances I have been unable to ascertain the slightest indisposition. Even in a variety of instances where they were teething, or had slight com- plaints of the bowels, the symptoms did not appear to me to be greater, than might reasonably be ascribed to the ac- companying irritation. Dr. Jenner has recorded (p. 131) that the Vaccine virus was inserted into the arm of a child about twenty hours old, who went through the disease without apparent illness, yet 33 was found effectually to resist the action of variolous mat- ter with which it was subsequently inoculated." I vaccina- ted mv youngest child when only three weeks old, in whom> although the areola extended nearly from the shoulder to the elbow, I discovered no marks of indisposition during its progress ; yet he has withstood the variolous action in three successive inoculations by six punctures, as well as by exposure to a man labouring under the Natural Small-pox. I cannot however, though so fully acquiescing in the truth of the benignity of this disease, accord with those gentle- men who consider the constitutional disease by no means essential to the permanent efficacy of the Vaccine. It ap- pears to me an absolute truth, that a constitutional affection must occur, however slight it be, to produce the astonish- ing change we find effected in the system. It seems ut- terly impossible a mere local disease could suffice to produce this general effect. I shall however extend this argument by stating, that the Revd. Mr. Holt, in the Medical Journal for December 1799, has mentioned the cases of William Neil of ten years, and Hannah Beal of six years of age, who had each above one hundred pustules in different parts of their bodies, which assumed precisely the appearance of that given by inoculation, except that they were smaller: no com- plaint of more than ordinary indisposition was made in ei- ther case." Eight children vaccinated from the matter of these pustules had the disease in the mildest form. These cases, whilst they evince the mildness of the Vaccine, shew the existence of a constitutional affection, without which such a general eruption could not have occurred. I have met with one case in which about the eleventh or twelfth day, a true Vaccine pustule formed upon the inside of the right knee : now there can scarcely exist a doubt in this case of a constitutional affection; yet it was so very slight, that, except the pain of the axilla, it was not to be percei- ved (case 42.) On these cases then I would ground my [ 5 1 J4 opinion, that a constitutional effect must take place,- to se- cure the system from future danger of Variolous infection.^ This fortunate exemption from, or rather moderation of febrile action, is however, not universal. In various in- stances, even in children, the symptoms are considerable, tho' rarely sufficient to produce alarm. The pain arising from the inflamed and tumid state of the axillary glands,, in manv instances is considerable for a day or two, or even longer ; thoi where it exceeds a moderate degree, it ap- pears generally to depend on the too free use of the arm whilst the glands are in the above state; and hence it usu- ally is greater in adults than in children, because they are unwilling to suspend their daily occupations. This is not however always the case, for we often see examples of continued labour, without the slightest increase of the con- stitutional affection, even when this is apparent. When the pain of the axilla exists, I have generally ob- served a pain of the part vaccinated, extending upwards to the axilla, as if in the course of the lymphatics. This pain is sometimes very considerable, being accompanied with a burning or stinging sensation, and with more than usual tumefaction and hardness of the surrounding cellular mem- brane. The absorption of the virus differing as we have seen very materially in different people, it may reasonably be supposed, (as really is the case) that considerable variety ex- ists in the commencement of the axillary inflammation and subsequent indisposition. It is in the actual state of inflam- mation of the axillary glands, that animpiudent use ©f the * No one I believe will doubt the necessity cf a general affection of the system in the small pox, to secure it against a future attack : most Practitioners must have e-ther seen, or read of cases of a perfect local variolous pustule, which by no means proved a preventive to the fu- ture attack, of this complaint. I shall in a subsequent part give some very strong instances of a second attack, of small pox, neither of which were merely local j but attended by every requisite which cast prove a constitutional affection. 35 arm may tend to prolong the disease ; and hence 1 have seen the pain continued for full three weeks ; accompanied with considerable tumefaction of the arm, and a blush of inflam- mation, extending to the wrist and above the elbow. The febrile symptoms vary very considerably. I have already mentioned that in some persons, especially children, they are not evident ; whilst in others, the disease has been accompanied with all the intermediate grades of drowsiness and head ach, up to chills, pain of back and limbs, and even nausea and vomiting. This is seldom the case ; so seldom indeed, that I must confess, I believe with Dr. Jen- ner, these violent symptoms arise not necessarily from the disease, but from the accidental irritation and consequent inflammation of the vaccinated part. In confirmation of which I can safely affirm, the only considerable cases of fever 1 have met with in this disease, have arisen after the tenth and twelfth days ; when an ugly sore has been induced by rubbing ofF the scab in its forming state, or great in- flammation has taken place by the irritation of rough clothes, &c. Previous to this, a moderate degree of febrile indisposition and axillary inflammation was all that was complained of; whereas at this period, great fever, head ach, pain of back, nausea and vomiting, took place. I shall have occasion shortly to say more on this point ; 1 shall on~ ly add at present, that this occurrence is not uniform, even when continued irritation would lead us to anticipate the most disagreeable effects. In one case of a black child of about a twelvemonth old, about the fourth day, the apex of the small pustule which was forming was rubbed ofF, and this was successively the case every day or two, nearly seven or eight times, owing to her tight and rough clothes. She had a slight indisposition on the eighth day with pain in the axilla, the former of which I ascribed to her teeth, three of which came through at this period, and though I fully expected a disagreeable sore, yet by the sixteenth or eighteenth day it was nearly dried away, without producing any inconvenience. About a month after this, I inoculated 3 6 the child for the small pox, under a firm persuasion that she would take the infection • the three punctures I made inflamed slightly, and advanced to the state of pustules, which never completely maturated, but dried away about the eleventh or twelfth day, without producing any erupti- on, or any febrile indisposition (case 18). From the earliest appearance of the pustule, a slight de- gree of inflammation surrounds its base. This scarcely ap- pears to enlarge, except from accidental irritation, till to- wards the close of that period when the constitutional effects seem subsiding, and which in most of the cases I have seen was on the tenth day. At this period it begins to augment pretty rapidly ; in some instances, it has not diverged from the tumour mere than half an inch, whilst in others it has extended from two to four, five, and nearly six inches. This inflammation, known by the name of the efflorescence and areola, is mostly of the same circumscribed circular appearance of the pustule, but at times it diverges unequally, its existence does not seem to be essential to the perfection of the disease, although its presence is desi- rable, from its being most frequently present. It was for a considerable time regarded as a proof of the certainty of the constitutional influence of the disease on the system ; which, without its presence was viewed as a mere local affection; Mr. Ring however expresslv mentions, that he has known " several cases where there was a total ab- sence of areola," yet in none had he known the patient capable of receiving the infection of the small pox. I have seen two cases of this kind, both of which have since been ineffectually inoculated for the small pox ; so that I feel perfectly assured of the efficacy of the Vaccine, even when unconnected with this peculiar appearance. I have stated that the areola does not always occur : I have also remarked, that a moderate degree of inflamma- tion surrounds the base of the tumour from its commence- ment, even when no areola follows. As these two grades therefore seem totally unconnected, although the areola 37 when it takes place, appears only to be an extension of the former, I have occasionally noted it down under the name of the secondary inflammation, to distinguish it from the primary or permanent one. The induration of the sur- rounding skin is more or less considerable as the areola ad- vances, and generally declines as the efflorescence recedes. 1 have already mentioned the difficulty of ascertaining the presence of the areola in the black skin of the African • In the mulatto it is in most cases sufficiently evident. I have always considered the above mentioned tumefaction and induration of the surrounding skin as the sole criterion of its existence in the negro. As I have met with seve- ral instances of the absence of this state of the skin in the negro, I have considered it as evincing the non-existence of an areola. The two cases above mentioned were white, in whom I could make no mistake on this point: I leave it to be verified therefore, by those whose greater sources of observation on the negro, may qualify them to deter- mine it. As I have seen cases in which no areola existed, so I have also met with several instances, both of its early and tardy appearance. The early advance, as mav be supposed, is in those cases which have been followed rapidly by the subsequent changes. This was remarkably the case in my own person. By the commencement of the fifth day, two very fine pustules were progressing, with an efflorescence of nearly one fourth of an inch, at which period, I experienced considerable head ach and drowsiness ; on the sixth day, these symptoms had augmented, and shooting pains, ex- tending from the pustules to the axilla, were plainly per- ceived. The axillary glands were slightly enlarged. The efflorescence had advanced considerably, Avith slight tension and tumefaction of the parts. By the eighth day the areo- la was between two and three inches in extent from the pustule, or about five inches in diameter ; by the 10th day, or the usual time of the areola forming, the pustules were nearly scabbed over, of a dark mahogany colour ; the efflo- 38 rescence had gone entirely by the twelfth day, and one of the scabs fell off on the fifteenth, and the other on the six- teenth day, both leaving a second scab beneath, which fell off on the twenty-third and twenty-eighth days. Another instance came under my notice, of a child whom 1 vaccinated nine times before infection took place (case 9). From this child on the seventh day I obtained matter. On the Sth a scab was forming with a slight areola, which was perceptible the preceding day. About the sixteenth day the scab fell off, leaving another beneath. On the twenty- first day I inoculated her in two places with variolous mat- ter, taken the preceding day from a patient labouring under the natural small pox. The punctures slightly inflamed for three or four days and then gradually dried away. It is re- markable in this case, that the matter I employed for Vacci- nation which took effect, was taken on the eighth day from a child, in whom the areola did not occur till the eleventh ; which last case was vaccinated with infection taken on the eighteenth day of the disease, one day only antecedent to the areola.* In one other case the areola be- gan on the seventh day, and by the ninth was nearly gone, the scab being partly formed (case 42). It may not be un- interesting to add, that this case I vaccinated with infection taken from a secondary pock on the arm of her sister, about two inches above the original one, on the twelfth day from vaccination, and the third or fourth of its appearance. -About the tenth or eleventh day, a Vaccine pock appeared on the inside of the right knee. This case I have before adverted to, and these, are the only two cases I have met with, of any other pustule than on the vaccinated part ; I except the appearance of pimples which are not uncom?* * I notice this to prove, that the early or tardy appearance of the disease, does not influence such as are produced from its infection* 39 moil, and which probably may depend on the Vaccine, Variolous inoculation failed in this instance. f 1 cannot tell the latest period of the appearance of the areola. I have mentioned a case above from which I took matter on the eighteenth day, at which time the areola ap- peared just commencing (Dr. Hewson's letter, p. 27). I have seen it several times as late as the twelfth day. It might be supposed the efflorescence would occur quick- ly, in proportion to the rapid progress of the pustule, — but this does not seem to be the case. In the instance formerly noticed as yielding matter on the latter end of the third day, the areola did not commence till the tenth day; nor did the scab complete itself before the usual period. Case 43. The heat of the vaccinated part appears to be considerably augmented ; how much the thermometer would indicate, I have never tried. A more troublesome attendant on the areola than the heat, is a violent sensation of itching. It is of a burning stinging kind, resembling I think the sting of nettles; and requires the utmost exertion to avoid scratch- ing. This itching sometimes extends several inches. It is generally bounded by the circumference of the areola,* and is one of the most unpleasant symptoms, though not always equally violent; in children it has to me appeared a chief f In one case which came under my care, an inflamed circle com- menced about the beginning of the fifth day, extending by the evening to nearly an inch from the pock ; but by the evening of the sixth, it had totally disappearedy and the true areola did not commence till the close of the eighth day. I could not ascribe this appearance to any particular cause, and it is the only instance of the kind I have seen. * Though it is generally towards the close bounded by the extent of the areola, yet we find it occasionally appearing at an earlier peri- od, as the fifth, sixth, seventh, &c. days, before the areola had com- menced, and extending then to two or mete inches from the pustule. Perhaps the extent of the itching may generally denote the future ex- tent of the areola, as I have noticed in several instances. I have seen ■\X decline before the areola commenced. 4° cause of their fretfulness and anxiety, even when the febrile indisposition appeared but very trifling. f In addition to the varieties existing in the appearance and magnitude of the areola, its continuance may also be men- tioned, as differing in different persons. It mostly however begins to recede about the twelfth or thirteenth days; com- mencing frequently from the centre, and gradually advan- cing to the circumference, so as to leave a ring of inflamma- tion at some distance round the pustule. The declension of the areola is nearly as rapid as its progress, leaving the skin for a short time of a dingy hue ; at least I have repeatedly- seen it.J -A desquamation of the cuticle to the extent of the areola generally follows. The change of colour which takes place in the centre of the pustule about the close of the tenth day, in consequence of the contained fluid beginning to dry away, indicates the commencement of tbe process of scabbing, which is mostly complete in two or three days ; that is to say, a darkish hue has by this time extended over its surface. The pock gra- dually hardens, becoming of a dark brown, mahogany, or chesnut colour, exhibiting a fine polish and of the same cir- cular, or oval, appearance with the pustule. In about ten days or two weeks, if it is not previously rubbed off, the fluid below having been totally absorbed, the scab begins to sepa- rate at its circumference from the surrounding skin ; it then soon falls off, leaving the skin below perfectly sound, though mostly with a depression or pit. In some cases the scab falls off before the fluid is perfectly absorbed, leaving consequent- ly, a surface not completely healed, on which a second and •f* This itching frequently continues troublesome although lead water or other cooling applications be employed. I have lately recei- ved a letter from England, in which I am informed, bathing the in- flamed part with rectified spirit of wine, or ardent spirits, has suc- ceeded immediately in removing it. I have not yet tried its efficacy. % Sometimes the areola declines in such a manner as to leave an external ring of inflammation, and an internal one adjoining thepus- ele. (See the plate, twelfth day.) 41 sometimes even a third and fourth scab successively form, without any inconvenience or uneasiness. It sometimes happens, as I have before stated to have been the case with myself, that the scab forms at a much earlier period, even so soon as the seventh and eighth days: it falls off proportionably early. In other cases no disposi- tion to form a scab exists as late as the fifteenth, sixteenth, and seventeenth days; even though the areola had commen- ced at the usual period, and continued not longer than is common. In the case I several times have adverted to (case 26) from which I obtained matter on the fifteenth day, the areola appeared on the thirteenth, but less regular than usual, on the fourteenth day the patient exerted himself very con- siderably at a fire in handing buckets, after which a red Bof the size of his finger was very conspicuous, run- rom the pustule to the axilla (doubtless exhibiting the of a lymphatic), but not accompanied with any pain: fifteenth the areola was nearly gone, but there was no ance of a scab. The pustule all this time was increas- ing, being at this period very nearly half an inch in diame- ter. On the sixteenth a scab commenced, which did not come off till the fifth week from vaccination, and then left a second scab beiow: I might have procured matter two or three days I believe longer than I did, but I was fearful of inducing a spurious disease.* In another case the areola commenced about the eleventh day, continuing the twelfth, thirteenth, and fourteenth, during all which time the pus- * With this matter I vaccinated at the same time two children, in one of whom the scab did not form till the fifteenth or sixteenth day, when the pock was nearly half an inch in diameter. In the other the scab progressed at the usual time (see case 33, 34.) All these facts convince me that perfectly limpid matter from a perfect pustule may at any time be taken before the scabbing commences. I do not how- ever mean to recommend it. One thing is remarkable in the above cases 5 that the matter failed in both, in the first attempt, when it was eight days old, but succeeded in the second attempt five days later. [ 6 ] tule increased considerably, and continued so to do till the seventeenth day, when it was more than one-third of an inch in diameter; it now began to scab, and rapidly increased. In this case I tried to obtain matter from the pustule previ- ous to the commencement of the areola, but it was scarcely enough to moisten the point of my lancet, though the pus- tule was as beautiful as I have seen. 1 did not try after the areola commenced; but I apprehend I might have secured some on the fifteenth and sixteenth days. These appear to be the varieties of the regular disease; I must not however omit to mention that I have met with several cases, in which from five or six, to twenty or thir- ty small pimples arose in the vicinity of the vaccinated part, continuing for about three days, and then gradually declining without filling with any, fluid. I considered them as arising from local irritation. It is mentioned by Ring and others as occasionally occurring. J Whether they ever fill, and assume a Vaccine appearance I know not, but ra- ther imagine this to be the case; in case 34, on the ninth day several little pimples broke out about the vaccinated part and above it. By the twelfth day they all had disap- peared but three, of which one assumed the true Vaccine character ; from it I transferred the disease to another per- son. It is to be noticed that these secondary pustules ad- vance rapidly to their acme, and as rapidly decline. The above-mentioned pustule had a scab nearly complete by the termination of the fifth day. Although the Vaccine erup- tion, independently of the local pock, is a very rare occur- rence, yet sufficient proof exists that such an eruption occa- sionally takes place. The above case is in point. The child vaccinated from it, had also a true Vaccine pock on the right thigh. These are the only cases I have seen; but President Jefferson in his letter to Mr. John Vaughan mentions two or three of about two hundred cases, who had from two to % These are the same kind I apprehend which are mentioned by Dr. jenner (seep. 13), and which are represented in the plate on the tenth day. 43 half a dozen pustules on the inoculated arm only.* The Rev'd. Mr. Holt I have mentioned above as giving two ex- traordinary cases of above one hundred pustules each, (see p. 33.) As for the pustules which appeared in London at the first introduction of the disease, little doubt is now en- tertained of their having been variolous. Dr. Woodville is I believe entirely of this opinion at present. It does not appear, that the infection of the true Vaccine pustulous cases is more disposed to produce a violent disease than if taken from the local pustule. In two or three instances in infants, about the sixteenth day, I have noticed a few minute pimples or specks on the face and neck, resembling flea-bites which gradually disap- peared ; whether they were any way connected with the Vac- •cine I cannot say. I have seen also about the same period a nearly similar eruption, but more numerous upon the head of an infant of two months old, which appeared to be attend- ed with considerable itching : it declined however in a few days. I do not think these were any more than accidental concomitants of the disease. I have seen a similar eruption on the twenty-first day, and on the fifteenth, in two chil- dren vaccinated on the same day and with the same matter. An eruption on different parts of the body, as a scarlet efflo- rescence, has also been mentioned by some authors. I have never seen it. Having thus given as concise a view of the origin, as also of the general appearance, the progress and the varieties of this extraordinary disease, which have come under my own notice, as was in my power. I shall say a few words on the medical treatment. " Much of the hazard incurred in the small-pox is owing to a larger eruption upon the skin than the constitution can support," as Mr. Aikin has justly remarked. This howe- ver is not the only source of danger. The febrile symptoms, * Probably these might be only pimples of the nature abovemen- doned ; I have not learnt if any came to maturity. 44 even when scarcely followed by a dozen pustules, are often accompanied by convulsions of the most alarming nature. Neither has the small-pox been rendered so perfectly safe by inoculation as some pretend to assert, as to enable us to insure its successful termination. Those Physicians there- fore, who oppose the Vaccine under the plea of the absolute safety of inoculation, must either be totally ignorant of the disease they profess to understand, or wilfully blind to the hazard incurred, from the narrow principle of self-interest. I shall however attempt to prove to the satisfaction of even these narrow-minded Practitioners, that it is as much their interest as their duty, to employ this, the mildest of diseases, in preference to one of the most destructive maladies of the human race. It has been estimated that one person in two hundred dies of the inoculated small-pox, and this is perhaps not much out of the wav on a large scale. Now if we consider the total inhabitants of this globe as amounting to a thousand million, we may calculate that the one-fiftieth part die annually, and a like number receive existence. Of this fiftieth part or twenty millions (supposing the whole number were to be inoculated for the small-pox) the above calculation of one-two-hundredth part falling a sacrifice to its fury, will yield a total annual mortality of one hun- dred thousand persons. When however we view the rava- ges of the Natural Small-pox, especially in the vast regions of Africa where medical advice is scarcely known, it would be found that not less than one in ten (many calculate one in six to die with the natural small-pox) or two million an- nually, fall victims to this dreadful disease. As this calcu- lation is onlv made on a supposition of a perfect regularity in the premises laid down, 1 shall take surer ground, by stating from the authority of Dr. Lettsom, that two hun- dred and ten thousand persons annually die of the Small-pox in Europe alone. And Dr. Herman Mc. Donald asserts that it proves fatal to forty millions in everv century. In France it is calculated that one in fourteen dies of the small-pox. The total number of deaths in a year is estimated at nine 45 hundred thousand on an average, of which upwards of six- ty-four thousand are of the small-pox. Dr. Moreau informs us sixteen thousand persons died of the small-pox at Naples in one year, and twenty thousand at Paris in another. In England thirty thousand perhaps are (were) carried off annually by the small-pox. How grateful to the feelings of the illustrious discoverer of the efficacy of Vaccination must die reflection prove, that to him will mankind owe the preservation of so many lives ! These strong and demonstrable truths must I think carry conviction to every mind, that great indeed is the moral obligation of Parents and Physicians, to save this immense population to the world, bv the general introduction of the Vaccine ; a disease, which most assuredly, has never of itself proved fatal to a single person. What must be the feelings of a parent who with these facts before him, (not founded on the assertion of an individual, but confirmed by the testimony of thousands of witnesses, the most respecta- ble for their talents and situation), what I ask must be his feelings, when he sees a beloved infant writhing under the tortures of this foe to mankind, without having even given him a chance to escape by shielding him with this " asgis of Jenner ?" If a parent's feelings can thus be wounded by self conviction; how much more intensely should that Physician suffer, who, duly impressed w T ith' the certainty of the preserving influence of the Vaccine, should lose a patient by inoculation ! For my own part, I freely own, that with my present views on this subject, I should feel myself accessary to the death of the patient | and nothing but inability to procure the Vaccine infection, w T ould ever now induce me to recur to variolous infection, antecedent to Vaccination, in which case I should regard it as the less of two evils.* * I may perhaps add another exception to this general determination. I mean the inability by repeated attempts to produce the Vaccine. See case 30, whom I vaccinated fourteen times ineffectually, previously to any attempt to inoculate. He has resisted one attempt to excite the Small-pox, 4 6 It appears to me most extraordinary, that every parent does not anxiously seize the opportunity of giving their helpless offspring a chance to escape the ravages of the Small pox. The simple act of substituting the minutest speck of Vaccine or Variolous infection, may prove the means of future happiness, or a source of hitter reflection, and too late repentance. If beauty in a female is desira- ble in the eyes of a parent, how much reflection is nrcessary before those pleasing prospects are blighted by the Small-pox ! Even were it proved the Vaccine was not the preservative it is, what ill is to be apprehended from a disease, so slight as to exceed the range of possibility, to suppose, that death could be induced by it ? How eccentric is the conduct of mankind ! With testimo- ny in favor of the Vaccine ten thousand times stronger than would be required by the most prejudiced person, to convict an individual in a court of justice, is it not surpri- sing the slightest objection can be advanced against it ? Can we be surprised at the disbelief evinced by many in the Holy Scriptures, though so strongly attested ; when we see this propensity to scepticism so prevalent on a subject, the truth of which every one has it in his immediate power to verify, and which appears to stand on a founda- tion as strong as Christianity itself? What shall we say of the conduct of those Physicians, who, without any endeavour to investigate the truth of the doctrines advanced respecting the Vaccine, arrogantly as- sume to themselves the privilege of denying its merits alto- gether, or else assume as a fact that its prophelactic pro- perties do not exceed the limits of a few years ? Such Phy- sicians there are, (if they deserve the title) and not many miles from this metropolis, who thus strive to check the progress of this invaluable blessing. If they wilfully re- ject the firm basis on which it stands, they certainly de- serve the detestation of mankind : if it arises from igno- ranee, we must pity the fate of such, as trust their lives in the hands of those, who will not take the 47 trouble to render themselves acquainted with the facts they thus presume to oppose. That it is the interest of Physicians to employ this in preference to the small-pox, will I hope be rendered evi- dent when I come to consider the difficulty of procuring and preserving the infection. On those two points I rest the argument ; because I am well satisfied none but Physi- cians will take the necessary trouble to effect these ends, or with but few exceptions. Those who are objects of charity must still continue such, whether the Vaccine or the Small-pox are employed ; and those who can afford to recompense a Physician for his labour, will scarcely take the disease into their own hands, merely to save a trifling expence.* But to return from this digression. It may readily be imagined, that a disease so mild as the Vaccine, very rarely requires the aid of medicine, indeed I might say, never, as far as it respects the mere disease. Perhaps nineteen of ' twenty scarcely exhibit a perceptible indisposition: during the period of dentition, or in slight complaints of the bowels, I have in several instances had reason to suppose the febrile symptoms were not increased by the accession of the Vaccine. In adults, they are occasionally more con- siderable ; but even they, suffer but little uneasiness which a dose of cooling physic is not capable of removing. Dr. Jenner says [p. 98) " from the very slight indispo- sition which ensues incases of inoculation, where the pus- tule, after affecting the constitution, quickly runs into a scab spontaneously, or is artificially suppressed by some pro- per application, I am induced to believe, that the violence of the symptoms may be ascribed to the inflammation and irritation of the ulcers (when ulceration takes place to any f The danger of producing a spurious disease in place of the ge- nuine pustule, should also have its due weight with thos^e who are disposed to take the disease into their own hands. 48. extent, as in the Casual Cow-pox), and that the constitu- tional symptoms which appear during the presence of the sore, while it assumes the character of a pustule only, are felt but in a very trifling degree." At (p. 103) he adds " that the most material indisposition, or at least that which is felt most sensibly, does not arise primarily from the •first action of the Virus on the constitution, hut it often comes on, if the pustule is left to chance, as a secondary disease" He further adds (p. 109) " As the cases of ino- culation multiply, I am more and more convinced of the extreme mildness of the symptoms arising merely from the primary action of the virus on the constitution, and that those symptoms which (as in the accidental Cow-pox) affect the patient with severity, are entirely secondary, ex- cited by the ♦irritating processes of inflammation and ulce- ration." I am happy to have the authority of this cele- brated character on this important point ; and as far as my •experience goes, I most unequivocally coincide in the above remarks. All the cases which have proved any way dis- agreeable, have been those, where from inattention the scabs have been rubbed off and ulceration produced. And this leasts me to say a few words on this head, as it regards the symptoms and medical treatment. It has been observed that in a majority of cases, the pro- cess of scabbing follows vesication with the most perfect regularity. In these cases little indisposition is perceptible ; but when from inattention or from any other source, the scab is either rubbed off, or the pock is much irritated ; vio- lent inflammation sometimes follows, accompanied with considerable tumefaction, extending to a greater or less dis- tance, sometimes even up to the shoulder and down to the wrist; great pain of the part vaccinated, shooting up to the axilla; to which succeed inflammation and swelling of the axillary glands, chills, fever, restlessness, anxiety, nau- sea, vomiting, head-ach and pain of the back. These symptoms in part, or successively, increasing, usually sub- side in a few days of themselves, though now and then a 49 case of greater violence will protract itself one, two, and even three weeks. It is however uncommon to find it so violent as not speedily to yield to a gentle antiphlogistic treatment, in which may be included due attention to the local complaint, which by this time has probably put on the state of a disagreable phagedenic ulcer ; sometimes with a luxuriant growth of flesh, shooting up nearly one- third of an inch above the surrounding skin, and very ten- der to the touch. The axillary glands I have seen swelled nearly as large as a pigeon's egg, and accompanied with an erysipelatous inflammation over the whole limb ; the ulcer at the same time pouring out a considerable quantity of a limpid fluid for the most part, but occasionally of a puru- lent nature : When the disease has got to such a height, (which it seems incapable of doing without a successive series of negligence and topical injury), it requires some active application to arrest its progress. In three or four cases which have come under my notice, I have found no- thing equal to the unguentum citrinum. The mercurial and the red precipitate ointments are much recommended. In milder cases lead water, or Goulard's extract, will ge- nerally prove effectual. When the inflammation and pain are very great, it is necessary sometimes to poultice the sore ; in one instance a poultice of the marsh mallow, ap- plied without my advice, seemed to give more relief than the usual bread and milk poultice. It is seldom I believe, that the above mentioned ointments applied night and morning to the surface of the sore only, % will not cause it to assume a healthy state in a few days ; lead water or merely cold water to the inflamed limb may be applied at the same time with advantage. Some smart purgative eve- ry day or two, and abstaining from animal food and liquors, * I saw one case in which the unguentum citrinum, applied incau- tiously over the surrounding inflamed skin, seemed to destroy it, and thereby augmented the sore. When applied solely to the ulcer its ef- fects were very advaiatageous. [ 7 ] So will generally produce a cure in a short time, or so dispose it to heal, that any common dressing will suffice. I have been much surprised to see the small cicatrix which has remained after such a disagreeable ulceration ; indeed it would seem as if it was incapable of exerting so much violence on the skin and cellular membrane as the Small-pox; although its appearance in such violent cases is 1 think nearly as alarming as that arising from the Small- pox. I form this opinion from the case of a mulatto wo- man who came under my care, and whom I vaccinated in two places of the fore-arm (case 25) ; the infection took effect, and by the fifth day, the punctures were raised into two purulent looking pustules, not of the regular Vaccine form. As I had not a doubt of the spurious nature of the disease, I repeated the Vaccination on the same arm at about two inches distance from the former. This attempt produced one of the most beautiful pustules I have seen, and little indisposition attended. About the cessation of the attending symptoms, notwithstanding my strictest cau- tion, I found her nursing a child, and otherwise using her arm, by which the true Vaccine pustule was rubbed ofF, and the crustaceous scabs of the spurious ones also. From this moment the symptoms increased; and ran to the extent I have above enumerated. The arm was swelled most enormously, and the pain and enlargement of the axillary glands was very alarming. The steady application of the citrine ointment, and one or two strong mercurial purges, soon relieved the most urgent symptoms ; and though the sores had extended themselves to above three-fourths of an inch, yet in less than a week they were reduced nearly one half, and the whole was perfectly well in about six weeks from the first Vaccination. In another instance, a child of two years of age, the pock which progressed in the most favorable manner, was unfortunately rubbed considerably on the seventh day, and this was repeatedly the case till the tenth and eleventh days, when the indisposition, till now trifling, became very serious : the inflammation and 5* swelling increased rapidly, and the pain was very severe. In this case it was that the axillary glands became nearlv as large as a pigeon's egg. The sore looked very ugly, and required constantly to be poulticed for several days, during which it was with difficulty I could persuade the mother to force down a dose of physic. It soon began to assume a better appearance, and by the end of the fourth week was nearly covered with a hard dark coloured scab. J must observe that this child was of a very gross habit of body, and much troubled with worms. Being anxious to see the regular progress of the disease, I did not restrict the child in his diet during this period. The weather was at the same time very variable, cold and wet,* and the child always out in the street. These circumstances will tend in some degree to account for the violence of the symptoms. Where proper precautions are adhered to, I believe but few instances of such violence would take place : indeed if the sore is taken immediately in hand, lead water would in nine cases of ten prove sufficient to check the further pro- gress. If the inflammation after the twelfth day should continue, lead water seems all that is required, and not even then, unless it should seem to increase ; for till that period, it is only progressing as it ought. It has been proposed by some, after this period, to check any further disposition in the pock to spread, by applying some active corrosive substance for a few seconds, by which cica- trization is forwarded and danger of ulceration is prevented. The sulphuric acid on the head of a probe is recommended to be held a few seconds to the pock and then washed off. Of its efficacy I cannot speak, as I have not tried it ; being more desirous of seeing the natural progress of the disease * Upon referring to the other cases which have proved troublesome, I find they all took place in the same state of the weather. And it has been observed in England that a cold N. E. wind produced an aggra- vation of the inflammation. 5* than to check it. Mr. Aiken has given a judicious caution against its premature use, lest it should entirely extin- guish the disease, before the constitution is rendered secure against the Variolous infection. In the above mentioned cases the cicatrices were very- small compared with the apparent ulceration. I must add, that nothing like convulsions appeared in any instance, al- though the symptoms ran so high. How different from the Small-pox ! I may indeed ask in what do they agree % I think I may say in nothing ! Whatever proves bad in the Vaccine, is not essential to, but an accidental concomitant of the disease; whilst what is good is exclusively its own. On the contrary, the Small-pox is bad from beginning to end, without a single admixture of good to recommend it ; and not unfrequently leaving a remembrance of itself to the termination of life. I cannot refrain from adding the character of the Vaccine, as drawn by the enthusiastic but masterly hand of Mr. Ring. " As to the genuine disease, if disease it can be called, on the third day it resembles a flea-bite ; on the sixth a crystal ; on the tenth a pearl ; on the twelfth a rose ;- — a rose without a thorn ! " The vesicle which it displavs, may be considered as a gem of inestimable value ; and the fluid which it contains, a precious balm. How enviable is the lot of that man, who has put the world in possession of such a treasure ! It is to himself an inexhaustible source of happiness ; and to the land which gave him birth an eternal monument of glory." See p. 743, As the preservation of this matter is of the highest im- portance to mankind, it is incumbent on every Physician to pay the strictest attention to this point, more especially those who live in the country, where a failure might be with difficulty supplied. Disappointments will often occur, even when every precaution is taken to insure success. Matter will frequently fail, though employed immediately after being taken from a pustule, at the earliest period : S3 this I apprehend must depend in a great measure on an in- disposition to receive the impression of the disease; we see the same in the Small-pox ; and the same diversity ex- ists in different persons, and in the same person at different times, with respect to the application of medicines. This torpor, or whatever it may be, is unaccountable per* haps, though the fact is certain. I have in a former part mentioned a few remarkable instances of this kind. Though the Vaccine infection fails perhaps more fre- quently in a first attempt than the Variolous, I do not so clearly perceive that it is more perishable. What would be the greatest period of time at which Small-pox matter would succeed, I do not exactly know. The Vaccine has proved effectual at the end of three months according to Dr. Jen- ner ; and Dr. Marshall succeeded with it after as long a pe- riod. I received a portion from England which proved suc- cessful, though it must have been nearly three months old. These circumstances appear favourable, but I suspect it would not often be the case without the greatest precauti- on.* Four portions of matter which I received from Eng- land, failed in taking effect though put up with the minu- test care. Matter which has been taken but a very short time, (not above a day or two) has failed in the hands of Practitioners to whom it was sent at but a few miles distance from town. Other portions have proved successful which, have been sent off under similar circumstances. When it is to be immediately employed, perhaps the lancet is the best mode of conveyance ; though 1 am not so satisfied on this head as I was, because the matter is very insoluble, and I apprehend is seldom so thoroughly dissolved, as when uni- ted with water by a lancet point on a piece of glass. If it is taken on a lancet, it is improper to allow it to remain more than a very few days, because it very soon rusts the iron. * By referring to case 47 in the tables, it will be seen that I had some reason to believe I succeeded in exciting the Vaccine with infec- tion almost four months old, which I had paid no particular attention to preserve from the air. 54 The method 1 have employed to preserve the infection has chiefly been on thread and glass. I have taken it on thread mostly for the purpose of sending to Practitioners at a distance from the city. I have generally inclosed the thread in a piece of paper, and surrounded it with gold-beater's skin, so as to transmit it readily in a letter by the post; or I have thrust the paper into a quill, and after stopping it with a cork, have surrounded this with gold-beater's skin. In a few instances I have sent the matter on a piece of glass, which I have fitted with a piece of talc or isinglass, and coated with gold-beater's skin ; and again I have put the impregnated thread between two plates of isinglass and coated it as before. All these several ways have I believe succeeded. For my own use, I preserve it between two plates of glass which I coat as above ; and I have always taken the precaution to note down on a piece of paper with which I surround them, the name of the patient, together with the sed the Small-pox?' I will give a short account of its discovery and progress, and leave you to judge. In June last, my anxious researches were gratified, by discovering vhat I judged to be the genuine Kine-pox on the hands of two respectable women, a mother and her daughter in my neighbourhood. From those I inoculated about twenty, including my own family, in the months of July and Au- gust. People's prejudices were hard to overcome, and so few applied that I lost the matter, but soon found that the children were for mere pastime inoculating one another at school, without any guide, excepting a small caution which I received from Dr. Waterhouse, and published, viz. ■' ne- ver to take matter for inoculation after the eighth day.' On the 9th of December last I inoculated Mr. Lemuel Taylor and ten children, in consequence 6f Mrs. Taylor having broke out that day with the Natural Small-pox. The whole of this family took the Small-pox from this first inoculation, exceptingrfour of his eldest children, who had received the Vaccine disease about five or six weeks previous. This wo- man .had the confluent pock to an alarming degree; the whole family attended her throughout (excepting the youngest, a sucking infant, which expired convulsed in the eruptive fever) ; the four abovementioned were inocu- lated with Variolous matter seven different times without the least effect, and yet remain so. " A young man aged twenty, received the Vaccine di- sease in July, and a little girl aged five years, also received it in January ; both have been thoroughly inoculated with Small-pox by a neighbouring Physician (an unbeliever) without effect. Those few experiments awakened the minds of the people to conviction, and as is usual, unlimited con- fidence succeeded extreme scepticism ; the Vaccine inocula- tion pervaded every class of citizens so generally, that of three thousand three hundred inhabitants contained in the town, two thousand at least are judged to have received it: pf those, fifty or sixty may be found who have from vari* no ©us motives, repeatedly visited the different Small-pox hos- pitals, with indifference, yet no one has yet taken the dis- ease. I shall be very happy to hear of its success, or anv unfavourable appearances that may happen in Philadelphia, or elsewhere: At present my faith in the utility of this new disease is unimpaired, but should it prove fallacious, I think the public have a right to the earliest information. " With sentiments of respect, " I am your humble servant, « JOSEPH TROWBRIDGE. es Banbury, April 1th, 1802." " Sheffield, \5th April, 1802. "Doctor John Redman Coxe, M Sir, " I delayed replying to your favour of the 17th ultimo, that I might communicate some facts in relation to the subject of domestic Kine-pox, which, at the time of my receiving your favour, wanted time to de- velope. " That the genuine Vaccine-pock has been derived from cows in one or more instances in my neighbourhood, is a fact, the truth of which I do not myself in the least doubt. The evidence on which my belief is founded I will attempt to detail to you in a brief and circumstantial manner. I was requested in the month of March, 1801, to visit a son of Colonel Joseph Goodrich, who I was informed was affected with sores or boils of peculiar appearance. I found him with several tumors upon his face and hands of the size of large boils, but flat upon the apex of each to the extent of a half dime piece, and having underneath, a small quantity of an almost colourless fluid. I was at once struck with the singularity of the appearance of these tumors. I had at that time a few patients under my care, whom I had caused to have the Kine-pox by inoculation; it occurred to me that the tumors resembled Kine-pox, but they were considerably larger and more prominent than Ill any I had seen In that disease. At my visit the next day, I strongly suspected the identity of his disease and Kine-pox, and that it was dissimilar to any thing else. I requested permission of the Colonel to inoculate some of his family with matter from the tumors, and others with Kine-pox matter, which I had in my possession, which was accord- ingly done. In two (which if my recollection serves me were all who received infection from the boy), the parts inoculated soon began to inflame, as in Kine-pox, and about the eighth day they had pyrexial symptoms. The progress was similar in one of those who received Kine-pox mat- ter. Hie tumors were larger, the local inflammation more extensive, and the symptoms all more violent, in those ino- culated from the boy than in the other person. One of those in particular had much local inflammation which continued several days, followed with the sloughing off of a sufficient quantity of substance to leave a pretty deep seated ulcer. The ulcer however, after digestion took place, •healed kindly. I was now satisfied for myself that I had dis- covered the Vaccine-pock. It now remained that the man- ner in which the boy obtained it should be investigated. The Colonel I well knew kept a large number of cows: upon enquiry I found, that his soniiad been in the prac- tice of milking them, and that it was recollected by the boy and others of the family, that one of the cows had been affected with sores upon her teats. It was also well remembered, that this boy a few days before the com- mencement of his disease, had in play with his compani- ons, received several scratches upon his face and hands. Into these lacerations it is not improbable that matter from the cows (taken upon the hands, and they accidentally ap- plied to the face) might have been insinuated, and in this way a complete inoculation come to be effected. " In about three weeks from the time when those whom I had inoculated in this family were diseased, I inserted into the arm of one of those who had been inoculated from the bov, and into that of the one who had had Kine- 112 pox otherwise, some good Variolous matter which had been taken, the day before, from a person in Smail-pox, but with no other effect in either, than a little inflammation of the part, which subsided in five or six days. This I thought pretty satisfactory evidence, that my domestic Vaccine disease was a preventive of Small-pox. I regret that experiments with this matter were not repeated while the matter which I had saved was active. But owing part- ly to a press of other avocations, and partly to the difficulty of obtaining subjects for experiment, the business was not prosecuted until the matter had lost its activity. " Fourteen days since (which is the circumstance that caused my delay in replying to your queries), I inoculated the whole four of my abovementioned patients with Vario- lous matter without effect. The matter was unquestion- ably good, and the insertion faithfully performed. I shall not swell this epistle with comments, but attend to your query with regard to the origin of the disease in the cow. My own mind with regard to the origin of the disease in' this case, as well as to the general principle, is in suspense. There is an air of improbability in the theory of the origin of the Vaccine disease from the heels of the horse, that I cannot get over. But to well authenticated facts I ought, as I hope I ever shall, yield conviction. Facts of this kind sufficient to establish the theory, I do not know that we are yet in possession of; circumstances in the case which 1 have related were not unfavorable to the truth of the theory. The Colonel had a large number of horses, and some of them I was informed, were affected with the Grease in the heels ; the same persons also who milked the cows dressed the heels of the horses. The disease therefore might have originated in this way. "I will just add that I have no doubt in my own mind, but that the Vaccine disease, was, in the course of the win- ter before last, derived from cows to the human species in two other families in this town. Several persons I be- lieve had the true disease. But as the facts did not come under my own observation, and as no experiments have been made on them with Variolous matter, I shall not swell this communication, already protracted beyond my expectation, with any particulars. " There have been inoculated* by me, and under my inspection, in this town, about fifty patients, who have had the Vaccine disease in a mild manner, and about half of them have been tested with Variolous matter without effect in any instance. " Should you wish Sir for any further information from me, in relation to this subject, I will ever cheerfully attend to your commands. If in the progress of your business in this line any new facts should occur, I will thank you to communicate them to me. ** I am Sir, respectfully, " Your Humble Servant, " Wm. BUEL." Dr. Waterhouse, to whom I wrote on the same subj ect^ politely furnished me with the following reply. It com- mences the letter from which I have given an extract at p. 70. " Dear Sir, '* Your letter of the 17th instant came to my hands last evening. In answer to your query respecting the indige- nous, or domestic origin of the Vaccine disease, I must in- form you that I have my doubts. I had early information from Drs. Buel, Trowbridge, and if I mistake not from Dr. North, on that subject. The matter sent me by the first never produced the disease, although the thread was as stiff as a wire with it: that was however no proof that it was not genuine. I have had information from perhaps a dozen quarters respecting this disorder among our cows; one was to me so un-equivocal, that I wrote to Dr. Jenner * The necessity of employing the term Vaccination in contradis- tinction to Inoculation will I hope soon be generally admitted. [ 15 ] ii4 that we had certainly found it among the American Line ; you will see however, in the London Medical and Physical journal for September, that we were deceived. A young woman at Dorchester in the county of Norfolk, had an e- -ruptive disease which she caught by milking a cow whose udder was covered with pustules ; this person had a severe- febrile affection, and painful pustules on her hands and arms ; she was therefore sent into the Small-pox hospital and took the Small-pox from inoculation. I doubt not the accuracy, much less the veracity of these Practitioners, but suspect they have been deceived in a way similar to that I have related in the Medical journal, under the communication respect- ing " the effects of heat on the virus." Medical pupils and others have slyly inoculated cows, merely for the sake of the experiment, or for a supply of matter. I inoculated one of my cows for that purpose and succeeded to my wish. That the Cow-pox has arisen spontaneously (if a person may use that term who believes, that strictly speaking, there is no such thing in nature) in the kine of our country is a matter of which I am far from being entirely satisfied. I shall not therefore cease a rigid enquiry relative to the domestic ori- gin of this distemper." If the disease whose history is recorded by Dr. Trow- bridge, was really the genuine Cow-pox, and of this there scarcely seems a doubt, how can we account for its producti- on where there appears no vestige of the Grease ? This must require the strictest attention to determine, as it will tend to prove the origin of the disease to be in the cow herself, or else that there has been some other source of communicati- on from the horse. It is not impossible to suppose a cow to take this disease from the matter of the Grease, even though we cannot trace it to its source from the horse through the hands of a man who may have previously dressed the diseas- ed heels. The matter of Grease or Scratches is a limpid fluid oozing from the cracks of the heels, and from thence consequently, must not unfrequently fall down upon, or be brushed off, by the herbage of the field in which the animal "5 may be feeding. Whilst still fluid upon the grass, we may easily imagine a cow might accidentally lay down in this very spot, so that her teats and udder should come in imme- diate contact with the infection, and thus by a species of inoculation produce the disease. There are many things of whose truth we are certain, which appear far more impro- bable. Some persons have supposed the disease could not originate from the horse, because it could not be traced com- pletely in every instance, through the hands of men employ- ed to milk. I think this mode of accounting for it may serve to reconcile these opponents.*' I hope these and the subsequent valuable communications will influence Practitioners to pay attention to the subject, in hopes of discovering the disease nearer at home. Dr. Jen- ner's idea that the virus, is as perfect in its Equine as in its Vaccine state at its first formation, is of the utmost import- ance, and will certainly meet with the attention it deserves, from every one disposed to forward his philanthropic views* T shall here introduce the following important commu- nication from Dr. Jenner to Dr. Waterhouse which he has very politely forwarded to me, Cambridge, May 26th, 1802, " Dear Sir, " I am induced to write to }K)u at this time to give you a short extract of a letter from the worthy jenner, which I received not long since, respecting a new source of the Vaccine virus, not knowing but what you would wish to insert it in your publication. It is this; " ' I have sent you- also some virus from a new stock. 6 The old stock now in use near three years, has not lost * If the Grease does not give origin to the Vaccine j it certainly seems to depend upon some common cause, with this last disease} the fame season and kind of weather disposing to both. u6 ; any of it's original properties, nor do I suppose it ever * will. A medical gentleman at Milan, Dr. Sacco, (who f informs me he has inoculated 8,000 persons in that city), f has lately sent me Vaccine virus taken from a dairv on the ' plains of Lombardy. It has produced again and again 4 the perfect pustule here. I always ventured to predict that * the Cow-pox was not confined to this island, but that e wherever, in the same dairy, there should happen to be ' the peculiar intercourse I have pointed out between the * horse, the man, the cow, and the milker, that there the ' disease may be called into existence. Abundant testimonies 6 of the source of the Vaccine virus have lately appeared, and ' I have long been convinced that it is as perfect in all its ex- * traordinary qualities in it's Equine as in its Vaccine state ; c perfect on it's first formation, and imperfect when secreted ' at a late period of the disease; just as it is, when transfer- c red, and subjected to go through it's progressive stages in * the human body.' " The following account of the discovery at Milan, in the words of Dr. Sacco himself, I shall be pardoned for intro- ducing in this place. It is extracted from the Philosophi- cal Magazine, No. 46, for March 1302, page 184. t{ < In our last we mentioned that Dr. Sacco, of Milan, had sent to Dr. Pearson, Cow-pox matter, taken from the Milanese cows. In a work published by Dr. Sacco, in Italian, entitled ' Practical Observations on the Use of the Cow-pock, as a Preservative against the Small-pox,' he gives the following account of the manner in which he procured the pus for inoculation, and also a representation of a cow's udder infected with the malady. " For some time I had been extremely desirous to repeat the experiments of Jenner, and for this purpose made dili- gent search to discover the Cow-pox in Lombardy, it beings extremely difficult, especially in the present circumstances, Xq obtain the pus from England. A fortunate combination ii7 of circumstances, by which it became necessary for me to go to the large town of Varese, in the beginning of autumn^ procured me an opportunity of examining a number of cows on their way from Switzerland to the fair of Lugano; and by this means, I had a favorable opportunity to make such researches, as might discover in some one of them the Cow- pox. It was on this occasion, that, conversing with some dealers in cattle, and countrymen who had large dairies in Lower Lombard y, I learnt that the cows among us are sub- ject to the Cow-pox. In this inquiry I took care to propose my questions in such a manner as to prevent the risk of be- ing imposed upon. A farmer of Cremona, who had bought forty cows in Switzerland, and had driven them from thence as far as Varese, assured me, that almost all of them had been successively attacked with pustules on the extremity of their nipples, and some of these were now converted into incrustations. I visited the cows, and had an opportunity of verifying his assertions. 1 picked off some of these in- crustations with an intention of applying them in fomenta- tion, if, perchance, 1 could not procure the true pus for inoculation. The same farmer promised me an opportunity of seeing this disease with my own eyes, and for this purpose conducted me to a neighbouring meadow, in which we found a herd of cows belonging to a friend of his. We examin- ed these cows, and discovered on two of them different red spots, which the farmer assured me was the first stage of the disease ; no other symptom appeared on the cows, but a slight degree of dejection. He assured me that this was the very disease I was in quest of, and that, in the course of two days, the pustules would unfold themselves. At this visit which I made to the cows, there was present a dealer in the Orison's cows, who fully confirmed the truth, of these assertions. He also added, that in his country, he had seen the cows affiicted with a similar eruption on their dugs, and to remove the incrustations, it was common to anoint them, with boiled oil used for varnish; and that bf n8 this means thev Fell off in the course of two or three days. Early next morning I went again to see the cows, examined them anew, and found on one of them four red spots, alrea- dy tumid and raised into pustules ; three of these were spread over the nippies, and the fourth lay in the middle of the dugs. The other cow had six pustules ; two on the nipples and the rest scattered above them. These were larger than those of the first cow, and around them appeared a slight red circle. Apparently these pustules occasioned much pain to the cow, for, on my approaching to examine them more minutely, they would scarcely permit me to touch them for one moment. Although the pustules were already large and prominent, they did not yet appear to me sufficiently mature to yield the matter I wanted. As the cows were that day to go forward on their way to Milan, I found my- self under the necessity of following them to their first halt- ing-place, in order to examine them again next day. I walked out at an earlv hour to the meadow where they were at pasture, I examined the pustules, which appeared to me to be now arrived at maturity. They were lucid, and of a pale red colour, with a brown spot in the middle more de- pressed; and I thought this a favorable moment to collect the matter, which, through the assistance of the herdsmen, I was easily enabled to do by repeatedly soaking a thread in it. Although I saw no reason to doubt that this was the true Cow-pox, yet, this being the first time 1 had ever seen it, I began to suspect, that the pustules might be of that kind which Jenner calls the spurious Cow-pox. I determined, therefore to decide the matter by experiment. A consider- able number of experiments, all uniform in their symptoms and progress, and always constant in theit results, put the matter beyond doubt, and gave me full conviction that this was the true Cow-pox. Such and so many are the obsta- cles to be overcome on the introduction of any innovation, however salutary, that I for some time despaired of being gl>le to induce any one to submit to inoculation with the ii9 matter I had collected. In fine, after many fruitless pet* suasions, 1 succeeded in my design ; the success which at- tended the first inoculations encouraged others to%ubmit to the same process. " Dr. Sacco then proceeds to detail three hundred cases, in which he applied the pus he had obtained in the manner des- cribed above. These cases were attended with various cir- cumstances ; but the inoculation succeeded to produce the Cow-pox in all of them ; and in a considerable number the inoculation for the Smail-pox was afterwards applied, but: without any effect."* As connected in some degree with the progress of Vacci- nation in different parts of the world, I trust it will not be uninteresting to give a short history of its introduction into tills metropolis. Having perused with much satisfaction Dr. Jenner's trea- tise on the " Variolar Vaccinas," together with some of the various periodical publications on the same subject about the close of 1800, I became very desirous of ascertaining the truth of so extraordinary a discovery. My desire was how- ever checked by learning through the medium of the daily papers, that the Small-pox bad been introduced into Mar- blehead, instead of the Vaccine, from which, (from my imperfect knowledge of the subject), I concluded the dis- eases were not easily discriminated. The history of this * It may not be amiss to mention that the pock represented on the infected \idder, very much resemble the pock on the hand in Dr. Jen- ner's first plate. They are not however coloured} and are apparent- ly more depressed in the centre. I wish we could generally fall upon some expression which might become general in the place of pustule. This is certainly an impro- per term, and the word pus, as used by Dr. Sacco and the English editor to imply the contents of such a vesicle, is yet more improper, for no such thing as pus is known in the Vaccine, except from acci- dental causes. The word pock will perhaps answer. no unfortunate event is minutely detailed by Doctor Water- house, in a communication dated February 1st. 1802, to the Editors of the New- York Medical Repository, and which has lately been published in the last Number of that valu- able work, Volume V, page 373, &c. This circumstance (with the particulars of which I was unacquainted), toge- ther with the introduction of a spurious disease into New- York, Norfolk, and other places, persuaded me it was bet- ter to adhere to the old mode of Variolous inoculation, rather than depend on a disease I considered so very uncer- tain. For some months 1 thought no more about it ; but finding by the publications from Europe, it was gaining, ground, and that many who at first opposed it, were now be- come its strenuous advocates, I resumed my favourable opi- nion of it, and determined if possible to procure the infection. Through the politeness of Doctor Bradley and Mr. Ring, I obtained from London, several successive portions of infec- tion about the end of September 1801. These failed in e- very instance. A subsequent portion however succeeded, which I received on the 13th or 14th of November. Pre-^ vious to this, I had fortunately obtained an infected thread from President Jefferson, which he kindly procured for me from Doctor Gantt, in consequence of my request through Mr. John Vaughan. The infection was accompanied with the following highly satisfactory letter on the subject, which I have the President's permission to make public. " Washington, November 5, 1801. " Dear Sir, " I received on the 24th ult. your favor of the 22d, but it is not till this day that I am enabled to comply with your request of forwarding some of the Vac- cine matter for Dr. Coxe. On my arrival at Monticello in July, I received from Dr. Waterhouse of Cambridge, some Vaccine matter taken by himself, and some which he at the same time received from Dr. Jenner of London. Both of ' I2t them succeeded, and exhibited precisely the same aspect and affection. In the course of July and August, I inoculated about seventy or eighty of my own family; my sons in law about as many of theirs, and including our neighbours who wished to avail themselves of the opportunity, our whole experiment extended to about two hundred persons. One only case was attended with much fever and some delirium ; and two or three with sore arms which required common dressings. All these were from accidents too palpable to be ascribed to the simple disease. About one in five or six had slight feverish dispositions, and more perhaps had a little head-ach, and all of them had swellings of the axillary glands, which in the case of adults disabled them from la- bour one, two, or three days. Two or three only had from. two to half a dozen pustules on the inoculated arm, and no where else, and all the rest only the single pustule where the matter was inserted, something less than a coffee-bean, depressed in the middle, fuller at the edges, and well defi- ned. As far as my observations went, the most premature cases presented a pellucid liquor the sixth day, which con- tinued in. that form the sixth, seventh, and eighth days, when it began to thicken, appear yellowish, and to be en- vironed with inflammation'. The most tardy cases offered matter on the eighth day, which continued thin and limpid the eighth, ninth, and tenth days. Perceiving therefore that the most premature as well as the tardiest cases embra- ced the eighth day, I made that the constant day for taking matter for inoculation, say, eight times twenty-four hours from the hour of its previous insertion. In this way it fail- ed to infect in not more I think than three or four out of the two hundred cases. I have great confidence therefore that I preserved the matter genuine, and in that state brought it to Dr. Gantt of this place on my return, from whom I obtained the matter I now send you, taken yesterday, from a patient of the eighth day. He has observed this rule as well myself. In my neighbourhood we had no opportuni- ty of obtaining Variolous matter, to try by that test the ge- r 16 ] 122 nuineness of our Vaccine matter ; nor can any be had here, or Dr. Gantt would have tried it on some of those on whom the Vaccination has been performed. We are very anxious to try this experiment, forthe satisfaction of those here, and also those in the neighbourhood of Monticello, from whom the matter having been transferred, the establishment of its genuineness here will satisfy them.* I am therefore induced to ask the favor of you to send me in exchange, some fresh Variolous matter, so carefully taken and done up, as that we may rely on it ; you are sensible of the dan- gerous security which a trial with effete matter might induce. 1 should add that we never changed the regimen nor occu- pations of those inoculated ; a smither at the anvil continu- ed in his place without a moment's intermission, or indispo- sition. Generally it gives no more of disease that a blister as large as a coffee-bean produced by burning would occa- sion. Sucking children did not take the disease from the inoculated mother. These I think are the most material of the observations I made in the limited experiment of my own family. In Aikin's book which I have, you will find a great deal more. I pray you to accept assurances of my esteem and respect. (Signed) « THOS. JEFFERSON. " Mr. John Vaughan." This letter together with the Vaccine infection, was re- ceived by Mr. Vaughan on the 9th of November, 1801 ; A day which I trust will be memorable among the citizens of Philadelphia, from the great benefit connected with it. I immediately employed the infection which Mr. Vaughan put into my hands on myself and four others ; although these last had never had the Small-pox, (which I had passed through in early life), my system nevertheless seemed more suscep- tible than their's, for I took the disease by the first attempt in two of three places, whilst I was necessitated to repeat * Iri consequence of this request, I forwarded some recent Vario- lous matter, but am ignorant of the result of the trials made. . 113 it in all the others. It has been said my disease was local; on this point I certainly feel myself competent to decide. I have in the Tables in the Appendix given the outlines of the case.* However this be, the matter from my arm proved a considerable source of infection, and either directly, or indirectly, has aided very extensively in propagating the di- sease. By the commencement of March I had supplied up- wards of one hundred persons with Vaccine infection, with most of whom I believe it succeeded; amongst these are Practitioners of Physic in this and the adjoining states, an4 also in those to the southward; I have likewise forwarded it to the Natchez, to New Orleans, and to Martinique; whether it has proved successful in these places I know not. Whilst I sincerely thank many gentlemen for their high- ly important communications, I have to apologise to others for my apparent neglect, in not supplying them with the in- fection which they have written for. It frequently happen- ed that I received such applications when I had scarcely any of the infection, f and they must be sensible it would not have been right to have deprived myself of that small stock, by which I trusted I should have been able to extend the di- sease. * It affords me pleasure to be able to say, that the disease on my arm, though advanced to the state of a scab, was at once recognised by an old English farmer, (from Suffolk, now residing near Chester), of the name of Ashford, to whom it appeared perfectly familiar, as well as at the less advanced period which is represented in Dr. Jen- ner's first plate. This man, though he has now resided several years in America, told me, he remembers the efficacy of the Cow-pock in resisting the Variolous contagion, but knew nothing of its having been effected through the medium of inoculation. •f I have already said, that many of my experiments were made with infection of various dates, in order to try the extent of time du- ring which it retained its powers ; hence it is no wonder I frequently failed j this, together with the various sources of failure I have former- ly enumerated, will I doubt not, excuse me. 124 The advantages of Vaccination to the southern and seve- ral of the middle states, where Variolous inoculation is rare- ly permitted, are incalculable. The same may be said of Kentucky, where I am informed, there are nearly one hun- dred thousand persons who never have had the Small-pox. J The advantages of this disease are scarcely less considerable to some of the eastern states. In the army and navy it doubtless deserves the attention of government, inasmuch as it seldom requires any confine- ment, or particular regimen; so lit.Ie, I have already noti- ced, that in England the soldiers are not even entered on the sick-list in consequence of this disease. It is not long since I was asked for matter for the Constellation frigate, in which the Small-pox made its appearance after leaving the city. I had unfortunately at the time but little to spare ; whether that which I sent took effect I know not. I was informed by her Commander Captain Murray, that in her last cruise, one hundred of his crew had the Small-pox, five or six of whom died. I need not say how great must have been the anxiety and inconvenience excited thereby, nor how much more serious such an occurrence might prove, should a ves- sel thus half unnian'd, meet with an enemy. The simple knowledge of the fact will I trust, lead those in whose de- partment this is placed, to attend to the subject. I think it proper here to mention the great necessity of investigating every idle tale which is brought forward to de- preciate the Vaccine. I have heard of a Practitioner of this city having a case with so bad an arm after Vaccination, as to make it expedient to amputate it; whereas this gentleman had not experienced the slightest inconvenience on this score. In another instance the Small-pox was said to have appear- ed after Vaccination. So far the story was true, but it was % I regret I have it not in my power to give any account of a disease afnong the cows in some parts of Kentucky, which Dr. Brown in- formed me he had reascn to believe was the genuine Cow-pox, and the particulars of which he promised to transmit. I have not yet re- ceived them. 125 not added that the child had never taken the disease, and was therefore inoculated to preserve it from the Small-pox which was in the neighbourhood. This was to be detected only by strict investigation ! Such are the falsehoods which impede the progress of the brightest discovery which has ever been made ! But the contest is in vain ! Time has drawn aside the veil which obstructed our knowledge of this invaluable blessing ; and in the examples of the Emperor of Constantinople,* of the Dowager Empress of Russia, § and the King of Spain, we may date the downfal of further op- position. I have thus brought to a conclusion the relation of the facts which have come under my notice, and have endeavoured faithfully to detail the result of my experience in the Vaccine from its first introduction to the present period. Most of the facts stated, I have myself observed, and have onlv to add, that I have never depended upon my memory, but have each day committed to paper every circumstance which appeared de- serving of notice, of those cases w r hich have come under my care. The infection when taken was always noted, both from whom I obtained it, and also the day of the month, and of the disease, so that I can trace to its origin almost e- very portion of matter, which I have either used myself, or sent to others. I hope this treatise, imperfect as it doubt- less is, will still have the effecu of aiding the extension of the most beneficial discovery which has ever been made, by tending to allay improper prejudice, and imprudent fears, both in Parents and in Physicians ; and also of awakening the philosophical researches of the curious, in order to as- certain with due precision, what is the real origin of this wonderful Prophylactic. * The favorite Sultana of the Emperor it is said, had her infant Vaccinated. § " The first child that was inoculated for the Cow-pox in Russia was named by the Empress Dowager, VaccinofF, and a pension was settled on her." ^pprntjir, CONTAINING First — Various Letters on the subject of the spurious cases of Vaccine which occurred in New-York, Norfolk, and elsewhere. Second — A set of Tables and Notes comprising the outlines of some of the first cases of the Vaccine which came under my care. Third — Sundry Remarks and Observations, SCc. which have occurred to my notice since the publication was put into the hands of the Printer, and which I must have introduced here, or have altogether omitted. Extract of a letter to Doctor Hosack, dated Philadelphia, the IQth cf January, 1802. " IT has been reported in this city, that you have had under your care, a child who took the Small-pox, after having passed through the Vaccine disease, and it has been urged by some as a cause for doubt of the efficacy of the latter in preventing the former. As this case militates so strongly against the present received opinions on this point in Europe, as well as against the experience I have had in several instances, I can scarcely doubt that the account has originated in some misrepresentation, and in consequence, most earnestly desire to have it from the fountain- head, as the only method of coming to the truth, &c. " I am, Dear Sir, ** Your very obedient Servant, '< JOHN REDMAN COXE." 128 SH? this I received the following Jnsme of it from Doctor Jackson ; he accordingly obtained it and carefully enclosed it in a phial, in such manner that it could undergo no change from the air : Without delay, I again inocula- ted six children with it ; among others, a child of Mr. Charles Wilkes, Cashier of the bank of New- York ; upon the third day, I examined the arms, and found them all very much inflamed, so much so, that I had no doubt of my success, with this third at- tempt ; the inflammation continued, and extended about an inch around the part inoculated, and in each a pustule was formed, which filled with a watery matter, and did not heal in less than ten or twelve days from the time of inoculation. I 129 "Upon the eighth and ninth days, Mr. Wilkes's child had- manifestly a degree of fever; in the other children there was no observable indisposition ; there was no eruption upon the skin in either of them ; but the inflammation of the arm was so great in all, that I had no doubt of the success of this inoculation ; but to ascertain it, I afterwards inoculated them with the Variolous matter : to my great surprise, the arms inflamed, they all sick- ened, and each had a considerable number of pustules. The con- clusion I drew from the above circumstances was, that the matter sent me by Doctor Pearson had totally lost its activity, from the open manner in which it had been conveyed, and the great length of time that, necessarily elapsed before I received it ; that the matter sent me by Doctor Jackson, was either not the genuine Vaccine matter, that it was not taken at a period of the disease in which it possesses the most active properties ; or, that it had undergone those changes which Doctor Jenner has stated it to be subject to. *' My want of success has, however, not altered my faith upon this subject ; the almost unanimous testimonies in its favour are not to be resisted ; in our own country, we have abundant proof ofits utility, &c. &c. " I am, Dear Sir, with great regard, « Your's, DAVID HOSACK. " Dr. John Redman Coxe." The following is an extract from my reply to the aho-ve, dated January l8/£, 1802. ** Allow me to thank you for your satisfactory letter ; I had ac- counted for the cases which came under your inspection, in the manner you have done, and am happy they have not damped your ardour. Permit me to ask the form and progress of the pus- tule, the colour of the scab, and whether you vaccinated with the matter of the pustules ? How long after the disea?e was it before you inoculated t >r the Small-pox ? Have you had any in- formation from Doctor Jackson, iclative to the matter he supplied you with ? " I hope you will pardon the trouble I give you, and believe me to be, Sir, " Your's sincerely, J. R. COXE." I'o which I received the following satisfactory reply. f( New-York, June %th t 1802. " Dear Sir, fi YOU will think me remiss in not having replied to your favour of January the 18th ; but I purposely post- poned my reply to the questions it contains, until my observations Ltt'l i jo spon'the Kine-pox have made me more familiarly acquainted! with the characters which distinguish the Gm///7# from the Spuriout kind. M I am now perfectly satisfied that the pustules which were produced upon the arms of those children I inoculaied with the matter I had received from Doctor Jackson, were very different from those of the genuine Cow-pox I have since employ d, and am at present in the use of: In the former a brown scab appeared very early after inoculation, which does not take place in the genuine Cow-pox ; the pustule had not in any stage of it that pe- culiar pearl colour, which characterises the genuine species ; the matter discharged from it was Uss limpid, more approaching in its appearance and consistence to common pus ; the pustule was not of so long duration, nor did it termit ate in th^ black scab, as in the genuine disease. The failure of those ca^es inocu- lated with the spurious matter stated in my first account, I learn, with' great regret, has given rise to a report in this city, which has prejudiced many families against the introduction of the Cow- pox ; but this prejudice must in a short time yield to the numerous testimonies which we now possess, to shew that the genuine Cow- pox is a perfect security against the Small-pox. "I am, Sir, with great regard, «« Your's, DAVID HOSACK. "Dr. John Redman Coxe." The following letter I received from Doctor Balfour, of Nor- folk, in consequence of a request to obtain for me every possible information relative to the spurious disease excited there. j) , " Norfolk, March 25, 1802. "To Doctor John Redman Coxe, Philadelphia. "Sir, " WHEN I last had the pleasu-e of seeing you in Phila- delphia, you were so good as to furnish me with some of the fresh~ est Vaccine fluid in your possession, f then promised to give you an account of the success I should meet with in propagating it in this place, and the history I cpuld collect (fori did not then reside in Norfolk), of the spurious disease which existed here the last year, and at that time was called Cow-pox. That it was a spurious disease there is now no doubt ; the event too truly proving — for unfortunately those who had th ; s false infection, afterwards took the Small-pox, and some, it is said, fell victims to the decep- tion. "The impression made on the public mind, in consequence of this error, is a perfect horror at the name of Cow-pox : It has been further increased bv the true Vaccine matter (with which several have since been inoculated), having failed to produce any I 13* disease at all ; its infecting powers from keeping being lost. The females of this city are particularly opposed to the Vaccine inocu- lauon ; so violent are they, that they generally declare they would rather their children should have the Small pox, and run their chance." *' 1 will now give you an account of the success of my practice : On the 7th of February, the day after I saw you, Doctor Currie of Philadelphia, kindly permitted me to take the fluid from the arm of a child under his care. It was on the ioth day, the areola just beginning, (I should have preferred it sooner). The same evening I left Philadelphia by water, and arrived here on the 17th fuliowini — i immediately inoculated a gentleman's child of this place, (Mr. Martin Fisks), and his negro woman: On the fourth day it was evident the infection had taken. In both cases the disorder progressed and declined in its most regular form ; by the 2zd of March there remained nothing but a hard shining scab, when I inoculated them both with fresh Small -pox matter; their arms were inflamed a little on the second day, but by the sixth were perfectly dried up, without producing the smallest af- fection of the system. Not perfectly satisfied with this assurance, knowing the public prejudice, I again inoculated both the child and negro woman with fresh Variolous matter from different per- sons. At the s/ime time I inoculated with different Small-pox matter, a child of Mr. Lynch's, and a negro child of Mr. Beale's, both oi whom had just got over the Vaccine disease ; but in every case the re-ult was just the same, a small inflamed spot was visi- ble on the second day and beginning of the third, but by the sixth was dried universally. "Thus have we at length succeeded after so many unsuccessful trials, in introducing into this town the mild antidote to Small- pox. So many attempts had been made before, without success, that even medical men declared they did not believe the disease could be brought here. * c It will, no doubt, take some time to remove the obstinate pre- judice of the public ; but like ail great truths, it ultimately must prevail, and surmount every obstacle ignorance can oppose. " Eighteen have had the disease in its mildest form, and numbers are now under inoculation. Not the least medicine has been required in either of the cases — -not one has been kept for a mo- ment from their labour or business — in no instance has there been an eruption of any kind ; their arms have not been sufficiently sore to require any attention, not nigh as much so, as in Small- pox. The fluid has universally been taken on the seventh, eighth or ninth days, never later, and always before the appearance of the areola. " There is one circumstance I must remark ; I observed that the threads t have seen impregnated, have always been fine flaxen I3t thread, the matter, whether Vaccine or Variolous, forming a crast on the outside. A thread of this kind is generally extremely stiff, and on being handled is apt to crack and make the dry matter fly off; to avoid this, I have preferred a cotton thread of double cr treble the size commonly used, and but slightly twisted : I am much mistaken, if to this apparently trifling circumstance, I am not in a great measure indebted for the facility with which I have communicated the disease ; for with the cotton thread, I can as freely give the infection when the matter is a number of days old (by moistening it with a little warm water or steam) as with the fresh fluid from the arm. <$ I have inoculated myself and another person, both of us had Small-po* in our infancy, decisively, having had fever, and a large number of pustules ; b it the result ha: been quite different from thv experiments made in Europe by Doctor Pearson, for our sys:-ems were both considerably affected, (and in the same man- ner), indeed more so than any of those I have vaccinated, who have not had Small-pox. The appearance of cur arms was, how- ever, quite different from theirs ; we were inoculated with fluid taken warm from the arm on the eighth day ; on the fourth, there was considerable inflammation ; on the same day the efflorescence, or areola, took place, extending three-fourths of an inch from the point of inoculation ; no pus'ule wa,s formed, as in those who had not had Smatl pox ; but a very small sore, depressed, and not a tenth part as big as in the regular infection ; on the sixth day we both had considerable fever, puking, violent head-ache, and creeping chills over the whole body, particularly the back. Our appetite iorsook us at the same time, and the glands of the axilla swelled and were painful : On the eighth day those symptoms aba- ted, the inflammation of our arms gradually subsided, (sooner than in the regular disease) and on the thirteenth day, little re- mained but a scab (not much bigger than a large pin's head) ; and a peeling of the scarf-skin as far as the areola had extended : As 1 observed before, I have not had a single patient who had not had the Small-pox, who had the disease nearly as severe as we had. 45 We have a third time inoculated for the Small-pox without ef- fect : One person of seventy years of age has gene through the in- fection, and afterwards perfectly resisted Small -pox— forty odd are r.ow under Vaccination. " I am, with great respect, «f Your obedient servant, " GEORGE BALFOUR." On the ioth of January, 1802, I wrote to Doctor Taylor, of Norfolk, requesting him to give me every information, relative to the same subject* I had previously written to Doctor Barraud, pf the same place. Those gentlemen did me the favour of reply- in?, as follows : 133 " Norfolk, April i$th, 1802. ie Dear Sir, ft WE feel ourselves obliged by your late com- munications on the subject of the Kine-pox, and for the trouble you have taken in possessing us with the Vaccine infection. Our acknowledgments would have been made more promptly, but that we wished to give you the fullest result of our lab urs ; and al- though we have again to regret that this benign antidote to Vario- lous contagion has another unlucky incident thrown in irs way by this late attempt to propagate it, yet we will relate to you the effects of our endeavours to introduce it in the last and present year. " In the first of the year 180 1, some threads were sent hither by Doctor Spense, of Dumfries, with assurances that they contained the genuine Vaccine infection ; coming in a direct way from Pro- fessor Waferhouse— We had for some t nr anxiously wished for the means of introducing the dLease, and we seized the opportu- nity of immediately essaying it. " Parts of these threads were distributed to several gentlemen of our faculty in the town, and were severally used — Appearances were flattering in a high degree; an early inflammation followed the insertion of every thread almost without an exception ; a pus- tule formed in the ordinary time, and the several characteristics of this inoffensive disease seemed to us complete. A sufficiency of infection was readily produced to proceed in our work — in se- veral cases the arm was trotiblesome'y sore, and in four instances under < ur immediate care there was fever that proved inconveni- ent for a day or two, attended with eruptions as abundant as gene- rally are found in the milder Small-pox. About eighty persons had been subjects of this inoculation, when' we procured some Variolous matter which for some weeks we h^.d not been able to ob- tain : That we might defeat all the scruples of those who ever oppose innovations, we determined to test it with this infection, ** The experiment was wholly unfortunate. Every person took the Small- pox, and went through it under all the ordinary cir- cumstances. f< Our disappointment was extreme- — It was increased by our having circulated this infection among our distant medical bre- thren, with accounts of our own success ar?d the progress we were making-— -Several of these gentlemen used it extensively, wish disappointments similar to ours. Dr. G. of Williamsburg, had several patients as much distressed with the fever as is seen to be the case in inoculated Small-pox ; two arms were sore enough to require the surgeon's aid for seme weeks. " Doctor Dick, of Alexandria, another of our correspondents, relates, that a person inoculated with some of this maiter, after having gone through the disease, resisted the Small- pox with which he was several times inoculated, and that at the end of *34 some few months, he took it in the natural way, And had it ««* verely. ■' Here then we seem to have unluckily received an anomalous disease, that late experience »n Kine-pox shews us to follow av\ untimely regard in taking the fluid from the pustule "In he late winter we had some communications wi.h Mr. Jef- ferson, who was made .cquainted with our disappointment He was obliging enough to send us a phial conta ning some infection that he recommenced as fresh and genuine : At this very moment your own favours were received. With these authorities we were enabled to make fresh exertions to promote this work of humanity, this most estimable discovery of all the last century. To quiet all objections, we commenced with one of cur own infants, and very soon after seventeen others submitted to the experiment.—- .Again we exposed ourselves to new mortifications ; our threads all proved ineffectual to our purpose, although we inserted them again and again. It follows that the delicate fluid, in these last cases, had suffered in travelling the short distance to us ; or that some unlucky incident occasioned its destruction. Yet the phial received from the President, came to our hands most carefully sealed, in a few days after the fluid was collected ; and the inge- nious method of coating it with the gold-beater's skin would seem to have defied all hazards. I mention these circumstances, merely to evidence the peculiar nicety that must be regarded in keeping or transporting this infection. '« While we were determining these last trials, Doctor Balfour brought with him from Philadelphia, some infection that has proved good ; but for this, we should have intruded on you once more. " We have some patients now under inoculation with some of this last infection, and if we meet with any circumstance worthy your rvotice, we will make it knowu to you. *' It is desirable that the friends of Medical science should watch over this new subject in the healing art, that they may entrench it from the accidents, and secure it against the tactions to which it seems exposed from its novelty and its nature. Assuredly it sails forth the patrons of humanity, and the ingenious enquirer. " With respect we are, 4t Your obedient Servants, " JAMES TAYLOR, " P. BARRAUD" These important and interesting communications will, I trust, be a guard against future danger, by shewing the great atten- tion which is necessary to become acquainted with the respec- tive characters of the two diseases, I now proceed to the tables. <5 Subject. Nartie and Age. Vaccine whence obtain. John R. Coxe 5 attempts 6th J. Ricart 6 mo. S. George 5 mo. E. Lige 3 mo. c MV.King,Loo- (ion. Mr. Jefftrson unkno^ 8th Busy Ginn 6 yrs. 1st atpt. 2d 3d 4th 5* Mr. R ng Mr. Ring do. Mr. Jefferson Case 1 Andrew Boziei 28 yrs. 2d atpt. Richard Bozier 3 years, 2d 3d Moily Bozier 1 yr. 1st atpt. 2d 3d 4th 5 th ^th 7 th 8>h 9th - Maxwell Sibelia Peale 3 years. , Lyttleton Ginn 29 years. Joseph Lee 3oyrs. 2datpt. Geo. Patterson 25 years. Asa Warren 5 years. Mr. Jefferson do. Mr. Jefferson do. Mr. Ring, Lon- don, Mr. Jefferson do. Mr. Ring Case 1 8 tin known 26 *3 3* _ Infec day tak nkno^ unkno\ do. 8th 8 th 9 th 8tiT" 8th 8 th do. unkno' 8th do. unkno' 9th 8th unknot 15 th 10th 8th Case Case 8 from the pock produ- ced by the 3d attempt. Case unknown Mr. Jefferson Case 8 8th 9 th 8 th 8th 9 th II By incision js meant merely a long division a thread. 9 Subject. Name and Age. Vaccine Inffc't day taker 8th 135 ON. jhowin- how old troduced j Issue,ofthe j attempt. j Constitutional indis General Disease. position. 1 Eruption, and where. i John TlTCoIe - 5 attempts 6th Mr.X.„g ; L..n- Mr. Jefferson.' unknown 1 3 punct 5 days [3 thread fails 2 successful Head-ach, fever, drowsy, com mencing on the fifth day, continu ing three or four days. None. 3 4 5 J. R.cart 6 mo. S. George 5 mo. E. Lige 3 mo. [•Mr. R'ng unknown „„ t „o.„ 7 punct fail As all these cases failed in repeated attempts with the first infection 1 received from London, I had inoculated them for the Small-pox before I obtained a fresh supply. 6 Betsy G.nn 6 yrs. 1 st atpt. ad 3d 4th 5th Mr. Ring Mr. Jefferson Case 1 7 unknown do. 8th Sth 9 th unknown do. 5 days 3 punct. do. 3 threads 3 punct. 3 do. fails do. succeeds fails succeeds Scarcely perceptible. A scratch of a cat upon the wrist, in consequence I suppose of the Vaccine matter coming in contact, produced a perfect pock. 7 Andrew Bozier 2 8yrs.2datpt. Mr. Jefferson do. 8 th 8th 5 days 8 ♦ 3 threads 2 do. fails succeeds About the twelfth much mdispo-j At least thirty small fiery looking sition, consequent to the too free usejp ; mples around the pustules, which of his arm whilst the axillary glands disappeared in about three days. . were inflamed. | 8 Richard Bozier 3 years. 2d 3d Mr. Jefferson do. Mr. Ring, Lon- don. 8th do. unknown 5 days 8 10 weeks 3 threads 3 threads 2 punct. fails succeeds succeeds No indisposition till the scab were rubbed of on the eleventh, wher an ugly ill-conditioned ulcer, consi derably deranged the constitution. Five pustules, on the vaccinated parts alone ; three or four fiery look- pimples on the eleventh day within the limits of the areola, they were gone by the fourteenth. 9 Molly Bozier 1 yr. 1st atpt. 2d 3d 4th s th 6 th 7 th 8ih 9 th Mr. Jefferson do. Mr. Ring Case 1 8 unknown z6 *3 32 Sth do. unknown 9th Sth unknown 15th 10th Sth 5 days 8 10 weeks 1 day unknown 39 days 54- 4 3 threads 3 do. 3 punct. 3 do. 1 incisn.| 2 punct. t do. 1 do. 1 do. fails do. do. do. do. do. do. do. succeeds None perceptible. None. o Maxwell Case 1 Sth 2 3 punct. succeeds Slight fever and head-ach for three or four days. | None. Sibella Peale 3 years. Case 8 from the pock produ- ced by the 3d attempt. 9 th 1 punct. succeeds Drooping ninth and tenth days, onl A considerable eruption of the the eleventh lively, on the thirteenthjChicken-pox on the back, face, and feverish and restless. extremities, amounting nearly to [eighty in number. Lyttleton Ginn 29 years. Case 8 8 th 4 2 threads succeeds Chilliness, succeeded by fever, head-ach, and pam of back ; nausea and vomit- ing, on the ninth, tenth, eleventh and twelfth days. On the 12th day several minute pimplesap- peared around the pock. On the 1 5th day of the Vaccine, 16 days from exposure to the Natural Small-pox, and ten from Variolous inoculation, he had an eruption of the Small- pox about forty in number. 3 Joseph Lee 30 yrs. 2d atpt. unknown Mr. Jefferson 8 th 22 2 punct. i thread succeeds do. ach &c. continuing a few days; then above th ; rty Variolous pustules, subsiding, when a new set of symp- nine days from inoculation and toms more violent attended, with eighteen from first exposure to the nausea and vomiting about the ele- Variolous contagion, venth dav. + Geo. Patterson 25 years. Case 8 8 th 10 2 incision succeeds Ninth day consider.! nausea and vomiting on t he 10th. t ion ; being the 25th day from expo- ure to the contagion. 5 tr Asa Warren 5 years. j | By incision is me read. Case 10 ant merely a long 9 th division of the cuticle , punct. , without succeeds the insertion of Head-ach, and drowsi- ness the 3d day, slight le- ver on the 9th &c. from having the scab rubbed off; also on the 27th aSth and 29th. rable number broke cut, large, and filling with a limpid fluid, which dried away on the 3d, 4th, and 5th days. This child was almost con- stantly exposed to the Variolous contagion du- ring the progress of the Vaccine. 19 Subject, i Vaccine InfectiOi. Name and Age. whence obtain, jdny taken] h Iff Jas. Patterson 3 months. Katy Smith 7 months, 2d Leah Rogers i year. 2d 3d Benj. Rush, jr 10 y-ears. Mrs. Morris H. C.Meade 6 weeks. William Webb Miss Forman Jacob Clarkson 20 years. 2d JennyBoon, 1st 40 years. John Talbot Wm. Chipley >. Ffireh 3d E. Jenner Coxe 23 days. Case 10 Case Case 16 14,15, i6',mixd. Case 15, 16. Case 1 1 (Englifhftock) Case J 5 Mr. Jeffer son Case 10 Case 6 10 C. 15 16 mix"d Case 23 2 S Case Case 25 29 9th 8 th 7 th 9th various various 9th 9th 4th ; 9th 8th or Qtn 10th 6th 6 th I 6th J 9th Case 23 9th * This Instead of ths 4th. was in fact the 213 was taken. n Subject. Vaccine Infecth SL Name and Age. whence obtain. day taken 3° Titian Peale Case 1 1 nth .2 vis. 2d atpt. do do. 3d 29 8 th 4th 23 nth 5 ih 3* 8th 6th 37 8 th 7 th 9 7th 8th 22 12th 9th 25 6th 10th 41 7th nth 44 8 th J2t!l 75 7 th 14th 76 9th 81 7 th i<;th Variolous 1 6 th Case 77 10th r 77 10th 37th 1 84 8 th I Variolous 3* M. Jones Case 25 7th 10 months. 3* Bridget Kerlin From a case or 18th, see 5 years. Dr. Hewson's case p. 27 .3 3 John Kerlin Case 26 TKh" 3 years. 2d do do. 54 Mary Kerlin Case 26 "TTTh - ' 10 months. 2d do do. J5 Nisa Rogers Case 23 10th. k years. 2d Mr. Jefferson 8th 3d Case 33 8ch 4th 43 7 th 5th obt. elsewhere unknown i • 6 th Case 44 9 th 3~6 Pyirhus Case 22 12th 14 years. 2d 37 6th 1 2th 3 37 Robert Case 22 11 years. 38 John Heineken Case 32 8 th __ 2 years. 39 Sally Dunn Case 37 6th 7 months. 40 Betsy Dunn Case 37 6th 4. years. 2d 39 _9i!2 6th 41 John Dunn Case 37 2 years. 2d 39 ■ 10th 3d 4° 9th 4th 42 7 th * With matter faken on the seventh day, I imme punctures in a w?ek afterwards, with matter of case time gone with young : What influence this might ha n Subject. Name ;uid Age. Vaccine whence obtain. Infecti day take! <>»• .| how in- j Issue of the [now old trodiiced.l attempt. I36 " Gejneral Disease. (■, Jus. Patterson 3 months. Case 10 9th * days 1 punct. Iretruion the gth.fiom the peck being much rub- bed.- From the 13th to 15th feverish at night. On the j 6th day, 3 or 4 very distinct Vari- olous pustules appeared on the face, which maturated rapidly ; both diseases were well by the 20th. In 7 weeks from Vaccination, 7 Katy Smith 7 months, zd Case 1 »3 9th 8th 11 3 1 punct. 1 punct. fails succeeds Slight indisposition on the ioth.| None. 8 Leah Rogers i year. 2d 3d Case 16 14,15, i6',mixd. 7 th 9th recent 1 various 1 punct. 1 do. 1 do. fails do. succeeds Restless and fretful the 8th day, probably from her teeth which eame through about this time. None. y Benj. Rush, jr. 10 years. Case 15, 16. various various 1 punct. succeeds Very slight. j None. Mrs. Morris Case 1 1 (Englifh ftock) uth- 3 days 1 pun. in each arm Succeeds jihe arms were in- flamed but not much evi- dence of pus- tules at the late period of the 8th day. On the 6th day pain of the ax- illae, restless and fonsiderably fe- verish on the 7th, chilly on the 8th and 9th, with fever dull and hea- vy. At about 12 days from Vaccina- tion four pustules were discovered in different places; I could not as- certain by the account I received if they possessed the true Vaccine cha- racter. I rather imagine they were adventitious pimples. 1 H.-C. Meade 6 weeks. Case 15 9th recent 1 punct. succeeds Drowsy on the 6th with slight starting occasionally at night. A small pimple on one leg the 5th day, g;one the next. ; William Webb Mr. Jefkrson 8 th 35 days 1 thread succeeds Eyes painful, feverish on the 10th continuing two or three days. None. 3 Miss Forman Case 10 9th 13 1 punct. succeeds Drowsy on the 6th, slight indis- position about the nth day. None. + Jacob Clarkson 20 years. 2d Case 6 10 4th * 9th 17 20 1 punct. 1 punct. both succeed Considerable fever 9th to 12th, itching considerable. None. 5 Jenny Boon, 1st 40 years. 2d C. 15 16 mix'd 8thor9lh I 2th 1 2 punct. 1 punct. Creeping scabs consi- dered as spu- rious. Succeeds. A- bout the 13th all 3 scabs rubbed off. Slight fever about the nth day, on the 15th violent fever, tension and inflammation of the arm, ending in ulceration with aggravated symp- toms. None. 6 John Talbot 2d Case 23 *5 10th 6 th 6 recent hread 1 punct. fails succeeds Drowsy with slight head-ach on the 7th and a fullness of the eyes on the 12th. 6 or 7 minute pimples near the pock about the 12th day, speedily 7 Wm. Chipiey Case 25 6 th 1 day . 1 punct. A creeping scab consider edas spurious But slight indispostion, much itching. S. Ffirth 2d 3d Case 25 2 5 29 6th 6th 9th 7 J 14 1 punct. 1 do. 1 do. failed do. do. 9 E.JennerCoxe 23 days. Case 23 9 th 1 punct. succeeds No indisposition appare U None. * This insteid of the 4th. was i wai taken. fact the aii day from Vaccination. I have marked it as the 4th, as it was this period from its progressing, that the mfectio* W- r Subject. Vaccine ION. how in- Issue of the „ . . General Disease. _Constitut,onal indisposition, j Eruptions, and where. J- Name and Age. whence obtain. [day take how old troduced attempt. 3° Tit^n Peale .2 vis. 2d atpt. Case 11 do nth 34 days 32 ipunct. do. Fails. do. 3d 29 8 th 5 do. do. 41 h 23 nth 33 do. do. 5ih 32 Sth recent do. do. 6 tli 37 8th recent do. do. 7th 9 7 tfa 4 days do. do. 8th 22 1 2th 54 S do. in I do. 9th 25 6 th 57 2 each a'fn 10th 41 7 th do. do. "" nth 44 Sth z do. do. izth 75 7 th 1 do. do. x^h 7 6 9th recent do. do. 14th 81 7 fh recent 3 do. do. 15th Variolous 5 t|a y s 1 do. do. i6th Case 77 10 th 10th 7 2 do. do. 17th ) 84 8th 4 2 do. mix do. _ I Variolous 17 1 ed. 3' M. Jones Case 25 7 th 17 1 punct. fails This case was not vaccinated a second time in consequence of some 10 months. doubts in the mother's mind. 32 Bridget Kerlin From a case of i8th, see 2 1 punct. succeeds Slight indisposition, and ramb None. 5 years. Dr. Hewson's case p. 27 ling on the 7th day. 3 3 John Kerlin Case 26 1 S th 8 1 punct. fails Fretful tire ninth night. None. 3 years, 2d do 13 do. succeeds 34 Mary Kerlin Case 26 1 S th 8 1 punct. fails Restless and feverish On the 9th, 3 or 4 small pimples appeared on 10 months. 2d do do. 13 do. succeeds the 9th and 10th days. the arm above the Vaccine pock, which by the 13th had all but one disappeared ; This shewed the genuine Vaccine character. 35 Nisa Rogers Case 23 IOth 32 1 punct. fails Much nausea and vomiting fiom the spurious disease, pro- 35 years. 2d Mr. Jefferson 8th 82 thread spurious duced by the 2d attempt, attended with high fever, head-ach, 3d Case 33 8,h 1 1 punct. do. pain of back, lassitude, great local itching from 4th to 6th 4th 43 7 th 1 2 do. fails day, with shooting pains and great axillarv inflammation. The None. 5th obt. elsewhere unknown unknown 1 do. spurious spurious disease by the 3d attempt was attended with great itch- 6 th Case 44 9 th recent. 1 do. succeeds ing. Head-ach, fever, pain of the axilla, &c. f;om sth to 8th day. In the spurious disease by the 5th attempt the symptoms were less violent. The 6th and genuine disease was very slight, _ although the part was much irritated. 30 Pv.ruus Case 22 I 2 th 36 days 1 punct. fails But very slightly indisposed. 1 None. _. 14 years. 2d 37 6th recent do. spurious 1 3 7 Robert Case 22 12th 36 days punct. succeeds Fever 9 ,h day wuh nausea and vomiting,! Nq ^ considerably indisposed to the 12th, | _ 11 years. 3^ John Heineken Case 32 8 th 4 punct. succeeds Slight lever 101I1 day, wrthnau- 1 None< . 2 years. sea and vomiting;. 1 39 Sally Dunn Case 37 6th 1 punct. succeeds Fretful the ninth night, slight! None> 7 months. r ever the tenth. | 4° Betsy Dunn Case 37 6th punct. rails Feverish 10th and 1 ith ; conside 1 One Imie pock formed on the verge 4 years. 2d 39 9 th recent punct. succeeds •able fever with vomiting the 13th. |of the large one and ran into it. __ 41 Tohn Dunn Ca>e 37 6th 4 days punct. fails Considerable fever on the 10th 2 years. 2d 39 10th recent punct. do. lay : Violent symptoms at a later 3^1 40 9th lecent punct. do. period from repeated irritations of *th 42 7 th 15 days! punct. | succeeds* he scab. * With matter taken on the seventh day, I immediately Vaccinated a cow punctures in a wsek afterwards, with matter of case 47 and case 49. The c time gone with young : What influence this might have, I know not. 1 the teats in two places ; they however both failed, i was nearly dry when I first attempted it, and it was 1 s did also a second trial by three ■on discovered that she was some 138 Subject. Name and Age. Vaccine whence obtain. Infecti dav taken on. how old how in- troduced. Issue of the attempt. Constitutional indis Genera position. l Disease. Eruptions, and where. Kitty Keilin 7 years. Case 34 12th recent 1 punct. succeeds Restless the 8th, scab complete the 12th, off the 18th. One pock on the inside of the right thigh, a P 4 parently \ accme. It had an areola, | of an inch but was considerably rubbed before I saw if Marg. Barnhill 2 years. Case 39 7th recent 1 punct. succeeds Drowsy the 5th and 6th days, slight indispo- | ■ — *■ sition the 10th, probably from a violent cold. | None. Mne. Davidson 2 years. 2d at. 3d 4th 5th Case 39 43 42 4* 47 9th 9th 7 th 7 th 7 th recent 4 l S recent 3 1 punct. do. do. do. » do. fails do. do. do. succeeds No indisposition. 'None. James Wilson 17 yrs. istat. 2d 3d Case 43 43 39 25 43 7 th 9th 9 th 6th 10th 5 7 58 8 1 punct. do. 1 do. in each arm, and also put on a sore from whence I rubbed a scab. ip.inea. thread in each arm. fails fails ►fails one succeeds fails Went to the country as soon as infected. Wilkinson Case 42 7 th 15 1 punct. Never called again, I know not if it took effect. Tom 24 yrs. do. 2d do. 3d do. obid. elsewhere Case 33 26 Mr. Jefferson elsewhere unknown 9th 15th 8th 8th 7 th unknown 27 49 90 119 8 1 punct. 1 thread 1 incision 2 do. thread incision fails succeeds fails do. succeeds fails On the 8th day from the 2d attempt, during which I made the other trials, a very fine pock was advancing, from which I obtained some limpid fluid, a pain of the back and head, and of the pock, shooting up to the axilla attended with consderable fever. The small-pox broke out on the evening of the nth day ; which makes the 1 6th from first expo- sure. It was very thick upon him. Noah Molden 24 yrs. 2d at. 3d 4 th 5 th 6th 7 th elsewhere Mr. Jefferson Case 47 elsewhere Case 44 5 1 5 * 8 th 8th 8th 8th 9th unknown 120 3 46 recent 5 2 punct. thread 1 punct. 1 do. 1 do. 1 do. 2 do. fails do. do. do. do. do. do. Did not take effect. See the Note. Matilda Evans 5 months. Case 41 7 th recent 1 punct. succeeds Indisposition] On the 20th day several little pimples appeared on the scarce evident. |face and neck which soon dried away. Theodos. Pettit a mon. 2d Case 43 44 4th & 5th 7th 24 recent 1 punct. do. fails succeeds scab not off till 6 weeks Slight indisposition on the 13th. An erupuon ot smaii rea pim- ples on the hands and neck, on the 1 5th, wjiich soon subsided. Thomas Burns 4. mon. 2d Case 43 44 4th & 5th 7 th 24 recent 1 punct. 1 do. fails succeeds Drowsy the 8th, slight indispo- sition the 1 2th, scab rubbed consi- derably. On the 2 red pimples , continued a few days. (£3= From these tables it would appear, that of fifty-one cases, we must, to form an accurate statement, dedu. I received from England) repeatedly, without any effect ; hence I conclude its activity was totally destroyed Small-pox, and hence wens not altogether fair subjects. Cases 31, 46 (iaone of whom it was not repeated ;es Z, 3, 4 , and 5, which were vaccinated (with infection .7, 28, 36, arid perhaps 48, which had previously had the second time, and the other I know not the issue of), making n» ft ft Subject. Name and Age. Vaccine whence obtain. Infecti dav taken 4^ Kitty Keilin 7 years. Case 34 1 2th 43 Marg. Barn hill 2 years. Case 39 7 th 44 Mne. Davidson 2 years. 2d at. 3d 4th 5th Case 39 43 42 4i 47 9th 9th 7 th 7th 7th 45 James Wilson. 17 yrs. istal. 2d 3d Case 43 43 39 2 5 43 7th 9th 9 th 6th 10th ■ 4 6 — Wilkinson Case 42 7 th 47 Tom 24 yrs. do. 2d do. 3d do. obtd. elsewhere Case 33 26 13 Mr. Jefferson elsewhere unknowr 9th 15th 8th 8th 7th 4S Noah Molden 24 yrs. 2d at. 3d 4th 5th 6th 7 th elsewhere Mr. Jefferson Case 47 elsewhere Case 44 5 1 51 unKnowr 8 th 8th 8th 8th 9th 49 Matilda Evans 5 months. Case 41 7 th 5° Theodos. Pettit 2 mon. 2d Case 43 44 4th & 5tl 7 th 5i Thomas Burns 4 mon. 2d Case 43 44 4th & 5 tt 7 th • {£5= From these tables it would appear, that of fift I received from England) repeatedly, without any e] Small-pox, and hence were not altogether fair subje< NOTES referring to the preceding Cases* Case i. In this case (my own), head ach, fever, and drowfi- ness, indicated a constitutional affection on the 5th day, towards the close of wh thrice, and oftener, besides exposing several of them to the Small pox. For the particulars of each cafe; the reader is referred to the Note?, the timbers annexed to which, refer to the fime in the lift of €«•««. 140 In twenty two successive attempts I failed, although in most in- stances I employed recent matter. In some few instances an in- tolerable itcning, (commencing sometimes in three or four hours from inserting the infection), preceded and accompanied a little pimple which died away in two, three, and four days. In a twenty third and twenty fourth attempt, with matter taken from a most perfect pock on the eighth day,* I at length succeed- ed in producing a spurious pock. About twelve hours after Vac- cination the punctures were attended with an intolerable itching, and an fnflamed circle was very conspicuous. By the third day a considerable pock had risen in both places, which by the fourth had rapidly increased, more especially in one (the other gradual- ly declined), which now had a light but well defined areola around it of about three fourths ot an inch diameter, with a hard base ; the flat surface of the true disease was absent, yet something like depression of the centre was obvious. As it augmented, it assumed more of the Variolous character, the matter though lim- pid at first, putting on a purulent appearance in a short time. On the close of the seventh day a scab was forming, the itching, areola, and hard circumscribed base were nearly gone ; and the scab came off about the twelfth day, without assuming so dark an aspect as that which forms in the genuine disease. A slight eschar still remains. No indisposition was evident. Since this period I have renewed the attempt four or five times ineffectually. It may not be amiss to remark that all my first attempts by above a dozen punctures with infection sent me from England, failed ; as well as in cases 2.3.4 5.6. From a perusal of the case above related, I think it mus r , (in- dependently of the constitutional affection) be credited by most persons, that I really underwent the genuine disease ; were this not the case, I cannot suppose 1 fhould have failed so uniformly in eveiy succeeding attempt, as certainly, to a mere local affection, my system could not have been le.^s susceptible than before. Case 2. Four days after my last attempt in this case, the pa- tient broke out with the chicken pox. I have net fiace repeat- ed it. Cases 3. 4. 5. After the ineffectual attempts I made here with the matter sent me from England, as I had no immediate prospect of procuring more,! inoculated the patients. Cask 6. The third attempt succeeded, as may be feen by the tables, but it did not advance till the eighteenth day fix days * With matte'* taken the preceding day from the same pock, I excited a genuine case of Vaccine, which was as perfect in its appearance 3nd pro- gress as any I have seen. after I had succeeded in exciting the disease by other infec- tion. In this case the scabs were repeatedly rubbed off, but the sores healed kindly without any application. On the eighth day I ino- culated her with recent Variolous matter, taken from her mother who was then labouring under a very full burden of the Natural Small pox, to which she had been exposed constantly for seven days. The three punctures I made, inflamed, and produced three fmall local pock, unaccompanied with fever or any eruption : they dried away by about the twelfth day. Case 7. Considerable inflammation and increase of fever fol- lowed the imprudent use of his arm, which swelled greatly, but yielded to a smart purgative and saturnine applications. On the fourteenth day I sent him to see the woman abovementioned (mo- ther to the preceding case) and inoculated him on the seventeenth and twenty-second days, by two punctures each time, with recent Variolous infection. No effect but a slight inflammation for three or four days was produced. It was the first case I inocula- ted after passing through the Vaccine, and interested me very much. Case 8, This is the first sore arm I witnessed. The child was remarkably gross in his habit, and subject to a purulent discharge from the ears. The weather at the time was very variable with easterly winds. Being anxious to see the progress of the disease, I omitted both medicine and diet, which probably would have checked the violence of the disease. To this I must add, that I had produced three pock on the arm about one fourth of an inch apart, forming a triangle, with infection received from the Pre- sident : I vaccinated the child three days after, in two other pla- ces, about an inch on each side of the above peck, (with matter just received from England), in consequence of my belief that the other had failed. Both attempts however succeeded, and five pock were the result, The three first were repeatedly rub- bed off and at length formed one sore of considerable magnitude, and accompanied with great tension and inflammation of the arm and of the axillary glands. Citrine ointment checked the ulcera- tion, and some active physic reduced the febrile symptoms ; On the twentieth day I inoculated him with recent Variolous in- fection ; The punctures inflamed two or three days when an at- tack of measles supervened, followed by dysenteric symptoms, The healing of the ulcer was checked considerably ; and was not completely healed for two months. About ten weeks from the first attempt to vaccinate him I again inoculated him ineffectu- ally. Case 9, This case I vaccinated as the tables shew, eight times ineffectually , by seventeen different punctures during ft L is 3 142 space oi two months and an half, The ninth attempt succeed- ed ; an areola appeared on the eighth day, I inoculated her in two places ineffectually on the twenty first day. The matter which produced the disease in this case was taken from a patient in whom the disease was excited by infection of the eighteenth day. The infection of this case I forwarded to London, to try whether re-transplanting altered its efHcacy, Case io. This case was a student of medicine from Ken- tucky. He was inoculated on the eighteenth day with recent matter, which produced slight inflammation for a few days: about seven weeks after it was ineffectually repeated. He several times also exposed himself to the infection from others. N. B. From his arm a fellow student in the same room who had had the Small pox, vaccinated himself, and produced two most perfect pock, accompanied with a constitutional affection unequivocally marked. Case ii. This case had no areola. On the thirteenth day the scab, which had been progressing, was suddenly suspended ; early on the fourteenth 1 an eruption of the Chicken pox, conti- nuing to appear for three days, and drying on the fourth. Dur- ing this period the Vaccine was completely stationary. On the fifth day the eruption was nearly dry, when immediately the Vaccine resumed its progress, and terminated favourably the twenty eighth day. Soon after this she had the Measles. Six months afterwards I inoculated her ineffectually by ihree punc- tures ; a local irritation for a few days was the only effect pro- duced. Case 12. This is the father of cafe 6, and was exposed to the Variolous contagion from his wife one whole day previous to Vac- cination, as well as during its whole progress. On the sixth day I inoculated him with matter from his wife, as I feared the Vac- cine might not be sufficiently advanced to secure the system. The Vaccine progressed, and in proper time the Small pox made its appearance, about forty in number, producing around the cir- cular Vaccine a zone of confluent pustules, which gave it an an- gulated appearance in a short time. Case 13. This man had been exposed to the contagion of the Small pox two days before Vaccination. On the eighth day of the Vaccine I inoculated him. He broke out with the Small pox on the ninth day from inoculation, violent fever preceeding. About thirty pustules, which maturated quickly. The Vaccine by ir- ritation produced, a sore, which healed kindly in a few days. In these as well as most of the blacks, the local inflammation was not to be distinguished except by a hard and tumid base. Cases 14 & 16. The particulars of these casts are detailed at p. 76, et se%. 143 Case 15. The disease was very mild. A month afterwards I was told he had the Small-pox. It proved however only a case of Chicken pox ; his father who had had the Small pox long before, took the disease from him and broke out in two weeks with a pre- cisely similar eruption, after a slight indisposition of two days ; The eruption dried away in four or five days. From this case the subject of C. 16, also took the disease. See p, 78 to yg, Case 17, In this case the pock was rubbed off six or seven times successively ; it did not however appear to have destroyed the Vaccine disposition ; I am not positive, as I have never ino- culated her. Case 18, The pock on this child's arm was rubbed off at least six t mes without any bad consequence. A month after Vaccina- tion, I inoculated her, under a firm persuasion the Small pox would fellow, as I supposed the Vaccine disposition was certainly destroyed. A half filled pustule alone was produced with mode- rate local inflammation ; no eruption nor any fever but what I ascribed to some teeth (molares), which came through at this pe- riod with considerable difficulty. Case 19, This case had been twice inoculated when an in- fant, but it was doubtful if he had taken the disease. Much itching attended. Case 20. I have noticed this case, more in consequence of its having been mentioned by some as a proof of the violence of the Vaccine. This lady on the 3d day of Vaccination travel- led down to Washington, which it is highly probable at that inclement season (December) might of itself induce a febrile in- disposition, independently altogether of the Vaccine, which had scarcely on the 9th day enlarged itself to a pock. General Mor- ris in a letter to me of January 1 ith, after mentioning the pus- tules, adds, " though she has been indisposed since, which I at- tribute entirely to a cold." Mrs. M. afterwards suffered from an attack of Measles ; yet all her subsequent indisposition, was by many friends ascribed to the Vaccine. — This lady it will be seen by the tables, was vaccinated with matter which derived its source from the English stock I had received. The day after I had in- troduced the virus, I found the child from whom I obtained it had broken out with an eruption, which I satisfied myself was the Chicken-pox, but as it was the first eruptive case which came under my notice, it gave me some uneasiness. — These circum- stances, which I stated to several, I afterwards heard mentioned in a way, that I could scarcely recognize the original account. Case 21. In this case no areola existed ; she has however re- sisted the Variolous inoculation. Case 22. Areola about three inches diameter. On the 12th day when it was retiring, I obtained a considerable quantity of 144 matter. On the 19th day he visited a patient in the natural Small-pox and inoculated himself with the matter; since that time I have repeated it ineffectually ; and he has frequently visit- ed Variolous patients. A species of herpes existed on his arms, &c. which I hoped would have been removed; it was however not effected. Case 24, This man, I have understood, has, since he has crossed this " adamantine bridge," nursed several persons in the Small-pox, Case 25. The violence of this case I have noticed at p. 50, as also the abundant supply of infection it yielded at p. 31. Case 26. From this case I obtained matter nine days succes- sively, from the 7th to the 15th. The areola had nearly gone when I took the last portion, on the 15th day, with which I ex- cited the genuine disease in c. 33, 34, Before it began to scab (on the 1 6th day) it was I think full half an inch diameter. The scab did not fall off for five weeks. No sore arm was produced although the pock was punctured perhaps 50 times. Cases 27, 28. The subjects of both these cases were study- ing medicine : both had had the Small-pox when young. The first had a small tumour of a spurious nature, produced, attended with considerable itching and axillary inflammation. In the last, a slight inflammation appeared for a few days. I believe he has since ineffectually repeated the attempt several times. Case 29. The scab came off the 21st day ; when I inoculated him with recent matter by one puncture. I repeated it on the 3 1 st day by two punctures, and in seven weeks from this time by three junctures without any other effect than slight local inflam- mation for three or four days. The matter was fluid from persons labouring under the Natural Small -pox. In four weeks from this last attempt, I sent him to see c, 47 on the 8th day of an ample eruption, of Small-pox. This man held the child one quarter of an hour in his arms ; but as may be expected without effect. Case 30. This child had just recovered from the Chicken- pox, taken from his sister c. 1 1. On the third day after the third attempt, he burnt his arm near the Vaccinated part. Is it pro- bable any effect was produced by the different irritation of the . burn, or by the constant application of lead-water ? At this pe- riod he became restless, eyes watery, &c. which continued the 4th, 5th and 6th days, when the Meastes made their appearance ; they soon disappeared : The speck at the Vaccinated part conti- nued to afford hopes it would succeed. It soon however came to nothing. Between the nth and 12th attempt, a period of nine weeks elapsed, when I vaccinated his infant sister of four weeks, She took the inaction without difficulty by the first attempt, r.nd 1 45 had it in the highest degree favourably. With recent infection from her arm I again repeated it on him without effect, and five days afterwards I tried ineffectually to produce it by first rubbing the arm well, and then scraping off the cuticle with the shoulder of my lancet, making also several slight punctures, over which I deposited a large portion of infection. Variolous infection after a few days of local irritation dried away, as did likewise a mix- ture of Variolous and Vaccine infection What can be the reason of so constant an opposition to the Vaccine infection ? The system doubtless would be equally uniform in opposing the Small-pox. Case 31. Some doubts arising in the mother's mind, I did not repeat the attempt. Case 32. The scab came off the twenty-ninth day: On the thirtieth, I inoculated her with recent matter by two punctures. They inflamed a day or two and disappeared. Case 33. The pock in this case augmented in size, after the subsidence of the areola, to nearly an half inch diameter. The scab did not appear till the fifteenth day ; on the twenty-sixth I inoculated her with recent matter, which inflamed a day or two and disappeared. This and the next case were produced with in- fection of the fifteenth day. Case 34. In this case the scab was repeatedly rubbed off, but eventually healed kindly. The pimple remaining had every evidence of the Vaccine pock, the circular form, depressed centre and flattened surface, with a beautiful areola of half an inch ex- tent. With the matter I vaccinated her sister, c. 42. Case 35. This is a curious case ; of six attempts two proved abortive and three produced a spurious disease, with a creeping scab or incrustation, containing a purulent fluid. The constitu- tional symptoms ran very high in these spurious products, and local irritation and pain was excessive, whereas the genuine e was very mild. ase 36. This boy is supposed to have had the Small-pox. The pock never assumed the character of the Vaccine. It was accompanied with great itching and ran its course very quick : On the nineteenth day I inoculated him with no effect. Case 37- The symptoms in this case, seem to have run higher than usual. They arose however, I believe, from irrita- tion produced by too free a use of the arm : The pock was very large. On the twenty-fourth day he was ineffectually inoculated in three places. Case 38. This child was teething at the time of Vaccination, he also had a cough, and a complaint of his bowels arising probably 146 from the teeth ; and probably giving ri^e to the slight indisposi- tion on the ninth day. On the eleventh the areola commenced, continuing to the fourteenth or fifteenth. The pock increased after the subsidence of the areola till the seventeenth day, when it was, I think, nearly an half inch in diameter. The scab now began to form, and soon perfected itself. Although this pock had a most flattering appearance, I repeatedly punctured it without obtaining any matter, once alone I procured an inconceivably small quan- tity. After the areola had subsided, I did not attempt to obrain it, though I might probably have then got a considerable por- tion. Case 39. The areola in this case was the most perfectly cir- cular I have seen ; it came on the tenth day. The matter I ob- tained on the seventh day, I forwarded to England. About six weeks after I inoculated it ineffectually with recent matter; a slight inflammation for a few days only occurring. Case 40. This child had the scab rubbed off repeatedly, and received several knocks upon it, which produced great irri- tation and the consequent symptoms. By the end of six weeks it was nearly well. Case 41. This child was a fat gross habit, much troubled with worms and very fretful at the time of Vaccination. I gave no orders as to diet or physic, which doubtless tended to increase the symptoms. The pock was repeatedly rubbed off, and much irritation produced. The weather also was raw and wind at east ; the child was always in the streets, till at length the symptoms in- creased greatly, with extreme pain and inflammation of the axil- lary glands. It was difficult to induce physic to be taken, but * it was astonishing how rapid a change for the better took place after the operation of an active purgative. Poultices were requi- red to alby the inflammation, and the citrine ointment followed with advantage. It took up eight weeks. Case 42. I have said in the tables that this case was vacci- nated with infection of the twelfth day. It was in fact only of the fourth day, as it was taken from a secondary pock. The are- ola here commenced the seventh day and was nearly gone by the ninth. On the fifteenth day I inoculated her in three places with matter taken the preceding day from a person labouring under the natural disease. A slight inflammation for a few days was all the effect produced. Case 43. In this case I obtained matter on the ninety-third hour from Vaccination, or less than four days; I might probably have obtained it sooner. I procured it six successive days, by repeated punctures, yet without producing a sore arm, or in the least injuring the pock. She had a bad cold previously to, and during Vaccination. 147 Case 44. A short time after the first attempt, she was at- tacked with cynanche trachealis, which she recovered from in two or three days ; after passing through the Vaccine she was inocuu lated with recent matter, which appeared to inflame for a few days, and then Disappeared. She has also been exposed to the natural contagion ineffectually. Case 45. This young man was sent to Philadelphia for Vac- cination, in order to insure obtaining the infection, by Doctor Chapman of Bucks county, to whom 1 had ineffectually forward- ed matter. The disease after repeated attempts, was excited by infection fifty-eight days old. From him I understand the disease has been extensively communicated. Case 46. I understood this gentleman, he had had the spu- rious disease at Norfolk, or some place to which it had been sent from thence. I know not if my attempt succeeded, as he did not favour me with a second visit. Case 47. The original matter which I received from Mr. Jefferson appeared to take effect here, but as the Vaccination was performed only five days previously to the eruption of the Small-pox, the pock which was apparently rising with great regularity, soon assumed the angulated irregular form of that dis- ease from the confluence of the pustules. I have no doubt but for this circumstance, a true Vaccine pock would have advanced to maturity, from matter then nearly four months old. This man had been exposed to the Variolous contagion from a fellow-ser- vant, five days before the first Vaccination, ft will be seen that one of the first attempts likewise succeeded with infection twenty- seven days old, but which advanced so slowly that I had renewed the attempt, under the idea of its having failed. I obtained in- fection from this pock before the Variolous eruption. Case 48. At the time of my last trial, he told me that in autumn last he had an eruption, which was supposed to be the Chicken-pox, accompanied with fever, head-ach and pain of the back ; it was not violent, though a considerable crop attend- ed — a fe I vaccinated Lewis Calansalin- go, a black child of six years of age, a Dispensary patient, with infection of thirty-two, and of three days old, ineffectually. At . the same time I also vaccinated his sister of four months with the same matter. In this case the last attempt succeeded and pro- gressed finely. On the eighth day, I vaccinated her brother with fluid matter from the arm. This took effect, and on the sixth day I obtained matter from it. It was a perfect pock in every respect. On the 14th June (the eighth day) a perfectly hard dark coloured scab was completely formed ; no indisposition at- tended, and no hardness had existed around the base of the tu- mor; so that I am fatisfied there was no areola. On the ele- venth day the scab was quite black, when I inoculated him by three punctures, which produced a slight inflammation for three or four days, and then dried away. The scab came off about the 14th or 15th day. THE following outlines of a case which occurred to Dr. Otto, T, introduce, to shew the Vaccine is not to be regarded as a perfect preservative against Small-pox, if the system has been exposed to the contagion before the Vaccine has exerted its full effect. On the 30th January, Miss P. was attacked with fever, &c. which continued the two following days, when an eruption of the Small-pox took place, between two and three hundred of which filled. Her sister, who never had had the disease, was constant- ly exposed to the contagion till the 3d of February, when she was Vaccinated. The symptoms of constitutional disease occurred [ '9 ] 150 with more than usual violence on the tenth, eleventh and twelfth' days, when they entirely ceased. On the evening of the sixteenth day, she had a chill, succeeded by fever during th»e night, though trifling compared with the previous attack ; the next morning an eruption of Small-pox occurred to the amount of one hundred, of which only two filled. Was the Small pox in this inflance moderated by the Vaccine ? I think I have found no difference in the susceptibility of the systems of whites and blacks, to the impression of the Vaccine. From what I can collect, I think fifteen hundred or two thou- sand persons in this city, must now have been subjected to the in- fluence cf the Vaccine, of which probably one hundred and fifty may have been tested with Variolous infection. It has appeared to me, that whenever the Vaccine is received by a person, who has previously undergone the Small-pox, it runs its course more rapidly than usual. The Warm months appear to have nearly suspended the fur- ther progress of Vaccination for the present. L may now ask where are our reservoirs for its future continuance? Those who imagined it was possible to keep it up in our charitable institu- tions, have taken no pains to realize their ideas ; which ideas have ten'ied to subvert the attempts to establish a Vaccine Institution. The necessity of such an Institution will, I ap- prehend, be soon felt, which I hope will lead to its speedy form- ation. This disease has yet to struggle with much opposition : — Man^ yet doubt its efficacy, which I can only account for, from the know- ledge that some of our Practitioners still persevere in the practice of inoculation. This apparent proof of their own want of faith in it, must certainly bias those who look up with deference to their medical opinions. The testimonial of our oldest Physicians Would strongly tend to accelerate its progress. With Mr. Ring we may say, " It is no want of candour to affirm that those who are hostile to Vaccine inoculation are total strangers to it ; those who are doubtful, are almost total strangers to it ; and I defy the whole world to produce one single instance of a person that has had any experience in the disease, **o is not a decided friend to the practice." See p. 720. T HAVE it fortunately in my power before concluding these ob- servations, to give an important document relative to the domes- i 5 i tic origin of the Vaccine among some cows in the neighbourhood of Philadelphia. I regret the information is not more extended, as it is of so interesting a nature to our inhabitants ; it is extract- ed from a letter of Dr. James Reynolds to me, dated PhiladeU phia, June 28, 1802, and is as follows: '* Early in March having Vaccinated Mr. Harwood's little son, at Mr. Bache's seat at Settle; the family, after my departure recollected that a young heifer on the estate had sores on her teats. On my next visit, in six or eight days, they mentioned the cir- cumstance ; the parts were by that time unfortunately covered by dry incrustations. " The idea however, naturally occurred, that as the habits and constitution of the cow, (some varieties of which are indige- nous) are nearly or precisely the same in Pennsylvania as in Bri- tain, by analogy, the same affections of the system are like to exist, and of course, the Cow-pox. (< To ascertain this, I spent some time in fruitless search, among the people who bring milk to our markets ; most of whom were shy, and offended by my inquiries. At last, one Mulvaney, who supplies my house, informed me, that a cow of his had sore teats, but he " guessed they were only scratched with briars." I called at his farm that evening, and had the gratification of pro- curing a considerable quantity of matter*. The next day I insert- ed portions'of it in three cases, which exhibited the most perfect appearances in all their stages. I have since used none but what is derived from this source, and have, by the desire of sceptical parents, successfully subjected several to the test of Variolous in- fection. " The following extract of a letter from Doctor Samuel Brown, of Lexington, (Kentucky), to Mr. John Vaughan, dated June 10th, will certainly afford pleasure to every humane mind. " It will give you satisfaction to hear that the Jennerian ino- r< culatioa has gone on here with astonishing rapidity. Many ** thousands have passed through that disease. People of all de- " scriptions communicate the infection, and although it is to be lt apprehended that some spurious cases may have occurred, un- " der the management of such untutored Practitioners, yet it is " believed that the genuine disease is pretty generally known and *'* diffused. Not less than one hundred and fifty thousand of our * This communication would have bern rendered much more valuable, by an account of the appearance of the disease in the cow t and o£ its supposed 152 : inhabitants, have never had the Small~pcx, What obligations do we not owe to Doctor Jenner, for the discovery of so safe . and easy a mode of escaping the ravages of that horrid dis- temper." By a letter from Mr. William Dunbar, dated " Natches, 30th May, 1802," to Mr. John Vaughan, we have the pleasing in- formation of the certain introduction of the Vaccine into that place. The prelude I hope of the final extinction of Small-pox in that part of America, I SHALL here conclude with a short remark on the still exist- ing prejudices of many against inoculation generally, under a false impression that, as all diseases are in the hands of the Al- mighty, it is a species of impiety to tempt him, by thus usurp- ing his prerogative in producing a disease, which probably might have been escaped ! But should not all who argue thus, to act consistently, refuse medical assistance in every instance ? Does not accepting a dose of physic from the hands of a Physician, argue the same impiety, inasmuch, as without fuch aid, health may be restored by the blessing of Providence? But the fact is, the error consists in blindly refusing to employ the means which are placed in our power, to remove the evils to which we are expo- sed.— -That same bounteous Creator who has provided us with Food necessary to our existence, has likewise supplied those medi- cines which are administered to our relief in a state of disease ; and has given reason to man, to enable him to distinguish what may benefit, from what may injure him. Inoculation then should be viewed as a medicine, disagreeable in itself, yet administer- ed to escape a greater evil.— -In the same light ought we to view, and to prefer, this new species of inoculation ; as it possesses every advantage, exempt from the disadvantages, of that dreadful dis- ease the Small-pox. JUST PUBLISHED, And to be Sold by James Humphreys, at the N.W. Corner of Walnut artz Dock-streets, Philadelphia, Price One Dollar and Seventy-five Cents. The Chemical Pocket-Book, MEMORANDA CHEMICA: Arranged in a Compendium of Chemistry: With Tables of Attractions , &c. tsfc. BY JAMES PARKINSON. With the lateft Difcoveries, from the London fecond Edition of 1801. c To which is now added, An Account of the principal Objections to the Antiphlogistic System of Chemiftry : BY JAMES WOODHOUSE, M. D. Profejfor of Chemiftry in the Unwtrfhy of Pennfylvania, &C, Embelli fried with Copperplates. Extracts from the Preface.